Complaints In General Practice Research Articles

Determinants of the clinical course of musculoskeletal complaints in general practice: design of a cohort study.

BackgroundMusculoskeletal complaints are frequent and have large consequences for public health. Information about the prognosis after presentation in general practice is far from complete. Knowledge about determinants of the clinical course of musculoskeletal complaints is essential for management decisions and to inform patients about their prognosis. The purpose of this study is to provide information about the prognosis of musculoskeletal complaints other than low back pain by studying the course of these complaints in general practice and to identify determinants of this course.MethodsPatients of 18 years and older, who present in general practice with a new episode of a musculoskeletal complaint of the neck, shoulder, elbow, wrist, hand, arm, hip, knee, ankle or foot, are recruited by their general practitioner (GP). Participants will receive complaint-specific questionnaires by mail at baseline and after 3, 6, 12 and 18 months. The following putative determinants of the course of the complaints will be investigated: sociodemographic characteristics, characteristics of the complaint, psychosocial job characteristics, physical workload, physical activity during leisure time, pain coping, mood, kinesiophobia, social support, optimism. The primary outcomes are perceived recovery, pain, functional status, sick leave and overall quality of life.

Rapid urinalysis assays for the diagnosis of urinary tract infection.

Urinary tract infection (UTI) in premenopausal women is a frequent complaint in general practice. UTI is usually diagnosed on the basis of clinical symptoms and the use of one or more laboratory tests, the most common being rapid urinalysis reagent assays (urine dip) or midstream urine culture. In order to correlate the leucocyte esterase results of a rapid urinalysis assay with direct urine microscopy for pyuria, undiluted non-centrifuged urine samples from 206 volunteer female healthcare professionals were subjected to analysis using direct urine microscopy using a counting chamber and a rapid urinalysis assay. Of the 206 specimens, 74 were positive for leucocyte esterase using the rapid urinalysis assay, and 39 specimens demonstrated significant pyuria (greater than or equal to 10 leucocytes/microl) on direct microscopy. When the leucocyte esterase results were correlated with the direct urine microscopy results, an assay reading of 15 leucocytes/microl ('trace' on the visual scale) had a sensitivity of 91%, specificity of 79%, positive predictive value of 53% and a negative predictive value of 97%. An assay reading of 25 leucocytes/microl ('+' on the visual scale) or greater had a sensitivity of 63%, specificity of 95%, positive predictive value of 75% and a negative predictive value of 91%. In premenopausal, non-pregnant females, a rapid urinalysis assay result of 25 leucocytes/microl or greater will predict significant pyuria on urine microscopy with reasonable confidence, thereby reducing the need for more costly urine cultures.

Teleconsulta em neurologia na unidade de saúde a: abordagem preliminar.

This paper begins by discussing the influence of neurological diseases in the practice of general practitioners. A thorough review of the literature allows us to conclude that the frequency of neurological complaints in general practice varies between 7% and 15% and that complaints of sleep disorders reach about 26% in those cases. However, general practitioners do not refer all these neurological cases to a neurologist. They screen the cases and refer only 9% of all observed patients. Next, we briefly analyse the impact of telemedicine in general practice. Given this technique's novelty, we present a predictive model for the utility of teleconsultation, which we are currently developing and testing. We then summarise the current status of general practitioners' referrals to our hospital's neurological outpatient clinic, given previous measures that targeted waiting list reduction and adequate referral. After this overview, we present our methodology, which includes the development and implementation of the technologies needed for teleconsultation and the discussion and application of medical protocols for clinical data, benefits and costs. Simultaneously, we investigated the real need for teleconsultation in Neurology according to the literature and to several, more or less optimistic, models of acceptance. Based on this method, teleconsultation began its regular operation in July 1998. We discuss the result of the first 14 weeks of operation. We observed that referral developed according to calculated predictions and that there were clear advantages regarding diagnostics, medication, exam requests, cost avoidance and patient trips to the central hospital. The data collected predicts that this method is useful, efficient and able to substantially reduce costs.

Treatment of shoulder complaints in general practice: long term results of a randomised, single blind study comparing physiotherapy, manipulation, and corticosteroid injection

Descriptive studies have shown that shoulder complaints can be persistent and recurrent, requiring long term evaluation of treatment.1 Unfortunately, in most randomised studies comparing treatments for shoulder complaints the study...

The long-term course of shoulder complaints: a prospective study in general practice.

