Symptoms In Primary Care Research Articles

Cancer incidence and competing mortality risk following 15 presenting symptoms in primary care: a population-based cohort study using electronic healthcare records

·ObjectivesAssessment of age, sex and smoking-specific risk of cancer diagnosis and non-cancer mortality following primary care consultation for 15 new-onset symptoms.Methods and analysisData on patients aged 30–99 in 2007–2017 were...

Study on OSA screening and influencing factors in community-based elderly hypertensive patients based on single-lead wearable ECG devices.

Assessing whether single-lead ECG can be effectively and relatively inexpensively used in large-scale OSA screening, and identifying factors influencing moderate-to-severe OSA among elderly hypertensive patients without atypical symptoms in primary care. The study gathered data from 15 medical institutions in Ningxia between January and December 2022 using cloud platforms. The dataset included basic information and 72-h ECG monitoring for 2573 hypertensive patients over 65. OSA screening was conducted using the single-lead wearable ECG devices based on the ACAT algorithm. A multivariable logistic regression identified the main factors affecting OSA severity in these patients, and the AUC was used to assess the model's predictive accuracy. The study found an OSA detection rate of 87.10%, with 55.42% being moderate to severe cases. Key risk factors associated with developing moderate-to-severe OSA included cardiac irregularities like supraventricular extrasystole and atrioventricular block, male gender, lifestyle factors like alcohol consumption and smoking, and health indicators such as SDNN ≤ 100ms, abnormal LF/HF ratio, BMI, and age. The model's accuracy for predicting OSA, indicated by a ROAUC of 0.625, was moderate. Factors like gender, tea consumption, stroke history, and ventricular tachycardia were also independently linked to OSA severity. This study combines single-lead wearable ECG devices with the ACAT algorithm for OSA screening in Ningxia, China. Initial screening identified 87.10% of participants as having OSA, with 55.42% being moderate to severe cases. This suggests a convenient, low-cost, and repeatable ECG-based method for OSA screening, potentially improving early detection and management of OSA by identifying potential risk factors.

Predictive value of abnormal blood tests for detecting cancer in primary care patients with nonspecific abdominal symptoms: A population-based cohort study of 477,870 patients in England.

Identifying patients presenting with nonspecific abdominal symptoms who have underlying cancer is a challenge. Common blood tests are widely used to investigate these symptoms in primary care, but their predictive value for detecting cancer in this context is unknown. We quantify the predictive value of 19 abnormal blood test results for detecting underlying cancer in patients presenting with 2 nonspecific abdominal symptoms. Using data from the UK Clinical Practice Research Datalink (CPRD) linked to the National Cancer Registry, Hospital Episode Statistics and Index of Multiple Deprivation, we conducted a population-based cohort study of patients aged ≥30 presenting to English general practice with abdominal pain or bloating between January 2007 and October 2016. Positive and negative predictive values (PPV and NPV), sensitivity, and specificity for cancer diagnosis (overall and by cancer site) were calculated for 19 abnormal blood test results co-occurring in primary care within 3 months of abdominal pain or bloating presentations. A total of 9,427/425,549 (2.2%) patients with abdominal pain and 1,148/52,321 (2.2%) with abdominal bloating were diagnosed with cancer within 12 months post-presentation. For both symptoms, in both males and females aged ≥60, the PPV for cancer exceeded the 3% risk threshold used by the UK National Institute for Health and Care Excellence for recommending urgent specialist cancer referral. Concurrent blood tests were performed in two thirds of all patients (64% with abdominal pain and 70% with bloating). In patients aged 30 to 59, several blood abnormalities updated a patient's cancer risk to above the 3% threshold: For example, in females aged 50 to 59 with abdominal bloating, pre-blood test cancer risk of 1.6% increased to: 10% with raised ferritin, 9% with low albumin, 8% with raised platelets, 6% with raised inflammatory markers, and 4% with anaemia. Compared to risk assessment solely based on presenting symptom, age and sex, for every 1,000 patients with abdominal bloating, assessment incorporating information from blood test results would result in 63 additional urgent suspected cancer referrals and would identify 3 extra cancer patients through this route (a 16% relative increase in cancer diagnosis yield). Study limitations include reliance on completeness of coding of symptoms in primary care records and possible variation in PPVs if extrapolated to healthcare settings with higher or lower rates of blood test use. In patients consulting with nonspecific abdominal symptoms, the assessment of cancer risk based on symptoms, age and sex alone can be substantially enhanced by considering additional information from common blood test results. Male and female patients aged ≥60 presenting to primary care with abdominal pain or bloating warrant consideration for urgent cancer referral or investigation. Further cancer assessment should also be considered in patients aged 30 to 59 with concurrent blood test abnormalities. This approach can detect additional patients with underlying cancer through expedited referral routes and can guide decisions on specialist referrals and investigation strategies for different cancer sites.

