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1.
Ann Fam Med ; 19(1): 44-47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33431391

RESUMO

We studied the changes in presented health problems and demand for primary care since the outbreak of coronavirus disease 2019 (COVID-19) in the Netherlands. We analyzed prominent symptom features of COVID-19, and COVID-19 itself as the reason for encounter. Also, we analyzed the number and type of encounters for common important health problems. Respiratory tract symptoms related to COVID-19 were presented more often in 2020 than in 2019. We observed a dramatic increase of telephone/e-mail/Internet consultations in the months after the outbreak. Contacts for other health problems such as prevention and acute and chronic conditions plummeted substantially (P <0.001); mental health problems stabilized.


Assuntos
/terapia , Medicina de Família e Comunidade/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/tendências , Humanos , Países Baixos/epidemiologia , Encaminhamento e Consulta/tendências , Telemedicina/tendências
2.
Womens Health Issues ; 31(1): 57-64, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32981825

RESUMO

BACKGROUND: Early pregnancy loss (EPL) is a common experience. Treatment options include expectant management, medication, and uterine aspiration. Although family physicians can offer comprehensive EPL treatment in their office-based settings, few actually do. This study explored the postresidency provision of EPL management and factors that inhibit or enable providing this care among family physicians trained in early abortion during residency. METHODS: Using an exploratory sequential mixed-methods design, we studied a sample of family physicians trained in early abortion during residency. We initially interviewed a subset trained in uterine aspiration during residency, then surveyed the entire sample. Interview transcripts were coded and analyzed using grounded theory; results informed survey development. On survey responses, we used Pearson χ2 to examine the association between certain variables and provision of EPL care options. RESULTS: Most of the 15 interview and 231 survey respondents provided expectant management of EPL. Of the survey respondents, 47.2% provided medication management and 11.4% manual vacuum aspiration. Key challenges and facilitators involved referral, training, ultrasound access, and managing systems-level issues. In bivariate analyses, providing prenatal care, offering abortion care, access to ultrasound, and competency were positively associated with providing EPL management options (p < .05). CONCLUSIONS: Clinical training alone is insufficient to expand access to comprehensive EPL care in family medicine office-based settings. Supporting family physicians during and after residency with training and technical assistance to address barriers to care may strengthen their abilities to champion practice change and expand access to comprehensive EPL management options.


Assuntos
Aborto Induzido , Aborto Espontâneo , Aborto Espontâneo/terapia , Medicina de Família e Comunidade , Feminino , Humanos , Médicos de Família , Padrões de Prática Médica , Gravidez , Estados Unidos
4.
Br J Gen Pract ; 71(702): 12-13, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33372100
7.
S Afr Fam Pract (2004) ; 62(1): e1-e3, 2020 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-33314949

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has changed the world as we knew it, and medical education is not an exception. Walter Sisulu University (WSU) has a distributed model of clinical training for the Bachelor of Medicine and Bachelor of Surgery (MBChB) programme. To address the challenges occasioned by the pandemic, the Department of Family Medicine and Rural Health undertook a modification of its MBChB VI programme. The changes aim to ensure the protection of all stakeholders and maintain the integrity of the programme, including the assessment. Changes were made in the delivery of the programme and in the way people interact with one another. Continuous assessment was modified, and the oral portfolio examination was introduced as the summative assessment tool. Although COVID-19 threatened the traditional way of teaching and learning, it however provided us with the opportunity to refocus and reposition our undergraduate medical programme.


Assuntos
Currículo , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/organização & administração , Medicina de Família e Comunidade/educação , /epidemiologia , Avaliação Educacional , Humanos , Pandemias , Avaliação de Programas e Projetos de Saúde , África do Sul/epidemiologia
9.
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
10.
Am Fam Physician ; 102(12): 740-750, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320508

RESUMO

Degenerative cervical myelopathy encompasses a collection of pathologic conditions that result in progressive spinal cord dysfunction secondary to cord compression. Patients are typically male (3: 1 male-to-female ratio), and the average age of presentation is 64 years. The exact incidence is unclear because of differences in terminology and because radiographic findings can be present in asymptomatic individuals. Common examination findings include neck pain or stiffness, a wide-based ataxic gait, ascending paresthesia in the upper or lower extremities, lower extremity weakness, decreased hand dexterity, hyperreflexia, clonus, Babinski sign, and bowel or bladder dysfunction in severe disease. Definitive diagnosis requires correlation of physical examination findings with imaging findings. Magnetic resonance imaging of the cervical spine with and without contrast media is the preferred imaging modality. Cervical spine computed tomography, computed tomography myelography, and plain radiography are helpful in certain situations. Treatment depends on the presence and severity of symptoms. Surgery is recommended for patients with moderate to severe symptoms or rapidly progressive disease. Conservative treatments with monitoring for progression may be considered in patients with mild to moderate disease. The evidence for the effectiveness of conservative treatments is scarce and of low quality, and outcomes can vary with individual patients. Primary care physicians play a vital role in recognizing the typical presentation of degenerative cervical myelopathy, coordinating treatment as indicated, and managing comorbidities.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Medicina de Família e Comunidade/métodos , Compressão da Medula Espinal/diagnóstico , Doenças da Medula Espinal/diagnóstico , Espondilose/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Cervicalgia/etiologia , Compressão da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem
13.
Am Fam Physician ; 102(12): 732-739, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320513

