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1.
Wiad Lek ; 73(9 cz. 2): 1909-1914, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33148833

RESUMEN

OBJECTIVE: The aim: To identify clinical and laboratory signs of digestive system disease in HIV-infected patients for helping family physicians. PATIENTS AND METHODS: Materials and methods: Research was conducted at five regional HIV / AIDS centers in Ukraine during 2017-2019. Randomly selected 342 adult HIV-infected patients were divided into two groups, with concomitant digestive system diseases and without concomitant digestive system disease. Statistical analysis was performed using the software package EZR 1.41 (Saitama Medical Center, Jichi Medical University, Japan). RESULTS: Results: The incidence of digestive system disease in patients with HIV clinical stages II, III and IV was significantly higher than in patients with HIV clinical stage I. Gastrointestinal disease was also significantly associated with the incidence of tuberculosis, candidiasis, kidney disease and HIV encephalopathy. Incidence of asthenic-vegetative and dyspeptic syndromes, weight loss, anemia and leukopenia, elevated liver enzymes, low CD4 counts and detectable viral load levels in patients on antiretroviral therapy were significantly more common in HIV-infected patients with gastrointestinal pathologies. HIV patients with digestive system disease significantly more often had changes to their therapy regiment, interruptions in treatment and more often experienced side effects. CONCLUSION: Conclusions: Digestive system disease becomes more common with the progression of HIV infection. Comorbidity of HIV infection and digestive system disease is characterized by changes in general clinical, biochemical and immunological blood parameters and patients with digestive system comorbidities more often have a poor virological response to antiretroviral therapy.


Asunto(s)
Enfermedades del Sistema Digestivo , Infecciones por VIH , Adulto , Biomarcadores , Enfermedades del Sistema Digestivo/epidemiología , Medicina Familiar y Comunitaria , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Ucrania , Carga Viral
3.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33181875

RESUMEN

The health-service redesign that came with the preparation for the surge of COVID-19 had a potential of disrupting the Family Medicine internship programme like it did to many other health and academic programmes. A team of Cape-Town based Community Health Centre (CHC) doctors mitigated this challenge by designing an innovative tool that facilitated ongoing supervision of the interns in order to achieve the outcomes of the Health Professions Council of South Africa (HPCSA).


Asunto(s)
Centros Comunitarios de Salud , Infecciones por Coronavirus , Consejo , Medicina Familiar y Comunitaria/educación , Internado y Residencia , Pandemias , Neumonía Viral , Preceptoría , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Personal de Salud , Humanos , Médicos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/virología , Sudáfrica
5.
J Prim Care Community Health ; 11: 2150132720966409, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33063617

RESUMEN

COVID-19 supportive quarantine care in the community is managed by primary care practices. There is no current guidance on how a primary care practice with high volumes of patients screened for COVID-19 can re-configure itself to become responsive to the pandemic. We examined Learning Health System guidance from the National Academies of Science, Engineering and Medicine and adapted it to our primary care practice to create an efficient, effective, adaptive response to the COVID-19 pandemic. We suggest evaluating this response in the future for effectiveness and efficiency.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Medicina Familiar y Comunitaria/organización & administración , Aprendizaje del Sistema de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Atención Primaria de Salud/organización & administración , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , Estados Unidos/epidemiología
6.
J Prim Care Community Health ; 11: 2150132720957442, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33089725

RESUMEN

The COVID-19 pandemic has presented new challenges in how Primary Care clinicians care for community patients. Our organization quickly allocated 1 of our community clinic sites into a dedicated COVID Clinic caring for the COVID positive or any patient with COVID like symptoms to minimize contact with the well patients. A prerequisite for all patients to be seen in the COVID Care Clinic was a virtual visit staffed with Advanced Practice Providers that would further determine if the patient needed to seek emergency medical care or be seen in the COVID Clinic. From March 23, 2020 through May 15, 2020, 852 patients with COVID symptoms were seen in this clinic rather than the emergency department. This article describes a collaborative effort to care for a community during the COVID-19 pandemic. This unique setting allowed us to focus an appropriate level of care to a high risk population in a safe and effective manner in the ongoing effort to flatten the epidemiological curve.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Infecciones por Coronavirus/terapia , Medicina Familiar y Comunitaria/organización & administración , Pandemias , Neumonía Viral/terapia , Infecciones por Coronavirus/epidemiología , Humanos , Minnesota/epidemiología , Neumonía Viral/epidemiología
7.
Ther Umsch ; 77(8): 371-378, 2020.
Artículo en Alemán | MEDLINE | ID: mdl-33054645

