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Clinical presentation, diagnosis, and management

Section edited by Attila Altiner and Norbert Donner-Banzhoff

This section covers all aspects of patient diagnosis and treatment for acute and chronic conditions within the context of primary care.

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  1. Content type: Research article

    Suggestions of overprescribing of proton pump inhibitors (PPIs) for long-term treatment in primary care have been raised. This study aims to analyse associations between general practice characteristics and in...

    Authors: P. F. Haastrup, S. Rasmussen, J. M. Hansen, R. D. Christensen, J. Søndergaard and D. E. Jarbøl

    Citation: BMC Family Practice 2016 17:57

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  2. Content type: Research article

    Patients with medically unexplained physical symptoms (MUPS) form a heterogeneous group and frequently attend their family physician (FP). Little is known about how FPs recognize MUPS in their patients. We con...

    Authors: Madelon den Boeft, Danielle Huisman, Johannes C. van der Wouden, Mattijs E. Numans, Henriette E. van der Horst, Peter L. Lucassen and Tim C. olde Hartman

    Citation: BMC Family Practice 2016 17:55

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  3. Content type: Research article

    A prerequisite for early lung cancer diagnosis is that individuals with respiratory alarm symptoms (RAS) contact a general practitioner (GP). This study aims to determine the proportion of individuals in the g...

    Authors: Lisa Maria Falk Sele, Sandra Elnegaard, Kirubakaran Balasubramaniam, Jens Søndergaard and Dorte Ejg Jarbøl

    Citation: BMC Family Practice 2016 17:47

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  4. Content type: Research article

    Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By c...

    Authors: Jean K Soler, Derek Corrigan, Przemyslaw Kazienko, Tomasz Kajdanowicz, Roxana Danger, Marcin Kulisiewicz and Brendan Delaney

    Citation: BMC Family Practice 2015 16:63

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  5. Content type: Research article

    Guidelines on hypertension management recommend adjusting therapeutic efforts in accordance with global cardiovascular risk (CVR) rather than by blood pressure levels alone. However, this paradigm change has n...

    Authors: Achim Mortsiefer, Tobias Meysen, Martin Schumacher, Heinz-Harald Abholz, Karl Wegscheider and Jürgen in der Schmitten

    Citation: BMC Family Practice 2015 16:56

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  6. Content type: Research article

    Referral for both lifestyle and surgical interventions are recommended as part of the clinical management of obesity in general practice. However, current practice falls short of this. This qualitative study a...

    Authors: Kyoung Kon Kim, Lin-Lee Yeong, Ian D Caterson and Mark F Harris

    Citation: BMC Family Practice 2015 16:45

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  7. Content type: Research article

    The vast majority of patients with diabetes have multiple chronic conditions, increasing complexity of care; however, clinical practice guidelines, interventions, and public reporting metrics do not adequately...

    Authors: Elizabeth M Magnan, Rebecca Gittelson, Christie M Bartels, Heather M Johnson, Nancy Pandhi, Elizabeth A Jacobs and Maureen A Smith

    Citation: BMC Family Practice 2015 16:42

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  8. Content type: Research article

    We see patients who present with spirometry airflow limitation despite their forced expiratory volume in one second (FEV1) as well as forced vital capacity (FVC) to be supernormal (FEV1/FVC < 70%, both the %FEV1 ...

    Authors: Satomi Shiota, Masako Ichikawa, Kazuhiro Suzuki, Yoshinosuke Fukuchi and Kazuhisa Takahashi

    Citation: BMC Family Practice 2015 16:41

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  9. Content type: Research article

    Antibiotic and oral corticosteroid prescribing rate in patients suffering from acute exacerbations of chronic obstructive pulmonary disease (COPD) or asthma in general practice are only sparsely described. Our...

    Authors: Salwan Al-ani, Mark Spigt, Johanna Laue and Hasse Melbye

    Citation: BMC Family Practice 2015 16:40

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  10. Content type: Study protocol

    In contrast with the recommendations of clinical practice guidelines, the most common treatment for anxiety and depressive disorders in primary care is pharmacological. The aim of this study is to assess the e...

