Family practice
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The feasibility as well as the suitability of several therapies for medically unexplained symptoms (MUS) in primary care applied by the family physician (FP) appeared to be low. FPs need effective and acceptable strategies to manage these functionally impaired patients. ⋯ MUS experts highlight the importance of generic interventions and doctor-patient communication and relationship. However, studies showing the effectiveness of these elements in the management of MUS in primary care is still scarce. Research as well as medical practice should focus more on these non-specific aspects of the medical consultation.
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Randomized Controlled Trial Comparative Study
Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care--a randomized clinical trial.
Patients with subacromial impingement syndrome (SIS) commonly seek primary care. Subacromial corticosteroid injection is the standard treatment given by GPs, which is supported by earlier studies reporting a positive effect but inconclusive evidence over the long- term. In Sweden, physiotherapists often choose acupuncture combined with exercises to treat SIS, which was reported as probably efficacious. ⋯ Both subacromial corticosteroid injection and a series of acupuncture treatments combined with home exercises significantly decreased pain and improved shoulder function in patients with SIS, but neither treatment was significantly superior to the other.
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Primary care should be the place for the early detection of mild cognitive impairment (MCI) and dementia; however, a considerable proportion of these processes remain undetected at this setting. Family doctors may not have enough time or expertise for cognitive testing. The utility of clinical variables, other than cognitive tests, has hardly been investigated. ⋯ Clinical data usually collected on medical history by PCP are useful to detect patients with MCI and dementia and also to predict MCI outcome.
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Community-based case management of high-frequency health service users, also termed 'high-intensity users' may reduce the demand on secondary care. In the UK, experienced senior nurses 'community matrons' have been appointed to provide more care in the community and to case manage high-intensity users and prevent unnecessary hospital admission. Computerized scoring systems have been developed to help with case finding. ⋯ Inter-professional networks, personal experience and training influence the patients identified for case management. The combination of an improved case finding tool and a better defined role for community matrons could lead to more standardized and equitable case selection.