Search results
Found 23087 matches for
We lead multidisciplinary applied research and training to rethink the way health care is delivered in general practice and across the community.
Reliability and feasibility of a near patient test for C-reactive protein in primary care
Background. The applications of new diagnostic technologies such as near patient tests are relevant to the further development and potential of primary care. Through their use, doctors in the community may increase the accuracy of their diagnoses and improve their ability to monitor disease. A reliable indicator of disease activity in various clinical conditions is C-reactive protein (CRP) and a near patient test for this is now available, although there is little information on its use outside hospitals. Aim. A study was set up to evaluate the feasibility of using a novel near patient test for CRP in primary care to validate the results against the laboratory 'gold standard' for CRP (Beckman Array) and to compare results with the usual inflammation test used in general practice. Method. Prospective recording of CRP as a near patient test on an 'intention to investigate' basis, with validation of results against the Beckman Array system for CRP and hospital laboratory erythrocyte sedimentation rate results, in six general medical practices in Birmingham. Main outcome measures were change in local laboratory usage, characteristics of patients chosen for testing, use of quality control, and comparison of readings with results from the same sample sent to an independent laboratory. Results. Tests of CRP levels were rarely requested before the study was undertaken. During the 3-month study period, 181 near patient tests were carried out, 146 (81%) to establish a diagnosis and the remainder for disease monitoring. Out of the tests, 67% were performed by general practitioners, mostly during the consultation itself. Using a cut-off level of 10 mg l -1, the near patient test and the Beckman Array gave results which agreed in 84% of cases. The sensitivity and specificity of the near patient test results were 97 and 79%, respectively. The predictive value of a positive result was 59% and that of a negative result was 99%. Cohen's Kappa was 62% and the overall mean bias for results in the range of the test was 6.11 mg l -1 (SE = 3.07 mg l -1. Each test took 6 min on average to perform, including all preparations, blood letting, performing the test and averaging the time for quality control estimations. The cost per test averaged £1.72, rising to £4.17 including labour, capital costs, quality controls and consumables (general practitioner performing the assay at average frequency found in this study). Conclusions. Measurement of CRP is rarely used in primary care and awareness of its value could be raised. This near patient test proved feasible for use by general practitioners and practice nurses. Its reliability compared with a laboratory result was satisfactory overall, and excellent with adequate operator technique.
Effectiveness and safety of diltiazem or lisinopril in treatment of hypertension after heart transplantation. Results of a prospective, randomized multicenter trail.
OBJECTIVES: The purpose of this study was to determine the effectiveness and safety of diltiazem or lisinopril for treatment of hypertension after heart transplantation. BACKGROUND: Systemic hypertension is common after heart transplantation, and to date there are no randomized, prospective multicenter treatment trials. METHODS: Members of the Cardiac Transplant Research Database Group developed and implemented a prospective, randomized multicenter trial of the effectiveness and safety of diltiazem or lisinopril in the treatment of hypertension in cyclosporine-treated patients after heart transplantation. RESULTS: One hundred sixteen patients with hypertension (blood pressure > or = 140/90 mm Hg) after heart transplantation were randomized for > or = 3 months of treatment. Of 55 diltiazem-treated patients, 21 (38%) were responders (diastolic blood pressure < 90 mm Hg), 23 (42%) were nonresponders (diastolic blood pressure > or = 90 mm Hg), and 11 (20%) were withdrawn from the study. Of 61 lisinopril-treated patients, 28 (46%) were responders, 22 (36%) were nonresponders, and 11 (18%) were withdrawn. There was no difference in baseline characteristics or percent responders between the two groups. Systolic pressure decreased from 157 +/- 2.3 to 130 +/- 2.0 mm Hg (mean +/- 1 SEM) in the diltiazem-treated responders and from 153 +/- 2.1 to 127 +/- 2.7 mm Hg in the lisinopril-treated responders (p < 0.0001). Diastolic pressure decreased from 100 +/- 0.9 to 85 +/- 1.6 mm Hg in the diltiazem-treated responders and from 100 +/- 1.0 to 84 +/- 2.0 mm Hg in the lisinopril-treated responders (p < 0.0001). There were a total of 35 reported adverse events, 22 of which led to withdrawal of the patient from the study. All drug-related side effects were considered minor and resolved with discontinuation of the drug. CONCLUSIONS: These results indicate that both diltiazem and lisinopril are safe for treatment of hypertension after heart transplantation, although titrated monotherapy with either drug controlled the condition in < 50% of patients.
Effect of Helicobacter pylori eradication therapy on dyspeptic symptoms in primary care
Objective. The aim was to explore the effect of eradication therapy on dyspeptic symptoms in patients with known peptic ulcer disease (PUD). Method. A total of 164 known dyspeptics and 147 non-dyspeptic attenders at six UK general practices were recruited. The Helisal Rapid Blood test was performed in the practices and eradication therapy left to the preference of the general practitioner. Patients were followed prospectively by a Likert scaled symptom questionnaire and record review. The symptom questionnaire distinguished between patients known to have dyspepsia and those not. Results. There was a statistically significant decrease in dyspeptic symptoms in patients with known PUD who received eradication therapy (n = 43, Z = -2.63, P = 0.009). Conclusions. Eradication of Helicobacter pylori in primary care can lead to a reduction in consumption of H2 receptor antagonists and hence cost savings. This study demonstrates that dyspeptic symptoms also decrease. The questionnaire could be used in further studies to evaluate the effect of management on dyspeptic symptoms in the primary care setting.
