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2.
BMJ ; 372: m4858, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468518

RESUMO

OBJECTIVE: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. DESIGN: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. SETTING: 76 general practices in the United Kingdom. PARTICIPANTS: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. INTERVENTIONS: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. MAIN OUTCOME MEASURES: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. RESULTS: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of -3.4 mm Hg (95% confidence interval -6.1 to -0.8 mm Hg) and a mean difference in diastolic blood pressure of -0.5 mm Hg (-1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. CONCLUSIONS: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. TRIAL REGISTRATION: ISRCTN13790648.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Hipertensão/terapia , Autogestão , Telemedicina/métodos , Idoso , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Monitorização Ambulatorial da Pressão Arterial/economia , Monitorização Ambulatorial da Pressão Arterial/normas , Feminino , Medicina Geral/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido
3.
Eur J Gen Pract ; 26(1): 182-188, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33337939

RESUMO

COVID-19 outbreak has significantly changed all aspects of general practice in Europe. This article focuses on the academic challenges for the discipline, mainly in the field of education, research, and quality assurance. The efforts of the European Region of the World Organisation of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) to support academic sustainability of the discipline in the time of pandemic are presented. Medical education was affected by the pandemic, threatening both its productivity and quality. Emerging new educational methods might be promising, but the results of their rapid implementation remain uncertain. A relatively small number of publications related to COVID-19 and general practice is available in the medical literature. There is a shortage of original data from general practice settings. This contrasts with the crucial role of GPs in fighting a pandemic. COVID-19 outbreak has opened widely new research areas, which should be explored by GPs. Maintaining the quality of care and safety of all patients during the COVID-19 pandemic is the utmost priority. Many of them suffer from poor access or inadequate management of their problems. Rapid implementation of telemedicine brought both threats and opportunities. The COVID-19 pandemic also challenged doctors' safety and well-being. These aspects will require discussion and remedy to prevent deterioration of the quality of primary care. WONCA Europe is making a multi-faceted effort to support GPs in difficult times of the pandemic. It is ready to support future efforts to uphold the integrity of family medicine as an academic discipline.


Assuntos
Pesquisa Biomédica , Educação Médica , Medicina de Família e Comunidade/métodos , Educação a Distância , Europa (Continente) , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/normas , Medicina Geral/educação , Medicina Geral/métodos , Medicina Geral/normas , Humanos , Qualidade da Assistência à Saúde , Telemedicina
6.
Aust Health Rev ; 44(5): 733-736, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878685

RESUMO

The COVID-19 pandemic has resulted in multiple changes in the delivery of general practice services. In response to the threat of the pandemic and in order to keep their businesses safe and viable, general practices have rapidly moved to new models of care, embraced Medicare-funded telehealth and responded to uncertain availability of personal protective equipment with innovation. These changes have shown the adaptability of general practice, helped keep patients and practice staff safe, and undoubtedly reduced community transmission and mortality. The pandemic, and the response to it, has emphasised the potential dangers of existing fragmentation within the Australian health system, and is affecting the viability of general practice. These impacts on primary care highlight the need for improved integration of health services, should inform future pandemic planning, and guide the development of Australia's long-term national health plan.


Assuntos
Infecções por Coronavirus/diagnóstico , Diagnóstico Precoce , Medicina Geral/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Atenção Primária à Saúde/organização & administração , Medicina Estatal/organização & administração , Telemedicina/organização & administração , Austrália , Betacoronavirus/patogenicidade , Medicina Geral/métodos , Medicina Geral/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Telemedicina/métodos
7.
Br J Gen Pract ; 70(699): e696-e704, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32895242

