scholarly journals Hypercalcemia: An Ominous sign of Malignancy

2021 ◽  
pp. 1-2
Author(s):  
Zachary R Teibel ◽  
◽  
Mohammad Jurri ◽  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Serum Calcium ◽  
Primary Care Physicians ◽  
Elevated Serum ◽  
Clinical Manifestations ◽  
Metastatic Breast ◽  
Care Physician ◽  
Asymptomatic Patients ◽  
Malignant Breast

Hypercalcemia is a disorder commonly encountered by primary care physicians. The diagnosis often is made incidentally in asymptomatic patients Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. 90% of cases of hypercalcemia are due to primary hyperparathyroidism and malignancy. This article highlights the importance of proper work-up of elevated serum calcium levels and complications that can arise from failure to do so. This is a case report of a 63-year-old female who was found to have asymptomatic hypercalcemia of 10.5 mg/dl but was lost to follow up and presented four years later to her primary care physician with complaints of pain in the neck and weakness in bilateral shoulders, arms, wrists, and numbness of 4th and 5th digits. MRI revealed lytic lesions on the cervical and thoracic spine with compression deformity likely due to metastatic breast cancer. Lab reports revealed a serum calcium level of 12.1mg/dl and the patient’s chart (mammogram/ breast US) confirmed malignant breast cancer.

scholarly journals Rheumatic polymyalgia: clinic, diagnosis, principles of therapy (to help the primary care physician)

2021 ◽  
pp. 164-169
Author(s):  
M. S. Svetlova
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Care Physician ◽  
Diagnostic Methods ◽  
Malignant Neoplasms ◽  
Adequate Treatment ◽  
Laboratory Activity

In recent decades, there has been an increase in the number of elderly people. Among the patients of the primary care physician, without a doubt, those who are over 60 years old predominate. A feature of the elderly is polymorbidity. Combined pathology, numerous complaints of patients make it difficult to diagnose diseases, require patience from the doctor, and, of course, knowledge. There are diseases that are peculiar only to the elderly, developing only after 50 years. These include rheumatic polymyalgia. This pathology is not frequent and, in this regard, is not very familiar to outpatient therapists. However, it is to them that elderly patients turn with complaints of pain and stiffness in the shoulder and/or pelvic girdle, in the neck, in the joints of the hands, fever, weight loss, sleep disorders, depression, general malaise (the main complaints of patients with rheumatic polymyalgia). The above-mentioned clinical manifestations, as well as the high laboratory activity inherent in this disease, make the doctor look for malignant neoplasms, infectious, systemic processes. This takes a long time, the diagnosis is delayed, the sufferings of the patient are prolonged. The article presents data on the prevalence, clinical features, methods of diagnosis of rheumatic polymyalgia and its differential diagnosis. The criteria of the disease, the principles of management of the patient at the outpatient stage  (step-by-step treatment with glucocorticoids, alternative approaches, prevention of side effects of therapy, which develop quite often) are also given. Awareness of primary care physicians about rheumatic polymyalgia, its manifestations and diagnostic methods will speed up the diagnosis, timely consultation of the patient with a rheumatologist, which will allow you to start adequate treatment, significantly improve the quality of life of an elderly patient, and prevent the destabilization of concomitant diseases.

Primary Care

2019 ◽  
pp. 194-200
Author(s):  
Inge Kriel ◽  
Geertruida de Bock ◽  
Sabine Siesling ◽  
Annette Berendsen
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Patient Management ◽  
The Elderly ◽  
Care Physician ◽  
Survivorship Care ◽  
Breast Cancer Patients ◽  
Care For The Elderly ◽  
The Family

Abstract: Primary care physicians play a vitally important role in care and in the management of patients with breast cancer in any setting, but their contribution is especially valuable in a developing country setting. Communication between the family physician and the specialist ensures holistic patient management. Whereas the specialist focuses on management of the breast cancer, the generalist assesses and manages the complex interplay between pre-existing chronic medical conditions and the breast cancer. The biopsychosocial model is the cornerstone of general practice. The primary care physician plays an important role in managing breast cancer patients in all phases of the disease: prediagnosis, diagnosis, during treatment, after-treatment survivorship care, care for the elderly, and palliative care.