Development and psychometric evaluation of a questionnaire for the assessment of depression in primary care: a cross-sectional study

ObjectivesTo develop a new questionnaire for the diagnostic assessment of depression adapted to the primary care setting by combining psychiatric criteria and heuristics of general practitioners (GPs). Psychometric evaluation of...

The impact of primary-care led, faecal immunochemical test-based, triage of new-onset colorectal symptoms on time to diagnosis of colorectal cancer-An observational study.

Since December 2015, a faecal immunochemical test (FIT) has been provided to primary care in NHS Tayside as an adjunct to clinical acumen in the assessment of new-onset bowel symptoms. The aim of this work was to assess the impact of this approach on time to diagnosis of colorectal cancer (CRC). NHS Tayside Cancer audit data from January 2013 to December 2019 were reviewed to identify all CRC patients diagnosed via the primary-care referral pathway for a period before and after the introduction of FIT. Their electronic patient records were accessed and date of referral and any contemporaneous FIT and full blood count (FBC) result were recorded. Time from referral to diagnosis of CRC was calculated for each patient and compared between subgroups. The study cohort consisted of 959 patients: 378 and 581 from the time periods before and after the introduction of FIT, respectively. The median time to diagnosis before FIT was 30 days [interquartile range (IQR) 16-57 days] versus 25 days (IQR 14-47 days) following the introduction of FIT (p = 0.006). Following the introduction of FIT, patients who completed a FIT had a median of time to diagnosis of 23 days (IQR 14-43 days) compared with 30 days (IQR 16-62 days) for patients not completing a FIT (p = 0.019). FBC results were available for 97.5% of FIT patients to aid safety-netting of patients with a low or undetectable faecal haemoglobin concentration. The introduction of FIT-based triage of new bowel symptoms in primary care as an adjunct to clinical acumen is associated with a reduced time to CRC diagnosis.

Assessing Substance Use Disorder Symptoms with a Checklist among Primary Care Patients with Opioid Use Disorder and/or Long-Term Opioid Treatment: An Observational Study.

Primary care (PC) offers an opportunity to treat opioid use disorders (OUD). The Substance Use Symptom Checklist ("Checklist") can assess DSM-5 substance use disorder (SUD) symptoms in PC. To test the psychometric properties of the Checklist among PC patients with OUD or long-term opioid therapy (LTOT) in Kaiser Permanente Washington (KPWA). Observational study using item response theory (IRT) and differential itemfunctioning (DIF) analyses of measurement consistency across age, sex, race and ethnicity, and receipt of treatment. Electronic health records (EHR) data were extracted for all adult PC patients visiting KPWA 3/1/15-8/30/2020 who had ≥ 1 Checklist documented and indication of either (a) clinically-recognized OUD (i.e., documented OUD diagnosis and/or OUD medication treatment) or (b) LTOT in the year prior to the checklist. The Checklist includes 11 items reflecting DSM-5 criteria for SUD. We described the prevalence of 2 SUD symptoms reported on the Checklist (consistent with mild-severe DSM-5 SUD). Analyses were conducted in the overall sample and in two subsamples (clinically-recognized OUD and LTOT only). Among 2007 eligible patients, 39.9% endorsed ≥ 2 SUD symptoms (74.3% in the clinically-recognized OUD subsample and 13.1% in LTOT subsample). IRT indicated that a unidimensional model for the 11 checklist items had excellent fit (comparative fit index = 0.998) with high item-level discrimination parameters for the overall sample and both subsamples. DIF across age, race and ethnicity, and treatment was observed for one item each, but had minimal impact on expected number of criteria (0-11) patients endorse. The Substance Use Symptom Checklist measured SUD symptoms consistent with DSM-5 conceptualization (scaled, unidimensional) in patients with clinically-recognized OUD and LTOT and had similar measurement properties across demographic subgroups. The Checklist may support symptom assessment in patients with OUD and diagnosis in patients with LTOT.