Assessment of the long-term course of shoulder complaints in patients in general practice with special focus on changes in diagnostic category and fluctuations in the severity of the complaints. Prospective descriptive study. Four general practices in The Netherlands. All patients (101) with shoulder complaints seen in a 5 month period were included. Assessment took place 26 weeks and 12-18 months after inclusion in the study with a pain questionnaire and a physical examination. A total of 51% of the patients experienced (mostly recurrent) complaints after 26 weeks and 41% after 12-18 months. Diagnostic changes were found over the course of time, mostly from synovial disorders towards functional disorders of the structures of the shoulder girdle, but also the other way round. Although 52 of the 101 patients experienced complaints in week 26, 62% of those patients considered themselves 'cured'. After 12-18 months, 51% of the 39 patients experiencing complaints felt 'cured'. Many patients seen with shoulder complaints in general practice have recurrent complaints. The nature of these complaints varies considerably over the course of time, leading to changes in diagnostic category. Because of the fluctuating severity of the complaints over time, feeling 'cured' or not 'cured' is also subject to change over time.

Classification of shoulder complaints in general practice by means of cluster analysis

Objective: To determine if a classification of shoulder complaints in general practice can be made with a cluster analysis of variables of medical history and physical examination. Method: One hundred one patients with shoulder complaints were examined upon inclusion (week 0) and after 2 weeks. Eleven variables of the medical histories and 19 variables of the physical examinations were used for the analysis. Results: The analyses of week 0 and week 2 reveal three stable clusters: one cluster with almost half of the patients who hardly had limitations in the range of scapulohumeral mobility (ROM), one cluster with a small number of patients with a short history of complaints and a limitation of scapulohumeral mobility in all directions (7 and 6, respectively), and a third cluster containing the rest of the patients, with 30% to 50% limitation in ROM. The degree of limitation in ROM decreased after 2 weeks. Comparison of the patients in the clusters of week 0 and week 2 revealed a shift of patients within the clusters, although the number of patients in the clusters remained almost constant. Conclusion: Only three stable clusters could be identified, which questions the suitability of more detailed classifications, such as described by Cyriax or the Dutch Guidelines for Shoulder Complaints, for the diagnosis of patients with shoulder complaints in general practice.

Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study

Objective: To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice.Design: Randomised, single blind study.Setting: Seven general practices in the Netherlands.Subjects:...

The course of pain and the restriction of mobility in patients with shoulder complaints in general practice

The objective of this research was to study the course of the pain and the restriction of mobility of the scapulohumeral joint (ROM) over time, and the factors influencing it, in patients with shoulder complaints in general practice. A total of 101 patients participated in this 25-week follow-up study. For the first 2 weeks, a non-steroidal anti-inflammatory drug (NSAID) was prescribed, after that period the physician could follow his usual therapeutic approach. The NSAIDs prescribed during the first 2 weeks resulted in a rapid decrease in the pain and the ROM. The group with the most severe pain consumed the most tablets, which resulted in a significant decrease in the pain and the ROM. It appeared that the course of the pain from week 2 to week 8 was significantly influenced by pain at inclusion, diagnosis and therapy. The most rapid decrease in the ROM appeared in the first 2 weeks. At week 0 and week 2, differences, in the ROM were seen in the subgroups for diagnosis pain score and age. The pain and the ROM showed most decrease in the first weeks. After 6 weeks hardly any changes were seen in the pain score and the ROM score. The margin of the pain score and the ROM score between the "cured" and the "not cured" patients was a very narrow one.

Shoulder disorders in general practice: incidence, patient characteristics, and management.

To study the incidence and management of intrinsic shoulder disorders in Dutch general practice, and to evaluate which patient characteristics are associated with specific diagnostic categories. In 11 general practices (35,150 registered patients) all consultations concerning shoulder complaints were registered during a period of one year. Patients with an intrinsic shoulder disorder who had not consulted their general practitioner for the complaint during the preceding year (incident cases) were asked to participate in an observational study. Participants completed a questionnaire regarding the nature and severity of their complaints. The general practitioners recorded data on diagnosis and therapy. The cumulative incidence of shoulder complaints in general practice was estimated to be 11.2/1000 patients/year (95% confidence limits 10.1 to 12.3). Rotator cuff tendinitis was the most frequently recorded disorder (29%). There were 349 incident cases enrolled in the observational study. Patient characteristics showed small variations between different diagnostic categories. Age, duration of symptoms, precipitating cause and restriction of movement seemed to be discriminating factors. Twenty two percent of all participants received injections during the first consultation; most (85%) were diagnosed as having bursitis. The majority of patients with tendinitis (53%) were referred for physiotherapy. With respect to diagnosis and treatment, the practitioners generally appeared to follow the guidelines issued by the Dutch College of General Practitioners. Although the patient characteristics of specific disorders showed some similarities with the clinical pictures described in the literature, further research is required to demonstrate whether the proposed syndromes indeed constitute separate disorders with a different underlying pathology, requiring different treatment strategies.

Benign positional vertigo: recognition and treatment.