Community Physician's Role in Case Management of Children With Chronic Illnesses

PEDIATRICS ◽  
1989 ◽  
Vol 84 (3) ◽  
pp. 465-471
Author(s):  
Gregory S. Liptak ◽  
Gail M. Revell
Keyword(s):  
Primary Care ◽  
Case Management ◽  
Primary Care Physicians ◽  
Current System ◽  
Care Physician ◽  
Case Managers ◽  
Chronic Illnesses ◽  
Rural Physicians ◽  
Children With Chronic Illnesses ◽  
Time Required

There is general agreement that case management should be provided to children with chronic illnesses, yet it is not clear who should provide this service. A survey of physicians and parents of children with chronic illnesses was conducted to evaluate the practice and views of pediatricians and compare their assessments with those of parents. Surveys were mailed to 360 physicians and 519 families with response rates of 39% and 63%, respectively. The majority of physicians (74%) thought that the primary care physician should provide case management. When compared with parents, physicians underestimated the parental need for information about the child's diagnosis (8% vs 52%, P < .001), treatments (3% vs 54%, P < .01), and prognosis (30% vs 78%, P < .01). They also overestimated parental needs for information regarding financial aid (70% vs 58%, P < .01), vocations (78% vs 54%, P < .01), and insurance (62% vs 51%, P < .05). Four services ranked by need by parents in the top 10 were not ranked in the top 10 by physicians. Rural physicians noted that services were more difficult to obtain than did those in nonrural areas. The physicians surveyed made several recommendations for steps that could be implemented to facilitate their role as case manageers. If primary care physicians are to be effective case managers, alterations in the current system of care will be required including continuing education related to chronic illness, information about community resources, reimbursement for the time required to perform case management, and better communication between physician and parents.

The Role of the Primary Care Physician in the Care of Children with Serious Heart Disease

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 284-290
Author(s):  
Paul C. Young ◽  
Yu Shyr ◽  
M. Anthony Schork
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Chronic Illness ◽  
Medical Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Services

Objective. To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease. Setting. Pediatric Cardiology Division; Tertiary Care Children's Hospital. Subjects. Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease. Design. Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness. Results. All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness. Conclusions. Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.

Health Literacy in Primary Care: Reflections and Suggestions for Physicians, Researchers, and Administrators

2021 ◽  
pp. 155982762110412
Author(s):  
Anne Sprogell ◽  
Allison R. Casola ◽  
Amy Cunningham
Keyword(s):  
Primary Care ◽  
Health Literacy ◽  
Primary Care Physician ◽  
Healthcare System ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Health Records ◽  
The Past ◽  
Personal Bias ◽  
Concept Of Health

As the healthcare system evolves, it is becoming more complicated for physicians and patients. Patients might have had one doctor in the past, but now are likely to regularly see several specialists along with their primary care physician. Patients can access their health records online, which increases transparency and accountability, but adds more information they have to interpret. This is the concept of health literacy—the ability to obtain, process, and act upon information regarding one’s health. This article will characterize health literacy in primary care and provide three areas that primary care physicians and researchers can direct their focus in order to increase health literacy among patients: community engagement, trainee education, and examination of personal bias.

Delivery of Survivorship Care by Primary Care Physicians: The Perspective of Breast Cancer Patients

2009 ◽  
Vol 27 (6) ◽  
pp. 933-938 ◽  
Author(s):  
Jun J. Mao ◽  
Marjorie A. Bowman ◽  
Carrie T. Stricker ◽  
Angela DeMichele ◽  
Linda Jacobs ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Multivariate Regression ◽  
Care Delivery ◽  
Postmenopausal Breast Cancer ◽  
The United States ◽  
Cancer Therapies ◽  
Survivorship Care ◽  
General Care