Improving Diagnosis and Care for Patients With Sarcoma: Do Real-World General Practitioners Data and Prospective Data Collections Have a Place Next to Clinical Trials?

There has been growing interest in the use of real-world data (RWD) to address clinically and policy-relevant (research) questions that cannot be answered with data from randomized controlled trials (RCTs) alone. This is, for example, the case in rare malignancies such as sarcomas as limited patient numbers pose challenges in conducting RCTs within feasible timeliness, a manageable number of collaborators, and statistical power. This narrative review explores the potential of RWD to generate real-world evidence (RWE) in sarcoma research, elucidating its application across different phases of the patient journey, from prediagnosis to the follow-up/survivorship phase. For instance, examining electronic health records (EHRs) from general practitioners (GPs) enables the exploration of consultation frequency and presenting symptoms in primary care before a sarcoma diagnosis. In addition, alternative study designs that integrate RWD with well-designed observational RCTs may offer relevant information on the effectiveness of clinical treatments. As, especially in cases of ultrarare sarcomas, it can be an extreme challenge to perform well-powered randomized prospective studies. Therefore, it is crucial to support the adaptation of novel study designs. Regarding the follow-up/survivorship phase, examining EHR from primary and secondary care can provide valuable insights into identifying the short- and long-term effects of treatment over an extended follow-up period. The utilization of RWD also comes with several challenges, including issues related to data quality and privacy, as described in this study. Notwithstanding these challenges, this study underscores the potential of RWD to bridge, at least partially, gaps between evidence and practice and holds promise in contributing to the improvement of sarcoma care.

OA03 Developing a multivariable prediction model to identify anti-CCP positive individuals among those with non-specific musculoskeletal symptoms in primary care

Abstract Background/Aims A phase of immunologically imminent rheumatoid arthritis (RA) precedes the onset of clinical RA, characterised by increased circulating anti-cyclic citrullinated peptide (anti-CCP) antibodies. Early identification in the pre-clinical phase of RA in primary care (PC), through targeted anti-CCP testing, could prompt secondary care referral for earlier diagnosis, achieving better long-term outcomes. This study aimed to develop a model identifying those likely to be anti-CCP positive amongst people presenting to PC with non-specific musculoskeletal symptoms. Methods Participants were recruited across the UK between 2014 and 2020 to the Leeds ‘Co-ordinated Programme to Prevent Arthritis’, a prospective, observational cohort study. Participants were aged ≥18 years who presented to PC with non-specific musculoskeletal symptoms and no history of clinical synovitis. Fifteen baseline predictors were considered: age; gender; smoking status; first degree relative (FDR) with RA; and patient reported pain in: neck; back; shoulders; elbows; hips; wrists; thumbs; hand and/or fingers; knees; ankles; foot and/or toes. Participants were followed up at 12 months to determine if they had developed RA. Analysis was performed in R. Variable selection was carried out via LASSO logistic regression. Model performance was assessed using area under the receiver operating characteristic curve (ROC AUC); decision curve analysis was utilised to assess clinical utility. Internal validation was carried out via 200 bootstrap re-samples with replacement to estimate corrected model fit estimates. Results Analysis included 6,879 participants; 203 (2.95%) anti-CCP positive. Thirteen predictors were retained (age and ankles omitted); scores for each predictor were: sex (male) [+3], FDR with RA [+3], smoking (ever) [+2], pain in back [-3], neck [-2], knee [-1], wrist [+4], foot/toes [+3], hand/fingers [+3], shoulder [+3], thumb [+1]. With a score of ≥ 11 (≥4% risk) for anti-CCP testing, the ROC AUC was 0.65 (95% CI [0.61-0.69], corrected AUC=0.49). Choosing a threshold of 4% suggested that the benefit of testing one anti-CCP positive patient is 24 times larger than the harm of testing one anti-CCP negative patient. Sensitivity and specificity were 38.42 and 81.88 and positive- and negative-predicted values were 6.06 and 97.76. The net benefit was 0.0040 (corrected=0.0026). This threshold resulted in 19% being tested, corresponding to 39% of all anti-CCP positive participants. 12 month follow-up data were available for 2,480 participants. Out of those who would be tested using our model, 6.68% developed RA, compared with 1.94% if everyone was tested. Out of those tested who were anti-CCP positive, 56.85% developed RA (amongst those tested who were anti-CCP negative, 1.23% developed RA). Conclusion Targeted use of anti-CCP testing in PC may prompt earlier identification of people at risk of RA. Interviews with PC clinicians are currently being undertaken to understand the key behaviours required to support clinicians using this prediction model, alongside heath economic modelling to explore potential cost-effectiveness. Disclosure H.J. Siddle: Grants/research support; HJS has received funding from HEE/NIHR for this research [ICA-SCL-2018-04-ST2-004]. M. Wilson: None. J.L. Nam: None. L. Garcia-Montoya: None. L. Duquenne: None. K. Mankia: Consultancies; Serac Lifesciences. Honoraria; Galapagos, Lilly, Abbvie. Grants/research support; Eli Lilly, Gilead. Other; Attending meetings/travel: Abbvie. P. Emery: Consultancies; Lilly, Galapagos. Honoraria; Novartis, Lilly, Abbvie, Gilead, Galapagos. Grants/research support; Lilly, Samsung. Other; Advisory Board: Lilly, Astra Zeneca, BMS. E.M.A. Hensor: Grants/research support; Institution level grant for the NIHR Leeds Biomedical Research Centre.

