Primary care respiratory journal : journal of the General Practice Airways Group
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Clinical signs of infection do not allow for correct identification of bacterial and viral aetiology in acute respiratory infections. A valid tool to assist the clinician in identifying patients who will benefit from antibiotic therapy, as well as patients with a potentially serious infection, could greatly improve patient care and limit excessive antibiotic prescriptions. Procalcitonin is a new marker of suspected bacterial infection that has shown promise in guiding antibiotic therapy in acute respiratory tract infections in hospitals without compromising patient safety. ⋯ However, procalcitonin measurement should not be used as the sole basis for clinical decisions; clinical skills are prerequisites for the correct use of this new tool in practice. At present there is no point-of-care test for procalcitonin with acceptable precision, severely hampering its application in primary care. This article reviews the physiology of procalcitonin, describes the assays available for its measurement, evaluates the present evidence from primary care on its use to identify correctly patients who are likely to benefit from antibiotic treatment and to rule out serious infections, and comments on further research to determine a future role for procalcitonin in primary care.
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Comparative Study
Measuring walking speed in COPD: test-retest reliability of the 30-metre walk test and comparison with the 6-minute walk test.
To examine test-retest reliability of the 30-metre walk test (30mWT) in patients with chronic obstructive pulmonary disease (COPD) and to compare the 30mWT with the 6-minute walk test (6MWT). ⋯ The 30mWT is a reliable submaximal test that is easy to perform and can be used to measure physical function (walking ability) in patients with COPD. It may be well suited for primary care settings.
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To assess the misclassification of chronic obstructive pulmonary disease (COPD) in Australian primary care. ⋯ Symptom-based diagnosis of COPD in primary care is unreliable, especially if patients are overweight, so diagnostic spirometry is essential to avoid inappropriate management.