Anecdotal evidence rapidly accumulated during March 2020 from sites around the world that sudden hyposmia and hypogeusia are significant symptoms associated with the SARS-CoV-2 pandemic. Our ...objective was to describe the prevalence of hyposmia and hypogeusia and compare it in hospitalized and non-hospitalized COVID-19 patients to evaluate an association of these symptoms with disease severity. We performed a cross-sectional survey during 5 consecutive days in March 2020, within a tertiary referral center, associated outpatient clinic, and two primary care outpatient facilities in Paris. All SARS-CoV-2-positive patients hospitalized during the study period and able to be interviewed (
n
= 198), hospital outpatients seen during the previous month (
n
= 129), and all COVID-19-highly suspect patients in two primary health centers (
n
= 63) were included. Hospitalized patients were significantly more often male (64 vs 40%) and older (66 vs 43 years old in median) and had significantly more comorbidities than outpatients. Hyposmia and hypogeusia were reported by 33% of patients and occurred significantly less frequently in hospitalized patients (12% and 13%, respectively) than in the health centers’ outpatients (33% and 43%, respectively) and in the hospital outpatients (65% and 60%, respectively). Hyposmia and hypogeusia appeared more frequently after other COVID-19 symptoms. Patients with hyposmia and/or hypogeusia were significantly younger and had significantly less respiratory severity criteria than patients without these symptoms. Olfactory and gustatory dysfunction occurs frequently in COVID-19, especially in young, non-severe patients. These symptoms might be a useful tool for initial diagnostic work-up in patients with suspected COVID-19.
Aim
To compare prednisone and placebo for the treatment of outpatients treated for acute exacerbations of chronic obstructive pulmonary disease (COPD) in a primary care setting.
Methods
A ...multicentre, parallel, double-blind, pragmatic randomised controlled trial was performed in France. A total of 66 general practitioners included patients aged ≥40 years with cumulative smoking of ≥10 pack-years and a diagnosis of certain or likely acute exacerbation of COPD. Oral prednisone (40 mg) or placebo were administered daily for 5 days. The main outcome was treatment failure at 8 weeks, defined as a composite criterion based on the occurrence of at least one of the following: unplanned visit to an emergency department or to a practitioner in the ambulatory setting, hospital admission or death. The planned sample size was 202 patients per group.
Results
175 patients were included from February 2015 to May 2017 (43% of the planned sample). All-cause 8-week treatment failure rate was 42.0% in the prednisone group and 34.5% in the placebo group (relative risk 1.22, 95% CI 0.87–1.69, p=0.25). Respiratory-related 8-week treatment failure rate was 27.6% in the prednisone group and 13.6% in the placebo group (relative risk 2.00, 95% CI 1.15–3.57, p=0.015).
Conclusion
Although the planned sample size was not achieved, the study does not suggest that oral corticosteroids are more effective than placebo for the treatment of an acute exacerbation of COPD in a primary care setting.
The therapeutic management strategy is based on the regular evaluation of the control of asthmatic disease, with an effective minimum dose research and the assessment of environmental factors, not to ...mention the important place of therapeutic education.
These professional recommendations relate to the management and follow-up of adult and adolescent asthma patients aged 12 and over.
The recommendations answer the following questions:
1. How to make the initial diagnosis of asthma?
2. What allergological check-up should be done in asthmatics
3. How to manage an asthma exacerbation?
4. How to manage difficult asthma?
5. What therapeutic strategies?
6. How to manage a woman's asthma during pregnancy?
7. Environmental factors in asthma management review
Recent medical guidelines for acute low back pain (aLBP) are unevenly followed. Based on financial criteria or associated with a desirability bias, studies incompletely describe the actual management ...provided by general practitioners (GPs) in terms of diagnosis, treatment and prevention of progression towards chronicity.
To compare actual practices of French GPs for aLBP management with clinical guidelines.
A young simulated patient (SP) consulted, using a single scenario of aLBP, in 30 primary care practices in the Paris region.
Heterogeneous data were collected according to the grid items: during the questioning, 29 GPs (97%) asked for age and 1 GP (3%) for pregnancy; during the clinical examination, 21 GPs (70%) asked for spinal stiffness and 3 GPs (10%) for cauda equina syndrome. Non-steroidal anti-inflammatory drugs were prescribed by 27 GPs (90%). Imaging (2 GPs or 7%) and physiotherapy (3 GPs or 10%) was rarely prescribed. A sick leave was prescribed by 22 GPs (73%). Twenty-seven GPs (90%) reassured the patient.
aLBP management was in line with international guidelines in terms of clinical examination, physiotherapy and imaging prescriptions and some risk factors for chronicity were taken into account. However, patient questioning was brief, and drug and sick leave prescriptions did not meet international guidelines. The SP approach seems to be a useful tool for assessing actual GP practices.
