Living with long COVID

2021 ◽  
Vol 3 (9) ◽  
pp. 362-368
Author(s):  
Debbie Louise Duncan
Keyword(s):  
Primary Care ◽  
Anxiety And Depression ◽  
Shortness Of Breath ◽  
Multifaceted Approach ◽  
National Statistics ◽  
Life Threatening ◽  
Supportive Management ◽  
Rule Out

One in five people have symptoms that persist after 5 weeks, and one in ten have symptoms for 12 weeks or longer after an acute COVID-19 infection ( Office for National Statistics [ONS], 2020 ). NICE ( National Institute for Health and Care Excellence, 2020 ) defines this condition as post-COVID syndrome or long COVID. Common symptoms vary from fatigue, shortness of breath, palpitations, insomnia and anxiety and depression and encompasses a plethora of debilitating symptoms ( Dani et al, 2021 ). The new guideline for NICE (2021) recommends that patients presenting with new or ongoing symptoms 4 weeks or later after an initial COVID infection should have the investigations done to rule out acute, life-threatening complications or identify any unrelated diagnosis ( NICE, 2021 ). Garg et al (2020) suggests that long COVID is a multisystem syndrome and needs a multifaceted approach to tackle the physical, cognitive, psychological, social, and vocational aspects of this condition. This article looks at the literature about long COVID and suggests there is a clear pathway for treatment in primary care. Certainly that all physicians should be equipped to recognise long-COVID and provide supportive management ( Dani et al, 2021 ).

Living with long COVID

2021 ◽  
Vol 32 (9) ◽  
pp. 369-373
Author(s):  
Debbie Louise Duncan
Keyword(s):  
Primary Care ◽  
Anxiety And Depression ◽  
Shortness Of Breath ◽  
Multifaceted Approach ◽  
National Statistics ◽  
Life Threatening ◽  
Supportive Management ◽  
Rule Out

Post-COVID syndrome, or long COVID, is an increasing problem. Debbie Duncan looks at the evidence for management in primary care One in five people have symptoms that persist after 5 weeks, and one in ten have symptoms for 12 weeks or longer after an acute COVID-19 infection ( Office for National Statistics [ONS], 2020 ). NICE ( National Institute for Health and Care Excellence, 2020 ) defines this condition as post-COVID syndrome or long COVID. Common symptoms vary from fatigue, shortness of breath, palpitations, insomnia and anxiety and depression and encompasses a plethora of debilitating symptoms ( Dani et al, 2021 ). The new guideline for NICE (2021) recommends that patients presenting with new or ongoing symptoms 4 weeks or later after an initial COVID infection should have the investigations done to rule out acute, life-threatening complications or identify any unrelated diagnosis ( NICE, 2021 ). Garg et al (2020) suggests that long COVID is a multisystem syndrome and needs a multifaceted approach to tackle the physical, cognitive, psychological, social, and vocational aspects of this condition. This article looks at the literature about long COVID and suggests there is a clear pathway for treatment in primary care. All physicians should be equipped to recognise long-COVID and provide supportive management ( Dani et al, 2021 ).

scholarly journals Hypothetical COVID-19 protection mechanism: hints from centenarians

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Franca Rosa Guerini ◽  
Matteo Cesari ◽  
Beatrice Arosio
Keyword(s):  
Adaptive Immune Response ◽  
Human Leukocyte ◽  
Human Longevity ◽  
Biological Mechanisms ◽  
Protection Mechanism ◽  
Leukocyte Antigen ◽  
Adaptive Immune ◽  
Life Threatening ◽  
Coronavirus Infection ◽  
Rule Out

