Primary care respiratory journal : journal of the General Practice Airways Group
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Clinical signs of infection do not allow for correct identification of bacterial and viral aetiology in acute respiratory infections. A valid tool to assist the clinician in identifying patients who will benefit from antibiotic therapy, as well as patients with a potentially serious infection, could greatly improve patient care and limit excessive antibiotic prescriptions. Procalcitonin is a new marker of suspected bacterial infection that has shown promise in guiding antibiotic therapy in acute respiratory tract infections in hospitals without compromising patient safety. ⋯ However, procalcitonin measurement should not be used as the sole basis for clinical decisions; clinical skills are prerequisites for the correct use of this new tool in practice. At present there is no point-of-care test for procalcitonin with acceptable precision, severely hampering its application in primary care. This article reviews the physiology of procalcitonin, describes the assays available for its measurement, evaluates the present evidence from primary care on its use to identify correctly patients who are likely to benefit from antibiotic treatment and to rule out serious infections, and comments on further research to determine a future role for procalcitonin in primary care.
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Comparative Study
Measuring walking speed in COPD: test-retest reliability of the 30-metre walk test and comparison with the 6-minute walk test.
To examine test-retest reliability of the 30-metre walk test (30mWT) in patients with chronic obstructive pulmonary disease (COPD) and to compare the 30mWT with the 6-minute walk test (6MWT). ⋯ The 30mWT is a reliable submaximal test that is easy to perform and can be used to measure physical function (walking ability) in patients with COPD. It may be well suited for primary care settings.
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Randomized Controlled Trial
A randomised controlled trial of the effect of automated interactive calling combined with a health risk forecast on frequency and severity of exacerbations of COPD assessed clinically and using EXACT PRO.
We have developed a winter forecasting service to predict when patients with COPD are at higher risk of an exacerbation and alert them via an automated telephone call. ⋯ The ability of the forecast to predict high risk periods was confirmed unequivocally. Alert calls appeared to reduce the frequency and severity of exacerbations but these effects did not reach statistical significance, perhaps because of the number of participants, lower than expected exacerbation rates, and the fact that there was contact with patients in both groups whenever they appeared to be exacerbating.
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Bronchopulmonary dysplasia (BPD) results from prematurity and surfactant deficiency with contributing factors from barotrauma, volutrauma, and oxygen toxicity from supportive mechanical ventilation care and infection. These factors result in chronic inflammation with recurring cycles of lung damage and repair that impair alveolarisation and vascularisation in developing infant lungs. ⋯ As these patients age, primary care physicians need to understand the impact on pulmonary function. This discussion reviews the pulmonary function outcomes resulting from BPD through later childhood and young adulthood.
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To examine the burden of respiratory symptoms, quality of life and co-morbid illness in COPD patients receiving maintenance treatment in a real world setting. ⋯ COPD is commonly diagnosed and treated in patients without airflow obstruction. Many COPD patients receiving LABD monotherapy continue to suffer significant symptoms, exacerbations and poor quality of life.