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- Page navigation anchor for Evidence – based physical examination and point of care testing to improve patient’s care and avoid unnecessary hospital admissionEvidence – based physical examination and point of care testing to improve patient’s care and avoid unnecessary hospital admissionI very much appreciate the article by Jochen et al.1 Evidence – based physical examination and an accurate history taking can lead in up to 77- 90 % of cases to a patient’s diagnosis,2 but there are limitations of history taking and clinical signs on physical examination.The clinical assessment of renal failure is limited and two -thirds of acute kidney injury identified in hospital started in the community with a high mortality.3 Identifying renal impairment by an eGFR Analyzer or urgent blood test (biomarker) via a domiciliary phlebotomist or specimen transport can potentially reduce disease progression and hospital admission, which applies to abdominal pain as well.4 The clinical evaluation of abdominal pain can be limited , as no finding on clinical examination can effectively rule out appendicitis.5 The Alvarado Clinical decision model - is recommended as the most user-friendly while being among the most powerful, but it in cooperates biomarkers.6 Further research has to be undertaken in the value of biomarkers in the diagnostic reasoning process and its application and availability in the GP setting.7,8 Knowledge about in cooperating the accuracy and limitations of the physical examination in the diagnostic process by introducing teaching of evidence based physical examination in the undergraduate curriculum and postgraduate education an...Show MoreCompeting Interests: None declared.
- Page navigation anchor for Rural GP - practical ideas for more research into CRP point of care testingRural GP - practical ideas for more research into CRP point of care testingI have worked in rural general practice for over 25 years and would like to share my experience of point of care testing (POCT) of CRP in clinical situations that every GP will recognise, when vague symptoms and signs pose particular problems .The are following are examples where I found it was especially useful .• Patient with an exacerbation of COPD - a normal CRP makes it much easier to confidently withhold antibiotics.• Patient with known diverticulosis as well as IBS presenting with abdominal pain and vague tenderness. It is much easier to withhold antibiotics with a normal CRP.• Elderly dementia patient, mildly confused or “ off legs " with no obvious signs – are you looking for urgent social service input or for hospital admission? – a high CRP can point you towards pathology eg pneumonia which may not be obvious in this age group.In 2014-15 I studied 202 patients where I used POCT CRP. In approximately two thirds of cases it helped me to exclude significant illness (and frequently withhold antibiotics); in about one fifth it was useful to identify serious illness.There are limitations to any test; interpretation needs to be made in context and can sometimes be confusing; it should be never be a substitute for clinical judgement but I maintain it can be a useful adjunct in the GP...Show MoreCompeting Interests: None declared.