RESUMEN

Elevated liver function tests - as incidental finding in general practice Abstract. In general practice, elevated liver function tests are found in 25 % of patients presenting with unspecific symptoms or during a routine health checkup. Approximately 2.5 % of the general population are expected to show elevated values. Conversely, liver disease can present without abnormal liver function tests. Liver disease is not only frequent but may also imply a significant mortality. Worldwide its prevalence is steadily rising, and liver disease has become the fifth leading cause of death. Responsible for the rapidly increasing prevalence are primarily non-alcoholic fatty liver disease (NAFLD), alcohol-related liver disease (ARLD) and viral hepatitis. Due to the large range of possible differential diagnoses and the coexistence of aetiologies liver diseases represent a diagnostic challenge with important prognostic implication. In case of elevated liver function, a detailed medical history and a thorough clinical examination should be performed first. This allows narrowing down possible causes to the few most likely differential diagnoses. Subsequently, depending on the level of elevated liver function and the clinical presentation as hepatitis or cholestasis, screening tests for differential liver diseases are performed. Laboratory diagnostics and obligatory ultrasound scan can be supplemented by non-invasive methods (e. g. elastography, MRI / MRCP / CT) and in selected cases invasive methods (liver biopsy, ERCP). In the following article we delineate the diagnostic approach to elevated liver function tests using algorithms.


Asunto(s)
Medicina Familiar y Comunitaria , Hallazgos Incidentales , Humanos , Pruebas de Función Hepática , Imagen por Resonancia Magnética , Ultrasonografía
10.
Z Evid Fortbild Qual Gesundhwes ; 156-157: 50-58, 2020 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-32952045

RESUMEN

BACKGROUND: The delegation of traditional GP tasks to qualified medical assistants (MFA) includes several modalities based on extended qualification curricula known as "Nicht-ärztliche Praxisassistentin" (NäPa) [non-physician practice assistant], also known as the "Entlastende Versorgungsassistentin" (EVA) and the "Versorgungsassistentin in der Hausarztpraxis" (VERAH and VERAH Plus) [professional healthcare assistants in the family practice]. Delegation to MFA has gained importance in recent years due to an increasing workload of general practitioners in Germany. OBJECTIVES: This article examines the characteristics of general practitioners (GPs) currently delegating activities to MFAs with and without extended qualification based on the three mentioned modalities (EVA, VERAH and VERAH Plus). In addition, we explore whether the delegated activities are delivered in the office, at the patient's home or in the nursing home and how GPs perceived the potential of future delegation. MATERIALS AND METHODS: Between April and August 2016, we conducted an anonymous postal survey of a representative randomized sample of general practitioners in North Rhine-Westphalia (n = 2,404). The questionnaire contained questions about practice staff, setting for delivery of the delegated activity as well as the perceived added values of and barriers to delegation. We compare characteristics of GPs delegating to MFA with extended qualification to those delegating to standard qualified MFA. RESULTS: The response rate was 32 % (n = 762). Almost one third of the respondents (n = 239) delegated tasks to MFAs with extended qualification. These GPs are more likely to be younger and male and less likely to be working alone in individual practice. They delegate more activities to be delivered in all settings than GPs employing MFAs without extended qualification. DISCUSSION AND CONCLUSIONS: GPs benefit from delegating to MFA with extended qualification as shown by the associated added values and setting of deployment for delivery of tasks. Delegation to non-medical staff should be considered by more GPs as a means of supporting healthcare delivery. In addition to legal changes, further procedures are needed to encourage GPs to get more actively involved with the issue of delegation and consider to further develop the competence of their staff and deploy them accordingly.


