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Homeopathy for COVID-19 in primary care:A randomized,double-blind,placebo-controlled trial(COVID-Simile study)

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Journal of Integrative Medicine 2022年第3期20卷 221-229页

作者： Ubiratan Cardinalli Adler Maristela Schiabel Adler Ana Elisa Madureira Padula Livia Mitchiguian Hotta Amarilysde Toledo Cesar JoséNelson Martins Diniz Helen de Freitas Santos Edson Zangiacomi Martinez Department of Medicine Federal University of São CarlosSão Carlos 13565-905Brazil Homeopathy Solidarity Outpatient Extension Program Mackenzie Presbyterian UniversitySão Paulo 01302-907Brazil Municipal Center for Integrative and Complementary Practices in Health Guarulhos 07023-051Brazil HN-Cristiano Institute São Paulo 02013-001Brazil School Health Unit Federal University of São CarlosSao Carlos 13565-905Brazil Federal Institute of Education Science and Technology of São PauloBirigui 16201-407Brazil Department of Social Medicine Ribeirão Preto Medical SchoolUniversity of Sao PauloRibeirao Preto 14049-900Brazil

Background:Different homeopathic approaches have been used as supportive care for coronavirus disease 2019(COVID-19)cases,but none has been tested in a clinical ***:To investigate the effectiveness and safety of the homeopathic medicine,Natrum muriaticum LM2,for mild cases of ***,setting,participants,and interventions:A randomized,double-blind,two-armed,parallel,singlecenter,placebo-controlled clinical trial was conducted from June 2020 to April 2021 in S?o-Carlos,*** aged>18 years,with influenza-like symptoms and positive result from a real-time polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were recruited and randomized(1:1)into two groups that received different treatments during a period of *** group received the homeopathic medicine Natrum muriaticum,prepared with the second degree of the fifty-millesimal dynamization(LM2;Natrum muriaticum LM2),while the other group received a *** measures:The primary endpoint was time until recovery from COVID-19 influenza-like *** measures included a survival analysis of the number and severity of COVID-19 symptoms(influenza-like symptoms plus anosmia and ageusia)from a symptom grading scale that was informed by the participant,hospital admissions,and adverse ***-Meier curves were used to estimate time-to-event(survival)***:Data from 86 participants were analyzed(homeopathy,n=42;placebo,n=44).There was no difference in time to recovery between two groups among participants who were reporting influenzalike symptoms at the beginning of monitoring(homeopathy,n=41;placebo,n=41;P=0.56),nor in a sub-group that had at least 5 moderate to severe influenza-like symptoms at the beginning of monitoring(homeopathy,n=15;placebo,n=17;P=0.06).Secondary outcomes indicated that a 50%reduction in symptom score was achieved significantly earlier in the homeopathy group(homeopathy,n=24;placebo,n=25;P=0.0

关键词： Homeopathy COVID-19 primary care Natrum muriaticum Randomized controlled trial

primary care for cancers at diagnosis and follow-up:a narrative review

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Family Medicine and Community Health 2013年第1期1卷 56-67页

作者： CHEW BOON HOW SRI WAHYU TAHER Department of Family Medicine Universiti Putra MalaysiaMalaysia Klinik Kesihatan Simpang Kuala Alor SetarKedahMalaysia

This paper is concerned about the family physician’s role in early cancer diagnosis and follow-up with his/hers patients who have just been diagnosed with cancer;treatment modalities for cancer;and family physician continuous roles for patients who are under definitive cancer treatment,experiencing side-effects of cancer treatment;some of the effective means to reduce these side-effects during cancer treatment and management of oncologic *** some knowledge on the current cancer therapies would undoubtedly help family physicians to follow up patients with cancer more confidently,to appreciate their side-effects,symptomatic treatment,recognize the limit of primary care and be even useful for counseling and consultation with patients or their family members with a family history of *** searches with terms comprised“cancer”,“malignancy”,“primary care”,“general practice”,“cancer AND diagnosis”and“cancer AND follow-up”were done in the major databases such as Pubmed,ScienceDirect and *** employed selective searches with the above terms and their combination in some of the major journal such as The Lancet Oncology,The Lancet,New England Journal of Medicine,*** were followed by snowballing the relevant articles from the citation of references in those selected *** goal of this narrative review is not to provide exhaustive documentation of sound evidence for practice of primary care for cancer patients at diagnosis and *** mainly aims to provide specific evidence-based information and suggestions that are thought to be relevant for primary care professionals and policymakers.

