ABSTRACT
OBJECTIVES: The rapid and accurate diagnosis of heart failure in primary care is a major unmet clinical need. We evaluated the additional use of B-type natriuretic peptide (BNP) levels. DESIGN: A randomized controlled trial. SETTING: Twenty-nine primary care physicians in Switzerland and Germany coordinated by the University Hospital Basel, Switzerland. SUBJECTS: A total of 323 consecutive patients presenting with dyspnoea. INTERVENTIONS: Assignment in a 1 : 1 ratio to a diagnostic strategy including point-of-care measurement of BNP (n = 163) or standard assessment without BNP (n = 160). The total medical cost at 3 months was the primary end-point. Secondary end-points were diagnostic certainty, time to appropriate therapy, functional capacity, hospitalization and mortality. The final diagnosis was adjudicated by a physician blinded to the BNP levels. RESULTS: Heart failure was the final diagnosis in 34% of patients. The number of hospitalizations, functional status and total medical cost at 3 months [median $1655, interquartile range (IQR), 850-3331 vs. $1541, IQR 859-2827; P = 0.68] were similar in both groups. BNP increased diagnostic certainty as defined by the need for further diagnostic work-up (33% vs. 45%; P = 0.02) and accelerated the initiation of the appropriate treatment (13 days vs. 25 days; P = 0.01). The area under the receiver-operating characteristics curve for BNP to identify heart failure was 0.87 (95% confidence interval, 0.81-0.93). CONCLUSIONS: The use of BNP levels in primary care did not reduce total medical cost, but improved some of the secondary end-points including diagnostic certainty and time to initiation of appropriate treatment.
Subject(s)
Biomarkers/blood , Dyspnea/diagnosis , Heart Failure/diagnosis , Natriuretic Agents/blood , Natriuretic Peptide, Brain/blood , Aged , Aged, 80 and over , Dyspnea/economics , Dyspnea/therapy , Electrocardiography , Female , Heart Failure/economics , Heart Failure/therapy , Humans , Male , Middle Aged , Natriuretic Peptide, Brain/economics , Primary Health Care , ROC Curve , Radiography, Thoracic , Single-Blind MethodSubject(s)
Diet, Vegetarian , Fatigue/etiology , Iron Deficiencies , Vitamin B 12 Deficiency , Adolescent , Adult , Age Factors , Aged , Child , Fatigue/chemically induced , Female , Humans , Hypoglycemic Agents/adverse effects , Male , Metformin/adverse effects , Sex Factors , Vitamin B 12 Deficiency/complicationsABSTRACT
We report a case of plant-poisoning of a young man following the consumption of a self-brewed infusion made of a solanaceous plant, to which he was seduced by his friends. He developed anticholinergic symptoms such as optical hallucinations, confusion, mydriasis and tachycardia. 14 hours after admission the patient was discharged from hospital in good health. With regard to this case we portray the mentioned plant (Scopolica carniolica Jacq.) and discuss the symptoms of belladonna-alkaloid-poisoning and its therapy. Further on, in a short literature survey, we depict the meaning of collective drug experiences with plants containing atropine-like substances in ancient and modern times.