Practices Of Primary Care Physicians Research Articles

Management of chronic heart failure: updates and implications for the primary care physician

The latest recommendations of the European Society of Cardiology on chronic heart failure published in 2021 propose several new concepts. The main changes include a revision of the classification but most importantly modifications in the therapeutic management, especially concerning the first-line treatment of heart failure with reduced ejection fraction. Since heart failure affects approximately 2% of the general population, these new recommendations will have a definite impact on the practice of primary care physicians. Integrating these changes into heart failure management is essential to improve the prognosis, symptoms and the quality of life of patients. This article presents the most significant changes and their implications for primary care physicians.

A survey of the training and working arrangements of general practitioners providing asthma and chronic obstructive pulmonary disease care in a rural area of Maharashtra State.

Chronic respiratory diseases (CRD), especially asthma and chronic obstructive pulmonary disease (COPD), are common public health problems resulting in a substantial burden of disease for individuals. There is a need to understand the perceptions and practices of primary care physicians ("general practitioners [GPs]") who provide most of the health care in rural India. We surveyed all private and public practitioners listed as practising in a rural area of Western India with the aim of identifying GPs (GPs: graduates, registered and allowed to practice in India) to understand their training, working arrangements, and asthma/COPD workload. We administered a short questionnaire at educational meetings or via e-mail to all private and public practitioners listed as providing community-based services in the Junnar block, Pune district, Maharashtra. The survey asked about qualifications, experience, and working arrangements, and about current asthma and COPD workload. A descriptive analysis was performed. We approached 474 practitioners (434 from private sector and 40 from public sector). Eighty-eight were no longer practising in the study area. The response rate was 330/354 (93.2%) of private and 28/32 (87.5%) of public sector practitioners. We excluded 135 nonrespiratory hospital specialists and 23 private practitioners whose highest qualification was a diploma. Our final sample of 200 GPs (70% males) was 177 from private sector and 23 from public sector. The private GPs had more experience in clinical practice in comparison to public GPs (18.6 vs. 12.8 years). Eighty-four percent of GPs from the private sector only had Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) qualifications, though >90% provided "modern medicine" services. In the public sector, 43.5% GPs only had AYUSH qualifications, though all provided "modern medicine" services. A minority (9% of private GPs and 16% of public GPs) provided both services. Nearly two-thirds (62%) of private GPs had inpatient facilities compared to only 9% of public sector GPs. In both sectors, more GPs stated that they managed people with asthma than treated COPD (Private: 97% vs. 75%; Public 87% vs. 57%). Many GPs practising "modern medicine" only had qualifications in Ayurveda/Homeopathy and fewer GPs are involved in the management of COPD as compared to asthma. These are important factors that form the context for initiatives seeking to improve the quality of community-based care for people with CRD in Maharashtra state in India.

A primary care team approach to secondary prevention of work-related musculoskeletal disorders: Physical therapy perspectives

BACKGROUND: Among work-related conditions in the United States, musculoskeletal disorders (MSDs) account for about thirty-four percent of work absences. Primary care physicians (PCPs) play an essential role in the management of work-related MSDs. For conditions diagnosed as work-related, up to seventeen percent of cases are PCP managed; within these conditions, up to fifty-nine percent are diagnosed as musculoskeletal. Negative factors in treatment success confronting PCPs include time constraints and unfamiliarity with work-related MSDs. A multidimensional team approach to secondary prevention, where PCPs can leverage the expertise of allied health professionals, might provide a useful alternative to current PCP practices for the treatment of work-related MSDs. OBJECTIVE: Provide the structure of and rationale for an “extended care team” within primary care for the management of work-related MSDs. METHODS: A systematic literature search, combining medical subject headings and keywords, were used to examine eight peer-reviewed literature databases. Gray literature, such as government documents, were also used. RESULTS: An extended care team would likely consist of at least nine stakeholders within primary care. Among these stakeholders, advanced practice orthopedic physical therapists can offer particularly focused guidance to PCPs on the evaluation and treatment of work-related MSDs. CONCLUSIONS: A multidimensional approach has the potential to accelerate access and improve quality of work-related outcomes, while maintaining patient safety.

