The edition · Family Medicine
Chest pain in the surgery: a score plus point-of-care troponin missed one ACS in 740
A Dutch cluster-randomised diagnostic trial tests a rule GPs can apply at the desk. Also: ultra-processed food across eight million adults, simple tests for male urinary symptoms, what continuity saves, and how reassurance lands.
The edition in brief
In the POB-HELP trial in Dutch general practice, a rule combining the Marburg Heart Score with a point-of-care high-sensitivity troponin I test ruled out acute coronary syndrome with sensitivity 98.3% and negative predictive value 99.7%, missing one case among 740 patients, and missed no myocardial infarction; referral rates did not fall. A meta-analysis of 51 cohorts and 8.8 million adults associated ultra-processed food intake with higher risks of cardiovascular events (HR 1.24), diabetes, depression and death, with low-to-moderate certainty. In 601 men with lower urinary tract symptoms in 67 practices, a model built from symptom scores, a bladder diary, PSA, flow rate and residual volume identified bladder outlet obstruction well (c-index 0.82 on validation). An Alberta study associated high clinic continuity with lower acute care costs for people with chronic disease, most of all for the most complex. An experimental study found patients believed normal results more when the doctor delivering them showed warmth and competence.
Ultra-processed food: consistent associations across eight million adults
Include ultra-processed food in lifestyle advice as a simple, countable target, while being honest that the evidence is observational.
Male urinary symptoms: simple tests predicted outlet obstruction without urodynamics
Use a bladder diary, symptom score, PSA, flow and residual volume to identify outlet obstruction in men with LUTS before referring.
Clinic continuity was associated with lower acute care costs, most in complex patients
Protect continuity for your most complex chronic-disease patients — they are where it seems to matter most.
Normal results reassure more when delivered with warmth and competence
When giving normal results, explain what was excluded and acknowledge the symptoms — the result alone will not reassure.
The Marburg Heart Score in 30 seconds
Score age/sex, vascular history, exertional pain, non-reproducible pain and the patient's own belief — 0–2 is low risk.
Ruling out ACS at the desk: Marburg Heart Score plus point-of-care troponin
For acute chest pain in general practice, a low Marburg Heart Score with a normal point-of-care hs-troponin safely rules out ACS.
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