    Authors: Amale Jauregui, Joaquín Ponte, Monika Salgueiro, Saloa Unanue, Carmen Donaire, Maria Cruz Gómez, Natalia Burgos-Alonso and Gonzalo Grandes

    Citation: BMC Family Practice 2015 16:39

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  11. Content type: Research article

    Prolonged stress may lead to mental illness, but the prevalence of stress in a working age population seeking primary health care for whatever reason, is unknown. This paper seeks to examine to what extent thi...

    Authors: Lilian Wiegner, Dominique Hange, Cecilia Björkelund and Gunnar Ahlborg Jr

    Citation: BMC Family Practice 2015 16:38

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  12. Content type: Study protocol

    No more than 10-15% of type 2 diabetes mellitus (T2DM) patients achieve all treatment goals regarding glycaemic control, lipids and blood pressure. Shared decision making (SDM) should increase that percentage;...

    Authors: Henk den Ouden, Rimke C Vos, Carla Reidsma and Guy EHM Rutten

    Citation: BMC Family Practice 2015 16:27

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  13. Content type: Research article

    Chronic kidney disease (CKD) is predominantly managed in primary care in the UK, but there is evidence of under-identification leading to lack of inclusion on practice chronic disease registers, which are nece...

    Authors: Simon DS Fraser, Julie Parkes, David Culliford, Miriam Santer and Paul J Roderick

    Citation: BMC Family Practice 2015 16:18

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  14. Content type: Research article

    Acute cough is a common problem in general practice and is often caused by a self-limiting, viral infection. Nonetheless, antibiotics are often prescribed in this situation, which may lead to unnecessary side ...

    Authors: Sven Streit, Peter Frey, Sarah Singer, Ueli Bollag and Damian N Meli

    Citation: BMC Family Practice 2015 16:15

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  15. Content type: Research article

    In order to provide smoking cessation support to their patients in line with clinical practice guidelines, general practitioners must first ascertain whether their patients’ use tobacco. This study examined (i...

    Authors: Jamie Bryant, Mariko Carey, Rob Sanson-Fisher, Elise Mansfield, Tim Regan and Alessandra Bisquera

    Citation: BMC Family Practice 2015 16:8

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  16. Content type: Study protocol

    Vascular ulcers are commonly seen in daily practice at all levels of care and have great impact at personal, professional and social levels with a high cost in terms of human and material resources. Given that...

    Authors: Kepa M San Sebastian, Igone Lobato, Igone Hernández, Natalia Burgos-Alonso, Maria Cruz Gomez-Fernandez, Jose Luis López, Begoña Rodríguez, Anna Giné March, Gonzalo Grandes and Isabel Andia

    Citation: BMC Family Practice 2014 15:211

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  17. Content type: Research article

    Antidepressant prescribing continues to rise. Increased long-term prescribing and higher doses are contributing to current growth; however, patient factors associated with the use of higher doses remain unknow...

    Authors: Chris F Johnson, Nadine J Dougall, Brian Williams, Stephen A MacGillivray, Alasdair I Buchanan and Richard D Hassett

    Citation: BMC Family Practice 2014 15:210

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  18. Content type: Research article

    Acute chest pain constitutes a considerable diagnostic challenge outside hospitals. This will often lead to uncertainty in choosing the right management, and the physicians’ approach may be influenced by their...

    Authors: Robert Anders Burman, Erik Zakariassen and Steinar Hunskaar

    Citation: BMC Family Practice 2014 15:1127

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  19. Content type: Study protocol

    Chest complaints presented to a general practitioner (GP) are frequently caused by diseases which have advantageous outcomes. However, in some cases, acute coronary syndrome (ACS) is present (1.5-22% of cases)...

    Authors: Robert TA Willemsen, Frank Buntinx, Bjorn Winkens, Jan F Glatz and Geert Jan Dinant

    Citation: BMC Family Practice 2014 15:203

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  20. Content type: Research article

    Tympanometry and pneumatic otoscopy are recommended for diagnosis of otitis media, but are not frequently used by general practitioners (GPs). We examined how, after targeted short training, GP diagnosis and m...

