When “unclear headache” has an obvious reason—Applying ID-Migraine™ to referral letters

Background: Migraine is underdiagnosed especially by general practitioners and non-neurologists. In our experience, validated screening and diagnosing tools for migraine are generally not used outside neurology. The three-item identification of migraine (ID-Migraine™) is a short and validated screening/diagnosing tool; positive predictive value for migraine is 93% if at least two out of nausea, photophobia, or disability are present. Aim: To investigate the diagnostic yield of ID-Migraine™ when applied to the information provided in the referral letters. Methods: Retrospective analysis of 95 referral letters of patients referred for undetermined headache who were finally diagnosed with migraine at our Tertiary Care Headache Center. Results: Median age was 34 years, and 75% were women. Migraine was suspected by the referring physician in 33% of patients, whereas the remainder were classified as unclear. ID-Migraine™ criteria were fulfilled in 59% of patients with referral diagnosis of suspected migraine and 23% of patients with unclear headache, respectively. Clinical characteristics associated with migraine suspicion were photophobia and other visual symptoms. Conclusion: Applying ID-Migraine™ in primary care, emergency departments, or in specialists’ consultations outside neurology might lead to an increased frequency of migraine recognition. Knowledge about and access to those criteria should be increased, especially in the primary care setting.

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ID-Migraine™ questionnaire and accurate diagnosis of migraine

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170069 ◽

2017 ◽

Vol 75 (7) ◽

pp. 446-450 ◽

Cited By ~ 7

Author(s):

Ana Carolina Musser Tavares de Mattos ◽

Jano Alves de Souza ◽

Pedro Ferreira Moreira Filho ◽

Mauro Eduardo Jurno ◽

Luis Guilhermo Coca Velarde

Keyword(s):

Primary Care ◽

Positive Predictive Value ◽

Care Setting ◽

Screening Tool ◽

Primary Care Setting ◽

Tertiary Hospital ◽

Accurate Diagnosis ◽

International Studies ◽

Portuguese Version ◽

Id Migraine

ABSTRACT Objective To analyze the applicability of the Portuguese version of ID-MigraineTM in a sample of Brazilian patients. Methods Patients with headache were recruited from the neurology outpatient clinic of a tertiary hospital and submitted to the ID-MigraineTM questionnaire. The diagnosis of headache was made according to the ICHD-2 criteria. Results Of the 232 patients, 86% had migraine. The questionnaire showed a sensitivity of 92% (95%CI, 88% to 95%), specificity of 60% (95%CI, 43% to 77%) and a positive predictive value of 93% (95%CI, 89% to 96%). Discussion Our results were similar to other international studies of the ID-MigraineTM application. The Portuguese version is considered easy to use, and an appropriate screening tool for migraine diagnosis in our sample. Conclusion Considering the characteristics of our health system, we can infer that this questionnaire would be beneficial in a Brazilian primary care setting; however, more studies are necessary.

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Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Heart ◽

10.1136/heartjnl-2020-316904 ◽

2020 ◽

pp. heartjnl-2020-316904

Author(s):

Louise Feldborg Lyckhage ◽

Morten Lock Hansen ◽

Jens Christian Toft ◽

Susanne Lis Larsen ◽

Bente Brendorp ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Care Setting ◽

Primary Care Setting ◽

Diagnostic Yield ◽

Univariate Analysis ◽

Holter Monitoring ◽

Number Needed To Screen ◽

Pulse Palpation ◽

Diagnostic Benefit

Background and purposeThe diagnostic benefit of using continuous ECG (cECG) for poststroke atrial fibrillation (AF) screening in a primary care setting is unclear. We aimed to assess the diagnostic yield from screening patients who previously had a stroke with a 7-day Holter monitor.MethodsPatients older than 49 years, naive to AF, with an ischaemic stroke over 1 year before enrolment were included. In a primary care setting, all patients were screened for AF using pulse palpation, 12-lead ECG and 7-day Holter monitoring. Further, NT-proBNP was determined at baseline.Results7-day Holter monitoring uncovered AF in 17 of 366 patients (4.6% (95% CI 2.7 to 7.3)). The number needed to screen was 22 patients (14–37). 12-lead ECG uncovered AF in 3 patients (0.82% (95% CI 0.17 to 2.4)), and 122 patients had irregular pulse during pulse palpation (33.5% (95% CI 28.7 to 38.2)). When using 7-day Holter monitoring as reference standard, the sensitivity of pulse palpation and 12-lead ECG was 47% (95% CI 23% to 72%) and 18% (95% CI 4% to 43%). High levels (≥400 pg/mL) of NT-proBNP versus low levels (≤200 pg/mL) were not associated with AF in the univariate analysis nor when adjusted for age (OR 2.4 (95% CI 0.5 to 8.4) and 1.6 (95% CI 0.3 to 6.0)).ConclusionsA relevant proportion of patients with stroke more than 1 year before inclusion were diagnosed with AF through 7-day Holter monitoring. Given the low sensitivities of pulse palpation and 12-lead ECG, additional cECG may be considered during poststroke primary care follow-up.

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A Retrospective Cohort Study of Heart Failure in the Australian Primary Care Setting – Clinical Characteristics of HF Patients (SHAPE Study)

Heart Lung and Circulation ◽

10.1016/j.hlc.2019.06.055 ◽

2019 ◽

Vol 28 ◽

pp. S157 ◽

Cited By ~ 1

Author(s):

A. Sindone ◽

R. Audehm ◽

D. Haikerwal ◽

K. Lim ◽

P. Piazza ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

Care Setting ◽

Primary Care Setting

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Patient-centred care in an occupational medicine clinic

Occupational Medicine ◽

10.1093/occmed/kqz092 ◽

2019 ◽

Vol 69 (6) ◽

pp. 441-444

Author(s):

S Lari ◽

A M S Thompson ◽

V Spilchuk ◽

M Afanasyeva ◽

D L Holness

Keyword(s):

Primary Care ◽

Occupational Health ◽

Occupational Medicine ◽

Care Setting ◽

Primary Care Setting ◽

Tertiary Care ◽

Patient Perception ◽

Patient Perceptions ◽

Health Clinic ◽

Patient Centredness

Abstract Background Patient-centred care (PCC) has been associated with improved patient satisfaction outcomes in a variety of clinical settings. There is a paucity of research addressing the concept of PCC in an occupational medicine context. Aims To assess patient perception and compare physician and patient perceptions of patient centredness of the care at a specialty occupational medicine clinic. Methods An observational study design using the Patient Perception of Patient Centeredness Questionnaire (PPPC) at an ambulatory tertiary care occupational health clinic. Results were analysed using a standardized coding system. Summary scores were compared to results reported in a primary care setting. Patient and physician scores were compared to detect physician–patient differences in perceived patient centredness of care. Results Of 47 eligible patients 37 consented to participate and seven were excluded due to incomplete data. Summary scores of patient perceptions of patient centredness were similar but somewhat better than scores reported in a primary care setting. Perceived patient centredness of care was high and there was minimal discordance between patient and physician scores. Conclusions This study demonstrated that PCC can be measured in an occupational health setting. In an ambulatory tertiary care occupational health clinic there was a high degree of patient centredness of care which may be explained by a variety of factors. Future research should consider whether similar findings exist in other occupational medicine practice settings.

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