Russian Family Doctor

The web-based program is described in the article. The program aimed on the assessment of health conditions of the elderly and old adults. It based on the method of comprehensive geriatric assessment. The structured approach allows using it even by preoccupied general practitioners, revealing the unmet needs of the old patients. The evidence based recommendations for the diagnosing and screening of unmet needs and for rehabilitations and treatment, plans are described.

The analysis of clinical features (age, sex, dyspnoe, smoking status, symptoms of heart failure, etc) was done in the elderly with broncho-obstructive syndrome identified with spirometry. Bronchial obstruction revealed if a fixed ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) was less than 0,70 (70%). Spirometry was performed in 605 people. Frequency of airflow limitation (FEV1/FVC < 0,70) in the sample was 20% (95% CI = 17%-24%), and increased with age. Patients with broncho-obstructive syndrome showed no clinical features which could physician to rely on in diagnosing broncho-obstructive syndrome without spirometry.

Spirometry is the main diagnostic method of the chronic obstructive pulmonary disease in primary care level. Quality spirometry is a key role in the study of the prevalence of airway obstruction. Aim: to assess the quality of spirogram according to the American Thoracic Society (ATS)/European Respiratory Society (ERS) criteria, performed by GPs in frame of the RESPECT study (RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related aetiology). Methods: Spirogram quality assessment was performed according to ATS/ERS criteria for reproducibility and acceptability. Results: Altogether 2093 spirograms before and 1533 spirograms after reversibility test were evaluated. Mean Evol less than 150 ml was obtained for the majority of spirograms (for 1817 spirograms without reversibility test, 90,9%; and for 1343 spirograms with reversibility test, 89,6%). In other cases mean Evol was less than 5% forced vital capacity (FVC). The mean forced expiratory time (FET) more than 6 sec was carried out for 970 spirograms without bronchodilator (48,6%) and for 584 spirograms with bronchodilator test (39%). In remain cases with FET less than 6 sec the plateau on the curve «volume-time» was achieved. The reproducibility, based on FVC and forced expiratory volume for the 1 sec (FEV1), was obtained for 92,1% spirograms without reversibility test (n = 1839) and for 89,8% spirograms with reversibility test (n = 1346). In total, 12,3% (n = 260) spirograms without bronchodilator and 12,2% (n = 187) with bronchodilator were assumed as unreproducible and unacceptable. Conclusion: The RESPECT investigators are able to perform spirometry with acceptable quality according to ATS/ERS criteria. The spirometry educational course makes it possible to implement spirometry in the daily work in the primary care, likewise early detection of airway obstruction.

To help family physicians who frequently treat patients with ophthalmological complaints, an overview of the etiology, pathogenesis, clinical manifestations and treatment of dry eye syndrome provides in this article.