AbstractThe risk of serious complications and the fatality rate due to COVID-19 pandemic have proven particularly higher in older persons, putting a further strain in healthcare system as we dramatically observed.COVID-19 is not exclusively gerophile (géro “old” and philia “love”) as young people can be infected, even if older people experience more severe symptoms and mortality due to their greater frailty. Indeed, frailty could complicate the course of COVID-19, much more than the number of years lived. As demonstration, there are centenarians showing remarkable capacity to recover after coronavirus infection.We hypothesize that centenarian’s portfolio could help in identifying protective biological mechanisms underlying the coronavirus infection.The human leukocyte antigen (HLA) is one of the major genetic regions associated with human longevity, due to its central role in the development of adaptive immune response and modulation of the individual’s response to life threatening diseases. The HLA locus seems to be crucial in influencing susceptibility and severity of COVID-19.In this hypothesis, we assume that the biological process in which HLA are involved may explain some aspects of coronavirus infection in centenarians, although we cannot rule out other biological mechanisms that these extraordinary persons are able to adopt to cope with the infection.

scholarly journals Cross-sectional study evaluating the association between integrated care and health-related quality of life (HRQOL) in Dutch primary care

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e040781
Author(s):  
Pim P Valentijn ◽  
Marcel Kerkhoven ◽  
Jantien Heideman ◽  
Rosa Arends
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Primary Care Practice ◽  
Anxiety And Depression ◽  
Care Practice ◽  
Cross Sectional ◽  
Practice Population ◽  
Related Quality ◽  
Health Related

ObjectivesThe aim of this study was to evaluate the association between integrated care and health-related quality of life (HRQOL) in a primary care practice population.DesignA cross-sectional survey study.SettingPrimary care practice population.ParticipantsA sample (n=5562) of patients in two general practitioner practices in the Netherlands.Primary outcome measuresThe Rainbow Model of Integrated Care Measurement Tool patient version and EQ-5D was used to assess integrated service delivery and HRQOL. The association between integrated care and HRQOL groups was analysed using multivariate logistic regression.ResultsOverall, 933 respondents with a mean age of 62 participated (20% response rate) in this study. The multivariate analysis revealed that positive organisational coordination experiences were linked to better HRQOL (OR=1.87, 95% CI 1.18 to 2.95), and less anxiety and depression problems (OR=0.36, 95% CI 0.20 to 0.63). Unemployment was associated with a poor HRQOL (OR=0.15, 95% CI 0.08 to 0.28). Ageing was associated with more mobility (OR=1.06, 95% CI 1.04 to 1.09), self-care (OR=1.06, 95% CI 1.02 to 1.11), usual activity (OR=1.03, 95% CI 1.01 to 1.05) and pain problems (OR=1.02, 95% CI 1.01 to 1.04). Being married improved the overall HRQOL (OR=1.60, 95% CI 1.13 to 2.26) and decreased anxiety and depression (OR=0.47, 95% CI 0.31 to 0.72). Finally, females had a poor overall HRQOL (OR=1.67, 95% CI 0.48 to 0.93) and more pain and discomfort problems (OR=1.47, 95% CI 1.11 to 1.95).ConclusionThis study shows for the first time that organisational coordination activities are positively associated with HROQL of adult patients in a primary care context, adding to the evidence of an association between integrated care and HRQOL. Also, unemployment, ageing and being female are accumulating risk factors that should be considered when designing integrated primary care programmes. Further research is needed to explore how various integration types relate to HRQOL for people in local communities.

scholarly journals Unilateral mydriasis in a child with a ventriculoperitoneal shunt for obstructive hydrocephalus: a diagnostic dilemma

2020 ◽  
Vol 13 (12) ◽  
pp. e237257
Author(s):  
Monidipa Banerjee ◽  
Eiman Haj Ahmed ◽  
Kathryn Foster ◽  
Arundoss Gangadharan
Keyword(s):  
Ipratropium Bromide ◽  
Obstructive Hydrocephalus ◽  
Sudden Onset ◽  
Unique Case ◽  
Diagnostic Dilemma ◽  
Vp Shunt ◽  
Life Threatening ◽  
Unilateral Mydriasis ◽  
The Brain ◽  
Rule Out

There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. An urgent CT scan of the brain did not show any new intracranial abnormality. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect.

