Primary Care Medicine - Science topic

Obturator reflex or adductor spasm can cause bladder perforation leading to morbidity in the post operative period especially if the tumor is located at the lateral wall of urinary bladder as the nerve traverses near to it.

It is cost effective and far more practical to treat with Viamin D supplements across population/ communities to have larger positive impact on health. Countries with resource constraints can't test Vitamin D deficiency in their entire population because of high costs.

When dealing with result base management (RBM)?

Pre/post test questions after educational session regarding implementing COWS screening tool during treatment for opioid addiction using Buprenorphine

As per literature search, I found that most of the systematic reviews on corticosteroid therapy in prevention of pre-term birth complications are conducted in high economic countries. I am interested to do a systematic review on corticosteroid therapy in prevention of pre-term birth complications in middle and low economic countries, where there is a high infant mortality rate due to pre term delivery. Iam completely new to this concept. Your contribution, suggestions and support is required to design, conduct and publish this study. I hope any one who are expertise in this area can help me. 

Thank you

The question is I need to know if there is any difference or improvement in 10 patients when comparing their history of doctor visits, emergency department visits, behavior health visits and rehab visits before and after the treatment regime.

Note: treatment regime is to help patients get off from narcotic use.

hospital personel must follow and evaluate prehospital care and join to prehospital EMS

This case just brought to our attention (patient's report with pictures attached). Patient urgently seeking consultation by a local dermatologist who is willing to prove/disprove the alleged etiology. Needed for liability and for adequate medical documentation for publishing the case in a scholarly journal.

Nikola Bradic MD

Clinic of Anesthesiology, Resuscitation and Intensive Care Medicine

Department of Cardiovascular Anesthesiology and Cardiac Intensive Medicine

University Hospital Dubrava

10000 Zagreb, Croatia

e-mail: nbradic@kbd.hr

I ask for  Arabic Version of Roe Anginal questionnaire

This is because I have seen three variations:

 1.one level teaspoon of salt plus eight level teaspoons of sugar plus one litre of clean drinking or boiled water  

2. six level teaspoons of sugar and one-half level teaspoon of salt in one liter of (clean) water.  

3.1 level teaspoonful (3ml) of salt plus 10 level teaspoonful or 5 cubes of sugar in 600mls of clean water  No 3. Seems more popular in Nigeria.   I.

ANY DIFFERENCE IN THE OUTCOME 

During  our  Post  graduate  training we  had  been  under  the  impression that  Fever  is  the  Most  difficult symptom  to  solve  and  fever  does  not  kill  the  patients  but  it  can  kill  a  Doctors  reputation,  But  here  the  story  comes :  In  early  2k,  I  was  on  duty  as  Assistant  Professor in  Medical  wards  of  a  reputed  Medical  college - Govt. Stanley  Medical  College,  in  Chennai - India. At  about  4  pm  my  Post  graduate in  Medicine  admitted  an  Young  27  years  old  female  with  an  history  of  fever  since 2  days.  She  delivered a baby  about  a  week  ago (  Full term  natural  delivery  and  smooth  ante-natal history). She  was  breast  feeding  the  baby. History  and  physical  examination  were  unremarkable.  I  was  angry  with  the  post  graduate  for  hospitalising  a recent puerperal mother  for  a  short  acute  febrile  illness without any  significant  physical  findings. About  an  hour  later  I received a  call from  the  post  graduate that  She  became seriously  ill  gasping  for  breath  and  rapidly  desaturating  in  the  ECG  room  while  an  ECG  was  recorded .  I  became  very  furious  towards  the  attitude  of  that  postgraduate  for  sending  the  patient  for  an  ECG,  which  I  thought  was  an  unwarranted  test  in  a  febrile  patient.  She  was  shifted  to  M-ICU  intubated  and  cardiac  resuscitation  was  attempted. In  vain.  She succumbed  to  the  undiagnosed  Acute  short  febrile  illness.  But  the ECG  was  very  diagnostic  in  determining  the  cause  of  death. Following  this  experience  until  now,  I  order  an  ECG  for  every  febrile  patients.

I would like to analize which is the answers rate of GP\FM on web-based survey that they received.