Knowledge, Attitudes and Practices of Primary Care Physicians Regarding Tobacco Dependence Treatment in Muscat Governorate, Oman: A cross-sectional study.

ObjectivesThis study aimed to assess the knowledge, attitudes and practices (KAPs) of primary care physicians (PCPs) regarding tobacco dependence treatment (TDT) and to identify barriers to TDT practice in Muscat, Oman.MethodsThis cross-sectional study was carried out from September 2019 to December 2019 at all 27 health centres in Muscat. All 313 PCPs working in these health centres were invited to participate. An adapted version of a previously validated 36-item questionnaire was used to assess KAPs regarding TDT services.ResultsA total of 255 PCPs completed the survey (response rate: 81.5%) and they demonstrated poor knowledge (40%) but positive attitudes (60%) about TDT services. Of these, the majority were female (85.9%), had never smoked (99.2%) and were general practitioners (64.3%). The mean age was 34.3 ± 6.3 years. Only 28.2% had previously received TDT training and less than half displayed accurate TDT-related knowledge, with undergraduate medical school representing the main source of such knowledge (58.8%). While 96.9% of the PCPs agreed on the importance of TDT, only 28.6% reported feeling sufficiently confident to provide such services themselves. Lack of training (83.5%) and time (71.4%) were the main barriers to TDT practice.ConclusionOverall, PCPs in Muscat demonstrated poor knowledge but positive attitudes with regard to TDT; however, further knowledge and training is required in order to ensure the effective and accurate provision of TDT services. These findings provide baseline data which may be of value for further research and in overcoming barriers to TDT practice in Oman; for instance, establishing cessation services as part of the package of care in primary health centres could address the time constraints barriers identified by the PCPs.

Knowledge, attitude, and practice of primary care physicians about developmental dysplasia of the hip in a tertiary referral hospital in Riyadh, Saudi Arabia

Objectives: The aim of the study was to determine the current knowledge, attitude, and practice of developmental dysplasia of the hip (DDH) management among primary care physicians (PCP) in Saudi Arabia. Methods: A cross-sectional study on PCP from a single health-care system in Riyadh, Saudi Arabia, was conducted using a survey questionnaire to evaluate the medical knowledge, attitude, and current practice in the clinics, including diagnosis and screening skills. Results: Sixty-five PCPs participated in the survey, 32 (49.2%) were general practitioners and 33 (50.8%) were fellows and consultants. Only six physicians (9.2%) had formal training on DDH management. Twenty respondents (30.8%) had poor knowledge, while 45 (69.2%) had sufficient knowledge of DDH. Most of the respondents believed in the importance of asking about risk factors, the presence of DDH screening protocols and community awareness, and 89.2% of the respondents believed they need to go for further training about DDH. Fifty-nine respondents (90.8%) would refer a DDH case to an orthopedic surgeon when there are positive findings by a radiograph or ultrasound. Forty-two (64.6%) never examined the hip for DDH, and 30 (46.2%) never referred a DDH case. Conclusion: Knowledge of DDH among our PCP directly involved in the screening and management of DDH is sufficient. However, there is a discordance between knowledge to attitude and practice.

Naproksen – multifunkcjonalny lek w świetle aktualnych badań i doniesień

The therapeutic effects of naproxen and its unique pharmacological properties allows it to use not only in the practice of primary care physicians, but also in specialist clinics. Naproxen is effective in relieving musculoskeletal pain of various origins, and additionally has anti-inflammatory and antipyretic properties. This enables its effective use in chronic diseases such as: RA, OA, AS, as well as for effective reduction of symptoms of classic infections, especially viral infections, reducing pain in muscles, joints, head and lowering fever.

A cross-sectional study on the ability of physicians to hypertension management in China's Sichuan Tibetan rural area.