RESUMO

BACKGROUND: The first wave of the London COVID-19 epidemic peaked in April 2020. Attention initially focused on severe presentations, intensive care capacity, and the timely supply of equipment. While general practice has seen a rapid uptake of technology to allow for virtual consultations, little is known about the pattern of suspected COVID-19 presentations in primary care. AIM: To quantify the prevalence and time course of clinically suspected COVID-19 presenting to general practices, to report the risk of suspected COVID-19 by ethnic group, and to identify whether differences by ethnicity can be explained by clinical data in the GP record. DESIGN AND SETTING: Cross-sectional study using anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four adjacent east London clinical commissioning groups. The study population includes 55% of people from ethnic minorities and is in the top decile of social deprivation in England. METHOD: Suspected COVID-19 cases were identified clinically and recorded using SNOMED codes. Explanatory variables included age, sex, self-reported ethnicity, and measures of social deprivation. Clinical factors included data on 16 long-term conditions, body mass index, and smoking status. RESULTS: GPs recorded 8985 suspected COVID-19 cases between 10 February and 30 April 2020.Univariate analysis showed a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. In a fully adjusted analysis that included clinical factors, South Asian patients had nearly twice the odds of suspected infection (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.83 to 2.04). The OR for black patients was 1.47 (95% CI = 1.38 to 1.57). CONCLUSION: Using data from GP records, black and South Asian ethnicity remain as predictors of suspected COVID-19, with levels of risk similar to hospital admission reports. Further understanding of these differences requires social and occupational data.


Assuntos
Infecções por Coronavirus , Grupos Étnicos/estatística & dados numéricos , Medicina Geral/métodos , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/etnologia , Diagnóstico Diferencial , Feminino , Disparidades nos Níveis de Saúde , Humanos , Londres/epidemiologia , Masculino , Registros Médicos Orientados a Problemas/estatística & dados numéricos , Pessoa de Meia-Idade , Saúde das Minorias/estatística & dados numéricos , Múltiplas Afecções Crônicas/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/etnologia , Prevalência , Fatores de Risco
8.
Clin Interv Aging ; 15: 1427-1437, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884251

RESUMO

Purpose: Demographic change and lack of specialized workforces are challenging. Likewise, home visits by general practitioners (GPs) become rarer. If a nursing home resident develops acute symptoms, nurses are often inclined to call the rescue service. Besides patient-related consequences, this might lead to unnecessary hospitalization and far-reaching health economic costs. Due to legal restrictions of remote treatment in Germany, which were recently loosened, telemedicine is still in the early stages. The aim of this study was to employ a holistic telemedical system for nursing homes which facilitates the connection to a GP and thus avoids unnecessary hospitalizations in the case of ambulatory-sensitive illnesses. Materials and Methods: After an inter-professional requirement analysis, the iterative development was started. In addition to an audio-video connection, several point of care measurements were integrated. Finally, first field tests were performed in a nursing home in a rural area in Germany. Results: One nursing home was equipped with telemedical system based on the results of the requirement analysis and tele-medically connected to a GP. Over a period of seven months, 56 routine and emergency teleconsultations took place. Only one of those required a hospital admission. In addition to video telephony, electrocardiography and assessment of vitals such as pulse, blood pressure, oxygen saturation and auscultation of heart and lungs were applied frequently. Conclusion: A telemedical system including integrated medical devices was successfully developed and has turned out to be helpful and even necessary for careful and reliable decision-making by the GP. First test results show high acceptance for elderly care. Involved patients, nurses, and the GP itemize various specific benefits, including economic, personal, and altruistic issues. Another issue that the current COVID-19 crisis brought to light is lowering the risk of contagion; GPs can replace their home visits by using telepresence combined with point of care measures.


Assuntos
Infecções por Coronavirus , Medicina Geral/métodos , Casas de Saúde , Pandemias , Pneumonia Viral , Consulta Remota/métodos , Consulta Remota/organização & administração , Idoso , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Feminino , Alemanha , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Consulta Remota/instrumentação , Software , Inquéritos e Questionários
9.
Aust Health Rev ; 44(5): 737-740, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32853536

RESUMO

In March 2020, the Australian Government added new temporary telehealth services to the Medicare Benefits Schedule (MBS) to reduce the risk of patient-patient and patient-clinician transmission of the 2019 coronavirus (COVID-19). Here, the MBS statistics for general practitioner activity and the associated costs are described; a small increase in both activity and costs for the new MBS telehealth items were observed. The opportunities for future research and policy implications are also discussed.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Medicina Geral/organização & administração , Medicina Geral/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Telemedicina/organização & administração , Austrália , Betacoronavirus/patogenicidade , Medicina Geral/métodos , Humanos , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
10.
J Med Internet Res ; 22(10): e19415, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32812887