RESUMO

Peripheral neuropathy, a common neurologic problem encountered by family physicians, can be classified clinically by the anatomic pattern of presenting symptoms and, if indicated, by results of electrodiagnostic studies for axonal and demyelinating disease. The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among those older than 50 years. Common identifiable causes include diabetes mellitus, nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies. Peripheral neuropathy is idiopathic in 25% to 46% of cases. Diagnosis requires a comprehensive history, physical examination, and judicious laboratory testing. Early peripheral neuropathy may present as sensory alterations that are often progressive, including sensory loss, numbness, pain, or burning sensations in a "stocking and glove" distribution of the extremities. Later stages may involve proximal numbness, distal weakness, or atrophy. Physical examination should include a comprehensive neurologic and musculoskeletal evaluation. If the peripheral nervous system is identified as the likely source of the patient's symptoms, evaluation for potential underlying etiologies should initially focus on treatable causes. Initial laboratory evaluation includes a complete blood count; a comprehensive metabolic profile; fasting blood glucose, vitamin B12, and thyroid-stimulating hormone levels; and serum protein electrophoresis with immunofixation. If the initial evaluation is inconclusive, referral to a neurologist for additional testing (e.g., electrodiagnostic studies, specific antibody assays, nerve biopsy) should be considered. Treatment of peripheral neuropathy focuses on managing the underlying etiology. Several classes of medications, including gabapentinoids and antidepressants, can help alleviate neuropathic pain.


Assuntos
Medicina de Família e Comunidade/métodos , Anamnese/métodos , Doenças do Sistema Nervoso Periférico/diagnóstico , Exame Físico/métodos , Neuropatias Diabéticas/diagnóstico , Diagnóstico Diferencial , Humanos , Doenças do Sistema Nervoso Periférico/prevenção & controle
14.
Pan Afr Med J ; 35(Suppl 2): 126, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33282081

RESUMO

Family medicine residency training programs should put in place COVID-19 action plan in conjunction with other clinical departments, employee health personnel, and infection control leads. Programs should develop coping strategies that balance resident and patient safety, resident wellbeing, clinical training services, and resident education.


Assuntos
Medicina de Família e Comunidade/educação , Internato e Residência , Humanos , Pandemias , Catar/epidemiologia
15.
Praxis (Bern 1994) ; 109(16): 1251-1259, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33292013

RESUMO

Pelvic Inflammatory Disease - Synergies between Family Practices and Gynaecological Specialised Assessment Abstract. The 'pelvic inflammatory disease' (PID) describes an ascending inflammation of the upper female genital tract, beginning with a local cervicitis and proceeding to endometritis and adnexitis. It is a common clinical picture with rising numbers in recent years, and it occurs both in gynaecological and general practice. The symptoms are often unspecific, discrete or althogehter lacking. In order to reduce long-term risks of chronic pelvic pain, sterility and/or ectopic pregnancies, rapid diagnosis followed by immediate therapy and a good interdisciplinary cooperation are necessary. Screening programs for chlamydia and gonococcus as the most common pathogens of PID have not yet been implemented in Switzerland so far.


Assuntos
Infecções por Chlamydia , Gonorreia , Doença Inflamatória Pélvica , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/terapia , Medicina de Família e Comunidade , Feminino , Humanos , Doença Inflamatória Pélvica/diagnóstico , Doença Inflamatória Pélvica/terapia , Gravidez , Suíça
16.
Semergen ; 46(8): 560-565, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33239153

RESUMO

With the current pandemic, there is now the possibility of using technological tools, such as teleconsultation or remote consultation. In rural or even semi-urban areas, access to medical services may be restricted due to transportation problems. In other places access to the consultations is limited to avoid contagion from the patient or healthcare personnel. This is why technological solutions are used to allow us to monitor our patients remotely, especially in the case of chronic patients, or as a form of triage to potential patients with coronavirus. Unfortunately, this type of system has not been used with the same continuity as in other countries, and very often our health personnel do not know the correct way to carry out a teleconsultation (by phone or video). With this document, an initial guide is presented on how to make a teleconsultation in Primary Care.


Assuntos
Medicina de Família e Comunidade/métodos , Atenção Primária à Saúde/métodos , Consulta Remota/métodos , Algoritmos , Tomada de Decisão Clínica/métodos , Acesso aos Serviços de Saúde , Humanos , Relações Médico-Paciente , Telefone , Comunicação por Videoconferência
18.
Wiad Lek ; 73(9 cz. 2): 1909-1914, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148833

RESUMO

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.


Assuntos
Doenças do Sistema Digestório , Infecções por HIV , Adulto , Biomarcadores , Doenças do Sistema Digestório/epidemiologia , Medicina de Família e Comunidade , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Ucrânia , Carga Viral
20.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33181875

RESUMO

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).


Assuntos
Centros Comunitários de Saúde , Infecções por Coronavirus , Aconselhamento , Medicina de Família e Comunidade/educação , Internato e Residência , Pandemias , Pneumonia Viral , Preceptoria , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Pessoal de Saúde , Humanos , Médicos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , África do Sul
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