scholarly journals Three Questions to Screen your Patients for Chemical, Food, and Drug Intolerances the Brief Environmental Exposure and Sensitivity Inventory (BREESI)

2020 ◽  
Author(s):  
Raymond F Palmer ◽  
Carlos Roberto Jaén ◽  
Roger B. Perales ◽  
Rodolfo Rincon ◽  
Jacqueline Viramontes ◽  
...  
Keyword(s):  
Primary Care ◽  
Positive Predictive Value ◽  
Environmental Exposure ◽  
Health Care Professionals ◽  
Predictive Value ◽  
Primary Care Clinic ◽  
Diagnostic Tools ◽  
Care Clinic ◽  
Predictive Values ◽  
Chemical Intolerance

Abstract Background: The 50-item Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a validated questionnaire used worldwide to assess intolerances to chemicals, foods, and/or drugs and has become the gold standard for assessing chemical intolerance (CI). Despite a reported prevalence of 8-33%, CI often goes undiagnosed in epidemiological studies and routine primary care. To enhance the QEESI’s utility, we developed the Brief Environmental Exposure and Sensitivity Inventory (BREESI) as a 3-item CI screening instrument. We tested the BREESI’s potential to predict whether an individual is likely to respond adversely to structurally unrelated chemicals, foods, and drugs. Methods: We recruited 286 adult participants from a university-based primary care clinic and through online participation. The positive and negative predictive values of the BREESI items were calculated against the full QEESI scores. Results: 90% of participants answering “yes” to all three items on the BREESI were classified as very suggestive of CI based upon the QEESI chemical intolerance and symptom scores both ≥ 40 (positive predictive value = 90%). For participants endorsing two items, 92% were classified as either very suggestive (39%) or Suggestive (53%) of CI (positive predictive value = 87%). Of those endorsing only one item, only 13% were found to be very suggestive of CI. However, 70% were classified as Suggestive. Of those answering “No” to all of the BREESI items, 99% were classified as not suggestive of CI (i.e., negative predictive value = 99%). Conclusions: The BREESI is a versatile screening tool for rapidly determining potential CI, with clinical and epidemiological applications. Together, the validated BREESI and QEESI provide much needed diagnostic tools that will help inform treatment protocols and teach health care professionals about Toxicant Induced Loss of Tolerance – the mechanism driving CI.

scholarly journals Evaluation of a two-minute strep A direct swab test (SADST) on patients with pharyngitis at a primary care clinic

1986 ◽  
Vol 97 (1) ◽  
pp. 133-138 ◽  
Author(s):  
G. F. Araj ◽  
H. A. Majeed
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Culture Method ◽  
Care Clinic ◽  
Predictive Values ◽  
Primary Care Clinics ◽  
Clinical Laboratories ◽  
Standard Culture ◽  
Group A ◽  
Lancefield Group

SUMMARYA two-minute strep A direct swab test (SADST) was used to detect the presence of Lancefield group A streptococci (GAS) from the throats of 207 patients with pharyngitis at a primary-care clinic. The results were compared with a standard culture method. Fifty-one specimens were positive and 156 specimens were negative for GAS by culture. The SADST had a sensitivity of 96% (49 of 51) and specificity of 98·7% (154 of 156). The predictive values of a positive and negative SADST, for GAS, were 96% and 98·7 % respectively. The SADST showed negative reactions with five specimens containing beta-haemotytic streptococci other than GAS and 34 known stock cultures other than GAS. Our results indicate that SADST is a rapid, simple, convenient and reliable test to use for diagnosis of GAS pharyngitis at primary care clinics, physicians' offices and clinical laboratories.

scholarly journals Does improving indoor air quality lessen symptoms associated with chemical intolerance?

