Can simple tests performed in the primary care setting provide accurate and efficient diagnosis of benign prostatic hyperplasia? Rationale and design of the Diagnosis Improvement in Primary Care Trial.

Effective treatment of benign prostatic hyperplasia (BPH) improves lower urinary tract symptoms (LUTS) and patient quality of life, and reduces the risk of complications arising from disease progression. However, treatment can only be initiated when men with BPH are identified by accurate diagnostic tests. Current evidence suggests that diagnostic procedures employed by primary care physicians vary widely across Europe. The expected increases in BPH prevalence accompanying the gradual aging of the population, coupled with greater use of medical therapy, mean that general practitioners (GPs) are likely to have an increasingly important role in managing the condition. The GP/primary care clinic is therefore an attractive target location for strategies designed to improve the accuracy of BPH diagnosis. The Diagnosis Improvement in Primary Care Trial (D-IMPACT) is a prospective, multicentre, epidemiological study that aims to identify the optimal subset of simple tests applied by GPs in the primary care setting to diagnose BPH in men who spontaneously report obstructive (voiding) and/or irritative (storage) LUTS. These tests comprise medical history, symptom assessment with the International Prostate Symptom Score questionnaire, urinalysis, measurement of serum levels of prostate-specific antigen and subjective GP diagnosis after completing all tests including digital rectal examination. GP diagnoses and all other tests will be compared with gold-standard diagnoses provided by specialist urologists following completion of additional diagnostic tests. D-IMPACT will establish the diagnostic performance using a non-subjective and reproducible algorithm. An adjusted and multivariate analysis of the results of D-IMPACT will allow identification of the most efficient combination of tests that facilitate accurate BPH diagnosis in the primary care setting. In addition, D-IMPACT will estimate the prevalence of BPH in patients who present spontaneously to GPs with LUTS.

[Determination of glycosylated hemoglobin in clinical practice care of diabetes]. / La determinación de hemoglobina glucosilada en la práctica clínica asistencial de la diabetes.

At the end of 1989 a transversal study to know the availability of glycosylated hemoglobin as a control parameter in diabetic patients was done. Two hundred and three physicians-specialists in diabetes-provided information on the fraction, technique and reference interval used in their clinical practice. 90 +/- 4% of the participants were able to obtain, in their settings, the determination of glycosylated hemoglobin. Regarding work-places it is outstanding that 36 +/- 15% of the physicians in primary care did not have the possibility to get this parameter determined. Fraction and technique more widely used were, respectively, HbA1 and Ionic Interchange Chromatography performed with HPLC. There was no homogeneity in the reference intervals for HbA1 and HbA1c, considering different methodologies. The possibility to obtain different glycosylated hemoglobin determined, depends on the setting where the health care is being provided. It is important to know the reference interval of the Center where the determination is being done, in order to correctly interpret the glycosylated hemoglobin values of each patient.