Chronic pain affects 23 million people in France and is one of the leading reasons for consultations with general practitioners (GPs). Despite having over 250 chronic pain centers nationwide, these facilities are overwhelmed, with waiting times of up to eight months. In response, the French National Authority for Health (HAS) proposed a “Healthcare Pathway for People with Chronic Pain” in 2023. However, no institutional resources are available to implement this pathway in primary care.A chronic pain healthcare pathway was implemented within a Primary Care Team in a specific region. Developed collaboratively by various healthcare professionals, the pathway involved a self-assessment of pain by a paramedic, followed by a consultation with the GP to review the assessment and set treatment goals. A multi-professional meeting, including a pain specialist, formulated a treatment plan. Six months later, an assessment was conducted. Over two years, 30 chronic pain patients were managed locally, with only two referred to hospital-based teams. This process involved a one-hour paramedic consultation, a GP consultation, and a multi-disciplinary consultation for each patient, requiring financial resources to cover associated costs.Successful implementation of a primary care pathway depends on clearly defining each professional’s role. Coordination and continuous patient monitoring are crucial for effective care, allowing caregivers to focus on quality care. Adequate human and financial resources are necessary for sustainability.The integration of a pathway in primary care, supported by tele-expertise during multi-disciplinary meetings, ensures efficient chronic pain management in the community. However, it requires a GP involved in pain management and a dedicated coordinator for vigilant patient monitoring. Financial support is essential for the pathway’s long-term sustainability.This experience demonstrates the feasibility of a primary care pain pathway. However, its successful implementation requires adequate human and financial resources, which are not currently planned by public health authorities.

Upper limb musculoskeletal disorders have been extensively studied in the workplace. In older adults, their prevalence and consequences, in terms of associated activity limitations and pain, remain largely unexplored, except in a few studies focusing on shoulder pain.To quantify the prevalence of activity limitations and pain associated with upper limb dysfunction, among independent older adults living in assisted living facilities.A cross-sectional, declarative study is ongoing in three assisted living facilities in XXX, XXX. At least 162 residents aged 75 years or older will complete a self-administered questionnaire. Exclusion criteria included cognitive disorders hindering questionnaire comprehension or being under guardianship or conservatorship. The Disabilities of the Arm, Shoulder and Hand (DASH) score and sociodemographic characteristics were described using R. The study was approved by the Ethics Committee of XXX (No. XXX).Among the 78 residents (63 women) currently included, the average DASH score was 28.5 ± 22.9 (0 = no disability; 100 = most severe disability). Upper extremity pain was reported by 64% of residents; 86% of them experienced shoulder pain, 44% hand pain, 26% wrist pain, and 12% elbow pain. Additionally, 26% of the residents who experienced pain had not informed their general practitioner of this issue.In these preliminary results, DASH scores and pain prevalence were elevated, with substantial underreporting to the general practitioner. This may reflect specific resident characteristics, including recruitment location and a higher inclusion age threshold than in previous studies. High interindividual variability in DASH scores was also observed. These findings highlight the potential value of systematic screening in primary care to limit the risk of functional decline, but should be interpreted cautiously given their preliminary nature.Upper limb activity level restrictions and pain were common in the study population. The full dataset will be obtained in February 2026. Descriptive statistics will be updated, and associations between residents’ characteristics and outcomes will be explored to assess the generalizability of the results to a broader population of older adults.

Early identification and management of chronic kidney disease (CKD) - affecting 850 million people worldwide - are essential to slow progression and reduce complications. Yet, underdiagnosis remains common despite clear screening tools (creatinine, albuminuria). This reflects persistent gaps in care coordination between primary and specialist teams, undermining timely intervention and optimal patient outcomes.This systematic review aimed to describe how early-to-moderate CKD is identified and managed in high-income countries, and to assess initiatives designed to improve care.Outpatients with early-to-moderate CKD (stages 1–3b) and healthcare professionals involved in their care. We searched, MEDLINE, Embase, Cochrane Library, Knowledge Translation+, and PDQ-Evidence for descriptive, qualitative, mixed-methods, and interventional studies focusing on early-to-moderate CKD management in high-income countrie Data were extracted using JBI tools. We conducted a convergent integrated synthesis.Ninety studies were included (46 descriptive, 23 qualitative/mixed-methods, 21 interventional), involving 33.4 million patients and 3,180 professionals. Primary care management of early-to-moderate CKD was consistently suboptimal, with limited guideline knowledge leading to inadequate albuminuria screening, poor coding, insufficient follow-up, and medication errors. Coordination with nephrologists was inconsistent, referral criteria were variably applied, and many eligible patients were not referred. Patients frequently lacked awareness of their diagnosis and encountered barriers to self-management. Interventional studies showed modest effects: educational programs alone rarely improved screening or prescribing; screening campaigns increased testing but had uncertain cost-effectiveness; and digital decision-support tools improved specific processes but yielded inconsistent clinical benefits. The most effective strategies were multimodal interventions, combining decision-support systems, practice facilitators or trained nurses, structured monitoring, and patient education, which improved CKD identification, albuminuria testing, blood pressure control, and medication safety.This review reveals a gap between guidelines and real-world practice in CKD management in primary care, marked by challenges in screening, diagnosis and coordination with nephrologists. Multimodal interventions (digital tools, interprofessional teams) improve guideline adherence, though effectiveness varies. Heterogeneity in study designs and outcomes precluded meta-analysis.Early-to-moderate CKD care remains suboptimal. Improving outcomes requires integrated, multimodal interventions supporting primary care teams, enhancing coordination with nephrology, and empowering patients.