This study aimed to investigate the hypertension management abilities of rural physicians in a high‐altitude Tibetan area. A cross‐sectional survey was conducted in the Ganzi Tibetan Autonomous Prefecture, China, in October 2020. Information about healthcare resources in local medical institutions, along with the knowledge, attitudes, practices, and training status of primary care physicians, was collected. Limited resources were observed in terms of equipment, drugs, and personnel in the 18 township hospitals included. A total of 132 physicians participated in this survey. The scores for hypertension‐related knowledge, attitudes toward hypertension management, routine practice ability, priority given to hypertension, and confidence in performing certain tasks were 32.60%, 67.40%, 18.90%, 65.15%, and 35.60%, respectively. The most concerning issues lay in the ignorance of the healthy lifestyle, undervaluation of cardiovascular risks, and lack of confidence in optimally performing management activities. Only 9.85% of the physicians received more than 24 days of training per year; 28.79% preferred a longer training time. While training was generally provided in conference sessions (63.64% of current training programs), physicians preferred remote education (55.30%), and on‐site guidance (46.21%) from professionals. The current training was centered around clinical skills (61.36%) and was identified as a major training requirement by the physicians surveyed (80.30%). This survey suggests that the medical resources may not be effective, with deficiencies present in the knowledge and practices of primary care physicians in the Sichuan Tibetan area. Hypertension education and skill‐development courses based on the specific issues identified should be provided to these physicians in the future.

Knowledge, attitudes, and practices of primary health care physicians, junior doctors, and medical college students towards autism in Duhok, Iraq

Background and objective: The knowledge of autism spectrum disorder among physicians and medical students is limited. This study aimed to find out the level of knowledge, attitudes, and practices of primary health care physicians, junior doctors, and 6th year medical college students in Duhok province, Iraqi Kurdistan toward autism spectrum disorder. Methods: A cross-sectional study was carried out from September 10th until October 30th, 2016. A self-administered questionnaire was used for data collection. Two hundred and two questionnaires were completed by the three participants’ groups. Data analysis was carried out using the statistical analysis system (SAS, version 9.4). Results: Of the 202 participants, 24.8% were sixth year medical students, others were junior doctors (35.6%) and primary health care physicians (39.6%). Of them, 51.5% were females and 48.5% were males. High percentages (90.1% and 91.1%) of respondents heard and knew about autism spectrum disorder, respectively. They showed poor information on identification and management. Primary health care physicians had more knowledge on the genetic basis of autism (P <0.001) and behavioral therapy for autism (P = 0.016). No significant differences in knowledge was found between both gender groups except that female participants had limited knowledge on its genetic basis (P = 0.007). Conclusion: Although primary health care physicians, rotators, and medical students generally heard about autism spectrum disorder, they had limited knowledge of its diagnosis and management. It is recommended to introduce autistic disorders lectures to the medical college curriculum and training of physicians by experienced professionals. Keywords: KAP; Physicians; Medical students; Autism.

Use of heuristics during the clinical decision process from family care physicians in real conditions.

The available evidence on the use of heuristics and their relationship with diagnostic error in primary care is very limited. The aim of the study is to identify the use of unknown thought and specifically the possible use of Representativeness, Availability and overconfidence heuristics in the clinical practice of primary care physicians in cases of dyspnoea and to analyse their possible relationship with diagnostic error. A total of 371 patients consulting with new episodes of dyspnoea in Primary Care centres in Spain were registered. Based on specific operational definitions, the use of unconscious thinking and the use of heuristics during the diagnostic process were assessed. Subsequently, the association between their use and diagnostic error was analysed. In 49.6% of cases, the confirmatory diagnosis coincided with the first diagnostic impression, suggesting the use of the representativeness heuristic in the diagnostic decision process. In 82.3% of the cases, the confirmatory diagnosis was among the three diagnostic hypotheses that were first identified by the general physicians, suggesting a possible use of the availability heuristic. In more than 50% of the cases, the physicians were overconfident in the certainty of their own diagnosis. Finally, a diagnostic error was identified in 9.9% of the recorded cases and no statistically significant correlation was found between the use of some unconscious thinking tools (such as the use of heuristics) and the diagnostic error. Unconscious thinking manifested through the acceptance of the first diagnostic impression and the use of heuristics is commonly used by primary care physicians in the clinical decision process in the face of new episodes of dyspnoea; however, its influence on diagnostic error is not significant. The proposed explicit and reproducible methodology may inspire further studies to confirm these results.

Does behavioral intervention affect intention to quit? : A quasi-experimental study from primary healthcare settings in India.

