Infantile haemangiomas: Identifying high-risk lesions in primary care

Abstract Background Genome-wide association studies have identified thousands of disease-associated single nucleotide polymorphisms (SNPs). A subset of these SNPs may be additively combined to generate genetic risk scores (GRSs) that confer risk for a specific disease. Although the clinical validity of GRSs to predict risk of specific diseases has been well established, there is still a great need to determine their clinical utility by applying GRSs in primary care for cancer risk assessment and targeted intervention. Methods This clinical study involved 281 primary care patients without a personal history of breast, prostate or colorectal cancer who were 40–70 years old. DNA was obtained from a pre-existing biobank at NorthShore University HealthSystem. GRSs for colorectal cancer and breast or prostate cancer were calculated and shared with participants through their primary care provider. Additional data was gathered using questionnaires as well as electronic medical record information. A t-test or Chi-square test was applied for comparison of demographic and key clinical variables among different groups. Results The median age of the 281 participants was 58 years and the majority were female (66.6%). One hundred one (36.9%) participants received 2 low risk scores, 99 (35.2%) received 1 low risk and 1 average risk score, 37 (13.2%) received 1 low risk and 1 high risk score, 23 (8.2%) received 2 average risk scores, 21 (7.5%) received 1 average risk and 1 high risk score, and no one received 2 high risk scores. Before receiving GRSs, younger patients and women reported significantly more worry about risk of developing cancer. After receiving GRSs, those who received at least one high GRS reported significantly more worry about developing cancer. There were no significant differences found between gender, age, or GRS with regards to participants’ reported optimism about their future health neither before nor after receiving GRS results. Conclusions Genetic risk scores that quantify an individual’s risk of developing breast, prostate and colorectal cancers as compared with a race-defined population average risk have potential clinical utility as a tool for risk stratification and to guide cancer screening in a primary care setting.

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24-Months Cluster-Randomized Intervention Trial of a Targeted Fall Prevention Program in a Primary Care Setting

Journal of General Internal Medicine ◽

10.1007/s11606-021-06944-w ◽

2021 ◽

Author(s):

Christian Hentschke ◽

Martin Halle ◽

Barbara Geilhof ◽

Peter Landendoerfer ◽

Wolfgang Blank ◽

...

Keyword(s):

Primary Care ◽

High Risk ◽

Fall Prevention ◽

Care Setting ◽

Primary Care Setting ◽

Fear Of Falling ◽

Community Dwelling ◽

Risk Of Falling ◽

Injurious Falls ◽

Cluster Randomized

Abstract Background Falls and fall-related injuries are common in community-dwelling older persons. Longitudinal data on effective fall prevention programs are rare. Objective Therefore, we evaluated a 4-months multi-component exercise fall prevention program in a primary care setting on long-term effects over 24 months on falls and concomitant injuries in older community-dwelling persons with high risk of falling. Design and Setting In the Prevention of Falls (PreFalls) study, forty general practitioners in Germany were cluster-randomized (1:1) into an intervention group (IG) or control group (CG). Three hundred seventy-eight independently living people with high risk of falling (78.1 ± 5.9 years, 75% women) were assigned to IG (n = 222) or CG (n = 156). Intervention and Measurements Patients in IG took part in a 4-months multi-component exercise program comprising strength and balance exercises (28 sessions); patients in CG received no intervention. Primary outcome measure was number of falls over 24 months, analyzed by a patient-level, linear mixed Poisson model. Secondary endpoints were number of fall-related injuries, changes in physical function, fear of falling, and mortality. Results After 24 months, the IG demonstrated significantly fewer falls (IRR = 0.63, p = 0.021), injurious falls (IRR = 0.69, p = 0.034), and less fear of falling (p = 0.005). The mortality rate was 5.0% in IG and 10.3% in CG (HR = 0.51, 95% CI: 0.24 to 1.12; p = 0.094). Conclusions In older community-dwelling persons with high risk of falling, a short-term multi-component exercise intervention reduced falls and injurious falls, as well as fear of falling over 24 months.

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Behavioral and biologic evidence of persistent high-risk behavior in an HIV primary care population

AIDS ◽

10.1097/00002030-200002180-00012 ◽

2000 ◽

Vol 14 (3) ◽

pp. 297-301 ◽

Cited By ~ 49

Author(s):

Emily J. Erbelding ◽

David Stanton ◽

Thomas C. Quinn ◽

Anne Rompalo

Keyword(s):

Primary Care ◽

High Risk ◽

Risk Behavior ◽

High Risk Behavior ◽

Primary Care Population ◽

Hiv Primary Care

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CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening

Open Heart ◽

10.1136/openhrt-2020-001459 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001459

Author(s):