    Authors: Penelope Abbott, Sara Rosenkranz, Wendy Hu, Hasantha Gunasekera and Jennifer Reath

    Citation: BMC Family Practice 2014 15:181

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  21. Content type: Research article

    Non-specific physical symptoms (NSPS), such as headache and abdominal pain, are common reasons for children to consult primary care. NSPS represent a significant burden not only on society, but also on health ...

    Authors: Mujahed Shraim, Milisa Blagojevic-Bucknall, Christian D Mallen and Kate M Dunn

    Citation: BMC Family Practice 2014 15:195

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  22. Content type: Research article

    Improving the quality of care for patients with vascular disease is a priority. Clinical guidance has emphasised the importance of early identification and active management of chronic kidney disease (CKD) in ...

    Authors: Hannah Gaffney, Thomas Blakeman, Christian Blickem, Anne Kennedy, David Reeves, Shoba Dawson, Rahena Mossabir, Peter Bower, Caroline Gardner, Victoria Lee and Anne Rogers

    Citation: BMC Family Practice 2014 15:196

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  23. Content type: Research article

    The utility of clinical exercise tests depends on their support of treatment decisions. We sought to assess the utility of exercise tests for the selection of primary-care patients for referral to cardiologic ...

    Authors: Gunnar Nilsson, Thomas Mooe, Lars Söderström and Eva Samuelsson

    Citation: BMC Family Practice 2014 15:182

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  24. Content type: Research article

    The prevalence of coexisting chronic conditions (multimorbidity) is rising. Disease labels, however, give little information about impact on subjective health and personal illness experience. We aim to examine...

    Authors: Nahal Mavaddat, Jose M Valderas, Rianne van der Linde, Kay Tee Khaw and Ann Louise Kinmonth

    Citation: BMC Family Practice 2014 15:185

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  25. Content type: Study protocol

    Urinary tract infections (UTI) are the most frequent bacterial infection affecting women and account for about 15% of antibiotics prescribed in primary care. However, some women with a UTI are not prescribed a...

    Authors: Janine Bates, Emma Thomas-Jones, Timothy Pickles, Nigel Kirby, Micaela Gal, Emily Bongard, Kerenza Hood, Nicolas Francis, Paul Little, Michael Moore, Kate Rumsby, Carlos Llor, Curt Burgman, Theo Verheij, David Cohen, Mandy Wootton…

    Citation: BMC Family Practice 2014 15:187

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  26. Content type: Research article

    Initiation of statin therapy as primary prevention particularly in those with mildly elevated cardiovascular disease risk factors is still being debated. The 2013 ACC/AHA blood cholesterol guideline recommends...

    Authors: Yook Chin Chia, Hooi Min Lim and Siew Mooi Ching

    Citation: BMC Family Practice 2014 15:172

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  27. Content type: Research article

    Transient ischaemic attack (TIA) is characterised by its transient nature with symptoms of neurological dysfunction resolving within 24 hours. The occurrence of TIA is a major risk factor for stroke with 10-s1...

    Authors: Elizabeth J Croot, Tony W Ryan, Jennifer Read, Fiona Campbell, Alicia O’Cathain and Graham Venables

    Citation: BMC Family Practice 2014 15:174

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  28. Content type: Research article

    Oral anticoagulation (OAC) with coumarins and new anticoagulants are highly effective in preventing thromboembolic complications. However, some studies indicate that over- and under-treatment with anticoagulan...

    Authors: Lisa-R Ulrich, Karola Mergenthal, Juliana J Petersen, Ina Roehl, Sandra Rauck, Birgit Kemperdick, Sylvia Schulz-Rothe, Andrea Berghold and Andrea Siebenhofer

    Citation: BMC Family Practice 2014 15:170

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  29. Content type: Research article

    Over 90% of antibiotics for human use in Europe are prescribed in primary care. We assessed the congruence between primary care treatment guidelines for skin infections and commensal Staphylococcus aureus (S. aur...

    Authors: Evelien ME van Bijnen, W John Paget, Casper DJ den Heijer, Ellen E Stobberingh, Cathrien A Bruggeman and François G Schellevis

    Citation: BMC Family Practice 2014 15:175

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  30. Content type: Research article

    Overweight and obesity are common in the Netherlands: in 2006 51% of adult men and 42% of adult women were overweight; 10% of men and 12% of women were obese. Patients with overweight or obesity in the Netherl...