Asunto(s)
Médicos Generales , Actividad Extravehicular , Medicina Familiar y Comunitaria , Alemania , Humanos , Masculino , Encuestas y Cuestionarios
13.
Rev Med Suisse ; 16(708): 1818-1821, 2020 Sep 30.
Artículo en Francés | MEDLINE | ID: mdl-32997453

RESUMEN

This study focuses on the management of chronic depression at the general practitioner's office and the collaboration between general practitioner (GP)-psychiatrist. Our study's highlights two different situations: patients able to verbalize their psychological suffering and who can be directly referred to the psychiatrist and patients expressing their psychological suffering mainly by physical symptoms. GPs consider they first have to work with their patient to help them connect their somatic symptoms and their psychological suffering, which will allow them to refer their patient to the psychiatrist. If this work does not succeed, the GP remains at the forefront of medical care. Long-term support continues, where the GP sometimes ends up giving up on curing and focusing on the doctor/patient relationship.


Asunto(s)
Depresión/terapia , Medicina Familiar y Comunitaria , Médicos Generales , Psiquiatría , Enfermedad Crónica/psicología , Enfermedad Crónica/terapia , Depresión/psicología , Humanos , Relaciones Médico-Paciente , Estrés Psicológico
14.
J Am Board Fam Med ; 33(Supplement): S1-S9, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32928942

RESUMEN

Family Medicine was a child of the 1960s. Triggered by compelling social need for care outside of large hospitals, Family Medicine emphasized access to personal physicians based in the community. As a protest movement, the ABFP required ongoing recertification for all Diplomates, with both independent examination and chart audit. Fifty years later, society and health care have changed dramatically, and it is time again to consider how Board Certification must respond to those change. We propose three interlocking arguments. First, even before COVID-19, health and health care have been in a time of fundamental transformation. Second, given the role Board Certification plays in supporting improvement of healthcare, Board Certification itself must respond to these changes. Third, to move forward, ABFM and the wider Board community must address a series of wicked problems - i.e., problems which are both complex-with many root causes-and complicated- in which interventions create new problems. The wicked problems confronting board certification include: 1) combining summative and formative assessment, 2) improving quality improvement and 3) reaffirming the social contract and professionalism and its assessment.


Asunto(s)
Certificación/normas , Competencia Clínica/normas , Medicina Familiar y Comunitaria/normas , Mejoramiento de la Calidad , Certificación/métodos , Certificación/tendencias , Medicina Familiar y Comunitaria/educación , Medicina Familiar y Comunitaria/tendencias , Humanos , Estados Unidos
15.
Ann Fam Med ; 18(5): 461-462, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32928765

RESUMEN

Covid-19 has rapidly changed physician-patient interaction, from hands-on to hands-off medicine. In this essay, 2 family physicians on different continents reflect on the meaning of touch in clinical practice and how virtual care is transforming this tacit aspect of patient care. Although technology enables physicians to stay in touch with patients verbally, we have lost the ability to physically touch. Traditionally, touch is central to medical practice, physical examination guides diagnosis and informs management. But the silent language of touch fulfills a deeper symbolic function, enabling physicians to acknowledge patient concerns in a tangible way. Touch expresses healing, extending beyond skin-to-skin contact to express humanity, caring, and connection. As we adapt to novel technologies, we wonder how, as family physicians, we will adapt our clinical acumen to extend our ability to connect with patients.


Asunto(s)
Medicina Familiar y Comunitaria , Relaciones Médico-Paciente , Telemedicina , Canadá , Humanos , Irlanda , Tacto
19.
Praxis (Bern 1994) ; 109(12): 952-954, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-32933395

RESUMEN

CME/Answers: Pituitary Incidentaloma in Adults: Key Knowledge for the General Practice Abstract. Incidentally detected pituitary masses, so-called pituitary incidentalomas, are increasing in frequency as the frequency of performing imaging increases. Evaluation of the imaging from a trained neuroradiologist as well as additional endocrinological and, if necessary, neuroophtalmological studies are part of the initial assessment that drives the treatment decision: in the case of benign small lesions with unremarkable assessment results, follow-up is indicated, whereas potentially malignant lesions or lesions with endocrinological or neuroophtalmological irregularities are usually treated. In borderline cases, interdisciplinary work is beneficial for the determination of the case-specific treatment procedure.


Asunto(s)
Medicina General , Neoplasias Hipofisarias , Adulto , Medicina Familiar y Comunitaria , Humanos , Hallazgos Incidentales , Neoplasias Hipofisarias/diagnóstico
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