Frontotemporal dementia: a review for primary care physicians.
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Frontotemporal dementia (FTD) is one of the most common forms of dementia in persons younger than 65 years. Variants include behavioral variant FTD, semantic dementia, and progressive nonfluent aphasia. Behavioral and language manifestations are core features of FTD, and patients have relatively preserved memory, which differs from Alzheimer disease. Common behavioral features include loss of insight, social inappropriateness, and emotional blunting. Common language features are loss of comprehension and object knowledge (semantic dementia), and nonfluent and hesitant speech (progressive nonfluent aphasia). Neuroimaging (magnetic resonance imaging) usually demonstrates focal atrophy in addition to excluding other etiologies. A careful history and physical examination, and judicious use of magnetic resonance imaging, can help distinguish FTD from other common forms of dementia, including Alzheimer disease, dementia with Lewy bodies, and vascular dementia. Although no cure for FTD exists, symptom management with selective serotonin reuptake inhibitors, antipsychotics, and galantamine has been shown to be beneficial. Primary care physicians have a critical role in identifying patients with FTD and assembling an interdisciplinary team to care for patients with FTD, their families, and caregivers. (+info)
Trends in menopausal hormone therapy use of US office-based physicians, 2000-2009.
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Validation of the Minnesota living with heart failure questionnaire in primary care.
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INTRODUCTION AND OBJECTIVES: To evaluate the applicability, internal consistency and validity of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) when used in primary care, compared with the Short Form-36 (SF-36) health survey. METHODS: The two questionnaires were administered to 589 patients with chronic heart failure who were registered with 97 primary care physicians. The applicability, internal consistency and validity of the MLHFQ were evaluated and comparisons were made with the SF-36. RESULTS: More than 90% of patients completed the questionnaires. The percentage of uncompleted items was low. Cronbach's alpha ranged from 0.79 to 0.94 for the various MLHFQ dimensions. Exploratory factorial analysis identified two factors that explained 65.8% of the variance. Moderate to good correlations were observed between similar dimensions of the MLHFQ and SF-36 (correlation coefficient -0.43 to -0.73). There were significant associations between scores on the MLHFQ and clinical measures of disease severity. CONCLUSIONS: When used in primary care, the MLHFQ had a high level of acceptability and good psychometric properties compared with the SF-36. Consequently, it would be useful for assessing health-related quality of life in patients with chronic heart failure. (+info)
The views of primary care physicians on health risks from electromagnetic fields.
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Clinical inertia in patients with T2DM requiring insulin in family practice.
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OBJECTIVE: To describe the clinical status of patients with type 2 diabetes mellitus (T2DM) in the primary care setting at insulin initiation and during follow-up, and to assess the efficacy of insulin initiation and intensification. DESIGN: Ontario FPs from the IMS Health database who had prescribed insulin at least once in the 12 months before November 2006 were randomly selected to receive an invitation to participate. Eligible and consenting FPs completed a questionnaire for each of up to 10 consecutive eligible patients. Patient data were recorded from 3 time points. SETTING: Family practices in Ontario, Canada. PARTICIPANTS: One hundred and nine FPs and 379 of their T2DM patients taking insulin (with or without oral agents). MAIN OUTCOME MEASURES: Glycated hemoglobin (HbA(1)(c)) levels, daily insulin dose, and use of concomitant oral agents at insulin initiation and 2 subsequent visits. RESULTS: Data from each patient were obtained on insulin initiation and intensification, glycemic control, further pharmacologic therapy, and related complications. Mean time from diagnosis of T2DM to insulin initiation was 9.2 years. Mean HbA(1)(c) values were 9.5% before insulin initiation, 8.1% at visit 2 (median 1.2 years later), and 7.9% at visit 3 (median 3.9 years after initiation). Mean insulin dose was 24 units at initiation, 48 units at visit 2, and 65 units at visit 3. At visit 3, 20% of patients continued to have very poor glycemic control (HbA(1)(c) > 9.0%). With the exception of a decrease in sulfonylurea use, concomitant use of oral antihyperglycemic agents remained static over time. CONCLUSION: Even in patients identified as being sufficiently high risk to warrant insulin therapy, a clinical care gap exists in physician efforts to achieve and sustain recommended HbA(1)(c) target levels. Family physicians need strategies to facilitate earlier initiation and ongoing intensification of insulin therapy. (+info)
Survey of the knowledge and management of transient ischemic attacks among primary care physicians and nurses.
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Primary care physicians and elder abuse: current attitudes and practices.
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CONTEXT: while estimates suggest that between 1.4% and 5.4% of older adults experience abuse, only 1 of 14 cases of elder abuse or neglect is ever reported to authorities. It is critical for clinicians to be aware of elder abuse in order to improve primary care. OBJECTIVE: to understand Michigan primary care physicians' knowledge of and reporting practices for elder abuse, including the type of elder abuse education they received, the nature of their clinical practice, and the barriers that prevent them from reporting elder abuse. METHODS: a 17-item survey was mailed to 855 primary care physicians in Michigan in 2 waves between October 2007 and December 2007. RESULTS: Of the 855 surveys mailed, 222 were returned for a response rate of 26%. The majority of physicians (131 [67%] of 197 physicians) believed that their training about elder abuse was not very adequate or not adequate at all. Physicians with fewer than 10 hours of training were more likely to rate their training as not adequate when compared to those who had more than 10 hours of clinical training (chi(2)=64.340, P<.001). Whether abuse was reported was highly correlated with whether it was suspected (chi(2)=26.195, P<.001). Those physicians who reported receiving formal training on the topic of elder abuse in residency programs and those who reported participating in CME activities while in practice were less likely to identify not recognizing abuse at time of patient visits as a barrier to reporting. CONCLUSION: recognizing the subtle signs of elder abuse continues to be a barrier for physicians who treat older adult patients. However, education may improve primary care physicians' ability to detect and recognize elder abuse. (+info)
Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions.
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