    Authors: Elisabeth Govers, Jacob C Seidell, Marjolein Visser and Ingeborg A Brouwer

    Citation: BMC Family Practice 2014 15:161

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  31. Content type: Research article

    Depression is common among persons with diabetes and associated with adverse health outcomes. To date, little is known about the causal mechanisms that lead to depression in diabetes. The aim of the present st...

    Authors: Sylvia Boehme, Christian Geiser and Babette Renneberg

    Citation: BMC Family Practice 2014 15:157

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  32. Content type: Research article

    Early detection and effective management of risk factors can potentially delay progression of chronic kidney disease (CKD) to end-stage kidney disease, and decrease mortality and morbidity from cardiovascular ...

    Authors: Rachael C Walker, Mark R Marshall and Nick R Polaschek

    Citation: BMC Family Practice 2014 15:155

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  33. Content type: Study protocol

    In patients treated with oral anticoagulants, subcutaneous injections of anti-tetanus vaccine are usually recommended to reduce the risk of bleeding, although the effectiveness of the vaccine has only been pro...

    Authors: Fernando I Lago-Deibe, Maria-Victoria Martín-Miguel, Carmen Velicia-Peñas, Isabel Rey Gómez-Serranillos and Manuela Fontanillo-Fontanillo

    Citation: BMC Family Practice 2014 15:147

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  34. Content type: Study protocol

    Although hypercholesterolemia is considered a cardiovascular risk factor, in isolation it is not necessarily sufficient cause for a cardiovascular event. To improve event prediction, cardiovascular risk calcul...

    Authors: Mireia Fàbregas, Irene Berges, Francesc Fina, Eduardo Hermosilla, Ermengol Coma, Leonardo Méndez, Manuel Medina, Sebastià Calero, Elena Serrano, Rosa Morros, Mònica Monteagudo and Bonaventura Bolíbar

    Citation: BMC Family Practice 2014 15:135

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  35. Content type: Research article

    Therapeutic inertia has been defined as the failure of health-care provider to initiate or intensify therapy when therapeutic goals are not reached. It is regarded as a major cause of uncontrolled hypertension...

    Authors: Jean-Pierre Lebeau, Jean-Sébastien Cadwallader, Isabelle Aubin-Auger, Alain Mercier, Thomas Pasquet, Emmanuel Rusch, Kristin Hendrickx and Etienne Vermeire

    Citation: BMC Family Practice 2014 15:130

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  36. Content type: Research article

    Symptoms that cannot be attributed to any known conventionally defined disease are highly prevalent in general practice. Yet, only severe cases are captured by the current diagnostic classifications of medical...

    Authors: Mette T Rask, Rikke S Andersen, Flemming Bro, Per Fink and Marianne Rosendal

    Citation: BMC Family Practice 2014 15:118

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  37. Content type: Research article

    Ultrasound imaging (US) is considered an accurate and widely available method to diagnose subacromial disorders. Yet, the frequency of the specific US-diagnosed shoulder disorders of patients with shoulder pai...

    Authors: Ramon PG Ottenheijm, Inge GM van’t Klooster, Laurens MM Starmans, Kurt Vanderdood, Rob A de Bie, Geert-Jan Dinant and Jochen WL Cals

    Citation: BMC Family Practice 2014 15:115

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  38. Content type: Research article

    The general practitioner (GP) plays an important role for chronic disease care. Continuous and close contact with daytime general practice is intended to prevent medical problems arising outside office hours d...

    Authors: Lone Flarup, Grete Moth, Morten Bondo Christensen, Mogens Vestergaard, Frede Olesen and Peter Vedsted

    Citation: BMC Family Practice 2014 15:114

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  39. Content type: Research article

    Atrial fibrillation is very common in people aged 65 or older. This condition increases the risk of death, congestive heart failure and thromboembolic conditions. Many patients with atrial fibrillation are asy...

