Kearns-Sayre syndrome: Two case reports and a review for the primary care physician.

Kearns-Sayre syndrome (KSS) is a mitochondrial encephalopathic disorder. Because mitochondria are ubiquitous organelles that are present in almost every human tissue, their dysfunction can affect nearly any organ system and give rise to a wide range of clinical characteristics. 1: As is the case with most diseases associated with mitochondrial DNA (mtDNA) mutations, the clinical features of KSS were defined before modern molecular genetic classifications emerged. 2: The exact prevalence of KSS is unknown; however, estimates place it at about 1:100,000 people. Although it is a rather rare syndrome, the ability to recognize or consider KSS as part of a differential diagnosis is crucial. Reported here are two case reports: 1) a 30-year-old Caucasian female patient who presented for evaluation to her primary care physician's office and, and 2) A 57-year-old Caucasian female patient long-term C care resident. Guidelines are listed for management as a primary care physician as well as signs and symptoms that are often associated with Kearns-Sayre syndrome and other mitochondrial disorders.

A Holistic Approach to Physical and Mental Health: Associations Between Chronic Disease and Psychiatric Conditions.

Prior studies suggest that patients with chronic conditions are more likely to develop psychiatric disorders compared to healthy individuals without any medical conditions. The objective of this study was to investigate the link between chronic conditions and psychiatric disorders. The authors hypothesize that patients with chronic conditions have a higher comorbidity of certain psychiatric disorders compared to healthy individuals. Patients from Rowan University School of Osteopathic Medicine (Rowan SOM) Family Medicine offices completed an anonymous survey about medical and psychiatric diagnoses (Appendix 1). Multivariate analysis was used to examine the relationships between patients' rank of control of their chronic medical and psychiatric conditions compared to the age of onset and total number of conditions. One-hundred thirteen study participants reported having at least one chronic condition and seventy-four reported having at least one psychiatric disorder listed on the survey. Among the participants comorbid with both medical and psychiatric conditions, patients' ranking of control of their chronic conditions positively correlated with their ranking of control of their psychiatric disorders (p = 0.009). Patients' ranking of control of their chronic conditions negatively correlated with the total number of psychiatric disorders (p = 0.002). The study did not generate significant evidence to support the original hypothesis. The results highlight a strong relationship between patients' perceived control of their physical health and mental health. The comorbidity of both chronic conditions and psychiatric disorders may present challenges for patients. Utilizing a holistic approach to patient care can help clinicians improve patient outcomes.

Klinefelter syndrome in primary care: A case and review.

Reviewed here is a case of Klinefelter Syndrome (KS) diagnosed by a primary care physician after recognition of key features of KS, confirmed by karyotype, along with a discussion of factors associated with this patient's diagnosis and care. Recognition of the key features of this syndrome is important in order to provide proper screening, risk mitigation and treatment to these patients.

Factors and Preferences in Patient Selection and Location of Care.

There are many factors that influence the decisions that patients make regarding where they receive care. Two hundred thirty-three patients were surveyed in the primary care setting to determine patient satisfaction and characteristics that led patients to seeking treatment at primary care offices, urgent care centers, or emergency rooms. Respondents rated quality of care highest at the primary care office (P < .001). Patients also demonstrated preference for in-person care compared with video conferencing or telephone visits (P < .001).

Health-related Internet use among patients of osteopathic physicians.

CONTEXT: Using the Internet has transformed communication and improved access to health-related information for patients and physicians. OBJECTIVE: To determine why patients use the Internet for health-related information, where patients find answers to their questions, and whether patient use of the Internet impacts the patient-physician relationship. This study focused on patients of osteopathic physicians to confirm previously published data in a more specific population. METHODS: An anonymous 25-item survey was distributed to patients in a primary care setting. The survey elicited information regarding demographics, health-related Internet use, and discussion of Web-based health information during the clinical visit. RESULTS: Two hundred eighty-five patient surveys were collected. Data based on sex, age, education level, and ethnicity were evaluated. Two hundred fifty of 280 patients (89%) reported that they use the Internet to find health-related information, and 134 of 250 patients (54%) indicated that they changed their health-related behaviors based on information they found. Seventy-three of 133 patients (55%) who changed their behaviors reported these findings to their physicians. This finding differed by age and ethnicity. Patients aged 50 to 64 years (22 responses, 73%) were the most likely group to report behavioral changes to their physicians (P=.048). No patients who identified themselves as of Asian/Pacific Islander descent indicated that they reported behavioral changes to their physician (P=.043). Two hundred forty-two of 261 patients (93%) reported that their personal physician is the most reliable source for health information. CONCLUSION: Most patients use the Internet to find health-related information, but many of them are not reporting potentially important health-related behavioral changes to their physicians. However, most patients still consider their physician as the most reliable source for health-related information. Physicians should ask patients about Internet use and counsel them about where to find reliable, accurate, high-quality health information.