Dyslipidemia remains a main risk among modifiable ones for atherosclerotic cardiovascular disease. The updated 2025 focused on the ESC/EAS Guidelines highlights new evidence and recommendations that impact primary prevention, pharmacotherapy, and risk assessment approaches which offers clear updates for family physicians and especially the way they handle patient`s treatment.To summarize changes in practical updates in dyslipidemia management for general practitioners, highlighting recent methods of assessing cardiovascular risk, pharmacological strategies, while integrating doable steps into regular clinic visits.We conducted a narrative synthesis based on the 2025 ESC/EAS updated guidelines, along with newer research and recent publications on implementation in general practice with tools meant to facilitate its do ability. The examination highlighted how strong the underlying evidence was, while also pointing out actual factors that matter for doctors working in primary care.The 2025 ESC/EAS guidelines offer general practitioners a significant shift in approaches; especially while evaluating cardiovascular risks, also a variety of treating options and strategies for dyslipidemia. Family physicians should adopt tools like SCORE2, including risk modifiers, and consider non statin therapies if there is indication. Applying these recommendations has shown that is not only able to reduce cardiovascular risk but also may ensure equitable preventive care in the local primary care settings.Updated guidelines significantly affect the way cardiovascular disease`s prevention is managed in primary care clinics; since updated risk assessment strategies must now fit with wider choice of treatment using the new guidelines. Moving forward, a challenge will be to provide fair availability of advanced medications while also using tests that adjust risk assessments in special cases.The 2025 ESC/EAS guidelines offer general practitioners a significant shift in approaches; especially while evaluating cardiovascular risks, also a variety of treating options and strategies for dyslipidemia. Family physicians should adopt tools like SCORE2, including risk modifiers, and consider non statin therapies if there is indication. Applying these recommendations has shown that is not only able to reduce cardiovascular risk but also may ensure equitable preventive care in the local primary care settings.

Chest pain is among the most frequent complaints in patients presenting to the emergency department, and acute coronary syndrome (ACS) remains a diagnostic challenge for clinicians. The HEAR score is a clinical tool developed to identify patients at low risk for ACS.This study aimed to evaluate the performance of the HEAR score in excluding ACS and predicting major adverse cardiovascular events (MACE) within six weeks.We conducted a prospective, descriptive, and analytical study at the emergency department of Mongi Slim Hospital between January 1, 2022, and September 30, 2023. Patients presenting with acute non-traumatic chest pain were included. The HEAR score was calculated for each patient, and a follow-up telephone contact was performed after six weeks to identify any MACE.A total of 277 patients were enrolled, with a mean age of 63 ± 16.5 years and a male-to-female ratio of 1.9.Based on the HEAR score,38.3% were classified as low risk,49.1% as intermediate risk, and 12.6% as high risk. ACS was diagnosed in 27.8% of patients, with only 0.9% in the low-risk group. The HEAR score showed an area under the curve (AUC) of 0.85 (p < 0.01;95% CI [0.80–0.89]). A threshold of <4 had a sensitivity of 98.7%,specificity of 52.8%, positive predictive value (PPV) of 45.6%,negative predictive value (NPV) of 98.2%,and likelihood ratio (LR-) of 0.02 for excluding ACS.HEAR score <4 was predictive of absence of ACS in univariate analysis (p < 0.01; OR = 1.78; 95% CI [1.56–2.04]). Within six weeks,21%of patients experienced MACE.The AUC for predicting MACE was 0.74 (p < 0.01; 95% CI [0.68–0.80]), with a HEAR cutoff <3 showing sensitivity 98.2%,specificity 33.6%,PPV 27.9%,NPV 98.7%, and LR- 0.05.HEAR score <4 predicted the absence of MACE (p < 0.01; OR = 5; 95% CI [4.9–7.2]).Previous studies support these findings.Mirfazaelian et al.demonstrated that HEAR score cutoffs<2,<3,and<4 in the emergency department had high sensitivity and NPV,with<2 being sufficient for early discharge.Similarly,Šljivo et al.reported high sensitivity and NPV for 30-day MACE in 2024.The HEAR score is a simple and reliable clinical tool to rule out ACS in low-risk patients,aiding rapid triage and decision-making in the emergency setting.

