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Benfante A.,University of Palermo | Benfante A.,Instituto Euro Mediterraneo Of Science E Tecnologia | Messina R.,University of Palermo | Messina R.,Instituto Euro Mediterraneo Of Science E Tecnologia | And 2 more authors.
Pulmonary Pharmacology and Therapeutics | Year: 2017

Introduction Asthma and COPD are under-diagnosed and undertreated in adult populations, mainly due to the discrepancy between guideline recommendations and clinicians' practices. One of the reasons of this discrepancy is the difficulty encountered in real life in sharing the management of chronic respiratory diseases between general practitioners (GPs) and respiratory physicians. Methods An explorative, population-based investigation was performed to test whether, and to what extent, an active collaboration between GPs and pulmonologists increases the diagnosis and proper treatment of chronic obstructive airway diseases. The “COPD action” involved an in-house intervention by pulmonologists who trained GPs on how to diagnose the disease and interpret the spirometry, yielding a final agreed diagnosis. Results A total of 210 subjects (M/F: 156/54; age: 62.5 ± 13.8, mean ± SD) were consecutively invited by 20 GPs and classified in a) healthy, b) symptomatic with no airway obstruction, and 3) affected by chronic respiratory diseases. 11% of previously defined “healthy” subjects were diagnosed with COPD, and symptomatic subjects were diagnosed with asthma (20%) or COPD (23%). In addition, in those who already carried a diagnosis of chronic respiratory diseases as judged by GPs, the diagnosis of COPD decreased significantly after respiratory specialist intervention (p = 0.001), in favor of asthma and chronic bronchitis. Furthermore, following the clinical and lung function assessments performed by the respiratory physicians, changes in inhaled treatments were statistically significant for each therapeutic category (test-retest reliability: r = 0.42; p < 0.001). Conclusion In conclusion, the collaboration between GPs and pulmonologists based on a pro-active approach to the individuals attending the primary care offices followed by an in-house intervention by specialists may largely improve the diagnosis and management of chronic respiratory diseases. © 2017 Elsevier Ltd

Passamonti M.,Societa Italiana di Medicina Generale e delle Cure Primarie SIMG | Musazzi L.,Polo Didattico | Pigni M.,Societa Italiana di Medicina Generale e delle Cure Primarie SIMG | Testolin E.,Societa Italiana di Medicina Generale e delle Cure Primarie SIMG | And 3 more authors.
Giornale Italiano di Diabetologia e Metabolismo | Year: 2015

Comorbid diabetes and depression pose a major clinical chal- lenge as each condition worsens the outcome of the other. The relationship between type 2 diabetes (T2DM) and depression is amply documented. We designed a retrospective study in our practice to assess the changes in glycated hemoglobin (HbA1c) in patients with T2DM concomitant with depression, before and after treatment with an anti-depressant drug that achieved remission of the depressive symptoms. In all, 32 patients met the inclusion criteria (M/F 8/24; mean age ± SD 72.03 ± 9.65 years). HbA1c dropped from 7.8 ± 1.75% to 6.8 ± 1.60% after complete remission of the symptoms of de- pression (p = 0.02). This reduction is not only statistically signifi- cant but is clinically important, considering that most antidiabetic drugs in current use are equally effective in reducing HbA1c. We are therefore convinced that caregivers need to be fully aware of the problem of depression in diabetes patients, with a view to designing a questionnaire to detect it and to plan appropriate treatment. © 2015 UTET Periodici Scientifici srl. All rights reserved.

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