The British journal of general practice : the journal of the Royal College of General Practitioners
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Multicenter Study
Understanding general practice: a conceptual framework developed from case studies in the UK NHS.
General practice in the UK is undergoing a period of rapid and profound change. Traditionally, research into the effects of change on general practice has tended to regard GPs as individuals or as members of a professional group. To understand the impact of change, general practices should also be considered as organisations. ⋯ Viewing general practices as small organisations has generated insights into factors that influence responses to change. Change tends to occur from the bottom up and is determined by beliefs about organisational reality. The conceptual framework suggests some questions that can be asked of practices to explain this internal reality.
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Multicenter Study Comparative Study
Prediction of an unfavourable course of low back pain in general practice: comparison of four instruments.
Several instruments can be used to identify patients with an unfavourable course of low back pain in general practice. However, it is unclear which instrument is the predictor of outcome. ⋯ Although the prediction rule performed best with regard to calibration and discrimination, it needs to be externally validated. Risk estimation by GPs performs as well as other instruments and, at present, seems to be the best available option.
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Multicenter Study
Use of antibiotics for sore throat and incidence of quinsy.
Quinsy is the most common major suppurative complication of sore throat. Evidence on the effectiveness of antibiotics in preventing quinsy is sparse. ⋯ Most patients with quinsy develop the condition rapidly, and many do not present with a respiratory tract infection to their GP first. The current low doses of antibiotics used in modern community settings may be less likely to protect against quinsy than the trial evidence suggests.
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Multicenter Study
Adults with Down's syndrome: the prevalence of complications and health care in the community.
Individuals with Down's syndrome are predisposed to a variety of medical conditions which can impose an additional, but preventable, burden of secondary disability. Although there are guidelines for health checks and medical management of children with Down's syndrome, the needs of adults are relatively neglected. ⋯ Many individuals with Down's syndrome do not have access to regular healthcare checks, despite the high frequency of common medical complications in adult life. Debate regarding the practicality and relevance of introducing regular health checks is warranted.
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Multicenter Study
Patient pressure for referral for headache: a qualitative study of GPs' referral behaviour.
Headache accounts for up to a third of new specialist neurology appointments, although brain lesions are extremely rare and there is little difference in clinical severity of referred patients and those managed in primary care. This study examines influences on GPs' referral for headache in the absence of clinical indicators. ⋯ Referral for headache is often the outcome of patient pressure interacting with GP characteristics, organisational factors and service availability. Reducing specialist neurological referrals requires further training and support for some GPs in the diagnosis and management of headache. To reduce clinical uncertainty, good clinical prediction rules for headache and alternative referral pathways are required.