The British journal of general practice : the journal of the Royal College of General Practitioners
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Antenatal services continue to change, stimulated by the Changing Childbirth report. Women's views should be an important component of assessing the quality of such services. To date, no published quantitative multidimensional assessment instrument has been available to measure their satisfaction with care. ⋯ This multidimensional satisfaction instrument has good face, content, and construct validity, and excellent internal reliability. It could be used to generally assess antenatal services or to screen them to detect areas where further in-depth qualitative enquiry is merited. Its sensitivity to change over time, external reliability, and transferability to non-Caucasian groups needs to be assessed.
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What should happen when an outpatient fails to attend a psychiatric clinic? Guidelines from the General Medical Services Committee suggest that general practitioners (GPs) have no further responsibility of care for a patient once a referral to a psychiatrist has been made. This raises questions about the formulation of effective management plans for those patients with whom psychiatric services find it difficult to engage due to non-compliance with assessment and follow-up. ⋯ Communication between GPs and psychiatrists about new patients seems adequate. However, there are important deficits in communication from psychiatrists to GPs about follow-up patients, especially non-attenders who are often more severely ill and difficult to engage. An effective response for this group is likely to need cooperative health and social service action rather than rigid guidelines concerning clinical responsibility.
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Comparative Study
Newer antidepressants: a comparison of tolerability in general practice.
An increasing number of antidepressants have been released on the United Kingdom market in recent years, and these are being prescribed more frequently in general practice. Clinical trials suggest that such agents have similar efficacy and the choice of drug is probably based on tolerability, toxicity in overdose, and cost. ⋯ Frequently reported events were similar for all six drugs but there were clinically and statistically significant differences for less frequently reported events. The adjusted mortality rate was identical between the six drugs. This study provides valuable comparative data for six, widely used antidepressants in general practice.
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England's first health strategy, The Health of the Nation, was formulated without systematic input from the citizens whose health it targeted. Several studies indicate that citizens, when asked to prioritize services, rank interventions for acute and life-threatening conditions highest. But how they view and what they want in the areas of prevention, public health, or care for the chronically and mentally ill is not known. ⋯ Citizens in this study contributed a broad range of relevant, appropriate, and innovative ideas on how to develop health strategy. The use of focus groups to achieve this is practical and efficient.
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The use of aloe vera is being promoted for a large variety of conditions. Often general practitioners seem to know less than their patients about its alleged benefits. ⋯ Even though there are some promising results, clinical effectiveness of oral or topical aloe vera is not sufficiently defined at present.