Jelle C L Himmelreich ◽

Wim A M Lucassen ◽

Ralf E Harskamp ◽

Claire Aussems ◽

Henk C P M van Weert ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

High Risk ◽

The Netherlands ◽

Patient Selection ◽

Low Cost ◽

Calibration Plot ◽

Primary Care Data ◽

C Statistic ◽

Kaplan Meier

AimsTo validate a multivariable risk prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF)) for 5-year risk of atrial fibrillation (AF) in routinely collected primary care data and to assess CHARGE-AF’s potential for automated, low-cost selection of patients at high risk for AF based on routine primary care data.MethodsWe included patients aged ≥40 years, free of AF and with complete CHARGE-AF variables at baseline, 1 January 2014, in a representative, nationwide routine primary care database in the Netherlands (Nivel-PCD). We validated CHARGE-AF for 5-year observed AF incidence using the C-statistic for discrimination, and calibration plot and stratified Kaplan-Meier plot for calibration. We compared CHARGE-AF with other predictors and assessed implications of using different CHARGE-AF cut-offs to select high-risk patients.ResultsAmong 111 475 patients free of AF and with complete CHARGE-AF variables at baseline (17.2% of all patients aged ≥40 years and free of AF), mean age was 65.5 years, and 53% were female. Complete CHARGE-AF cases were older and had higher AF incidence and cardiovascular comorbidity rate than incomplete cases. There were 5264 (4.7%) new AF cases during 5-year follow-up among complete cases. CHARGE-AF’s C-statistic for new AF was 0.74 (95% CI 0.73 to 0.74). The calibration plot showed slight risk underestimation in low-risk deciles and overestimation of absolute AF risk in those with highest predicted risk. The Kaplan-Meier plot with categories <2.5%, 2.5%–5% and >5% predicted 5-year risk was highly accurate. CHARGE-AF outperformed CHA2DS2-VASc (Cardiac failure or dysfunction, Hypertension, Age >=75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [Female]) and age alone as predictors for AF. Dichotomisation at cut-offs of 2.5%, 5% and 10% baseline CHARGE-AF risk all showed merits for patient selection in AF screening efforts.ConclusionIn patients with complete baseline CHARGE-AF data through routine Dutch primary care, CHARGE-AF accurately assessed AF risk among older primary care patients, outperformed both CHA2DS2-VASc and age alone as predictors for AF and showed potential for automated, low-cost patient selection in AF screening.

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Using routinely collected primary care records to identify and investigate severe asthma: a scoping review

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-020-00213-9 ◽

2021 ◽

Vol 31 (1) ◽

Author(s):

Jonathan Stewart ◽

Frank Kee ◽

Nigel Hart

Keyword(s):

Primary Care ◽

High Risk ◽

Severe Asthma ◽

Scoping Review ◽

Asthma Severity ◽

Data Sources ◽

Full Potential ◽

High Risk Disease ◽

Asthma Outcomes ◽

Disease Variant

AbstractShielding during the coronavirus pandemic has highlighted the potential of routinely collected primary care records to identify patients with ‘high-risk’ conditions, including severe asthma. We aimed to determine how previous studies have used primary care records to identify and investigate severe asthma and whether linkage to other data sources is required to fully investigate this ‘high-risk’ disease variant. A scoping review was conducted based on the Arksey and O’Malley framework. Twelve studies met all criteria for inclusion. We identified variation in how studies defined the background asthma cohort, asthma severity, control and clinical outcomes. Certain asthma outcomes could only be investigated through linkage to secondary care records. The ability of primary care records to represent the entire known asthma population is unique. However, a number of challenges need to be overcome if their full potential to accurately identify and investigate severe asthma is to be realised.

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Prognostic ability of STarT Back Screening Tool combined with work-related factors in patients with low back pain in primary care: a prospective study

BMJ Open ◽

10.1136/bmjopen-2020-046446 ◽

2021 ◽

Vol 11 (6) ◽

pp. e046446

Author(s):

Monica Unsgaard-Tøndel ◽

Ottar Vasseljen ◽

Tom Ivar Lund Nilsen ◽

Gard Myhre ◽

Hilde Stendal Robinson ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

High Risk ◽

Work Ability ◽

High Risk Group ◽

Low Back ◽

Related Factors

ObjectivePrimary care screening tools for patients with low back pain may improve outcome by identifying modifiable obstacles for recovery. The STarT Back Screening Tool (SBST) consists of nine biological and psychological items, with less focus on work-related factors. We aimed at testing the prognostic ability of SBST and the effect of adding items for future and present work ability.MethodsProspective observational study in patients (n=158) attending primary care physical therapy for low back pain. The prognostic ability of SBST and the added prognostic value of two work items; expectation for future work ability and current work ability, were calculated for disability, pain and quality of life outcome at 3 months follow-up. The medium and high-risk group in the SBST were collapsed in the analyses due to few patients in the high-risk group. The prognostic ability was assessed using the explained variance (R2) of the outcomes from univariable and multivariable linear regression and beta values with 95% CIs were used to assess the prognostic value of individual items.ResultsThe SBST classified 107 (67.7%) patients as low risk and 51 (32.3%) patients as medium/high risk. SBST provided prognostic ability for disability (R2=0.35), pain (R2=0.25) and quality of life (R2=0.28). Expectation for return to work predicted outcome in univariable analyses but provided limited additional prognostic ability when added to the SBST. Present work ability provided additional prognostic ability for disability (β=−2.5; 95% CI=−3.6 to −1.4), pain (β=−0.2; 95% CI=−0.5 to −0.002) and quality of life (β=0.02; 95% CI=0.001 to 0.04) in the multivariable analyses. The explained variance (R2) when work ability was added to the SBST was 0.60, 0.49 and 0.47 for disability, pain and quality of life, respectively.ConclusionsAdding one work ability item to the SBST gives additional prognostic information across core outcomes.Clinical trial number:NCT03626389

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Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person

Journal of Opioid Management ◽

10.5055/jom.2021.0621 ◽

2021 ◽

Vol 17 (2) ◽

pp. 109-113

Author(s):

Julienne K. Kirk, PharmD, CDE, BCPS ◽

Matthew Q. Tran, PharmD ◽

Samantha Pelc, PharmD ◽

Katherine G. Moore, PharmD, BCPS, BCACP

Keyword(s):

Primary Care ◽

High Risk ◽

Family Medicine ◽

Quality Improvement Intervention ◽

Opioid Overdose ◽

Naloxone Administration ◽

Support Person ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting.Design: Prospective quality improvement intervention in an academic family medicine clinic.Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set.Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person.Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

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