#### Summary points Dizziness is one of the most common complaints in general practice, and yet doctors often find it difficult to establish a firm diagnosis in individual patients. Benign positional vertigo accounts for about a fifth of the referrals to specialised vertigo clinics1 and is the most commonly missed treatable condition. Fortunately, it can be readily diagnosed by positional testing. Recent insights into its pathophysiology have provided new means of effective treatment that can be applied in clinics. The incidence of benign positional vertigo is conservatively estimated to be 64 per 100000 population per year.2 Therefore a general practitioner is likely to see several new patients every year. Age at onset spans from childhood to senescence, but most patients are over 40.3 4 Women are affected about twice as often as men.5 Most patients report attacks of rotational vertigo of between 10 and 20 seconds that …

Empirical evaluation of the ‘Cognitive Difficulties Scale’ for assessment of memory complaints in general practice: A study of 1628 cognitively normal subjects aged 45–75 years

AbstractThe Cognitive Difficulties Scale (CDS, McNair and Kahn, 1984) was used to assess memory complaints in 1648 subjects devoid of severe medical or psychiatric disorder. The subjects, aged 45–75 years, were recruited when visiting their general practitioner. The CDS was well accepted and showed a good and stable factorial structure. A weak correlation was found between CDS score and the results of a short neuropsychological battery. A high CDS score was associated with advancing age, low educational level, and psychological motives for visiting. A reduced 26‐item version is proposed to shorten the time required to fill in the scale.

Psychiatric disorder and gynaecological symptoms in middle aged women: a community survey.

In a community survey 521 women aged 35-59 were selected at random from all patients registered in two groups practices. They were interviewed at home and assessed by means of standardised psychiatric measures and detailed gynaecological inquiry. Levels of psychiatric morbidity were found to be within the expected range for such a sample. Both psychiatric morbidity and the personality dimension of neuroticism were significantly associated with gynaecological symptoms, including dysmenorrhoea and premenstrual tension, some symptoms of excessive menstruation, and flushes and sweats but not disappearance of menstruation for over six months. Current psychiatric state was significantly associated with recent adverse life events and with indices of psychiatric vulnerability (neuroticism and previous psychiatric history), suggesting possible aetiological links with gynaecological symptoms. The findings of this study have implications for the management of gynaecological complaints in general practice.

Book reviewsA Back Pain Bibliography. By WyckeBarry, pp. xvi + 463, 1983 (Lloyd-Luke, London) £17.50 ISBN 0–85324–193–7

Although back pain is not a new clinical problem, it has in recent years been recognised as a major source of disability and is now one of the most frequently encountered complaints in general practice. The quantity of research in this field has increased considerably over the last few years, and it is now recognised as an area of special importance. A major problem for workers in back pain research is the multidisciplinary nature of the subject, extending as it does from basic science through many different branches of clinical medicine. The literature is copious and is often difficult to cross-correlate, even with computer assistance. We should, therefore, welcome any book which attempts to smooth the pathways between the disciplines.

Treatment of Acute Sore Throat in General Practice

Sore throat is a common complaint in general practice, but doctors do not agree on the best method of treat ment. Earlier trials of sulphonamide drugs gave con flicting results (Rhoads and Afremow, 1940; Freis, 1944; Clodfelter, 1945; Commission on Acute Respira tory Disease, 1945), but more recently MacDonald and Watson (1951) and Landsman and her colleagues (1951) both concluded that the sulphonamide treatment they used was not effective. As with many of the earlier trials, the patients treated by MacDonald and Watson were young Service men, and their findings are not necessarily applicable toyounger patients or to those living in their own homes. Furthermore, although there was little difference between the average duration of symptoms and signs in treated and control cases, a statistically significant preponderance of patients making a good recovery after 72 hours' treatment had received sulphonamide. Landsman's patients were of all ages and were treated in general practice, but the total number of cases was too small to put the question beyond doubt. Evaluation of penicillin in the treatment of sore throat has been bacteriological rather than clinical. Investigations by Plummer et al. (1945), Keith et al. (1945), and Denny et al. (1953) confirmed that penicillin eradicated streptococci from the throat and strongly sug gested that clinical recovery was also accelerated. A controlled trial of penicillin in sore throat in this country was reported by Gardner (1953), who treated 102 cases of food-borne streptococcal tonsillitis with penicillin, sulphadimidine ( sulphamezathine ), or aspirin. The average recovery time in the penicillin group was similar to that in the sulphadimidine group and about half as long as that in the aspirin group, but as the numbers were small the differences were not statistically significant. The problem that faces the general practitioner, how ever, is not the treatment of streptococcal tonsillitis but of acute febrile sore throats, of which only a proportion may be streptococcal. Though certain broad differences between large groups of cases of streptococcal and non streptococcal sore throat have been observed (Com mission on Acute Respiratory Diseases, 1944, 1947; Landsman et al., 1951), the classification of an individual case on clinical grounds alone is not practicable. Pro bably most doctors prescribe intramuscular penicillin if the illness is severe, but find more difficulty in deciding whether to use penicillin or sulphonamide, with the atten dant risk and discomfort, for less severe infections. Because it was felt that no adequate evaluation of sul phonamide or of oral penicillin in the treatment of cases of this kind had been made, the investigation described below was undertaken.