Diagnostics and modern treatment of migraine: what can a general practitioner do?

2021 ◽  
pp. 13-18
Author(s):  
V. V. Osipova
Keyword(s):  
Migraine Attack ◽  
Behavioral Therapy ◽  
Treatment Strategies ◽  
Diagnostic Errors ◽  
Evidence Base ◽  
Preventive Therapy ◽  
Basic Principles ◽  
High Effect ◽  
Primary Health ◽  
Modern Treatment

The article focuses on the basic principles of diagnosis and treatment of migraine at the stage of primary health care. The diagnostic criteria of migraine, common diagnostic errors and alarming symptoms that are indications for instrumental investigations are given. The main treatment strategies of migraine are described: behavioral therapy, attack relief, and preventive therapy. Special attention is being paid to the treatment of a migraine attack, depending on its severity, including the features of the use of simple analgesics and triptans – specific drugs that have a pathogenetic antimigrenous effect. The principles of the use of tryptans that provide a high effect of relieving a migraine attack are being listed. The advantages of eletriptan as a last‑generation triptan, which is highly effective in relieving migraine attacks and is safer than other drugs in this class, are highlighted. Among the modern classes of drugs that have an evidence base in migraine prevention, those that can be successfully used by general practitioners are indicated.

Behavior Therapy of Depression

2016 ◽  
pp. 422-434
Author(s):  
Samuel H. Hubley ◽  
Sona Dimidjian
Keyword(s):  
Behavior Therapy ◽  
Behavioral Treatment ◽  
Behavioral Activation ◽  
Behavioral Therapy ◽  
Treatment Strategies ◽  
Evidence Base ◽  
Primary Treatment ◽  
Future Research ◽  
Problem Solving Therapy ◽  
Therapy Interventions

This article discusses the three primary contemporary behavior therapy interventions for depression: problem-solving therapy (PST), coping with depression (CWD), and behavioral activation (BA).   After providing an overview of the historical roots of behavioral treatment for depression, the article describes the theoretical foundation of each approach. It then considers the evidence base, citing clinical trials that have evaluated the efficacy and effectiveness of PST, CWD, and BA. It also examines the primary treatment strategies of each approach and concludes by suggesting directions for future research that emphasize the need to clarify mechanisms of change and to extend the scope of behavioral therapy for depression.

State of the Art Reviews: Nonpharmacologic Approaches for the Treatment of Insomnia

2007 ◽  
Vol 1 (4) ◽  
pp. 274-282 ◽  
Author(s):  
Ann M. Lynch ◽  
Courtney I. Jarvis ◽  
Ronald J. DeBellis ◽  
Anna K. Morin
Keyword(s):  
Behavioral Therapy ◽  
Treatment Options ◽  
Sleep Onset ◽  
Treatment Strategies ◽  
Economic Consequences ◽  
Patient Specific ◽  
Sleep Onset Latency ◽  
Medline Search ◽  
Wake Time ◽  
Nonpharmacologic Treatment

Insomnia is a common condition resulting in significant clinical and economic consequences. This review discusses the efficacy of nonpharmacologic treatment options commonly recommended for sleep onset and sleep maintenance insomnia. In addition, the efficacy of these approaches as part of a multifaceted intervention and in comparison to that of pharmacologic options is reviewed. The primary literature and review articles on the nonpharmacologic treatment of insomnia were identified through a MEDLINE search between 1966 and August 2006. Articles on the nonpharmacologic treatment of primary insomnia, including clinical trials on the efficacy of individual and combination treatment options, were reviewed. The nonpharmacologic treatment options for insomnia include stimulus control, sleep hygiene educations, sleep restriction, paradoxical intention, relaxation therapy, biofeedback, and cognitive-behavioral therapy. These treatment strategies produce significant changes in several sleep parameters of chronic insomniacs, including sleep-onset latency, wake time after sleep onset, sleep duration, and sleep quality. Many therapeutic options are available to treat insomnia, including nonpharmacologic strategies. Treatment recommendations, both pharmacologic and nonpharmacologic, should be made based on patient-specific insomnia symptoms, treatment history, and medical history.

scholarly journals Evaluation of effectiveness of mass screening for tuberculosis infection in children from 1 to 7 years old in Moscow

2022 ◽  
Vol 99 (12) ◽  
pp. 14-21
Author(s):  
L. V. Slogotskaya ◽  
E. M. Bogorodskaya ◽  
L. F. Shamuratova ◽  
T. A. Sevostyanova
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Skin Test ◽  
Positive Reaction ◽  
Mass Screening ◽  
Preventive Therapy ◽  
Tuberculosis Infection ◽  
Mantoux Test ◽  
Primary Health