RESUMO

In many countries, private companies provide primary care services based predominantly on offering video consultations via smartphones. One example is Babylon GP at Hand (BGPaH), which offers video consultations to National Health Service patients, 24 hours a day, and has grown rapidly in London over the last 3 years. The development of this type of service has been controversial, particularly in the United Kingdom, but there has been little formal published evaluation of these services in any country. This paper outlines the main controversies about the use of privately provided video consultation services for primary care and shows how they are informed by the limited evaluations that have been conducted, particularly the evaluation of BGPaH. This paper describes the advantages of these services in terms of convenience, speed of access, the ability to consult without traveling or face-to-face patient-doctor contact, and the possibility of recruiting doctors who cannot work in conventional settings or do not live near the patients. It also highlights the concerns and uncertainties about quality and safety, demand, fragmentation of care, impact on other health services, efficiency, and equity. There are questions about whether private primary care services based on video consultations have a sustainable business model and whether they will undermine other health care providers. During the recent COVID-19 pandemic, the use of video consulting has become more widespread within conventional primary care services, and this is likely to have lasting consequences for the future delivery of primary care. It is important to understand the extent to which lessons from the evaluation of BGPaH and other private services based on a video-first model are relevant to the use of video consulting within conventional general practices, and to consider the advantages and disadvantages of these developments, before video consultation-based services in primary care become more widely established.


Assuntos
Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Encaminhamento e Consulta , Telemedicina/métodos , Telemedicina/tendências , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Medicina Geral/métodos , Medicina Geral/tendências , Serviços de Saúde , Humanos , Masculino , Pandemias , Relações Médico-Paciente , Pneumonia Viral/epidemiologia , Medicina Estatal/tendências , Reino Unido
11.
Recenti Prog Med ; 111(7): 454-460, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-32658884

RESUMO

The lockdown of Italy, the re-orientation of many hospital departments into CoViD-19 patient care wards, the need to prevent the general practitioners from being infected has been arising the need of access to medical care in patients isolated at their homes. The specialists of the De Martinis Telemedicine Panel, addressing e-health issues, have been responding to the requests of general practitioners in 14 municipalities of Marche region, by implementing the televideoconsultation to 98 patients, 68 of whom with, certain, probable or supposed to be CoViD-19 infection. The patients were managed from remote until the symptoms were over. Sixty-five patients adhere the televideoconsultation completely and were cured, also with home oxygen therapy and other treatments additional to the standard anti-inflammatory and antibiotic drugs. However, they got stuck to full isolation while making use of no external human resources for health and relying entirely on the electronic prescription of their general practitioner and the help of the cohabiting family members. Two patients abandoned, including one owing to the lack of support from the cohabiting family member, and addressed themselves to the hospital care. However, they required no mechanical ventilation and were discharged being recovered within shortly. One over 90 years' old patient was hospitalised in agreement with the general practitioner for management problems. The results are discussed in relationship to the procedures put in practice, to the perspectives in the use of clinical televideoconsultation in the Italian health system, mainly in support to the primary health care, and to the limitations due to the poor development of other e-health tools such as the citizen's electronic health record.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Medicina Geral/métodos , Serviços de Assistência Domiciliar/organização & administração , Pandemias , Pneumonia Viral/terapia , Telemedicina/métodos , Comunicação por Videoconferência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Terapia Combinada , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/prevenção & controle , Registros Eletrônicos de Saúde , Prescrição Eletrônica , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto Jovem
12.
N Z Med J ; 133(1517): 32-55, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32595220

RESUMO

AIMS: To investigate how well the New Zealand PREDICT-CVD risk equations, derived in people aged 30-74 years and US Pooled Cohort Equations (PCEs) derived in people aged 40-79 years, perform for older people. METHODS: The PREDICT cohort study automatically recruits participants when clinicians use PREDICT software to conduct a CVD risk assessment. We identified patients aged 70 years and over, without prior CVD, renal disease or heart failure who had been risk assessed between 2004 and 2016. Equation performance was assessed in five-year age bands using calibration graphs and standard discrimination metrics. RESULTS: 40,161 patients (median 73 years; IQR 71-77) experienced 5,948 CVD events during 185,150 person-years follow-up. PREDICT-CVD equations were well calibrated in 70-74 year olds but underestimated events for women from 75 years and men from 80 years. Discrimination metrics were also poor for these age groups. Recalibrated PCEs overestimated CVD risk in both sexes and had poor discrimination from age 70 years for men and from age 75 years for women. CONCLUSIONS: While PREDICT-CVD equations performed better than PCEs, neither performed well. Multimorbidity and competing risks are likely to contribute to the poor performance and new CVD risk equations need to include these factors.