Purpose Most of the 182,460 women diagnosed with breast cancer in the United States this year will become long-term survivors. Helping these women transition from active treatment to survivorship is a challenge that involves both oncologists and primary care physicians (PCPs). This study aims to describe postmenopausal breast cancer survivors' (BCS) perceptions of PCP-related survivorship care. Patients and Methods We conducted a cross-sectional survey of 300 BCSs seen in an outpatient breast oncology clinic at a large university hospital. The primary outcome measure was a seven-item self-reported measure on perceived survivorship care (Cronbach's α = .89). Multivariate regression analyses were used to identify factors associated with perceived care delivery. Results Overall, BCSs rated PCP-related survivorship care as 65 out of 100 (standard deviation = 17). The areas of PCP-related care most strongly endorsed were general care (78%), psychosocial support (73%), and health promotion (73%). Fewer BCSs perceived their PCPs as knowledgeable about cancer follow-up (50%), late effects of cancer therapies (59%), or treating symptoms related to cancer or cancer therapies (41%). Only 28% felt that their PCPs and oncologists communicated well. In a multivariate regression analysis, nonwhite race and level of trust in the PCP were significantly associated with higher perceived level of PCP-related survivorship care (P = .001 for both). Conclusion Although BCSs perceived high quality of general care provided by their PCPs, they were not as confident with their PCPs' ability to deliver cancer-specific survivorship care. Interventions need to be tested to improve oncology-primary care communication and PCP knowledge of cancer-specific survivorship care.

scholarly journals Investigating information-seeking behaviors of primary care physicians who care for older depressed patients and their family caregivers: a pilot study

2005 ◽  
Vol 26 (4) ◽  
pp. 111 ◽  
Author(s):  
Mary Jo Dorsey ◽  
Ellen Detlefsen
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Information Seeking ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Structured Interviews ◽  
Depressed Patients ◽  
Types Of Information ◽  
Primary Care Practices ◽  
Information Seeking Behaviors

Objective – To describe preliminary findings from a study of information-seeking behaviors of primary care physicians who care for elderly and depressed patients, and the correlation between what is sought versus what is provided to the patient and (or) caregiver. Setting – Physicians in two large ambulatory primary care practices throughout urban Pittsburgh, Pennsylvania, who take care of geriatric patients. Methods – Structured interviews, with common questions, will be conducted with 12 primary care physicians to determine patterns of information-seeking behaviors. Environmental scans of physicians' offices for evidence of their existing information behaviors will complement the information obtained from the interviews. Results – This pilot study provides an analysis of the resources primary care physicians use to seek information to provide to patients and caregivers. Analyses show types of information sought, time spent seeking information, and methods used to find information given to patients. Conclusions – With mounting evidence of the Internet being used for patient self care, it is essential to understand if primary care physicians understand the scope and breadth of information readily available to their patients. The primary care physician needs to be aware of the types of information made available to their patients and the caregivers who are inclined to obtain information for the patient.

scholarly journals The study on knowledge-attitude-practice of primary care physician toward anticoagulants therapy in Non-valvular atrial fibrillation patients in Shanghai of China

2020 ◽  
Author(s):  
Shasha Ye ◽  
Tianhao Wang ◽  
Arthur Liu ◽  
Ying Yu ◽  
Zhigang Pan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Work Experience ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Bachelor's Degree ◽  
Cluster Sampling ◽  
Primary Role ◽  
Cross Sectional ◽  
Positive Attitudes

Abstract Background As the large number of CHS centers in China face the majority of NVAF patients, primary care physicians (PCPs) play the primary role in the prevention of embolization. Therefore, an awareness of anticoagulant management in NVAF patients must be brought into focus among PCPs in China. This study will help primary care physicians (PCPs) increase their awareness of oral anticoagulant (OAC) therapy for non-valvular atrial fibrillation (NVAF) to prevent embolization.Method This was a cross-sectional observational study of 462 PCPs in community health service (CHS) centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program.Result Among 462 participants, 69.3% (320/462) of females with a medical bachelor’s degree and more than 10 years of work experience predominated in the 30 to 49 years of age group. The mean score for “knowledge,” “attitude” and “practices” of OAC therapy in NVAF patients among PCPs was 3.68±2.752, 53.62±7.148, and 37.63±10.336, respectively. The level of knowledge of OAC therapy in NVAF patients among PCPs was insufficient in over half (75.8%) of participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of NVAF patients.Conclusion The knowledge and behaviors of PCPs were insufficient in OAC therapy to prevent embolization in NVAF patients. The study also revealed the positive attitudes of participants, and their desire to learn the latest knowledge of OAC therapy.

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