The Journal of family practice
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Randomized placebo-controlled trial comparing efficacy and safety of valdecoxib with naproxen in patients with osteoarthritis.
We compared the efficacy and upper gastrointestinal safety of the cyclooxygenase-2-specific inhibitor valdecoxib with naproxen and placebo in treating moderate to severe osteoarthritis of the knee. ⋯ Valdecoxib (10 and 20 mg once daily) is significantly superior to placebo and as effective as naproxen (500 mg twice daily) in improving moderate to severe osteoarthritis of the knee. Upper gastrointestinal tract safety of valdecoxib (5 and 10 mg) was comparable to that of placebo and significantly better than that of naproxen.
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Randomized Controlled Trial Clinical Trial
General health screenings to improve cardiovascular risk profiles: a randomized controlled trial in general practice with 5-year follow-up.
To investigate the impact of general health screenings and discussions with general practitioners on the cardiovascular risk profile of a random population of patients. ⋯ Health screenings reduced the CRS in the intervention groups. After 5 years of follow-up, the number of persons at elevated cardiovascular risk was about half that expected, based on the prevalence/proportion in a population not receiving the health checks (the control group). The impact of intervention was higher among at-risk individuals. Consultations about health did not appear to improve the cardiovascular profile of the study population.
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Randomized Controlled Trial Clinical Trial
Effect on antibiotic prescribing of repeated clinical prompts to use a sore throat score: lessons from a failed community intervention study.
Infections with group A streptococcus (GAS) occur in 10% to 20% of patients with sore throats, whereas antibiotics are prescribed 50% of the time. Clinical scoring rules can more accurately predict the likelihood of GAS infection, but whether family physicians will adopt such approaches is unclear. This study sought to determine whether repeated clinical prompts to use a scoring approach could help family physicians lower antibiotic use in patients with a sore throat. ⋯ Chart prompts during clinical encounters to use a clinical score in the assessment of patients with a sore throat did not reduce unnecessary antibiotic prescribing by family physicians. The problems encountered in conducting this community-based intervention trial are discussed in relation to the negative result.
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To determine the incidence of self-reported significant hip pain using a nationally representative sample of older adults in the United States. ⋯ Self-reported hip pain has increased since NHANES I (1971-1975). Further studies are needed to identify individuals at highest risk for severe hip pain and to identify optimal treatment of hip pain.
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To examine family physicians' referral decisions, which we conceptualized as having 2 phases: whether to refer followed by to whom to refer. ⋯ Referrals are commonly made during encounters other than office visits, such as telephone conversations or staff-patient interactions, in primary care practice. Training in the referral process should ensure that family physicians obtain the skills necessary to expand their scope of practice, when appropriate; determine when and why a patient should be referred; and identify the type of practitioner to whom the patient should be sent.