INTRODUCTIONTobacco is the leading cause of death and disease in India. This study examines the effect of training intervention in behavioral counseling on intention to quit tobacco in primary healthcare settings in India. The intervention included training to improve behavioral counseling practices of primary care physicians (PCPs) based on the 5As approach to increase patients’ motivation to quit tobacco.METHODSA quasi-experimental design was used for the study. The intervention consists of training of primary care physicians in the behavioral intervention in tobacco cessation. The intervention was conducted in twelve districts of two states in India (Rajasthan and Odisha) in 2016–2017. Four districts were randomly sampled for the study. A total of 1314 participants (intervention and control) were recruited for the study in the baseline and end-line surveys, respectively. Intention to quit in 30 days was the primary outcome measure. Difference-in-difference (DiD) logistic regression models were used separately for smokers and smokeless tobacco users to estimate the odds of intention to quit. Analysis was done in STATA Version 14.RESULTSThe intervention and time variable had a significantly positive influence on the intention to quit tobacco among smokers. Smokers in the intervention districts had higher odds of intention to quit (OR=9.82; 95% CI: 1.67–57.72) compared to smokers in the control districts. Smokeless tobacco (SLT) users had higher odds of intention to quit (OR=3.06; 95% CI: 1.35–6.98) in the end-line survey compared to baseline survey.CONCLUSIONSOur findings indicate that building capacity in behavioral intervention in primary care settings can help increase the intention to quit among smokers. The observed difference in intention to quit between smokers and SLT users suggests the need of tailored counseling interventions for SLT users. There is a need for further research to design and evaluate training and behavioral interventions for SLT and dual (smoking and SLT) users in primary care settings in low- and middle-income countries.

Beliefs and practices among primary care physicians during the first wave of the COVID-19 pandemic in Baden-Wuerttemberg (Germany): an observational study

BackgroundDuring the first wave of the COVID-19 pandemic various ambulatory health care models (SARS-CoV-2 contact points: Subspecialised Primary Care Practices, Fever Clinics, and Special Places for Corona-Testing) were organised in a short period in Baden-Wuerttemberg, a region in Southern Germany. The aim of these SARS-CoV-2 contact points was to ensure medical treatment for patients with (suspected) and without SARS-CoV-2 infection. The present study aimed to assess the beliefs and practices of primary care physicians who either led a Subspecialised Primary Care Practice or a Primary Care Practice providing care as usual in Baden-Wuerttemberg during the first wave of the COVID-19 pandemic.MethodsThis cross-sectional study was based on a paper-based questionnaire in primary care physicians during the first wave of the pandemic. Participants were identified via the web page of the Association of Statutory Health Insurance Physicians Baden-Wuerttemberg. The questionnaire was distributed in June and July 2020. It measured knowledge, practices, self-efficacy and fears towards SARS-CoV-2, using newly developed questions. Data was descriptively analysed.ResultsOne hundred fifty-five participants (92 leads of SARS-CoV-2 contact points/ 63 leads of primary care practices) completed the questionnaire. Out of 92 leads of SARS-CoV-2 contact points 74 stated to lead n Subspecialised Primary Care Practices. About half participants of both groups did not fear an own infection with the novel virus (between 50.8% and 62.2%), however about 75% feared financial loss. Knowledge was gained using various sources; main sources were the Association of Statutory Health Insurance Physicians (between 82.5% and 83.8%) and the German Society for Hygiene and Microbiology (RKI) (between 88.9% and 95.9%). Leads of Subspecialised Primary Care Practice felt more confident to perform anamnestic/diagnostic procedures (p < 0.001). The same was found for the confidence level regarding decision-making concerning the further treatment (p < 0.001). Several prevention measures to contain the spread of SARS-CoV-2 were adopted. Subspecialised Primary Care Practice had treated on average more patients with (suspected) COVID-19 (mean 408.12) than primary care practices (mean 83.8) (p < 0.001).ConclusionThe results of this study suggest that the Subspecialised Primary Care Practice that were implemented during the first wave of the SARS-CoV-2 pandemic contributed containment of the pandemic. Leads of Subspecialised Primary Care Practice indicated that physical separation of patients with potential SARS-CoV-2 infection was easier compared to those who continued working in their own practice. Additionally, leads of Subspecialised Primary Care Practice felt more confident in dealing with patients with SARS-CoV-2 infection.Trial registrationThe study has been prospectively registered at the German Clinical Trial Register (DRKS00022224).

