Family practice
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A controlled single subject trial compares the efficacy of a new treatment with a control treatment in an individual patient. The treatments are administered in a double-blind, randomized, multi-crossover sequence of periods. During the trial response measures are obtained from each treatment period and form the basis for the statistical evaluation. ⋯ Accordingly, less rigorous statistical requirements and power must be accepted. The consequence is an increased risk of both Type I and II errors. However, in comparison with the trial and error approach frequently applied in clinical practice, the controlled single subject trial may improve the certainty of therapeutic decisions in the individual patient.
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Advocacy of communication skills training in medical curricula is common, but this paper highlights some paradoxes which become apparent when such training is instituted. Fourth-year medical students completed a standardized questionnaire measure of empathy, before and after intensive training in counselling and communication in general practice. Low rates of empathetic responding were shown, and no increase occurred after training. The results are discussed in terms of an emerging dilemma within medical education and practice, namely the conflict between the traditional view of the doctor as problem-solver and recent evidence of the health benefits of a more patient-centred style of medical practice.
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The cost of a consultation with a general practitioner forms an integral part of many economic evaluations. If resources are to be allocated efficiently it is necessary to provide accurate costings. Despite this, the research literature lacks any established method for costing consultations. This paper reviews some of the approaches used in previous studies, considers some of the issues involved in costing consultations, and provides some guidelines to follow when costing general practitioner consultations.
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Serum total cholesterol and lipoprotein analysis was performed on the same blood samples of 139 asymptomatic Chinese subjects aged 40-60 years. There was a highly significant correlation between serum total cholesterol and low density lipoproteins (correlation coefficient = 0.8376, p less than 0.001) in Chinese, which means that total cholesterol can be used as the initial screening to identify individuals who may need lipoprotein analysis. ⋯ Thirty to forty per cent of the lipoprotein analyses recommended by the ANCEP guidelines were not necessary. There was no significant age or sex influence on the degree of correlation between serum total cholesterol and LDL.
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The present population-based study comprises 84% of all known diabetics cared for at a rural primary health care centre. Patient education has been given high priority as an integral part of the treatment provided by a specially trained nurse and dietician under the supervision of the general practitioners. Most of the patients were under good metabolic control, as reflected by HbA1 (diet-treated, n = 119, 7.3 +/- 1.3%; oral agent-treated, n = 127, 7.8% +/- 1.3%; insulin-treated, n = 110, 8.0 +/- 1.3%; reference range 5.3-7.3%). Obvious reasons for any high HbA1 values were found.