Family practice
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General practitioners' perceptions of low back pain (LBP) patients were investigated through a series of in-depth semi-structured interviews, as part of a wider study which also investigated patient perceptions. An exhaustive analysis of the interview transcripts revealed six principal ways in which GPs distinguished between different patients as a means of deciding how to treat them. This differentiation, on the basis of patient characteristics, is the major focus for the resulting discussion and conclusions, and is used as a way of exploring more effective strategies for the future.
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Case note data were obtained for 186 elderly primary care attenders who also completed the 15 item Geriatric Depression Scale (GDS15). The presence or absence in the case notes of a current or past diagnosis of depression, of current treatment of depression, and of a number of clinical features of depression were noted. Case notes were also rated for the presence or absence of contraindications to the use of tricyclic antidepressants (TCAs) and to serotonin-specific reuptake inhibitors (SSRIs). ⋯ The former was significantly associated with GDS caseness (P < 0.05). Twenty-four patients (13%) were currently on antidepressants, 19 of them receiving adequate doses (equivalent to at least 75 mg of amitriptyline). Current antidepressant treatment was not associated with GDS 'caseness'.(ABSTRACT TRUNCATED AT 250 WORDS)
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The 1990 contract for general practitioners in the UK offered incentives for them to organize health promotion clinics and required them to perform 'lifestyle' checkups of their patients every 3 years, despite uncertainty about the impact of such checks on patient health. To address this lack of appropriate evaluation, a follow-up study to assess benefits in terms of patient behaviour and health resulting from the introduction of lifestyle checkups in general practice in a sample of more than 7000 patients aged 30-70 from 18 practices in three FHSA areas (in south London, Surrey and Yorkshire) has been performed. Eighteen per cent of the random sample of patients reported having a health check in the previous year. ⋯ Respondents in less privileged socioeconomic groups were more likely to have had a health check, but less likely to have had a 'full' check. Reactions to the checks were mainly positive; 81% regarded the check as helpful, and only 6% reported it to be worrying and 6% a waste of time. The implications for the new health promotion banding system in the UK are discussed.
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During the 1987 Australian winter, respiratory illness patterns were studied in a population of 454 healthy adults, aged 18-59, over a period of 45 days. These patterns were matched with data obtained from laboratory diagnoses for respiratory viruses, Mycoplasma pneumoniae and bacteria. Influenza B/1/86 was by far the most prevalent pathogen but other viruses including influenza A, paramyxoviruses, respiratory syncytial virus and coronavirus OC-43 were also present, either alone or in combination during the sampling period. ⋯ However, there were only 52 instances of viral or M. pneumoniae infections, of which 37 had a defined aetiology, while the remainder were clinically silent. No bacterial pathogens could be detected from throat swabs taken from 15 of 37 volunteers in whom a viral infection was detected, or from 43 of 70 volunteers who did not experience such infections. The study indicates that major deficiencies in our understanding of the aetiology of respiratory viral illness are probably due to methodological problems in obtaining laboratory diagnoses for many respiratory viruses, and that great difficulties exist in establishing an aetiology for respiratory infections based upon clinical symptoms alone.
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Review articles play an important role in synthesizing primary research for dissemination to clinicians. In a previous study it was found that many review articles appearing in leading peer-reviewed general medical journals are not prepared systematically. Given that review articles feature prominently in primary care journals, this study assessed the extent to which review articles published in the seven main primary care journals during 1991 had been assembled using a systematic and scientific approach. ⋯ However, when standard criteria were used to assess their methodological rigour, only 25% of the articles had a total score of more than 8 points (out of a possible 16). The validity of any conclusions or recommendations made in a poorly assembled review need to be carefully examined. Improving the methodological standards by which reviews are assembled in primary care journals should be seen as both a challenge and a priority.