The Time to Inflammatory Bowel Disease Diagnosis for Patients Presenting with Abdominal Symptoms in Primary Care and its Association with Emergency Hospital Admissions and Surgery: A Retrospective Cohort Study.

Patients with inflammatory bowel disease (IBD) presenting to primary care may experience diagnostic delays. We aimed to evaluate this and assess whether time to diagnosis is associated with clinical outcomes. A retrospective cohort study using English primary care data from January 1, 2010, to December 31, 2019, linked to hospital admission data was undertaken. Patients were followed from the first IBD-related presentation in primary care to IBD diagnosis. Associations of time to diagnosis exceeding a year were assessed using a Robust Poisson regression model. Associations between time to diagnosis and IBD-related emergency hospital admissions and surgery were assessed using Poisson and Cox proportional hazards models, respectively. Of 28 092 IBD patients, 60% had ulcerative colitis (UC) and 40% had Crohn's disease (CD). The median age was 43 (interquartile range, 30-58) years and 51.9% were female. Median time to diagnosis was 15.6 (interquartile range, 4.3-28.1) months. Factors associated with more than a year to diagnosis included female sex (adjusted risk ratio [aRR], 1.23; 95% CI, 1.21-1.26), older age (aRR, 1.05; 95% CI, 1.01-1.10; comparing >70 years of age with 18-30 years of age), obesity (aRR, 1.03; 95% CI, 1.00-1.06), smoking (aRR, 1.05; 95% CI, 1.02-1.08), CD compared with UC (aRR, 1.13; 95% CI, 1.11-1.16), and a fecal calprotectin over 500 μg/g (aRR, 0.89; 95% CI, 0.82-0.95). The highest quartile of time to diagnosis compared with the lowest was associated with IBD-related emergency admissions (incidence rate ratio, 1.06; 95% CI, 1.01-1.11). Longer times to IBD diagnoses were associated with being female, advanced age, obesity, smoking, and Crohn's disease. More IBD-related emergency admissions were observed in patients with a prolonged time to diagnosis.

Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study

Objective To explore in a primary care setting the associations between patients’ daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures Association between self-reported BP and 10 self-report lifestyle-related variables. Results Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.

