Family practice
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Multicenter Study
Post-consultation illness trajectories in children with acute cough and respiratory tract infection: prospective cohort study.
Little is known about respiratory tract infection (RTI) severity in children following consultation. ⋯ We identified five distinct symptom trajectory groups showing the majority of children improved post-consultation, with only one group experiencing illness deterioration. The few characteristics associated with group membership did not fall into a pattern that seemed clinically useful.
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A platelet count >400 × 109/l (i.e. thrombocytosis) is a recently discovered risk marker of cancer. The risk of undiagnosed cancer in patients with thrombocytosis is 11.6% for men and 6.2% for women, well above the 3% risk threshold set by National Institute for Health and Care Excellence (NICE) for cancer investigation. Patients with a platelet count at the upper end of the normal range (325-400 × 109/l) could be at increased risk of undiagnosed malignancy. ⋯ These results suggest that clinicians should consider cancer in patients with a platelet count >375 × 109/l, review reasons for testing and any additional reported symptoms. Until these results are replicated on a larger scale, recommendations for clinical action cannot be made.
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Most patients with transient ischaemic attack (TIA) present to their GP. Early identification and treatment reduces the risk of subsequent stroke and consequent disability and mortality. ⋯ GPs weigh up the likelihood of TIA in the context of assessments of candidacy and diverse, often vague, symptoms. A diagnostic tool could support GPs in this process and help reduce reliance on referrals to TIA clinics for reassurance, provided the tool was designed to support decision making in cases of less 'typical' presentations.
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There remains a need to improve patient safety in primary care settings. Studies have demonstrated that creating high-performing teams can improve patient safety and encourage a safety culture within hospital settings, but little is known about this relationship in primary care. ⋯ Our findings suggest there is a relationship between team dynamics, care coordination and perceptions of patient safety in a primary care setting. To make patients safer, we may need to pay more attention to how primary care providers work together to coordinate care.
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The study aimed to decentralize hepatitis testing and management services to primary care in China. ⋯ Primary care providers in China could play a pivotal role in screening, diagnosing and treating millions of people with chronic hepatitis B and C in China.