Chronic kidney disease (CKD) is associated with accelerated functional decline, elevated cardiovascular risk, and increased mortality. Evidence suggests that structured physical activity can improve functional capacity, blood pressure control, and metabolic health in CKD populations; however, exercise prescription tailored for primary care delivery remains underdeveloped.To synthesize current evidence on exercise interventions applicable to adults with CKD in primary care settings and to identify practical components for safe, feasible, and effective exercise prescription.This integrative review followed a systematic search in PubMed using MeSH descriptors (“Chronic Kidney Disease,” “Exercise,” “Primary Health Care”) combined with Title/Abstract terms. Inclusion criteria encompassed adults (≥18 years) with CKD undergoing exercise interventions feasible for primary care, including randomized trials, observational studies, and protocols. Exclusion criteria comprised pediatric populations, inadequate kidney disease characterization, case reports, editorials, and studies conducted exclusively in tertiary settings without primary care transferability. Ten studies were identified; four met eligibility criteria after independent screening. Data were extracted using standardized forms addressing design, population characteristics, exercise modality, feasibility, safety, and outcomes.Included studies comprised one randomized controlled trial, two observational cohorts, and one protocol, representing diverse CKD populations and exercise modalities. A 12-month supervised aerobic-resistance program in stage G3b–4 CKD significantly improved six-minute walk distance and mobility without exercise-related adverse events. Observational data from kidney transplant recipients showed higher physical activity levels were independently associated with fewer cardiovascular risk factors. Isometric exercise protocols demonstrated high feasibility (59% attendance) and clinically meaningful systolic blood pressure reductions in community settings. One population-based protocol incorporated multi-component primary care, including structured physical activity assessment, to prevent frailty progression.Evidence demonstrates that structured exercise—particularly combined aerobic-resistance training and simplified isometric protocols—is feasible, safe, and beneficial across CKD stages. Protocol heterogeneity and limited representation of early CKD highlight the need for pragmatic, primary-care-based trials with standardized measures.Exercise prescription for adults with CKD is a safe, feasible, and clinically meaningful intervention. Primary care represents an effective platform for implementing low-complexity, evidence-based exercise programs that preserve functional capacity and mitigate cardiovascular risk.

While celiac disease (CD) prevalence is common (≈1%), most adult cases remain undiagnosed. In adults, diagnosis currently requires duodenal biopsies. In children, however, high anti-transglutaminase antibody (tTG) levels (≥10× normal) plus positive anti-endomysial antibodies (EMA) are sufficient for diagnosis, avoiding biopsies as per ESPGHAN guidelines. CD management relies on a strict lifelong gluten-free diet, requiring regular clinical and serological follow-up, including repeated serological testing. However, primary care screening and follow-up practices for CD in France remain unknown.To assess national and regional trends in CD management in primary care through the prescription of specific celiac antibodies.Using OPENBio data from the French national health insurance, we analysed prescriptions of anti-transglutaminase and anti-endomysial antibodies by general practitioners in metropolitan France (2014–2024). We included IgA and IgG serological tests for both antibodies. Overseas regions were excluded due to incomplete data. The primary endpoint was the national prescription rate (per 10,000 inhabitants/year). Secondary endpoints were regional rates to compare activity and identify high/low prescription areas. Statistical analysis included trend analysis via linear regression (2014–2024), Student’s t-test, and two-way ANOVA (region/year).We found a significant increase in CD serology prescriptions, from 17.3 per 10,000 inhabitants in 2014 to 36.5 in 2024, representing an average annual growth of 7.7%. A slight drop occurred during the 2020 COVID-19 crisis (4.2 fewer prescriptions/10,000, ~16% decrease). Among the tests prescribed, 84% were anti-tTG and 16% anti-EMA Regional disparities were observed, with a prescription gradient increasing from Southeast to Northwest. For example, Provence-Alpes-Côte d’Azur had 2.3 times more prescriptions than Pays de la Loire, consistently over 10 years.Prescriptions of anti-transglutaminase and anti-endomysial antibodies in France have increased by ~7.7% annually over the past decade. This may partly reflect the 2012 ESPGHAN guideline allowing paediatric diagnosis based solely on serology. The regional gradient (higher in the Southeast) could be linked to proximity to Italy, where CD screening is a public health priority.Future work will examine the impact of primary care antibody prescriptions on confirmed CD diagnoses using hospital data (PMSI).   Keywords: Celiac Disease, Serologic Tests, Antibodies, Primary Healthcare