Objectives: To investigate the diagnostic value of different clinical and laboratory findings in pneumonia and to explore the association between the doctor’s degree of suspicion and chest X-ray (CXR) result and to evaluate whether or not CXR should be used routinely in primary care, when available. Design: A three-year prospective study was conducted between September 2011 and December 2014. Setting: Two primary care settings in Linköping, Sweden. Subjects: A total of 103 adult patients with suspected pneumonia in primary care. Main outcome measures: The physicians recorded results of a standardized medical physical examination, including laboratory results, and rated their suspicion into three degrees. The outcome of the diagnostic variables and the degree of suspicion was compared with the result of CXR. Results: Radiographic pneumonia was reported in 45% of patients. When the physicians were sure of the diagnosis radiographic pneumonia was found in 88% of cases (p < 0.001), when quite sure the frequency of positive CXR was 45%, and when not sure 28%. Elevated levels of C-reactive protein (CRP) ≥ 50mg/L were associated with the presence of radiographic pneumonia when the diagnosis was suspected (p < 0.001). Conclusion: This study indicates that CXR can be useful if the physician is not sure of the diagnosis, but when sure one can rely on one’s judgement without ordering CXR. Key points There are different guidelines but no consensus on how to manage community-acquired pneumonia in primary care. When the physician is sure of the diagnosis the judgement is reliable without chest X-ray and antibiotics can be safely prescribed. Chest X-ray can be useful in the assessment of pneumonia in primary care, when the physician is not sure of the diagnosis.

Background: Differentiating between pneumonia and acute bronchitis is often difficult in primary care. There is no consensus regarding clinical decision rules for pneumonia, and guidelines differ between countries. Use of diagnostic tests and change of management over time is not known.Aim: To calculate the proportion of diagnostic tests in the management of lower respiratory tract infections (LRTIs) in a low antibiotic prescribing country, and to evaluate if the use and prescription pattern has changed over time.Design & setting: A register-based study on data from electronic health records from January 2006 to December 2014 in the Kronoberg county of south east Sweden.Method: Data regarding use of C-reactive protein (CRP), chest x-rays (CXRs), microbiological tests, and antibiotic prescriptions were assessed for patients aged 18–79 years, with the diagnosis pneumonia, acute bronchitis, or cough.Results: A total of 54 229 sickness episodes were analysed. Use of CRP increased during the study period from 61.3% to 77.5% for patients with pneumonia (P<0.001), and from 53.4% to 65.7% for patients with acute bronchitis (P<0.001). Use of CXR increased for patients with acute bronchitis from 3.1% to 5.1% (P<0.001). Use of microbiological tests increased for patients with pneumonia, from 1.8% to 5.1% (P<0.001). The antibiotic prescription rate decreased from 18.6 to 8.2 per 1000 inhabitants per year for patients with acute bronchitis, but did not change for patients with pneumonia.Conclusion: Use of CRP and microbiological tests in the diagnostics of LRTIs increased despite the fact that the incidence of pneumonia and acute bronchitis was stable.

Most studies on long-term follow-up of patients with COVID-19 focused on hospitalised patients. No prospective study with structured follow-up has been performed in non-hospitalised patients with C...

Lung auscultation is a fundamental diagnostic tool for respiratory conditions. Despite advancements in medical technology, the analogue stethoscope remains a crucial tool for diagnosing pulmonary diseases. However, traditional auscultation methods have limitations, including variability in sound interpretation and examiner dependency. This review explores the current standards of lung auscultation, highlighting the challenges and limitations of traditional methods. Further, it examines the potential of digital stethoscopes and artificial intelligence (AI) in enhancing the accuracy and reliability of lung sound analysis. A broad and iterative exploration of the literature was conducted, mainly using PubMed, Scopus, and Google Scholar. The advent of digital stethoscopes and AI presents a potential for more standardized lung auscultation. Although challenging, these technologies can standardize sound categorization, improve diagnostic accuracy, and facilitate remote consultations. There will be a need for large data sets with high quality sound files and outcome measures, and noise during recording needs to be handled. The integration of digital lung auscultation with telemedicine platforms could significantly improve patient monitoring and care, particularly for those with chronic respiratory conditions.

Background: The introduction of artificial intelligence (AI) in health care holds great promise, offering the potential to alleviate physicians’ workloads and allocate more time for patient interactions. After the emergence of large language models (LLMs), interest in AI has surged in the health care sector, including within primary care. However, patients have expressed concerns about the ethical implications and use of AI in primary care. Understanding patients’ perspectives on using AI in primary care is crucial for its effective integration. Despite this, few studies have addressed patients’ perspectives on using AI in primary care. Objective: This study aimed to synthesize qualitative research on primary care patients’ perspectives regarding the use of AI, including LLMs, in primary care. Methods: A qualitative systematic review, using thematic analysis, was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Databases, including PubMed, Scopus, Web of Science, CINAHL, and PsycINFO, were searched from inception to February 5, 2024. Eligible studies (1) used a qualitative interview research design, (2) explored primary care patients’ perspectives on the use of AI in primary care, (3) were written in English, and (4) were published in peer-reviewed scientific journals. Quantitative studies, gray literature, surveys, and studies lacking depth in qualitative analysis were excluded. The Critical Appraisal Skills Program (CASP) checklist was used for quality assessment. Results: Of 1004 studies screened, 6 were included, comprising 170 patients aged 13-91 years from 3 countries. Three themes emerged: “The Relationship with and Actions of AI Systems,” “Implementing AI responsibly,” and “Training Physicians and Artificial Minds.” Patients acknowledged AI’s potential benefits but advocated for clinician oversight, safety frameworks, and the preservation of patient autonomy. Conclusions: This systematic review provides an understanding of patients’ perspectives on AI in primary care. We identified heterogeneity in AI definitions across studies. Further research is needed on patients’ perspectives across different countries. Notably, our synthesis revealed a significant research gap, as none of the included studies particularly explored patients’ perspectives on LLMs, highlighting an important area for future research.

In primary care, the diagnosis of pneumonia is often based on history and clinical examination alone. However, a previous study showed that the general practitioner’s degree of suspicion correlates...