I would like to come up with an indicator of frailty for community living seniors using administrative data from diagnosis made by family physicians, specialists, during hospitalization or medication use. Who would have attempted this or know about any research on this? Thank you :-))

A local health service has recently introduced a, add on service to assist GPs in offering better service to people with chronic mental illness, after four years, there is need to determine whether that service is having desired outcomes.

In France, the prescription of benzodiazepines (BZD ) is a problem . Care for patients with chronic use is difficult. In terms of public health, it is particularly relevant to avoid this situation by prescribing these treatments wisely. A thesis carried out in 2012 resulted in the design of two brief first prescription of BZD guides , one to complaints for anxiety and the other for insomnia.

How would it be possible to assess the relevance of these guides, in actual practice conditions of general practice (GP) , knowing that the conditions of research in MG do not allow a large-scale intervention study ?

Interested in improved glycemic control RCTs and Meta-Analysis looking at MDI or glargine injections versus CSII pump administration

Hi. The CIPP (context, input, process, and product evaluation) evaluation approach has been proposed for healthcare programs (1).

I am looking for examples/references of this approach in a multidisiplinary primary care program setting.

Thanks, David

1. Kennedy-Malone L. Evaluation strategies for CNSs: application of an evaluation model... context, input, process, and product (CIPP) evaluation model developed by Stufflebeam. Clin Nurse Spec. 1996;10:195–198.

Looking for a model/theory/framework/ classic paper or systematic review that provides an overview on what factors influence a patient's decisions, in general and specific to treatment decisions?

which fluids are relevant? are antibiotics relevant?

Hi everyone! My name is Mandy. At the moment, I'm currently involved with a research study at UCSF, where we're doing a survey on how we can reduce suicide rates in primary care settings. According to the CDC, suicide rates in America are steadily increasing, becoming even higher than the rates of homicide. In fact, suicide is now the 10th leading cause of death, surpassing chronic liver disease.

If you are a physician, nurse practitioner, or a physician assistant in the United States, it'll be great if you can help us fill out this 5-10 min survey! We already have about 120 responses for this study, but we're hoping to get more participants for a more extensive study. Here is the link! http://www.surveygizmo.com/s3/1607736/PCP-Perceptions-in-Clinical-Care

Multiple studies have shown that inhibition of the renin-angiotensin-aldosterone (RAAS) system have been effective in reducing microalbuminuria among patients with diabetic nephropathy. Despite their usage, prevalence of CKD/ESRD persists (even becoming more prevalent). I have 2 questions: (1) How much renoprotection do ACEIs and/or ARBs provide to this population group? (or how much is the prevalence of CKD/ESRD related to ACEIs and/or ARBs usage?) (2) Are there any studies that predict the occurrence of CKD and/or ESRD among patients being treated with ACEIs and/or ARBs for the purpose of renoprotection, especially among paints with diabetic nephropathy?

Borderline Personality Disorder is not a diagnostic label usually used by primary care physicians in Spain. I'm not sure if this is a shortcoming or appropriate. Will more knowledge and use of the label BPD lead to better clinical management of BPD patients in primary care?

A young woman loses her husband in a car crash. She has no history of psychiatric disorders. She is grief-stricken and has to take time off work. Because of the removal of the bereavement exclusion, after 2 weeks, she clinically fulfills the ‘new’ criteria for major depression, She consults her primary care doctor...

It has been observed that countries with a strong focus on primary health care and primary care have better health outcomes.

In Italy primary care physicians, called "medico di base", do not have and do not use this important diagnostic tool. Consequently, Department of emergency and acceptation (DEA), known as ER in USA/ Pronto soccorso in italy, are always full and overcrowded.

Do you think that could be a good idea to provide medical studies with ecographs and to update physicians about its use?

I have performed a little experiment by applying the ASRS of 6 items to a sample of 400 consecutive attenders in nine primary care facilities. I was surprised because the proportion of positive screenings was around 20%. Adjusting this data by known sensitivity and specificity (see Ramos-Quiroga) the estimated 'true prevalence' was around 12%. However no patients in the sample (nor positive nor negative screening) has a diagnosis nor a treatment for ADHD.

Dear colleagues, what do you think about this findings?

I am working on a project with teens and relating the risk factors present in this age with premalignant lesions of the cervix.