2022 ◽  
Vol 23 ◽  
Author(s):  
Roger B. Perales ◽  
Raymond F. Palmer ◽  
Rudy Rincon ◽  
Jacqueline N. Viramontes ◽  
Tatjana Walker ◽  
...  
Keyword(s):  
Primary Care ◽  
Air Quality ◽  
Indoor Air Quality ◽  
Indoor Air ◽  
Primary Care Clinic ◽  
Symptom Improvement ◽  
Care Clinic ◽  
House Calls ◽  
Chemical Intolerance ◽  
Gastrointestinal Problems

Abstract Aim: To determine whether environmental house calls that improved indoor air quality (IAQ) is effective in reducing symptoms of chemical intolerance (CI). Background: Prevalence of CI is increasing worldwide. Those affected typically report symptoms such as headaches, fatigue, ‘brain fog’, and gastrointestinal problems – common primary care complaints. Substantial evidence suggests that improving IAQ may be helpful in reducing symptoms associated with CI. Methods: Primary care clinic patients were invited to participate in a series of structured environmental house calls (EHCs). To qualify, participants were assessed for CI with the Quick Environmental Exposure and Sensitivity Inventory. Those with CI volunteered to allow the EHC team to visit their homes to collect air samples for volatile organic compounds (VOCs). Initial and post-intervention IAQ sampling was analyzed by an independent lab to determine VOC levels (ng/L). The team discussed indoor air exposures, their health effects, and provided guidance for reducing exposures. Findings: Homes where recommendations were followed showed the greatest improvements in IAQ. The improvements were based upon decreased airborne VOCs associated with reduced use of cleaning chemicals, personal care products, and fragrances, and reduction in the index patients’ symptoms. Symptom improvement generally was not reported among those whose homes showed no VOC improvement. Conclusion: Improvements in both IAQ and patients’ symptoms occur when families implement an action plan developed and shared with them by a trained EHC team. Indoor air problems simply are not part of most doctors’ differential diagnoses, despite relatively high prevalence rates of CI in primary care clinics. Our three-question screening questionnaire – the BREESI – can help physicians identify which patients should complete the QEESI. After identifying patients with CI, the practitioner can help by counseling them regarding their home exposures to VOCs. The future of clinical medicine could include environmental house calls as standard of practice for susceptible patients.

scholarly journals Sensitivity and specificity of malaria rapid diagnostic test (mRDT CareStatTM) compared with microscopy amongst under five children attending a primary care clinic in southern Nigeria

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Oluwagbenga Ogunfowokan ◽  
Bamidele A. Ogunfowokan ◽  
Anthony I. Nwajei
Keyword(s):  
Primary Care ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Parasite Density ◽  
Primary Care Clinic ◽  
Malaria Diagnosis ◽  
Malaria Prevalence ◽  
Cross Sectional ◽  
Care Clinic ◽  
Predictive Values

Background: Malaria diagnosis using microscopy is currently the gold standard. However, malaria rapid diagnostic tests (mRDTs) were developed to simplify the diagnosis in regions without access to functional microscopy.Aim: The objective of this study was to compare the diagnostic accuracy of mRDT CareStatTM with microscopy.Setting: This study was conducted in the paediatric primary care clinic of the Federal Medical Centre, Asaba, Nigeria.Methods: A cross-sectional study for diagnostic accuracy was conducted from May 2016 to October 2016. Ninety-eight participants were involved to obtain a precision of 5%, sensitivity of mRDT CareStatTM of 95% from published work and 95% level of confidence after adjusting for 20% non-response rate or missing data. Consecutive participants were tested using both microscopy and mRDT. The results were analysed using EPI Info Version 7.Results: A total of 98 children aged 3–59 months were enrolled. Malaria prevalence was found to be 53% (95% confidence interval [CI] = 46% – 60%), whilst sensitivity and specificity were 29% (95% CI = 20% – 38%) and 89% (95% CI = 83% – 95%), respectively. The positive and negative predictive values were 75% (95% CI = 66.4% – 83.6%) and 53% (95% CI = 46% – 60%), respectively.Conclusion: Agreement between malaria parasitaemia using microscopy and mRDT positivity increased with increase in the parasite density. The mRDT might be negative when malaria parasite density using microscopy is low.