A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.R Johannessen ◽  
D Atar ◽  
O.M Vallersnes ◽  
A.C.K Larstorp ◽  
I Mdala ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Low Risk ◽  
Symptom Duration ◽  
Funding Source ◽  
Emergency Setting ◽  
Heart Score ◽  
Rule Out

Abstract Background Patients presenting with acute chest pain outside of hospitals represent a diagnostic challenge. Purpose We aimed to validate whether a single high-sensitivity cardiac troponin T (hs-cTnT) safely can rule out acute myocardial infarction (AMI) in a primary care emergency setting. In addition, we aimed to investigate if the hs-HEART (History, Electrocardiogram (ECG), Age, Risk factors, and hs-Troponin) score would add valuable diagnostic information. Methods This is a secondary analysis from a prospective diagnostic study, including 1711 patients with acute non-specific chest pain presenting to a primary care emergency clinic from November 2016 to October 2018. The European Society of Cardiology (ESC) 0/1-hour algorithm triages patients towards direct rule-out if the 0-hour hs-cTnT is below 5 ng/L, combined with a normal ECG and a 3-hour symptom duration. The hs-HEART score (0–10 points) was calculated retrospectively, and a score ≤3 points was considered low-risk. In addition, a modified hs-HEART score, with more comparable hs-cTnT cut-off values, was applied. The primary endpoint was AMI during the index episode; the secondary the 90-day incidence of AMI (including index) and all-cause death. Results Among 1711 patients, 61 (3.6%) had an AMI, and 525 (30.7%) were assigned towards direct rule-out. With no AMIs in this group, the rule-out safety was high (negative predictive value (NPV) and sensitivity 100%). The hs-HEART score triaged more patients (n=966) as low-risk, but missed six AMIs (NPV 99.4% and sensitivity 90.2%). The modified hs-HEART score (n=707, AMI=3) increased the low-risk sensitivity to 95.1%. The 90-day incidence of AMI and all-cause death in the direct rule-out, low-risk hs-HEART, and modified hs-HEART group, were 0.0%, 0.7%, and 0.4%, respectively. Conclusions The ESC direct rule-out approach, with a single hs-cTnT below 5 ng/L, combined with a normal ECG, and a 3-hour symptom duration, is superior to the two hs-HEART scores in ruling out AMI in a primary care emergency setting. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The Norwegian Research Fund for General Practice

Dimensions of neuroses seen in primary-care settings

1987 ◽  
Vol 17 (2) ◽  
pp. 461-470 ◽  
Author(s):  
D. P. Goldberg ◽  
K. Bridges ◽  
P. Duncan–Jones ◽  
D. Grayson
Keyword(s):  
Primary Care ◽  
Psychiatric Symptoms ◽  
Latent Trait ◽  
Anxiety And Depression ◽  
Symptom Dimensions ◽  
Symptoms Of Depression ◽  
Primary Care Settings ◽  
Severe Manifestation ◽  
The Common ◽  
Highly Correlated

SynopsisThis study uses methods of latent trait analysis to examine the relationships between psychiatric symptoms that constitute the common psychiatric disorders encountered in primary-care settings. Two highly correlated symptom dimensions of anxiety and depression are shown to underlie these disorders. Neurovegetative sysmptoms of depression are shown to be on the same dimension as psychic symptoms of depression, but to represent a more severe manifestation of depression.