The objective: to evaluate effectiveness of mass screening for tuberculosis infection in children aged 1 to 7 years in different periods – before and after the use of tuberculosis recombinant allergen skin test (TRA) in primary health care as an additional diagnostic method.Subjects and Methods. The study was designed as continuous observational prospective-retrospective study. Two different periods were assessed: the first one was 2014-2016 when screening for tuberculosis infection was performed in all children from 1 to 17 years (inclusive) using Mantoux test with 2 TU PPD-L in pediatric primary health care, and then children suspected to have a positive reaction were referred to TB dispensary where they were examined with a skin test with TRA if necessary. The second period was from 2018 to 2020 when children of 1-7 years old were given Mantoux test and if tuberculosis infection was suspected, a skin test with TRA was done both in primary health care network and TB units. In the first 3 years, 1,864,137 children were examined and in the second 3 years, 2,078,800 children from 1 to 7 years old were examined.Results. Among children of 1-7 years old who were screened by two stages (initial Mantoux test, and then in those who had a positive reaction, the TRA test was used), only 10-12% of those referred to a phthisiologist were subject to dispensary follow-up. Thus, with the implementation of the new edict on screening for tuberculosis infection in children with two tests, this proportion has not changed compared to previous years, when screening was carried out only with one Mantoux test. The reason why almost 90% of the children who were referred to TB Dispensary were not subject to dispensary follow-up is the following: children who have had previous conversion of tuberculin tests, along with everyone else are again screened with Mantoux test despite being previously followed up by TB dispensary due to the primary infection.Recommendations:Currently, there is no division of Group VI into Subgroups A, B, C in the dispensary follow up grouping. Why should conversion of Mantoux test reaction from negative into positive not be considered an infection, and the increase in the reaction must be at least 6 mm.Since Order No. 124n of the Russian Ministry of Health allows testing with TRA in the primary health care in case of suspected infection, it is advisable to refer those who have already had this test to a phthisiologist.A child with conversion of Mantoux test should not be re-screened with Mantoux test but the TRA test should be used. If a positive reaction to the TRA test occurs for the first time, it should be considered as conversion of this test, and in this case the child should be examined by computed tomography (CT), and preventive therapy should be prescribed. If in subsequent years the TRA reaction increases by at least 6 mm after previous preventive therapy, the child should be re-referred for CT to rule out the development of active tuberculosis.

scholarly journals International and Russian Experience in Primary Health Care Organization

2018 ◽  
pp. 146-148
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Medical Care ◽  
Health Care Organization ◽  
The United States ◽  
Evidence Base ◽  
Care Organization ◽  
Care Provision ◽  
Primary Health ◽  
Effective Instrument

In this study, they presented the analysis of current views on the important link in medical care provision to the population, namely, primary health care. According to the Alma-Ata Declaration on the organization of primary health care this type of medical assistance has made it possible to carry out reforms within this area in many countries, which has led to effective results (the reduction of infant mortality, the increase of life expectancy and a number of other indicators). In this paper, they performed the analysis of Russian and foreign sources of literature on the topic under study between 1978 and 2018. It has been established that primary health care is regarded as the most effective instrument of health protection than specialized medical care according to the experience of Russian Federation, a number of countries in Europe, Asia and the African continent, Australia and the United States. The performed analysis clearly shows that the experience of some countries demonstrates the correlation between the general coverage of primary health care and the achievement of public health indicative indicators. At the same time, the question is raised about the expediency of certain aspect replacement concerning the provision of specialized medical care by the doctors of general practice, i.e. primary health care. The obtained results can be interpreted as an evidence base for the necessity and an undeniable effectiveness of primary health care as a central link in the health care system.

Combining Cognitive-Behavioral Therapy and Pharmacotherapy for the Treatment of Panic Disorder

2006 ◽  
Vol 20 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Jasper A. J. Smits ◽  
Conall M. O’Cleirigh ◽  
Michael W. Otto
Keyword(s):  
Panic Disorder ◽  
Combination Treatment ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Treatment Strategies ◽  
Cognitive Behavior ◽  
Short Term ◽  
Medication Treatment ◽  
Novel Approaches

This article focuses on the role of combination treatment strategies in the management of panic disorder (PD). Despite short-term benefits, there is not consistent evidence for a longer-term advantage of combined treatment over cognitive-behavior therapy alone. In discussing this result, we place emphasis on ways in which medication treatment may interfere with the learning of safety in relation to feared cues in PD. These considerations are placed in the context of animal and human studies of factors that interfere with the extinction of fears. Strategies to overcome this interference are also discussed as are novel approaches to combination treatment.