scholarly journals An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dominicus Husada ◽  
Kusdwijono ◽  
Dwiyanti Puspitasari ◽  
Leny Kartina ◽  
Parwati Setiono Basuki ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Clinical Features ◽  
Predictive Value ◽  
Maculopapular Rash ◽  
Immunoglobulin M ◽  
World Health ◽  
Diagnostic Tools ◽  
Slight Reduction ◽  
Predictive Values ◽  
Sensitivity Specificity

Abstract Background Measles is a recurrent health problem in both advanced and developed countries. The World Health Organization (WHO) recommends anti-measles immunoglobulin M (Ig M) as the standard method of detecting the virus; however, many areas still present the inability to perform a serology test of anti-measles IgM. Therefore, a typical clinical feature is necessary to establish the diagnosis of measles. The objective of this study was to evaluate hyperpigmented rash and other clinical features as the diagnostic tools with respect to measles, especially in an outbreak setting. Methods In this observational diagnostic study, the inclusion criteria were as follows: between 6 and 144 months of age, fever, maculopapular rash for 3 days or more, accompanied by a cough, or coryza, or conjunctivitis. Those with a prior history of measles vaccination (1–6 weeks) were excluded, in addition to those with histories of corticosteroid for 2 weeks or more and immunocompromised conditions. The samples were taken from Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. We evaluated the sensitivity, specificity, the positive predictive value, and the negative predictive value of such clinical features. Hyperpigmented rash was validated using Kappa and Mc Nemar tests. Anti-measles Ig M was considered as the gold standard. Results This study gathered 82 participants. The clinical manifestations of all subjects included fever, cough, coryza, conjunctivitis, Koplik spots, and maculopapular rash (which turns into hyperpigmented rash along the course of the illness). Most maculopapular rashes turn out to be hyperpigmented (89%). Sensitivity, specificity, positive predictive value, and negative predictive values ​​of the combination of fever, maculopapular rash, and hyperpigmented rash were found to be at 90.7, 28.6, 93.2, and 22.2%, respectively. The Mc Nemar and Kappa tests showed p values of 0.774 and 0.119, respectively. Conclusion The combination of fever, maculopapular rash, and hyperpigmented rash can be used as a screening tool regarding measles infection in an outbreak setting, which can then be confirmed by anti-measles Ig M. Cough, coryza, and Koplik’s spot can be added to this combination, albeit with a slight reduction of sensitivity value.

Vision Screening Among Primary Care Clinic Patients

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 93A-93A
Author(s):  
Lwbba Chait ◽  
Angeliki Makri ◽  
Rawan Nahas ◽  
Gwen Raphan
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Vision Screening ◽  
Care Clinic

scholarly journals Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications

2021 ◽  
Vol 12 ◽  
pp. 215013272110350
Author(s):  
Pasitpon Vatcharavongvan ◽  
Viwat Puttawanchai
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Study Data ◽  
Patient Specific ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Care Clinic ◽  
Inappropriate Medications

Background Most older adults with comorbidities in primary care clinics use multiple medications and are at risk of potentially inappropriate medications (PIMs) prescription. Objective This study examined the prevalence of polypharmacy and PIMs using Thai criteria for PIMs. Methods This study was a retrospective cross-sectional study. Data were collected from electronic medical records in a primary care clinic in 2018. Samples were patients aged ≥65 years old with at least 1 prescription. Variables included age, gender, comorbidities, and medications. The list of risk drugs for Thai elderly version 2 was the criteria for PIMs. The prevalence of polypharmacy and PIMs were calculated, and multiple logistic regression was conducted to examine associations between variables and PIMs. Results Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively. Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI 2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively). Conclusion Prescriptions with PIMs were high in the primary care clinic. Describing unnecessary medications is crucial to prevent negative health outcomes from PIMs. Computer-based clinical decision support, pharmacy-led interventions, and patient-specific drug recommendations are promising interventions to reduce PIMs in a primary care setting.

scholarly journals 140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S200-S200
Author(s):  
Michael Hansen ◽  
Barbara Trautner ◽  
Roger Zoorob ◽  
George Germanos ◽  
Osvaldo Alquicira ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Safety Net ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Primary Care Patients ◽  
Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

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