Primary Care Access During the COVID-19 Pandemic: a Simulated Patient Study.

BackgroundPrimary care practices have experienced major strains during the COVID-19 pandemic, such that patients newly seeking care may face potential barriers to timely visits.ObjectiveTo quantify availability and wait times for new patient appointments in primary care and to describe how primary care practices are guiding patients with suspected COVID-19.DesignTrained callers conducted simulated patient calls to 800 randomly sampled primary care practices between September 14, 2020, and September 28, 2020.ParticipantsWe extracted complete primary care physician listings from large commercial insurance networks in four geographically dispersed states between September 10 and 14, 2020 (n=11,521). After excluding non-physician providers and removing duplicate phone numbers, we identified 2705 unique primary care physician practices from which we randomly sampled 200 practices in each region.Main MeasuresPrimary care appointment availability, median wait time in days, and practice guidance to patients suspecting COVID-19 infection.Key ResultsAmong 56% of listed practices that had accurate contact information listed in the directory, 84% offered a new patient in-person or virtual appointment. Median wait time was 10 days (IQR 3–26 days). The most common guidance in case of suspected COVID-19 was clinician consultation, which was offered in 41% of completed calls. Callers were otherwise directed to on-site testing (14%), off-site testing (24%), a COVID-19 hotline (8%), or an urgent care/emergency department (12%), while 2% of practices had no guidance to offer.ConclusionsDespite resource constraints, most reachable primary care practices offered timely new patient appointments as well as direct COVID-19 care. Pandemic mitigation strategies should account for and support the central role of primary care practices in the community-based pandemic response.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06804-7.

Knowledge, Attitude and Practice of Primary Care Physicians in Dealing with Acute Stroke in Indonesia

Objective: There are still many things that interfere with the practice of effective acute stroke management, with one of them being the failure of health workers providing appropriate management. Hence, this study was conducted to evaluate the level of knowledge, attitude and practices of primary care physicians (PCPs) in acute stroke management in Indonesia.Material and Methods: This cross-sectional face-to-face survey was conducted among all PCPs, from 63 primary health care centres; from October, 2019 to January, 2020 in Surabaya, Indonesia. A self-designed questionnaire, consisting of 25 questions, based on several guidelines, was used as the instrument of this survey.Results: In total, 134 PCPs participated. The majority of their level of knowledge obtained was in the moderate category (51.5%), while the majority of their attitude and practices towards stroke were in the good category (67.9% and 75.2%). Nearly 75.0% of PCPs also knew about thrombolytic therapy, but only &lt;50.0% knew the ‘golden period’ of thrombolytic therapy. A significant correlation was found between PCPs knowledge-attitude (p-value&lt;0.001), knowledge-practices (p-value=0.002) and attitude-practices (p-value&lt;0.001). There was also a significant difference in the level of stroke knowledge between PCPs, with different clinical practice experience (p-value=0.015). Better stroke knowledge tended to be obtained by PCPs with younger clinical practice experience.Conclusion: The level of knowledge, attitude and practices of PCPs in acute stroke management in Indonesia is good, but should still be improved; especially knowledge about the use of thrombolytic therapy and its ‘golden period.’

Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020

Headache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organized in Denmark. This description is followed by sections on the characteristics, diagnosis and treatment of each of the most common primary and secondary headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular challenges regarding migraine and female hormones as well as headache in children are addressed.

Can Machine Learning and AI Replace Otoscopy for Diagnosis of Otitis Media?