关键词： Cancers primary care General practice Office visits Diagnosis Survivors

Rabeprazole test for the diagnosis of gastro-oesophageal reflux disease: Results of a study in a primary care setting

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World Journal of Gastroenterology 2006年第16期12卷 2569-2573页

作者： Stanislas Bruley des Varannes Sylvie Sacher-Huvelin Fabienne Vavasseur Claude Masliah Marc Le Rhun Philippe Aygalenq Sylvie Bonnot-Marlier Yves Lequeux Jean Paul Galmiche Institut des Maladies de l'Appareil Digestif CIC-INSERM-CHU-44083 NANTES cedexFrance CH Draguignan France Laboratoire JANSSEN-CILAG-1 Avenue Camille Desmoulins -92787 ISSY les MOULINEAUX cedexFrance 4 rue de la Tourelle-44230 SAINT PERE en RETZFrance

AIM： To determine the diagnostic value of the rabeprazole test in patients seen by general practitioners. METHODS： Eighty-three patients with symptoms suggestive of GERD were enrolled by general practitioners in this multi-centre, randomized and doubleblind study. All patients received either rabeprazole （20 mg bid） or a placebo for one week. The diagnosis of GERD was established on the presence of mucosal breaks at endoscopy and/or an abnormal esophageal 24-h pH test. The test was considered to be positive if patients reported at least a ＂clear improvement＂ of symptoms on a 7-point Likert scale. RESULTS： The sensitivities of the test for rabeprazole and the placebo were 83% and 40%, respectively. The corresponding specificity, positive and negative predictive values were 45% and 67%, 71% and 71%, and 62% and 35%, respectively. A receiver operating characteristics （ROC） analysis confirmed that the best discriminatory cut-off corresponded to description of ＂clear improvement＂ CONCLUSION： The poor specificity of the proton-pump inhibitor （PPI） test does not support such an approach to establish a diagnosis of GERD in a primary care setting.

关键词： Gastro-oesophageal reflux disease Diagnostic tool Rabeprazole Proton pump inhibitors primary care

Colorectal cancer,screening and primary care: A mini literature review

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World Journal of Gastroenterology 2017年第33期23卷 6049-6058页

作者： Athanasios Hadjipetrou Dimitrios Anyfantakis Christos G Galanakis Miltiades Kastanakis Serafim Kastanakis primary Health care Centre of Kissamos First Department of Surgery Saint George General Hospital of Chania Private Family Practice Unit in Chania Department of Internal Medicine Saint George General Hospital of Chania

Colorectal cancer(CRC) is a common health problem,representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality,with annual deaths estimated at 700000. The western way of life,that is being rapidly adopted in many regions of the world,is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore,the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians(PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein,we review the main topics of CRC in the current literature,in order to better understand its pathogenesis,risk and protective factors,as well as screening techniques. Furthermore,we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.

关键词： Colorectal cancer Prevention Diagnosis Screening primary care

Process engineering for primary care:Quality improvement and population health

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Family Medicine and Community Health 2016年第2期4卷 29-35页

作者： William Riley Science Health care Delivery Arizona State University6930 East Bighorn CourtSuperstition MtAZ 85118USA

A fundamental paradox of the health care delivery systems in many industrialized nations is that desired population health metrics are often not achieved despite large expenditures in the health care delivery *** example,the United States commits nearly 18%of its GDP to the health care delivery system,the largest amount of any nation,yet is 37th in achieving health or health care delivery *** article addresses how general practice can be an important driver of population health in the Chinese health care delivery system through the application of quality improvement *** article shows examples of how the cause-and-effect diagram,the process map,and the plan,do,study,act(PDSA)cycle are important techniques to assist primary care practitioners for improving population health.

关键词： Population health general practice primary care quality improvement techniques

Overnight pulse oximetry for screening of obstructive sleep apnea in at-risk adult patients in the primary care setting:prospective case series

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Family Medicine and Community Health 2017年第3期5卷 215-222页

作者： Lap-Kin Chiang Cheuk-Wai Kam Lorna V.Ng Family Medicine and General Outpatient Department Kwong Wah HospitalHong Kong

Objective:To estimate prevalence of OSA among at risk adult patients in primary care *** test the correlation and agreement between overnight pulse oximetry and polysomnography(PSG).To test the OSA screening performance of overnight pulse *** and Setting:Prospective case series involving adult Chinese patients with risk fac-tors for OSA at a primary care clinic of Hong ***:The prevalence and severity of OSA were established based on overnight pulse oximetry derived oxygen desaturation index(ODI).Screening performance of overnight pulse oxi-metry was compared directly with gold standard diagnostic test ***:Three hundred and five male and 229 female patients were ***(48.3%)was the top presenting *** hundred and twenty five patients(60.9%)were screened positive to have *** hundred and nine patients had performed PSG,the ODI_4 and apnoea-hypopnea index(AHI)had Pearson correlation coefficient 0.71(Pprimary care population who are at risk for *** pulse oximetry shows good performance as a screening tool for the screening of OSA.

