Tool For General Practitioners Research Articles

Telemedicine as a tool for continuing medical education.

There is a growing interest in the use of digital technologies to foster learning in the health professions, along with the drive to expand teleconsultations arising from the COVID-19 pandemic. This study aims to explore whether telemedicine between levels of care can act as continuous medical education (CME) tool for general practitioners (GPs) and hospital consultants at the referral cardiology department. This qualitative study was embedded in an organizational case study of the introduction of a new service model in the Portuguese health system. Semi-structured interviews were audio-recorded and pseudonymized. The transcribed interviews were stored, coded, and content analysis was performed in MAXQDA. A total of 11 physicians were interviewed. GPs and cardiologists recognized that telemedicine between levels of care could act as a CME tool. Although they departed with different expectations, telemedicine helped them collaborate as a multidisciplinary team, exchanging feedback about clinical decisions, and constructing knowledge collaboratively. Telemedicine also supplemented existing learning meetings. The consequences of technology adoption may be viewed as a result of the actors involved (including the technology itself), characteristics of the context (including the organization), and an interaction between such factors. Teleconsultations can be a learning opportunity for the health professionals involved. Our findings suggest that, in the context of the Portuguese health system, telemedicine as a CME tool helped to build multidisciplinary teams which exchanged feedback and constructed shared knowledge to improve patients' outcomes. It also helped to identify practice-changing contents to be included in face-to-face educational meetings.

Performance of urinary NT-proBNP in ambulatory settings

BackgroundNT-proBNP (N-terminal prohormone of brain natriuretic peptide) has been established as a useful biomarker in plasma for children with congenital heart disease (CHD). Plasma values were shown to correlate well with urinary values. We designed a study to investigate the general utility of urinary NT-proBNP in children with and without CHD in an ambulatory setting. Material and methods202 children (mean age 93 months (1–225 months)) were included in the analysis. We investigated the performance of urinary NT-proBNP values determined from spot urine as a diagnostic tool for different forms of congenital heart disease. ResultsUrinary NT-proBNP is a good diagnostic tool for children with congenital heart disease (ROC area under the curve 0.807). Combining these values with the Ross-classification further improves the diagnostic power (ROC area under the curve 0.831) Analysis also showed significant differences between Lg10 urinary NT-proBNP values of healthy controls and those of children after corrective surgery. Furthermore, children who have completed the stages of Fontan palliation showed higher values than age matched controls. ConclusionsUrinary NT-proBNP can be used in an ambulatory setting to discriminate between relevant and nonrelevant CHD and might be valuable as a follow up parameter for children after biventricular repair or univentricular palliation. Age dependant urinary NT-proBNP normal values for children could be an easy-to-use tool for general practitioners as well as specialised clinics.

The Role in Teledermoscopy of an Inexpensive and Easy-to-Use Smartphone Device for the Classification of Three Types of Skin Lesions Using Convolutional Neural Networks.

Background. The use of teledermatology has spread over the last years, especially during the recent SARS-Cov-2 pandemic. Teledermoscopy, an extension of teledermatology, consists of consulting dermoscopic images, also transmitted through smartphones, to remotely diagnose skin tumors or other dermatological diseases. The purpose of this work was to verify the diagnostic validity of images acquired with an inexpensive smartphone microscope (NurugoTM), employing convolutional neural networks (CNN) to classify malignant melanoma (MM), melanocytic nevus (MN), and seborrheic keratosis (SK). Methods. The CNN, trained with 600 dermatoscopic images from the ISIC (International Skin Imaging Collaboration) archive, was tested on three test sets: ISIC images, images acquired with the NurugoTM, and images acquired with a conventional dermatoscope. Results. The results obtained, although with some limitations due to the smartphone device and small data set, were encouraging, showing comparable results to the clinical dermatoscope and up to 80% accuracy (out of 10 images, two were misclassified) using the NurugoTM demonstrating how an amateur device can be used with reasonable levels of diagnostic accuracy. Conclusion. Considering the low cost and the ease of use, the NurugoTM device could be a useful tool for general practitioners (GPs) to perform the first triage of skin lesions, aiding the selection of lesions that require a face-to-face consultation with dermatologists.