* Abbreviations: AI — : artificial intelligence AOM — : acute otitis media OCT — : optical coherence tomography OME — : otitis media with effusion TM — : tympanic membrane In this issue of Pediatrics , Crowson et al1 provide a glimpse to the future for otitis media (OM) diagnosis, perhaps. Data acquisition from 126 normal and 212 abnormal ear images met study quality criteria when children were brought to the operating room for an examination under anesthesia for tympanostomy tube placement for either recurrent acute otitis media (AOM) or otitis media with effusion (OME). To meet the quality criteria, 75% of the surface area of the tympanic membrane (TM) had to be visible and there had to be sufficient resolution to assess major landmarks. The otolaryngologist classified each ear at the time of myringotomy as effusion present or absent. If an effusion was present, the effusion was categorized as either serous, serous/mucoid, mucopurulent, or purulent. However, the deep learning model was used to target only a binary output of no effusion as normal or any effusion or any degree of TM pathology as abnormal. The model achieved a mean image classification accuracy of 83.8% (95% confidence interval: 82.7%–84.8%). In the hands of an experienced and trained clinician intent on making a correct diagnosis, … Address correspondence to Michael E. Pichichero, MD, Research Institute at Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621. E-mail: michael.pichichero{at}rochesterregional.org

Improving Effective Mental Health Consultation for Rural Older Adults Living With Depression and Pain: Learning From the Experiences of Rural Primary Care Physicians.

Novel approaches are needed to assist rural primary care physicians (PCPs) in caring for older patients living with depression and pain who are at an elevated suicide risk. To refine and improve a model of care (PREDICTOR: Pharmacy Identification and Primary Care Intervention of Older Adults at Risk for Suicide), we conducted qualitative interviews with rural PCPs about (1) caring for seniors with depression, pain, and suicidality and (2) their favored procedures for working with psychiatric consultants and the professional characteristics desired in an effective consultant. The study utilized a best-practice approach (including double coding) for qualitative interviews with 10 PCPs practicing in rural Pennsylvania. PCPs were interviewed about 3 themes related to caring for older adults with depression, pain, and suicidal ideation and working with psychiatric consultants. The study was conducted from January 2019 to May 2019. Four primary themes emerged from the interviews. (1) Rural PCPs become comfortable managing depression in older adults out of necessity, but desire collaboration on more complex mental health care. (2) Comorbid depression and pain are universally described as related through a vicious cycle in older adults. (3) Rural PCPs experience varying comfort with prescribing opioids for pain management in older patients, but most prefer not to prescribe opioids, and some refuse to do so. (4) PCPs endorsed the PREDICTOR remote consultation model as potentially beneficial to themselves and their older patients, but strongly desired that the consultant work with them as collaborators and for a collegial professional relationship with the mental health specialist. Rural PCPs are comfortable with remote consultation for older patients living with depression but desire collegial relationships with these consultants, supporting a collaborative approach. We describe explicit plans for implementing these findings as we refine PREDICTOR, in efforts to promote PCP practice change.

Диабетическая периферическая полинейропатия в практике врача первичного звена

Диабетическая периферическая сенсомоторная нейропатия относится к числу наиболее распространенных осложнений сахарного диабета. Диагностика диабетической периферической нейропатии состоит из оценки симптомов и клинического неврологического обследования с применением количественных тестов для оценки степени выраженности неврологических расстройств. В статье рассматриваются современные подходы к комплексному лечению болевой формы диабетической периферической нейропатии, начиная с компенсации углеводного обмена. Если, несмотря на нормализацию гликемии, у пациента сохраняются жалобы на боли или другие неприятные ощущения, необходимо назначать средства патогенетической либо симптоматической направленности с целью их уменьшения или полного исчезновения. Рассмотрены средства местной терапии для лечения диабетической периферической нейропатии, целью которой является купирование болевой симптоматики (антидепрессанты, противосудорожные средства, анальгетики, средства местного воздействия), а также средства патогенетической терапии, базирующиеся на воздействии на основные патогенетические компоненты диабетической периферической нейропатии (применение препаратов α-липоевой (тиоктовой) кислоты). Diabetic peripheral sensorimotor neuropathy is one of the most common complications of diabetes mellitus. Diagnosis of diabetic peripheral neuropathy consists of symptom assessment and clinical neurologic examination using quantitative tests to assess the severity of neurologic disorders. The article discusses modern approaches to the complex treatment of pain form of diabetic peripheral neuropathy, starting with the compensation of carbohydrate metabolism. If, despite the normalization of glycemia, the patient continues to complain of pain or other unpleasant sensations, it is necessary to prescribe pathogenetic or symptomatic agents in order to reduce or completely disappear. The means of local therapy for the treatment of diabetic peripheral neuropathy, the purpose of which is to relieve pain symptoms (antidepressants, anticonvulsants, analgesics, topical agents), as well as pathogenetic therapy, based on the effect on the main pathogenetic components of diabetic peripheral neuropathy (use of drugs α-lipoic (thioctic) acid).