关键词： Obstructive sleep apnea overnight pulse oximetry primary care

Combined automated screening for age-related macular degeneration and diabetic retinopathy in primary care settings

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Annals of Eye Science 2021年第2期6卷 3-10页

作者： Alauddin Bhuiyan Arun Govindaiah Sharmina Alauddin Oscar Otero-Marquez RTheodore Smith Research&Development Department iHealthScreen Inc.Richmond HillUSA Department of Ophthalmology Icahn School of Medicine at Mount SinaiNew YorkUSA

Background:Age-related macular degeneration(AMD)and diabetic retinopathy(DR)are among the leading causes of blindness in the United States and other developed *** detection is the key to prevention and effective *** have built an artificial intelligence-based screening system which utilizes a cloud-based platform for combined large scale screening through primary care settings for early diagnosis of these ***:iHealthScreen Inc.,an independent medical software company,has developed automated AMD and DR screening systems utilizing a telemedicine platform based on deep machine learning *** both diseases,we prospectively imaged both eyes of 340 unselected non-dilated subjects over 50 years of *** DR specifically,152 diabetic patients at New York Eye and Ear faculty retina practices,ophthalmic and primary care clinics in New York city with color fundus *** the initial review of the images,308 images with other confounding conditions like high myopia and vascular occlusion,and poor quality were excluded,leaving 676 eligible images for AMD and DR *** ophthalmologists evaluated each of the images,and after adjudication,the patients were determined referrable or non-referable for AMD *** AMD,172 were labeled referable(intermediate or late),and 504 were non-referable(no or early).Concurrently,regarding DR,33 were referable(moderate or worse),and 643 were non-referable(none or mild).All images were uploaded to iHealthScreen’s telemedicine platform and analyzed by the automated systems for both *** system performances are tested on per eye basis with sensitivity,specificity,accuracy,and kappa scores with respect to the professional ***:In identifying referable DR,the system achieved a sensitivity of 97.0%and a specificity of 96.3%,and a kappa score of 0.70 on this prospective *** AMD,the sensitivity was 86.6%,the specificity of 92.1%,and a kappa score of ***

关键词： Diabetic retinopathy age-related macular degeneration primary care

Tobacco cessation pharmacotherapy use among racial/ethnic minorities in the United States:Considerations for primary care

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Family Medicine and Community Health 2017年第3期5卷 193-203页

作者： Monica Webb Hooper Michael Payne Kimberly A.Parkinson Case Comprehensive Cancer Center Case Western Reserve UniversityClevelandOHUSA

Pharmacotherapies for tobacco cessation are efficacious and recommended during quit ***/ethnic minorities in the United States are less likely to use medication-based aids for tobacco cessation,despite greater difficulty achieving long-term *** reasons for this include,among others,provider-and patient-level *** care clinicians play an important role in encouraging racial/ethnic minority tobacco users to use cessation *** better understand pharmacotherapy use,we conducted a narrative review of patient-lev-el factors that may determine uptake and *** review indicates that social and cultural factors impact pharmacotherapy use,including health care experiences,beliefs,perceptions,and *** proportion of individuals using pharmacotherapy during quit attempts and adhering to the full course of treatment may be enhanced with greater attention to the ethnocultural concerns of these *** appropriate assessment and brief advice delivered by primary care providers could yield significant benefits in population *** for treating racial/ethnic tobacco users with pharmacotherapy for cessation are offered.

关键词： Tobacco cessation pharmacotherapy racial/ethnic minorities primary care physician advice nicotine replacement therapy varenicline bupropion

Patient views of the good doctor in primary care:a qualitative study in six provinces in China

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Global Health Research and Policy 2023年第1期8卷 293-301页

作者： Wenhua Wang Jinnan Zhang Jiao Lu Xiaolin Wei School of Public Policy and Administration Xi’an Jiaotong UniversityNo.28 West Xianning RoadXi’anPeople’s Republic of China Dalla Lana School of Public Health University of TorontoTorontoCanada

Background China has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms,but these initiatives have not adequately met patient needs and *** order to guide further reform efforts to better meet patient expectations,this study generates a profile of the good doctor in primary care from the patient *** Semi-structured interviews were conducted in six provinces(Shandong,Zhejiang,Henan,Shaanxi,Shanxi,Heilongjiang)in China.A total of 58 interviewees completed the recorded ***-based analysis was used to produce narrative *** research assistants listened to the recordings of the interviews and summarized them by 30-s *** analysis was performed on narrative summaries to identify thematic *** Five domains and 18 attributes were generated from the analysis of the interview *** domains of the good doctor in primary care from the patient perspective were:strong Clinical Competency(mentioned by 97%of participants)and Professionalism&Humanism(mentioned by 93%of participants)during service delivery,followed by Service Provision and Information Communication(mentioned by 74%and 62%of participants,respectively).Moreover,Chinese patients expect that primary care doctors have high educational attainment and a good personality(mentioned by 41%of participants).Conclusions This five-domain profile of the good doctor in primary care constitutes a foundation for further primary care workforce capacity *** primary care reform efforts should reflect the patient views and expectations,especially in the family physician competency framework and primary care performance assessment system ***,frontline primary care organizations also need to create supportive environments to assist competent doctors practice in primary care,especially through facilitating the learning o

关键词： Health policy primary care General practitioners Quality of care Qualitative research