The British journal of general practice : the journal of the Royal College of General Practitioners
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Identification of rheumatoid arthritis (RA) in primary care is challenging and often delayed. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing of people presenting to primary care with new-onset musculoskeletal symptoms without synovitis could help address this; those testing positive are at increased risk of developing RA. ⋯ Implementing a prediction model to guide targeted anti-CCP testing in primary care could be feasible. Further research is required to explore the potential benefits, risks, and costs of a pathway for identifying/managing people at risk of RA.
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Background Estimated incidence of cancer diagnosis during or shortly after pregnancy is 1 in 1,000 women. Pregnancy can impact symptom appraisal and help-seeking for symptoms subsequently diagnosed as cancer. Little is known about the pathway to cancer diagnosis in pregnancy or delays that women can encounter. ⋯ Conclusion Health services need to better support women presenting with possible cancer symptoms during pregnancy to ensure timely diagnosis. Recommendations include prioritising symptoms over attributing them solely to pregnancy, ensuring timely referrals to rule out serious conditions, and emphasising clear communication alongside robust safety-netting practices. A full assessment is essential before dismissing symptoms as pregnancy related.
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Background Antidepressants are associated with postural hypotension (PH), but it is not typically recognised as a common adverse effect. PH is linked with serious complications in older adults (e.g. falls, stroke, cognitive decline). Randomised Controlled Trials (RCTs) examining antidepressants often exclude older people and do not focus on adverse effects. ⋯ Risk of PH was highest with SSRIs (IRR 4.22, 95% CI: 3.76-4.74), followed by "Other antidepressants" (IRR 2.17 (95% CI: 1.76- 2.68), TCAs (IRR 2.12, 95% CI: 1.79-2.50). Conclusion A striking increased risk of PH was observed with all antidepressants in the first month, particularly SSRIs. Prescribers should be aware of this risk and may consider PH monitoring when initiating antidepressants.
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Low-dose amitriptyline and mirtazapine are widely prescribed off-label for insomnia disorder. However, evidence from placebo-controlled studies is lacking. ⋯ Compared to placebo low-dose mirtazapine provided a statistically significant and clinically relevant reduction of insomnia severity at 6 weeks, but not at later time points. Low-dose amitriptyline resulted in a statistically significant reduction at 6 weeks only which was not clinically relevant.
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Complications arising from uncontrolled type 2 diabetes mellitus (T2DM) pose a significant burden on individuals' wellbeing and healthcare resources. Digital interventions may play a key role in mitigating such complications by supporting patients to adequately self-manage their condition. ⋯ DiabeText successfully improved quality of life, diabetes self-management, and self-reported medication adherence in primary care patients with T2DM. Further research is needed to enhance its effects on physiological outcomes.