Otorrhoea – the discharging ear

Otorrhoea - discharge from the external auditory meatus – is a common presenting symptom in primary care in both children and adults. It may indicate infection or inflammation of the external or middle ear and is often accompanied by pain or hearing loss. Otorrhoea can be worrying and distressing for patients, and can impact school or work attendance. Both ear pain and discharge feature prominently within the clinical topic guide for ear nose and throat in the GP curriculum and commonly appears as a question in the Applied Knowledge Test examination. This article will review the most common causes of otorrhoea, how they may be differentiated, and their management.

DOMINO trial post hoc analysis: evaluation of the diet effects on symptoms in IBS subtypes.

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterized by recurrent abdominal pain related to defecation and/or associated to a change in bowel habits. According to the stool type, four different IBS subtypes can be recognized, constipation predominant (IBS-C), diarrhea predominant (IBS-D), mixed (IBS-M), and undefined (IBS-U). Patients report that their IBS symptoms are exacerbated by food. Thus, it is important to find a nutritional approach that could be effective in reducing IBS symptoms. The present work is a post hoc analysis of the previously published DOMINO trial. It aimed to evaluate the effects of a self-instructed FODMAP-lowering diet smartphone application on symptoms and psychosocial aspects in primary care IBS stratifying the results for each IBS subtypes. Post hoc analysis. Two hundred twenty-two primary care IBS patients followed a FODMAP-lowering diet for 8 weeks with the support of a smartphone application. Two follow-up visits were scheduled after 16 and 24 weeks. IBS-Symptoms Severity Score (IBS-SSS), quality of life (QoL), and adherence and dietary satisfaction were evaluated. After 8 weeks, IBS-SSS improved in all IBS subtypes (p < 0.0001). Physician Health Questiionnaire (PHQ-15) improved only in IBS-D (p = 0.0006), whereas QoL improved both in IBS-D (p = 0.01) and IBS-M (p = 0.005). This post hoc analysis showed that the app is useful in all IBS subtypes; thus, it could be used as an effective tool by both general practitioners and patients to manage symptoms in primary care. Ethical Commission University Hospital of Leuven reference number: S59482. Clinicaltrial.gov reference number: NCT04270487.

Study protocol for a nationwide implementation of internet-based vestibular rehabilitation for patients with chronic vestibular symptoms (I-RECOVER)

BackgroundVestibular rehabilitation is a safe and effective exercise-based treatment for patients with chronic vestibular symptoms. However, it is underused in general practice. Internet-based vestibular rehabilitation (Vertigo Training), which has proven to be effective as well, was developed to increase uptake. We now aim to improve the quality of care for patients with vestibular symptoms by carrying out a nationwide implementation of Vertigo Training. We will evaluate the effect of this implementation on primary care.MethodsOur implementation study consists of three successive phases:1) We will perform a retrospective observational cohort study and a qualitative interview study to evaluate the current management of patients with vestibular symptoms in primary care, in particular anti-vertigo drug prescriptions, and identify areas for improvement. We will use the results of this phase to tailor our implementation strategy to the needs of general practitioners (GPs) and patients.2) This phase entails the implementation of Vertigo Training using a multicomponent implementation strategy, containing: guideline adaptations; marketing strategy; pharmacotherapeutic audit and feedback meetings; education; clinical decision support; and local champions.3) In this phase, we will evaluate the effect of the implementation in three ways.a. Interrupted time series. We will use routine primary care data from adult patients with vestibular symptoms to compare the number of GP consultations for vestibular symptoms, referrals for vestibular rehabilitation, prescriptions for anti-vertigo drugs, and referrals to physiotherapy and secondary care before and after implementation.b. Prospective observational cohort study. We will extract data from Vertigo Training to investigate the usage and the characteristics of participants. We will also determine whether these characteristics are associated with successful treatment.c. Qualitative interview study. We will conduct interviews with GPs to explore their experiences with the implementation.DiscussionThis is one of the first studies to evaluate the effect of a nationwide implementation of an innovative treatment on Dutch primary care. Implementation strategies have been researched before, but it remains unclear which ones are the most effective and under what conditions. We therefore expect to gain relevant insights for future projects that aim to implement innovations in primary care.