Faecal calprotectin is not necessarily required as a screen for significant bowel disease in primary care

2021 ◽  
pp. 000456322110634
Author(s):  
Matthew Malcolm Andrew Waite ◽  
Louise Langmead ◽  
Ruth M Ayling
Keyword(s):  
Primary Care ◽  
Bowel Disease ◽  
Test Performance ◽  
Faecal Calprotectin ◽  
Immunochemical Test ◽  
Inflammatory Bowel ◽  
Clinical Records ◽  
Sensitivity Specificity ◽  
Disease Specific ◽  
Rule Out

Objective NICE recommends measurement of faecal haemoglobin (f-Hb) using faecal immunochemical test (FIT) when colorectal cancer is suspected and calprotectin (f-Cal) in the context of inflammatory bowel disease, though neither is disease specific. During the COVID-19 pandemic, f-Hb has been a requirement prior to referral for endoscopy in England; f-Cal is often performed simultaneously. The aim of this study was to investigate test performance of both tests for significant bowel disease in those patients referred. Design All adult patients with simultaneous measurements of f-Hb and f-Cal between April 2019 and September 2020 were included. For those referred, outcomes were determined from clinical records. Results 650 patients with simultaneous samples for f-Hb an f-Cal were managed in Primary Care; 319 patients were referred to hospital; SBD was found in 32 (10.0%) (CRC 5, high risk adenomas 5, IBD 22). At a cut-off of 10 μg/g for f-Hb and 200 μg/g for f-Cal, the sensitivity, specificity and negative predictive value for diagnosis of SBD were 84.4%, 58.2% and 96.7% and 68.8%, 89.6% and 95.7%, respectively. Performance of both tests would have enabled diagnosis of two more cases of significant, but non-malignant, bowel disease but required over 4% more referrals for investigation. Conclusion Use of FIT has become established to assist prioritisation of patients for referral from Primary Care. Whilst introduced specifically for CRC, FIT performs well as a rule out for IBD in Primary Care and the use of f-Cal is not required.

scholarly journals Diagnosis and treatment of community-acquired pneumonia in patients with acute cough: a quantitative study of decision thresholds in primary care

2018 ◽  
Vol 68 (676) ◽  
pp. e765-e774 ◽  
Author(s):  
Mark H Ebell ◽  
Isabella Locatelli ◽  
Yolanda Mueller ◽  
Nicolas Senn ◽  
Kathryn Morgan
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Signs And Symptoms ◽  
Clinical Decision ◽  
Community Acquired Pneumonia ◽  
Multivariate Model ◽  
Clinical Decisions ◽  
Acute Cough ◽  
Treatment Thresholds ◽  
Rule Out

BackgroundTest and treatment thresholds have not yet been described for decision-making regarding the likelihood of pneumonia in patients with acute cough.AimTo determine decision thresholds in the management of patients with acute cough.Design and settingSet among primary care physicians attending meetings in the US and Switzerland, using data from a prospective cohort of primary care patients.MethodClinical vignettes were used to study the clinical decisions of physicians regarding eight patients with cough that varied by six signs and symptoms. The probability of community-acquired pneumonia (CAP) was determined for each vignette based on a multivariate model. A previously published approach based on logistic regression was used to determine test and treatment thresholds.ResultsIn total, 256 physicians made 764 clinical decisions. Initial physician estimates systematically overestimated the likelihood of CAP; 75% estimating a higher probability than that predicted by the multivariate model. Given the probability of CAP from a multivariate model, 16.7% (125 of 749) changed their decision from ‘treat’ to ‘test’ or ‘test’ to ‘rule out’, whereas only 3.5% (26/749) changed their decision from ‘rule out’ to ‘test’ or ‘test’ to ‘treat’. Test and treatment thresholds were 9.5% (95% confidence interval (CI) = 8.7 to 10.5) and 43.1% (95% CI = 40.1 to 46.4) and were updated to 12.7% (95% CI = 11.7 to 13.8) and 51.3% (95% CI = 48.3 to 54.9) once the true probability of CAP was given. Test thresholds were consistent between subgroups. Treatment thresholds were higher if radiography was available, for Swiss physicians, and for non-primary care physicians.ConclusionTest and treatment thresholds for CAP in patients with acute cough were 9.5% and 43.1%, respectively. Physicians tended to overestimate the likelihood of CAP, and providing information from a clinical decision rule (CDR) changed about 1 in 6 clinical decisions.

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