Assuntos
Doenças Cardiovasculares/epidemiologia , Medicina Geral/métodos , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
13.
Rev Assoc Med Bras (1992) ; 66(4): 521-527, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32578790

RESUMO

Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery.


Assuntos
Infecções por Coronavirus/terapia , Medicina Geral/métodos , Pneumonia Viral/terapia , Respiração Artificial/métodos , Adolescente , Betacoronavirus , Criança , Estado Terminal , Hidratação/métodos , Monitorização Hemodinâmica/métodos , Humanos , Terapia Nutricional/métodos , Pandemias , Modalidades de Fisioterapia
14.
J Med Internet Res ; 22(6): e19786, 2020 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-32540845

RESUMO

BACKGROUND: The coronavirus disease (COVID-19) has become an urgent and serious global public health crisis. Community engagement is the first line of defense in the fight against infectious diseases, and general practitioners (GPs) play an important role in it. GPs are facing unique challenges from disasters and pandemics in delivering health care. However, there is still no suitable mobile management system that can help GPs collect data, dynamically assess risks, and effectively triage or follow-up with patients with COVID-19. OBJECTIVE: The aim of this study is to design, develop, and deploy a mobile-based decision support system for COVID-19 (DDC19) to assist GPs in collecting data, assessing risk, triaging, managing, and following up with patients during the COVID-19 outbreak. METHODS: Based on the actual scenarios and the process of patients using health care, we analyzed the key issues that need to be solved and designed the main business flowchart of DDC19. We then constructed a COVID-19 dynamic risk stratification model with high recall and clinical interpretability, which was based on a multiclass logistic regression algorithm. Finally, through a 10-fold cross-validation to quantitatively evaluate the risk stratification ability of the model, a total of 2243 clinical data consisting of 36 dimension clinical features from fever clinics were used for training and evaluation of the model. RESULTS: DDC19 is composed of three parts: mobile terminal apps for the patient-end and GP-end, and the database system. All mobile terminal devices were wirelessly connected to the back end data center to implement request sending and data transmission. We used low risk, moderate risk, and high risk as labels, and adopted a 10-fold cross-validation method to evaluate and test the COVID-19 dynamic risk stratification model in different scenarios (different dimensions of personal clinical data accessible at an earlier stage). The data set dimensions were (2243, 15) when only using the data of patients' demographic information, clinical symptoms, and contact history; (2243, 35) when the results of blood tests were added; and (2243, 36) after obtaining the computed tomography imaging results of the patient. The average value of the three classification results of the macro-area under the curve were all above 0.71 in each scenario. CONCLUSIONS: DCC19 is a mobile decision support system designed and developed to assist GPs in providing dynamic risk assessments for patients with suspected COVID-19 during the outbreak, and the model had a good ability to predict risk levels in any scenario it covered.


Assuntos
Infecções por Coronavirus/diagnóstico , Sistemas de Apoio a Decisões Clínicas , Medicina Geral/métodos , Clínicos Gerais , Aplicativos Móveis , Pneumonia Viral/diagnóstico , Medição de Risco/métodos , Triagem/métodos , Betacoronavirus , Assistência à Saúde/métodos , Surtos de Doenças , Feminino , Humanos , Masculino , Pandemias , Prognóstico , Saúde Pública/métodos
15.
Aust J Gen Pract ; 49(5): 288-292, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32416654

RESUMO

BACKGROUND: The number of people living with and beyond cancer is increasing substantially. Primary care has an important role in the ongoing management of cancer survivors. OBJECTIVE: The aim of this article is to outline common concerns of cancer survivors, evidence to support the role of general practitioners (GP) in survivorship care and key aspects of primary care-led survivorship care. DISCUSSION: Clinical trials have shown that, in particular circumstances and with well­designed models, GP-led care is as effective as oncology specialist-led care. Regardless of the model of care, general practice has key roles in care coordination, management of multimorbidity, secondary prevention and health promotion, management of psychosocial care and promotion of self-management. Communication and collaboration between GPs and specialist cancer services is critical to support patients and healthcare providers in the delivery of care.