Extramammary Paget&amp;rsquo;s disease: Persistent pruritus vulvae is an alarming symptom in primary care

No abstract available

A qualitative exploration of participant experiences of using Alpha-Stim AID for the treatment of moderate severity depressive symptoms in primary care

BackgroundAlpha-Stim AID is a device for the treatment of anxiety, insomnia and depression. Evidence on patient experiences of using the device for depressive symptoms is scarce. We explored participant experiences of the device during a randomised controlled trial comparing active versus sham Alpha-Stim AID (Alpha-Stim-D Trial) for the treatment of depressive symptoms in primary care. MethodsFourteen qualitative semi-structured interviews were conducted via Microsoft Teams or over the telephone six months after recruitment to the trial had finished. Participants reported moderate severity depressive symptoms (mean PHQ-9 score of 15.8), 50% were male and the mean age was 40.0 years (age range 19–65 years). Interviews were analysed using inductive reflexive thematic analysis. ResultsParticipants’ initial views of the Alpha-Stim AID device was that it was an interesting and novel treatment for depressive symptoms, although some were initially wary that the device may change brain function. Many found the device (active and sham) straightforward to use, portable and easy to incorporate into their life with positive effects on mood, anxiety and sleep. Some experienced difficulties with the battery, ear clips and wires. Additional challenges included the stigma of drawing attention to their need for a mental health treatment, device cost, and experiencing no change or worsening of symptoms. LimitationsThe study lacked perspectives from participants who decided not to commence using the Alpha-Stim AID device or complete treatment. ConclusionsPeople with depressive symptoms were interested in using the Alpha-Stim AID, as it provided an alternative accessible treatment option. Despite experienced barriers, Alpha-Stim AID was perceived favourably by most participants. Participant experience may be enhanced by addressing device impracticalities, but its cost could restrict treatment accessibility.

PRimary carE digital Support ToOl in mental health (PRESTO): Design, development and study protocols

BackgroundAbout 30–50% of Primary Care (PC) users in Spain suffer mental health problems, mostly mild to moderate anxious and depressive symptoms, which account for 2% of Spain's total Gross domestic product and 50% of the costs associated to all mental disorders. Mobile health tools have demonstrated to cost-effectively reduce anxious and depressive symptoms while machine learning (ML) techniques have shown to accurately detect severe cases. The main aim of this project is to develop a comprehensive ML digital support platform (PRESTO) to cost-effectively screen, assess, triage, and provide personalized treatments for anxious and depressive symptoms in PC. MethodsThe project will be carried out in 3 complementary phases: First, a ML predictive severity model will be built based on all the cases referred to the PC mental health support programme during the last 5 years in Catalonia. Simultaneously, a smartphone app to monitor and deliver psychological interventions for anxiety and depressive symptoms will be developed and tested in a clinical trial. Finally, the ML models and the app will be integrated in a comprehensive decision-support platform (PRESTO) which will triage and assign to each patient a specific intervention based on individual personal and clinical characteristics. The effectiveness of PRESTO to reduce waiting times in receiving mental healthcare will be tested in a stepped-wedge cluster randomized controlled trial in 5 PC centres. DiscussionPRESTO will offer timely and personalized cost-effective mental health treatment to people with mild to moderate anxious and depressive symptoms. This will result in a reduction of the burden of mental health problems in PC and on society as a whole. Trial registrationThe project and their clinical trials were registered in Clinical Trials.gov: NCT04559360 (September 2020).

Aile hekimliği polikliniğine başvuran hastalarda anal semptom varlığının sorgulanması