A randomized controlled trial of electromagnetic therapy in the primary care management of venous leg ulceration
Objective. The aim was to establish the potential efficacy, tolerability and side-effect profile of electromagnetic therapy as an adjunct to conventional dressings in the treatment of venous leg ulcers. Method. A prospective, randomized, double blind controlled clinical trial was carried out in a dedicated leg ulcer clinic based in one urban general practice. Nineteen patients with leg ulcers of confirmed venous aetiology were assessed. The main outcome measures were rate and scale of venous leg ulcer healing, changes in patient-reported pain levels, quality of life, degree of mobility, side effect profile and acceptability to patients and staff. Results. Sixty-eight per cent of patients attending this dedicated clinic achieved improvements in the size of their ulcer (4, 21%, healed fully) and in reduced pain levels (P < 0.05) during the trial, despite the chronicity of ulcer histories. Patients treated with electromagnetic therapy at 800 Hz were found at day 50 to have significantly greater healing (P < 0.05) and pain control (P < 0.05) than placebo therapy or treatment with 600 Hz. All patients reported improved mobility at the end of the study. The electromagnetic therapy was well tolerated by patients, with no differences between groups in reporting adverse events, and proved acceptable to staff. Conclusions. Despite the small numbers in this pilot study, electromagnetic therapy provided significant gains in the healing of venous leg ulcers and reduction in pain.
A prospective controlled trial of computerized decision support for lipid management in primary care
Objectives. This study aimed to assess the uptake and effect in primary care of a computerized decision support system (DSS) for the management of hyperlipidaemia. Method. A prospective controlled trial was conducted in 25 practices covering a population of 150,000 in the city of Birmingham. The Primed system, a specialist developed, rule based DSS for general practice, was introduced prospectively after a 3-month baseline data collection. The main outcome measures were nine months' data on prescribing of lipid lowering agents; use of laboratory tests; and referrals to secondary care for the investigation of hyperlipidaemia. Results. System use was lower than expected. A shift was observed towards requests for appropriate follow-up of previously abnormal lipid results and a greater emphasis on full lipid profiles, in line with the DSS guidelines. Referrals showed a 55% decrease on those expected (NS). The prescribing evaluation revealed a large variation between practices, but no significant alteration following system use. Views of users favoured decision support as a concept, but criticised technical problems with the system. Conclusions. Greater integration of DSS software and practice based data handling systems is needed. The mode of data capture, and hence both the content and form of knowledge representation, in DSS must take greater account of the primary care consultation process if such systems are to be of use to practitioners.
Undiagnosed systemic lupus erythematosus in the community
Background. Systemic lupus erythematosus (SLE) produces a wide range of symptoms, some of them mild; therefore it may be underdiagnosed. In a pilot study we tested the ability of a screening questionnaire to identify undiagnosed cases in the community. Methods. A 10-item questionnaire was mailed to 3500 women aged 18-65 randomly selected from a general practice list in Birmingham, UK. A random sample of 300 non-respondents were sent two further mailings. Women returning the questionnaire with three positive answers were to attend for an antinuclear antibody (ANA) test; and those testing positive were to be referred to a rheumatologist for standard clinical assessment. Findings. 1153 (30%) of the women responded, and 307 of these gave three or more positive answers on the questionnaire. The survey disclosed three women with previously undiagnosed SLE; and, in addition, it picked up all four of the women whose SLE had been diagnosed previously. Interpretation. The prevalence of SLE revealed by this survey in Birmingham women is 200/100 000 (95% confidence interval 80 to 412), whereas the prevalence of diagnosed SLE in this age group is 54/100 000 (95% CI 47-62). Thus, a substantial number of undiagnosed cases exist, and further work needs to focus on the prevalence in different ethnic groups and the benefits of early diagnosis and treatment.
Aggression against doctors: A review
Although the number of doctors abused is comparatively small, the perceived risk of violence presents a major issue for the whole profession since the consequences extend to all doctors through the intimidation reports in the medical press and newspapers engender.
Computerised data collection: Practicability and quality in selected general practices
The objective of the study as to assess the consistency with which a set of pre-defined data about three fictitious patients was entered into a sample group of practice computer systems, and to measure the time required for routine data capture of this kind. The study design was a prospective, piloted, postal survey, in which respondents were requested to enter a variety of general sample data onto their systems, to time the process, and record details of any difficulties. The subjects were 76 (39%) responding general practices in England and Ulster, from a random sample of members of a GP computer specialist group. These results (which in view of the highly motivated characteristics of the responding sample are likely to represent best practice) showed that differing conventions were applied in entering patient data, even among practices using the same type of computer system. Potentially significant errors and distortions were found in the data as recorded in the systems, such as the 29% of immunisation sequences which were slightly inaccurately entered. The main problems with the data entry comprised simple operator errors, inconsistency in the use of terms entered, and difficulties in recording negative data (only 20% of practices could enter patient ‘not incontinent’). Practices varied widely in the way they allocated data recording responsibilities to staff, with only 6% of practices involving all staff in data entry. The times reported for entering records varied con siderably, with an average of 26 seconds per data item (ranging from an average 10 seconds per data item to 60 seconds between doctors). The security of computer data was not a particular priority for 76% of practices. In conclusion, the workload of maintaining a fully computerised set of patient records can be substantial. The use of a computerised system for data capture by no means guarantees a standardisation of approach, either within or between practices. © 1995 Oxford University Press.
Emerging challenges for european general practice
This paper, based upon a plenary talk delivered at the 1995 WONCA World meeting in Hong Kong, speculates upon the evolving role of general practice within Europe, focusing on family medicine in the UK. Recent pressures for change have identified numerous challenges to family doctors and have resulted in an expanding and exciting potential for the future provision of primary care services. The relevance to a multinational readership is that elements of the UK experience are being replicated throughout Europe and the consequences for general practice are enormous. © 1995 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.