Chronic obstructive pulmonary disease and heart failure: research and clinical practice in primary care

The treatment of chronic obstructive pulmonary disease (COPD) and comorbidities, increasing with age, is the challenge that nowadays health care systems are facing to better care treat these patients. For this reason a clinical trial was conducted in the province of Trento by a group of 30 volunteer general practitioners members of SNAMID (Scientific Society for Continuing Medical Education of General Practitioners). The objectives were to identify: i) prevalence of COPD in patients (65-98 years) in the province of Trento; ii) presence and incidence of heart failure (HF) in COPD patients; iii) early detection of other chronic diseases; and iv) improving electronic medical records (EMR) as an innovation way of professional care management. From May 2011 to October 2013, 17 doctors completed the two-year work using the EMR. The studied patients were men and women (65-98 years), suffering from COPD; the considered data included: anthropometric information, smoking status, International Classification of Diseases (ICD)-9 diagnosis of COPD, HF and chronic diseases, specific blood and instrumental tests. The extracted results were then linked with data of sentinel therapies, collected by the EMR. The database obtained identified patients with COPD or HF not previously recognized with ICD-9 diagnosis. The study identified the sentinel drugs chosen for COPD and HF, excluding other drugs not selective for the study or confusing for a proper statistical evaluation

Il Gastropanel: un test di diagnostica gastrica prezioso e poco conosciuto in medicina generale

Nella diagnostica della patologia gastroesofagea in Medicina Generale, la sintomatologia gioca un ruolo limitato, se si esclude quello legato alla Malattia da Reflusso Gastroesofageo (MRGE) dove la pirosi retrosternale e i rigurgiti acidi sono sufficientemente sensibili per confermare questa affezione, anche con l’utilizzo del PPI test. Nel paziente dispeptico è invece molto difficile identificare la patologia sottostante solo in base ai sintomi e, pur essendo l’incidenza del carcinoma gastrico in netta diminuzione, la preoccupazione di misdiagnosticare questa affezione o le sue condizioni precancerose spinge molti MMG a richiedere una esofagogastroduodenoscopia (EGDS), esame molto utile ma invasivo e non gradito al paziente

A Quick Test of Cognitive Speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years.

ABSTRACT Background: A Quick Test of Cognitive Speed (AQT) is a brief test that can identify cognitive impairment. AQT has been validated in Arabic, English, Greek, Japanese, Norwegian, Spanish, and Swedish. The aim of this study was to develop Italian criterion-referenced norms for AQT. Methods: AQT consists of three test plates where the patient shall rapidly name (1) the color of 40 blue, red, yellow, or black squares (AQT color), (2) the form of 40 black figures (circles, squares, triangles, or rectangles; AQT form), (3) the color and form of 40 figures (consisting of previous colors and forms; AQT color-form). The AQT test was administered to 121 Italian cognitively healthy primary care patients (age range: 45-90 years). Their mean Mini-Mental State Examination (MMSE) score was 28.8 ± 0.9 points (range 26-30 points). AQT naming times in seconds were used for developing preliminary criterion cut-off times for different age groups. Results: Age was found to have a significant moderate positive correlation with AQT naming times color (r = 0.65, p < 0.001), form (r = 0.53, p < 0.001), color-form (r = 0.63, p < 0.001) and a moderate negative correlation with MMSE score (r = -0.44, p < 0.001) and AQT naming times differed significantly between younger (45-55 years old), older (56-70 years old), and the oldest (71-90 years old) participants. Years of education correlated positively but weakly with MMSE score (r = 0.27, p = 0.003) and negatively but weakly with AQT color (r = -0.16, p = ns), form (r = -0.24, p = 0.007), and color-form (r = -0.19, p = 0.005). We established preliminary cut-off times for the AQT test based on +1 and +2 standard deviations according to the approach in other languages and settings. Conclusions: This is the first Italian normative AQT study. Future studies of AQT - a test useful for dementia screening in primary care - will eventually refine cut-off times for normality balancing sensitivity and specificity in cognitive diagnostics