Family practice
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Childhood experiences profoundly affect later functioning as an adult. Family practitioners are well-placed to discover the links between childhood troubles and later somatization, depression or anxiety. ⋯ The high prevalence of triple problems suggests a need to reconsider concepts like somatic anxiety and anxious depression. The specificity of the relation between deprivation and somatization and of the relation between other life events and depression indicates that distinct causal mechanisms (in youth) contribute to these problems.
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Meta Analysis Comparative Study
Treatments for postherpetic neuralgia--a systematic review of randomized controlled trials.
A number of different therapies have been used for postherpetic neuralgia. We decided to conduct a systematic review of existing randomized controlled trials. ⋯ Based on evidence from randomized trials, tricyclic anti-depressants appear to be the only agents of proven benefit for established postherpetic neuralgia.
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National guidelines are rarely followed by immediate change in clinical behaviour. We present our experience of an active educational method for local development and implementation of a guideline. ⋯ Participation of intended recipient general practitioners and local specialists in the development of a guideline by an active educational method as described was followed by a favourable change in clinical behaviour which persisted for at least two years.
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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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The objective was to analyse clinical and non-clinical factors associated with the receipt of a prescription for a benzodiazepine among general practice patients. A survey of 110 consecutive patient encounters (consultations) as recorded by a representative sample of general practitioners in inner urban, outer urban and rural settings was designed. A total of 286 general practitioners took part during 1991-2. 31,256 patients (10,683 male; 34%) were surveyed and the odds of receiving a benzodiazepine script measured. ⋯ There is a need to educate doctors about the non-drug management of insomnia. The stereotype of the doctor over-prescribing a benzodiazepine without an appropriate problem/diagnosis should be questioned. On the other hand, there is concern that patient age continues to be associated with a prescription of these medications, when all other clinical and non-clinical factors are taken into account.