Abstract:
BACKGROUND:During an influenza epidemic prompt diagnosis of influenza is important. This diagnosis however is still essentially based on the interpretation of symptoms and signs by general practitioners. No single symptom is specific enough to be useful in differentiating influenza from other respiratory infections. Our objective is to formulate prediction rules for the diagnosis of influenza with the best diagnostic performance, combining symptoms, signs and context among patients with influenza-like illness. METHODS:During five consecutive winter periods (2002-2007) 138 sentinel general practitioners sampled (naso- and oropharyngeal swabs) 4597 patients with an influenza-like illness (ILI) and registered their symptoms and signs, general characteristics and contextual information. The samples were analysed by a DirectigenFlu-A&B and RT-PCR tests. 4584 records were useful for further analysis.Starting from the most relevant variables in a Generalized Estimating Equations (GEE) model, we calculated the area under the Receiver Operating Characteristic curve (ROC AUC), sensitivity, specificity and likelihood ratios for positive (LR+) and negative test results (LR-) of single and combined signs, symptoms and context taking into account pre-test and post-test odds. RESULTS:In total 52.6% (2409/4584) of the samples were positive for influenza virus: 64% (2066/3212) during and 25% (343/1372) pre/post an influenza epidemic. During and pre/post an influenza epidemic the LR+ of 'previous flu-like contacts', 'coughing', 'expectoration on the first day of illness' and 'body temperature above 37.8°C' is 3.35 (95%CI 2.67-4.03) and 1.34 (95%CI 0.97-1.72), respectively. During and pre/post an influenza epidemic the LR- of 'coughing' and 'a body temperature above 37.8°C' is 0.34 (95%CI 0.27-0.41) and 0.07 (95%CI 0.05-0.08), respectively. CONCLUSIONS:Ruling out influenza using clinical and contextual information is easier than ruling it in. Outside an influenza epidemic the absence of cough and fever (> 37,8°C) makes influenza 14 times less likely in ILI patients. During an epidemic the presence of 'previous flu-like contacts', cough, 'expectoration on the first day of illness' and fever (>37,8°C) increases the likelihood for influenza threefold. The additional diagnostic value of rapid point of care tests especially for confirming influenza still has to be established.
journal_name
BMC Fam Practjournal_title
BMC family practiceauthors
Michiels B,Thomas I,Van Royen P,Coenen Sdoi
10.1186/1471-2296-12-4subject
Has Abstractpub_date
2011-02-09 00:00:00pages
4issn
1471-2296pii
1471-2296-12-4journal_volume
12pub_type
杂志文章abstract:BACKGROUND:While increasing attention is being paid to enabling terminal patients to remain at home until death, limited information is available on the circumstances in which people at home actually die. Therefore this study aims to describe patient characteristics, functional and cognitive status and physical and psy...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-4
更新日期:2012-01-19 00:00:00
abstract:BACKGROUND:The utility of clinical exercise tests depends on their support of treatment decisions. We sought to assess the utility of exercise tests for the selection of primary-care patients for referral to cardiologic care, and to determine whether referral decisions were biased by gender or socioeconomic status. We ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-014-0182-9
更新日期:2014-11-30 00:00:00
abstract:BACKGROUND:Little is known about psychological impact of disclosing lifestyle-related diseases. Previous studies discussed the long-term psychological impact of disease disclosure, and a significant psychological impact was not observed. This study clarified the psychological impact on anxiety state of patients when li...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0272-3
更新日期:2015-05-14 00:00:00
abstract:BACKGROUND:After hours general practice clinics provide medical attention for clients with non-emergency situations but are seeking immediate treatment and unable to wait for a general practitioner during routine opening hours. Evidence on the impact that after hours clinics have on emergency department presentations i...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-017-0657-6
更新日期:2017-09-11 00:00:00
abstract:BACKGROUND:Audits have shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines. This study aimed to evaluate the knowledge, attitudes and practices, and the barriers faced by primary care practitioners in Barbados concerning the recom...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-11-96
更新日期:2010-12-03 00:00:00
abstract:BACKGROUND:Organisational problems contribute to many errors in healthcare delivery. Our objective was to identify the most important organisational items in primary care which could be targeted by programs to improve patient safety. METHODS:A web-based survey was undertaken in an international panel of 65 experts on ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-145
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Despite increased investment in primary care research and development (R&D), the level of engagement of primary healthcare professionals with research remains poor. The aim of this study is to assess the level of research activity and capacity for research among primary healthcare professionals in a health a...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-10-33
更新日期:2009-05-11 00:00:00
abstract:BACKGROUND:Overweight, obesity and hypertension can be prevented through improvements in lifestyle including nutrition and physical activity. General practitioners (GPs) in Australia have access to over 90% of the population in the course of a year and therefore, the general practice setting may be ideal to assist pati...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-11-8
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Consultations for minor ailments constitute a large part of the workload of general practitioners (GPs). As medical interventions are not always available, specific communication strategies, such as active listening and positive communication, might help GPs to handle these problems adequately. This study ex...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-38
更新日期:2008-06-30 00:00:00
abstract:BACKGROUND:The purpose of this study is to better understand differences in diabetes self-management, specifically needs, barriers and challenges among men and women living with type 2 diabetes mellitus (T2DM). METHODS:35 participants were recruited from a diabetes education center (DEC) in Toronto, Canada. Five focus...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-122
更新日期:2012-12-19 00:00:00
abstract:BACKGROUND:Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. METHODS:Internet based survey of 3081 primary care physicians, recruited via ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-016-0529-5
更新日期:2016-09-08 00:00:00
abstract:BACKGROUND:Depression is prevalent in people with type 2 diabetes and affects both glycemic control and overall quality of life. The aim of this trial was to evaluate the effect of the antidepressant paroxetine on metabolic control, quality of life and mental well-being in mildly depressed women with type 2 diabetes. ...