Assuntos
Sobreviventes de Câncer/psicologia , Medicina Geral/métodos , Assistência ao Paciente/métodos , Papel Profissional/psicologia , Austrália , Medicina Geral/tendências , Humanos , Assistência ao Paciente/psicologia , Sobrevivência
16.
Rev Med Suisse ; 16(692): 911-914, 2020 May 06.
Artigo em Francês | MEDLINE | ID: mdl-32374536

RESUMO

One part of the population of neurolesioned patients is the transition of young patients with neurodisabilities to adult life. To guarantee favourable social and professional reinsertion is a major challenge, requiring inter-professional care. For this reason, in 2006 the CHUV, Lausanne created a transition-consultation framework with neuro-paediatricians and adult neurologists specialised in neuro-rehabilitation linked to a Swiss pilot social and professional reinsertion project collaborating with the invalidity insurance. As a model of the follow up of neurolesioned patients, this article reports the results of the reinsertion project that aims to bring awareness to the general practitioner of an inter-disciplinary care method adaptable to individuals. The holistic service saves time and improves the rate of successful reinsertion of young adults into social and professional life.


Assuntos
Pessoas com Deficiência/reabilitação , Emprego , Medicina Geral/métodos , Relações Interpessoais , Pessoas com Deficiência/psicologia , Clínicos Gerais , Humanos , Encaminhamento e Consulta
17.
Ned Tijdschr Geneeskd ; 1642020 Mar 25.
Artigo em Holandês | MEDLINE | ID: mdl-32392007

RESUMO

The current guidelines for diagnosis and treatment of primary respiratory infections are still useful during the COVID-19 epidemic.Telephone triage of patients with respiratory complaints aims to identify patients with complications or an increased risk of complications.There are no indications to test for SARS-CoV-2 virus in general practice.During this COVID-19 epidemic, protective clothing is recommended in all physical contacts with patients with respiratory complaints.There is no reason to be cautious about using NSAIDs in patients suspected of COVID-19.Amoxicillin is first choice treatment for respiratory infections during the COVID-19 epidemic; there is lack of evidence to support azithromycin as a first choice.Respiratory rate > 24 / min or saturation <92-94% indicate imminent respiratory decompensation and may be reasons for referral.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Medicina Geral , Pneumonia Viral/diagnóstico , Infecções Respiratórias/virologia , Idoso de 80 Anos ou mais , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Medicina Geral/métodos , Medicina Geral/normas , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Infecções Respiratórias/tratamento farmacológico , Triagem
19.
Aust J Gen Pract ; 49(4): 189-193, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32233344

RESUMO

BACKGROUND: The benefit of exercise in the prevention and management of type 2 diabetes (T2D) has a strong evidence base, so it is important to ensure exercise is part of every patient's management plan. OBJECTIVE: This article reviews the evidence for exercise in T2D and the factors affecting a patient's willingness to commence and sustain enough exercise to gain benefit. The article offers tips about how to safely and effectively prescribe the 'medicine' of exercise for all, even the frailest patients; who to stabilise before an exercise program should begin; and how to use the skills of an accredited exercise physiologist (AEP) to deliver the best 'prescription' possible. DISCUSSION: General practitioners and their teams, along with other healthcare providers such as AEPs, can increase the amount of exercise medicine a patient receives. This is the case for those at risk of developing T2D, those with T2D and those with the many comorbidities associated with T2D.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício/métodos , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/psicologia , Terapia por Exercício/instrumentação , Terapia por Exercício/tendências , Medicina Geral/instrumentação , Medicina Geral/métodos , Medicina Geral/tendências , Promoção da Saúde/métodos , Promoção da Saúde/tendências , Humanos
20.
Aust J Gen Pract ; 49(4): 194-199, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32233347

RESUMO

BACKGROUND: Despite their rarity, primary tumours of the central nervous system have a devastating impact on patient survival and quality of life. The classification of glial tumours has recently changed, and large trials have provided data on treatment impact; however, the treatment armamentarium remains the same, and many questions persist. OBJECTIVE: The aim of this narrative review is to discuss the current understanding and management of the most common glial brain tumours to equip general practitioners (GPs) and other non-neuro-oncological specialists with appropriate knowledge to share care and support patients. DISCUSSION: Treatment of brain tumours is complex and multifaceted, and it involves many different specialists. Recent advances in translational research and molecular understanding of brain tumours raise hope that new treatments are imminent, and patients should be encouraged to participate in clinical trials. The GP has an important role in patient support and coordination of care.


Assuntos
Glioblastoma/diagnóstico , Glioblastoma/terapia , Gerenciamento Clínico , Medicina Geral/métodos , Glioblastoma/classificação , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências
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