P02-198 Validity and applicability of the mini international neuropsychiatric interview administered by family resident physicians in primary health care in Brazil

Purpose:To evaluate the “Mini International Neuropsychiatric Interview (MINI)” used by family resident physicians in primary health care (PHC) in Brazil.Methods:Training for administrating the MINI was given as part of a broad psychiatry education program, and was performed in PHC consultations. Interviews were held with 120 PHC patients. MINI was administered by 25 physicians, while the “Structured Clinical Interview for Diagnosis (SCID-I)” was administered by a psychiatrist. The physicians answered questions on the applicability of the MINI.Results:Concordance levels for the following diagnoses were analyzed: any mental disorder; depressive disorders in general, major depressive episode and dysthymia; anxiety disorders in general, generalized anxiety disorder and panic disorder; and substance abuse disorders. Kappa coefficients ranged between 0.65 and 0.85; sensitivity between 0.75 and 0.92; specificity, between 0.90 and 0.99; positive predictive values (PPV) between 0.60 and 0.86; negative predictive values (NPV) between 0.92 and 0.99; and accuracy between 0.88 and 0.98. The physicians considered MINI comprehensibility and clinical relevance satisfactory; the brevity of its administration was considered satisfactory for use with previous screening only.Conclusions:These good results may be related with more frequent, intensive, and diversified training in psychiatry. The MINI is a useful tool for general practitioners and should be part of the broad psychiatry education program offered to these professionals.

Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil

Objective To evaluate the validity and applicability of the Mini International Neuropsychiatric Interview (MINI) used by family medicine residents in primary health care (PHC) in Brazil. Methods Training for administrating the MINI was given as part of a broad psychiatry education program. Interviews were held with 120 PHC patients who were at least 15 years old. MINI was administered by 25 resident physicians, while the Structured Clinical Interview for Diagnosis (SCID) was administered by a psychiatrist blind to patients' results on the MINI, and the diagnoses on both interviews were compared. The resident physicians answered questions on the applicability of the MINI. Results Concordance levels for any mental disorder, the broader current diagnostic categories and the most common specific diagnoses were analyzed. Kappa coefficients ranged between 0.65 and 0.85; sensitivity, between 0.75 and 0.92; specificity, between 0.90 and 0.99; positive predictive values (PPV), between 0.60 and 0.86; negative predictive values (NPV), between 0.92 and 0.99; and accuracy, between 0.88 and 0.98. The resident physicians considered MINI comprehensibility and clinical relevance satisfactory. Conclusions These good psychometric results in a real-world setting may be related to a special training program, which is more frequent, intensive and diversified. In these conditions, the MINI is a useful tool for general practitioners.

Utility of the AIDA diabetes simulator as an interactive educational teaching tool for general practitioners (primary care physicians).

In previous "Diabetes Information Technology & WebWatch" columns, various user experience with an interactive educational "virtual diabetes patient" simulator called AIDA have been documented. The simulator is available free of charge from http://www.2aida.org on the Web, and user comments that have been received to date about the program have highlighted some of the many and varied ways in which a range of people have been applying the diabetes simulations in their own particular situations and practices. Inevitably, up to now, a great deal of attention has focused on use by individuals with diabetes and their relatives, as well as by health-care professionals such as diabetologists/endocrinologists and diabetes educators. However, an important group of health-carers involved in the provision of day-to-day care for many people with diabetes are primary care physicians (general practitioners). The current "Diabetes Information Technology & WebWatch" column addresses this area, overviewing a workshop which was held in September 2000 in Italy to gain experience with application of the AIDA diabetes simulation approach as a teaching tool for general practitioners (GPs). Feedback obtained from participants attending the workshop was very positive, with GPs reporting the simulation approach to be both of interest and use. Further workshops involving other healthcare professionals--in particular, nurses--are planned.