•We provide the first decision-making tool to facilitate the prescription of knee orthoses for patients with osteoarthritis.
To develop a decision-making tool (DMT) to facilitate the prescription of ...knee orthoses for patients with osteoarthritis (OA) in daily practice.
A steering committee gathered a multidisciplinary task force experienced in OA management/clinical research. Two members performed a literature review with qualitative analysis of the highest-quality randomized controlled trials and practice guidelines to confirm evidence concerning knee orthosis for OA. A first DMT draft was presented to the task force in a 1-day meeting in January 2016. The first version of the DMT was criticized and discussed regarding everyday practice issues. Every step was discussed and amended until consensus agreement was achieved within the task force. Then 4 successive consultation rounds occurred by electronic communication, first with primary- and secondary-care physicians, then with international experts. All corrections and suggestions by each member were shared with the rest of the task force and included to reach final consensus. The final version was validated by the steering committee.
The definition and indication of several types of knee orthoses (sleeve, patello-femoral, hinged or unicompartmental offloading braces) were detailed. Orthoses may be proposed in addition to first-line non-pharmacological treatment if patient acceptance is considered good. At every step, a specific clinical assessment is needed.
Based on the latest high-level evidence, practice guidelines, and an expert panel, a DMT to facilitate daily practice prescription of knee orthoses for OA patients was designed. An evaluation of DMT implementation in a wide range of health professionals is still needed.
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD ...is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.
Objective To develop an algorithm to help orthosis prescription for knee osteoarthritis patients. Material/Patients and methods Systematic review of the literature using a qualitative analysis on ...Pubmed databases, Cochrane Library and Pedro from 1966 to 2015, using the keywords “knee osteoarthritis”, “orthosis” with recommendations and highest quality trials. Development of a preliminary version of the algorithm using data from the literature and taking into account experience of different health professionals involved in the management of osteoarthritis patients. Validation of the algorithm by an international multidisciplinary expert college (PMR and sport medicine physician, rheumatologist, general practitioner, orthopaedic surgeon, physiotherapist, methodologist). New adaptations to obtain an acceptable final version. Results Elastic braces may be proposed in addition to the first-line non-pharmacological treatment (information/education, exercise and physical activity, weight reduction). Secondary a biomechanical analysis may be needed to provide a more rigid brace taking into account: the topography of pain, the lower limb static (varus/valgus), stability, any deformation reducibility. For unicompartimental OA, one can propose an unicompartmental discharge brace; a hinged stabilizing brace for bicompartmental OA with or without instability. For patellofemoral OA we can offer an orthotic with specific patellar device, Discussion/Conclusion Using an original methodology has produced an applicable algorithm in routine. A prospective validation in primary and secondary care to thirty patients is needed followed by an evaluation of the implementation of a wide range of health professionals in order to definitely validate the algorithm.
Few studies have addressed the pragmatic management of ambulatory patients with suspected community-acquired pneumonia (CAP) using a precise description of the disease with or without chest X-ray ...(X-ray) evidence.
To describe the characteristics, clinical findings, additional investigations and disease progression in patients with suspected CAP managed by French General Practitioners (GPs).
The patients included were older than 18 years, with signs or symptoms suggestive of CAP associated with recent-onset unilateral crackles on auscultation or a new opacity on X-ray. They were followed for up to 6 weeks. Descriptive analyses of all patients and according to their management with X-rays were carried out.
From September 2011 to July 2012, 886 patients have been consulted by 267 GPs. Among them, 278 (31%) were older than 65 years and 337 (38%) were at increased risk for invasive pneumococcal disease. At presentation, the three most common symptoms, cough (94%), fever (93%), and weakness or myalgia (81%), were all observed in 70% of patients. Unilateral crackles were observed in 77% of patients. Among patients with positive radiography (64%), 36% had no unilateral crackles. A null CRB-65 score was obtained in 62% of patients. Most patients (94%) initially received antibiotics and experienced uncomplicated disease progression regardless of their management with X-rays. Finally, 7% of patients were hospitalised and 0.3% died.
Most patients consulting GPs for suspected CAP had the three following most common symptoms: cough, fever, and weakness or myalgia. More than a third of them were at increased risk for invasive pneumococcal disease. With or without X-rays, most patients received antibiotics and experienced uncomplicated disease progression.
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