Chronic cerebral ischemia and headache in patients in primary care physician's practice

Today, chronic cerebral ischemia (CCI) is the most common diagnosis in our country, both in neurological and general medical practice. The high frequency of comorbid conditions and diseases predisposing to the development of CCI, and the association with the risk of stroke and dementia, which increase patient disability, make CCI an urgent medical and social problem. Proper diagnosis of CCI allows the prescription of effective treatment, prevents the disease progression, and the development of strokes and dementia. The article deals with the treatment principles for elderly and senile patients with headache and CCI in outpatient practice. It discusses the causes of headache in CCI patients and its treatment methods. It also covers in depth the spectrum of therapeutic effects of Neurox ® (ethylmethylhydroxypyridine succinate) and Neupilept ® (citicoline) in this category of patients.

Primary Care Physician Perspectives on Recommending E-cigarettes to Smokers: a Best-Worst Discrete Choice Experiment.

Recent clinical trials suggest that e-cigarettes may be more effective for smoking cessation than traditional cessation aids, yet primary care physician (PCP) practices regarding e-cigarette recommendations for smokers have not been studied in-depth. To identify factors influencing PCP recommendation of e-cigarettes for smoking cessation. Discrete choice experiment and survey. Florida PCPs. The survey included a discrete choice experiment in which PCPs indicated whether they would recommend e-cigarettes for each of 8 hypothetical patient profiles with the following contrasting characteristics: e-cigarette use, interest in approved cessation methods, smoking intensity, prior experience with approved cessation medications, quit intention, age, and comorbidity. Responses were summarized using descriptive statistics and standardized scores (SS). The sample (n = 216) was predominately male (76%), white (66%), and non-Hispanic (78%), and most respondents had held their medical degree for 20+ years (77%). The response rate was 28.7%. Most PCPs thought e-cigarettes were at least somewhat effective for smoking cessation (66%) and lowering disease risk (65%); 31% perceived e-cigarettes to be equally/more effective than traditional cessation aids. PCPs were split regarding whether e-cigarettes were less (50%) or equally harmful (38%) as cigarettes. Yet, few were very confident in their ability to counsel patients on e-cigarettes risks (27%) or benefits (15%). PCPs recommended e-cigarettes in 27% of patient profiles they evaluated. The most important factors influencing the decision to recommend or not recommend e-cigarette were patients' prior use of nicotine replacement therapy with (SS = 0.22, 95% CI = 0.17-0.27) and without use of other medications for cessation (SS = 0.18, 95% CI = 0.13-0.23), and being middle age (50years old) with chronic obstructive pulmonary disease (SS = 0.16, 95% CI = 0.10-0.23). Considering the increased patient use of e-cigarettes and increasing use for cessation, this study highlights the need for guidelines and education to aid PCPs' counseling of patients about e-cigarette use.

The scope of practice of primary health care physicians in rural and urban areas in Brazil.

This study aimed to identify differences in the scope of practice of primary care physicians and find the main factors associated with expanded practice in rural and urban areas of Brazil. Data from an online survey with 2,277 primary care physicians, conducted between January and March 2016, were used. Differences regarding activities and procedures performed by physicians per area were verified using Kruskal-Wallis/Dunn's post hoc and chi-square tests. Multivariate linear regression analyses were done using a bootstrap technique to identify the main factors associated with an expanded scope of practice. Regardless of the location, the results showed that the practices of the primary care physicians are below their competences. Rural physicians performed a higher number of procedures and activities compared with their peers from intermediate and urban municipalities. Within the overall sample, the variables related to a broader scope of practice included: male gender, work in rural municipalities, participation in training and continuing education programs and consultation of clinical protocols, articles and books. This study contributes with evidence that the medical scope of practice varies according to location. Recognizing and understanding the differences and associated factors for an expanded scope of practice is necessary to determine the skills and resources required for practice in rural and urban areas, collaborating in proposals of strategies to improve quality and access of health care services.