    Authors: Bert Vaes, Silke Stalpaert, Karen Tavernier, Britt Thaels, Daphne Lapeire, Wilfried Mullens and Jan Degryse

    Citation: BMC Family Practice 2014 15:113

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  40. Content type: Research article

    The Dutch National Immunisation Programme includes six tetanus toxoid (TT) vaccinations and reaches a high rate of vaccination coverage. In the Netherlands, several guidelines related to tetanus post-exposure ...

    Authors: Robine Donken, Nicoline van der Maas, Corien Swaan, Tjerk Wiersma, Margreet te Wierik, Susan Hahné and Hester de Melker

    Citation: BMC Family Practice 2014 15:112

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  41. Content type: Research article

    Effective and safe management of oral anticoagulant treatment (OAT) requires a high level of patient knowledge and adherence. The aim of this study was to assess patient knowledge about OAT and factors associa...

    Authors: Jean-François Chenot, Thanh Duc Hua, Manar Abu Abed, Hannelore Schneider-Rudt, Tim Friede, Simon Schneider and Stefan Viktor Vormfelde

    Citation: BMC Family Practice 2014 15:104

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  42. Content type: Study protocol

    As the first point of contact for patients and witnesses of stroke, General Practice receptionists can be instrumental in deciding the urgency of clinical contact. Despite the considerable complexity of this t...

    Authors: James P Sheppard, Satinder Singh, Janet Jones, Elizabeth Bates, John Skelton, Connie Wiskin, Richard J McManus and Ruth M Mellor

    Citation: BMC Family Practice 2014 15:91

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  43. Content type: Study protocol

    Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care ...

    Authors: Sergio Minué, Clara Bermúdez-Tamayo, Alberto Fernández, José Jesús Martín-Martín, Vivian Benítez, Miguel Melguizo, Araceli Caro, María José Orgaz, Miguel Angel Prados, José Enrique Díaz and Rafael Montoro

    Citation: BMC Family Practice 2014 15:92

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  44. Content type: Research article

    Stroke is a major cause of death and disability worldwide. Reducing the incidence of stroke has the potential to not only improve health outcomes, but also lead to significant cost savings for health services....

    Authors: Annemarei Ranta, Chwan-Fen Yang, Michael Funnell, Pietro Cariga, Catherine Murphy-Rahal and Naomi Cogger

    Citation: BMC Family Practice 2014 15:86

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  45. Content type: Research article

    Patients with elevated calcium concentrations have an increased morbidity due to various underlying illnesses. However, there is a lack of studies of quality of life and health care consumption in patients wit...

    Authors: Sofia Dalemo, Robert Eggertsen, Per Hjerpe, Svante Jansson and Kristina Bengtsson Boström

    Citation: BMC Family Practice 2014 15:84

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  46. Content type: Study protocol

    Insulin initiation and titration in primary care is necessary to respond to the growing epidemic of type 2 diabetes (T2D). The INITIATION study aims to evaluate the impact of implementing a new model of care w...

    Authors: Irene D Blackberry, John S Furler, Louise E Ginnivan, Hanan Derraz, Alicia Jenkins, Neale Cohen, James D Best, Doris Young, Danny Liew, Glenn Ward, Jo-Anne Manski-Nankervis and David N O’Neal

    Citation: BMC Family Practice 2014 15:82

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  47. Content type: Research article

    Point of care testing for C-reactive protein (CRP) has shown promise as a measure to reduce unnecessary antibiotic prescribing in respiratory tract infections (RTI), but its use in primary care is still contro...

    Authors: Elena Andreeva and Hasse Melbye

    Citation: BMC Family Practice 2014 15:80

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  48. Content type: Research article

    Evaluation of angina symptoms in primary care often includes clinical exercise testing. We sought to identify clinical characteristics that predicted the outcome of exercise testing and to describe the occurre...

    Authors: Gunnar Nilsson, Thomas Mooe, Hans Stenlund and Eva Samuelsson

    Citation: BMC Family Practice 2014 15:71

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  49. Content type: Research article

    Peripheral arterial disease (PAD) is a marker of systemic atherosclerosis and associated with a three to six fold increased risk of death from cardiovascular causes. Furthermore, it is typically asymptomatic a...

    Authors: Jane H Davies, Joyce Kenkre and E Mark Williams

    Citation: BMC Family Practice 2014 15:69

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