Information overload and “just‐in‐time” knowledge

We are all experiencing information overload. In the same way that the printing press has revolutionised the publishing industry, the Internet is revolutionising the amount of information available today. The ease with which electronic information can be stored, distributed and manipulated is threatening to enhance rather than to alleviate the information overload. We need to develop methodologies that will enable us to access relevant information at the time when it is required. The WaX system has been designed as a knowledge management tool for general practitioners to enable them to access the information they require within 15 to 30 seconds. It has been piloted in several regions in the UK with very positive results.

Multimedia education in headache: the European Neurological Network.

The European Neurological Network is a European Economic Community supported project. The purpose of the project was to develop a multimedia educational tool for general practitioners in order to improve their management of sleep disorders, epilepsy and headache. The project involves approximately one hundred engineers and physicians from Belgium, Denmark, England, Finland, France, Germany, Italy, Portugal and Spain. This paper concerns the multimedia educational tool on headache. The system consists of five different modules, i.e. classification, clinical data, headache tutorial, diagnostic headache diary and nomenclature. It is possible to move between the modules both vertically and horizontally. The headache classification of the International Headache Society is provided in full text as a work of reference. This classification is used world wide and has been adopted by International Classification of Diseases 10 Neurological Adaptation (ICD-10 NA) and the World Health Organisation. The clinical data concentrate on migraine and tension-type headache, the two most common headache disorders, but data on familial hemiplegic migraine, cluster headache, drug-induced headache and secondary headaches are also available. The headache tutorial consists of case records that the user can test their diagnostic abilities on. The diagnostic headache diary is an expert system on headache diagnostics. It can be filled in during a consultation in order to provide the headache diagnosis or it can be printed and used by the headache patient to record headache attacks and medicine consumption. The nomenclature module provides an explanation of words and expressions used in the system.

Does serology testing for H. pylori infections make sense for community-based physicians?

We investigated whether the serological assessment of H. pylori (Hp) infections is an accurate diagnostic tool for general practitioners, which meaning Cag A and Vac A antibodies (AB) have in patients with ulcer disease (UD) or non ulcer dyspepsia (NUD), whether assessment of these mentioned AB can explain the highly significant ethnical differences regarding LID and whether there are other serological laboratory parameters correlating with Hp infections (e.g. BSR, RBC, WBC, CRP, electrophoresis, further Hp-specific ABs). Hp-status was assessed by endoscopy (urease-test, histology) and compared to serological parameters (Hp-CFR; Hp-immunoblot (Mikrogen) IgG / IgA; AB against CagA, VacA, Urease A + B and further Hp-specific antigens). 122 patients were investigated, n=86 were Hp-infected and untreated, n=36 were Hp-negative following successful eradication therapy with a new triplescheme (for six days: 500 mg azithromycin od + 2000 mg tinidazole od + 40 mg pantoprazole hid): 1) In 58 % of the successfully Hp-eradicated patients highly positive serological Hp-tests could be found even 1 18 months following triple-therapy; in 21% of all successfully treated patients therapy was 12 18 months ago. 2) In untreated patients together both AB against CagA + VacA tended to be positive more frequent in patients with UD (45.5% CagA + VacA positive) than with NUD (25.0% CagA + VacA positive). 3) The 3-fold higher ulcer rate in Turkish patients at 30.3 % of all Hp-infected patients with upper abdominal complaints could not be sufficiently clarified by means of serology (CagA+VacA together positive in 47.0% of Turkish versus 28.5% in European patients). 4) In 9% of all Hp-infected NUD and UD patients no CagA -, as well as no VacA AB Could be shown. 5) In 4% of all Hp-infected patients no CagA-AB could be found despite VacApositivity. 6) Neither in Hp-infected nor in successfully treated patients a correlation could be found regarding Hp-status and other serological above mentioned laboratory parameters. Also, the determination of Hp-CFR, of AB against urease A + B and further Hp-specific antigens had no meaning for the assessment of the inflammatory process and the severity of disease, Our data show, that Hp-serology testing is of low value for community based physicians, because serological results neither yield a certain evidence of the existence of an acute Hp-infection nor for the pathogenicity of H. pylori or the severity of the disease caused by these bacteria.