Neurobiology and Treatment of OCD

2013 ◽  
pp. 646-661
Author(s):  
Susanne E. Ahmari ◽  
H. Blair Simpson
Keyword(s):  
Environmental Factors ◽  
Behavioral Therapy ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Evidence Based ◽  
Preclinical Studies ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Evidence Based Treatments ◽  
Genetic And Environmental Factors

Obsessive Compulsive Disorder (OCD) is a chronic, disabling disorder with a lifetime prevalence of up to 2-3%, and is a leading cause of illness-related disability. OCD is characterized by recurrent intrusive thoughts, images, or impulses (obsessions) that cause anxiety or distress, and repetitive mental or behavioral acts (compulsions). Though the etiology of OCD is unclear, current evidence implicates both genetic and environmental factors in its development. Our understanding of the neurobiology underlying OCD is still evolving, with convergent evidence from clinical and preclinical studies highlighting the importance of abnormalities in cortico-striatal-thalamo-cortical (CSTC) circuits. Evidence-based treatments for OCD include both pharmacotherapy and cognitive-behavioral therapy. This chapter will review the etiology and neurobiology of OCD, and will provide an overview of treatment strategies.

Optimal medical therapy in percutaneous coronary intervention patients: statins and ACE inhibitors as disease-modifying agents

2010 ◽  
pp. 456-475
Author(s):  
Simon J. Corbett ◽  
Kim F. Fox
Keyword(s):  
Research Effort ◽  
Treatment Strategies ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Pathological Process ◽  
Atherosclerotic Burden ◽  
Coronary Stenoses ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Disease Modifying Agents

The majority of this textbook is concerned with the indications for, and applications of, the numerous techniques that interventional cardiologists have at their disposal to assess and treat significant coronary stenoses. However, it is well recognized that atherosclerosis is far from being a discrete pathological process, such that by the time a person presents with clinically apparent coronary artery disease (CAD), they will often have widespread atheroma throughout their coronary tree. Combined with the reproducible observation that the majority of acute coronary syndromes arise from lesions that were not previously flow-limiting, much research effort has been directed at identifying treatment strategies that will favourably modify all of the patient’s atherosclerotic burden, not just that which can be targeted by percutaneous or surgical revascularization. In this chapter, we focus on the rationale and evidence base supporting the use of statins and renin–angiotensin–aldosterone system (RAAS) inhibition in patients with CAD.

scholarly journals The case for extended brief interventions

2011 ◽  
Vol 50 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Nick Heather
Keyword(s):  
Brief Intervention ◽  
Health Professionals ◽  
Evidence Base ◽  
Alcohol Problems ◽  
Brief Interventions ◽  
Treatment Services ◽  
Primary Health ◽  
Alcohol Brief Intervention ◽  
Single Well ◽  
Over Time

The case for extended brief interventions Brief interventions directed against hazardous and harmful drinking have become popular in recent years, both among researchers and, to some extent, among general practitioners and other health professionals. There is a strong evidence-base, at least in primary health care, to justify this popularity. But there is often confusion about what exactly alcohol brief intervention consists of. In fact, the term ‘brief intervention’ does not describe a single, well-defined activity but rather a family of interventions that differ in a range of ways. Although they all share the characteristics of being briefer than most formal treatment programmes for alcohol problems and of being aimed at drinkers with less severe problems and levels of dependence than those typically attending specialized treatment services, brief interventions differ among themselves in duration over time, number of scheduled sessions, procedures and accompanying materials, styles of interaction, delivery personnel and settings, and the underlying theoretical approach on which they are based.

Towards Integrated Service Delivery for Primary Health Care: Can Programs Meet People's Lives?

2000 ◽  
Vol 6 (4) ◽  
pp. 43
Author(s):  
Vivian Lin
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Service Delivery ◽  
Health Care Policy ◽  
Unit Cost ◽  
Policy Research ◽  
Evidence Base ◽  
Integrated Service Delivery ◽  
Primary Health ◽  
Integrated Service

The primary health care sector faces a number of challenges. Some of these are in the form of persistent problems which include, inter alia, health disparities in resources and outcomes, a fragmented health system, issues of power with respect to priority setting and resource allocation, and a poor information and evidence base with which to allocate resources and evaluate outcomes. These problems are perennially accompanied by a gap between the rhetoric of policy and the reality of implementation. Neo-liberal reforms present a series of challenges to primary health, with the introduction of unit-cost funding, competitive tendering and increased user pays. Changing epidemiological patterns, the rise of evidence-based medicine, and new information and communication technology all question accepted methods of practice. Eroding community confidence in government and professionals, and the growing polarisation of society are also cause for concern. Three areas for development in primary health care policy and practice may provide the keys for dealing with these challenges. These are, first, the development of integrated service delivery models, which move away from narrowly defined single purpose programs delivered by one provider. Second, the development of innovative policy and managerial tools that support the objectives of primary health care while addressing the concerns of policy makers. Finally, the development of a strategic research and development agenda that effectively links policy, research and practice.

Sign in / Sign up

Export Citation Format

Share Document