Introduction: Patients usually hide anal region diseases due to the sensitivity of the anal area. Questioning and successfully managing anal region disease symptoms in primary care will prevent late diagnosis of underlying diseases. This study aims to investigate the presence of anal symptoms in patients admitted to family medicine outpatient clinics for any reason. Methods: Our research is a descriptive study. A questionnaire form was created by scanning the literature, was applied by 5 different research assistants to patients aged 18 and over who applied to the family medicine outpatient clinic. It is aimed to reach the maximum number of individuals with the improbable sample. Results: 64.8% of the 165 participants included in the study are female, and 35.2% are male, with a mean age of 35,69 ± 14,53 (Min:18, Max:75). Anal symptoms were detected in 46 patients (27.9%) after questioning. The most frequently reported symptoms were constipation with a rate of 14.5% (n=24), rectal pain at a rate of 7.9% (n=13), rectal bleeding at a rate of 7.3% (n=12), rectal swelling at a rate of 5.5% (n=9) and rectal itching at a rate of 3.6% (n=6). 81.8% of these patients reported that they could share with their doctor when they have symptoms of moderate severity and above. 86.1% (n=142) said they would accept digital rectal examinations if necessary. Conclusion: It is crucial to determine the prevalence of anal symptoms in the general population. Although these symptoms affect the quality of life by causing severe pain and discomfort, they are rarely shared by patients. Routine questioning and examination of anal area symptoms enable more effective disease management. The majority of cases can be diagnosed after examination in primary care. Therefore, the first step is essential for the early diagnosis and treatment of these diseases. Keywords: Rectal Disease, Family Medicine, Digital Rectal Examination

Irritable bowel syndrome in children with chronic gastrointestinal symptoms in primary care.

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder in children. However, in primary care, it is still unknown whether there are differences in the prognosis of children with IBS compared to other diagnostic subgroups. Therefore, our aim was to describe the course of symptoms and health-related quality of life (HRQoL) for children with chronic gastrointestinal symptoms who either do or do not fulfil the Rome criteria for IBS in primary care. Second, we compared the diagnosis of the general practitioner (GP) with the Rome criteria. We conducted a prospective cohort study with 1-year follow-up, including children aged 4-18 years with chronic diarrhoea and/or chronic abdominal pain in primary care. During follow-up, the Rome III questionnaire, Child Health Questionnaire, and symptom questionnaires were completed. A total of 60/104 children (57.7%) fulfilled the Rome criteria for IBS at baseline. Compared to children without IBS, children with IBS were more commonly referred to secondary care, used more laxatives, and more often developed chronic diarrhoea and low physical HRQoL during 1 year. The diagnosis "IBS" from the GP matched the Rome criteria for only 10% of children, as most were diagnosed with "Constipation." There seems to be a difference in the treatment and prognosis of symptoms and HRQoL between children with and without IBS in primary care. This suggests that it is relevant to differentiate between these groups. The evaluation and use of feasible criteria to define IBS in different healthcare settings remains subject for further studies.

Complex therapy for prolonged cough in infectious and inflammatory diseases of the upper respiratory tract: case report

Cough is one of the most common symptoms in primary care. Despite the fact that a persistent cough resolves on its own in most cases and does not require special treatment, it can significantly reduce the quality of life and require large financial costs for treatment. Infectious and inflammatory diseases of the upper respiratory tract are one of the most common pathologies accompanied by cough. Protracted cough can significantly aggravate the course of the disease, and its duration for more than 4 weeks may indicate a chronic process. Drug therapy should be specific and combined, i.e. it should be aimed at the etiology of the disease, the pathogenetic mechanisms underlying it, and at alleviating symptoms, which leads to a speedy recovery of the patient. The article describes the causes leading to a prolonged cough in infectious and inflammatory diseases of the upper respiratory tract, the principles of differential diagnosis and some features of the treatment of persistent cough. Options for both etiotropic and pathogenetic therapy, as well as symptomatic treatment with ivy leaf extract and non-drug methods are given.In cases of infectious and inflammatory diseases of the upper respiratory tract and bronchi accompanied by a non-productive cough, adding of common ivy leaf extract to the treatment allows us to predict relief of sputum discharge, and, consequently, an improvement in the patient’s condition as early as on Day 4-5. It is important to note that this drug should not be used in combination with any antitussive drugs, as it makes it difficult to evacuate thin secret and results in its congestion in the airways. A clinical case of polyetiologic chronic cough combined treatment using reflexology is presented.

Early identification of persistent somatic symptoms in primary care: data-driven and theory-driven predictive modelling based on electronic medical records of Dutch general practices

ObjectiveThe present study aimed to early identify patients with persistent somatic symptoms (PSS) in primary care by exploring routine care data-based approaches.Design/settingA cohort study based on routine primary care data...