journal_title:BMC family practice
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1186/1471-2296-4-7
更新日期:2003-05-14 00:00:00
abstract:BACKGROUND:The increasing number of available point-of-care (POC) tests challenges clinicians regarding decisions on which tests to use, how to efficiently use them, and how to interpret the results. Although POC tests may offer benefits in terms of low turn-around-time, improved patient's satisfaction, and health outc...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-018-0893-4
更新日期:2019-01-10 00:00:00
abstract:BACKGROUND:Poorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with d...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-1102-9
更新日期:2020-02-13 00:00:00
abstract:BACKGROUND:Despite evidence supporting the effectiveness of alcohol screening and brief advice to reduce heavy drinking, implementation in primary healthcare remains limited. The challenges that clinicians experience when delivering such interventions are well-known, but we have little understanding of the patient pers...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-01142-9
更新日期:2020-04-22 00:00:00
abstract:BACKGROUND:Acceptance to a family practice is key to access and continuity of care. While Canadian patients increasingly report not being able to acquire acceptance to a family practice, little is known about the association between requiring opioids and acceptance. We aim to determine the proportion of family physicia...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-019-1027-3
更新日期:2019-10-23 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-1100-y
更新日期:2020-02-05 00:00:00
abstract:BACKGROUND:Although many studies have documented patient-, clinician-, and organizational barriers/facilitators of primary care among people with mental illnesses, few have examined whether these factors predict actual rates of preventive service use. We assessed whether clinician behaviors, beliefs, characteristics, a...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-017-0693-2
更新日期:2018-01-12 00:00:00
abstract:BACKGROUND:Disabling fatigue is the main illness related reason for prolonged absence from school. Although there are accepted criteria for diagnosing chronic fatigue in adults, it remains uncertain as to how best to define disabling fatigue and Chronic Fatigue Syndrome (CFS) in children and adolescents. In this popula...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-6-33
更新日期:2005-08-09 00:00:00
abstract:BACKGROUND:Late diagnosis is considered to be a major factor contributing to poorer cancer survival rates in the UK. Interventions have focussed on the promotion of earlier diagnosis in patients with potential cancer symptoms. However, to assess the effectiveness of these interventions, the time from symptom onset to p...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-014-0167-8
更新日期:2014-10-25 00:00:00
abstract:UNLABELLED:This work describes the methodology used to assess a strategy for implementing clinical practice guidelines (CPG) for cardiovascular risk control in a health area of Madrid. BACKGROUND:The results on clinical practice of introducing CPGs have been little studied in Spain. The strategy used to implement a CP...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-12-21
更新日期:2011-04-19 00:00:00
abstract:BACKGROUND:The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This st...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-71
更新日期:2012-07-25 00:00:00
abstract:BACKGROUND:The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the resear...
journal_title:BMC family practice
pub_type: 杂志文章,评审
doi:10.1186/s12875-016-0431-1
更新日期:2016-03-24 00:00:00
abstract:BACKGROUND:The prevention of type 2 diabetes is a recognised health care priority globally. Within the United Kingdom, there is a lack of research investigating optimal methods of translating diabetes prevention programmes, based on the promotion of a healthy lifestyle, into routine primary care. This study aims to est...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-13-46
更新日期:2012-05-29 00:00:00
abstract:BACKGROUND:Over 90% of antibiotics for human use in Europe are prescribed in primary care. We assessed the congruence between primary care treatment guidelines for skin infections and commensal Staphylococcus aureus (S. aureus) antimicrobial resistance levels in community-dwelling persons. METHODS:The prevalence of an...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-014-0175-8
更新日期:2014-10-25 00:00:00
abstract:BACKGROUND:Internationally, guidelines for depression recommend a stepped care approach, implying that antidepressant medication should not be offered as a first step treatment to patients with sub-threshold or mild depression. In the Netherlands, antidepressant prescribing rates in general practice as a first treatmen...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-35
更新日期:2014-02-19 00:00:00
abstract:BACKGROUND:There are gaps in knowledge and understanding about the relationships between primary care and community-based health and social services in the context of healthy aging at home and system navigation. This study examined provider perspectives on: a) older adults' health and social needs; b) barriers to acces...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-01143-8
更新日期:2020-04-23 00:00:00
abstract:BACKGROUND:Recurrent urinary tract infections (RUTIs) are commonly presented by women in primary care. In order to explore the poorly described experience of women with RUTIs a qualitative study was conducted that analysed data from a publically accessible internet-based self-help forum. METHODS:Qualitative Descriptio...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-162
更新日期:2014-09-26 00:00:00
abstract:BACKGROUND:Over three-quarters of all suicides are men (England and Wales), this is despite higher levels of anxiety and depression being reported by women. This disparity may in part be explained by atypical presentations of distress in men, and gendered issues around help-seeking. Consequently, the Atlas Men's Well-b...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-016-0410-6
更新日期:2016-02-02 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0225-x
更新日期:2015-01-28 00:00:00