Family practice
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Randomized Controlled Trial Multicenter Study
Cluster randomized trial of a multifaceted primary care decision-support intervention for inherited breast cancer risk.
GPs are increasingly expected to meet the needs of patients concerned about their risk of inherited breast cancer, but may lack skills or confidence to use complex management guidelines. We developed an evidence-based, multifaceted intervention intended to promote confidence and skills in this area. ⋯ No convincing evidence of the effectiveness of the intervention was found, probably reflecting barriers to its use in routine practice.
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Study designs based on the identification of cases are frequently utilized when undertaking epidemiological research. Traditionally these have been mainly based on identification of cases from hospital records. This paper discusses the use of study designs based on the identification of cases focusing on their application to research data derived from primary care. ⋯ Case-only designs, specifically the case-crossover and the within-person case-series, offer alternative designs that aim to overcome problems with confounding. The principles underlying these case-only designs are presented along with examples of their use. The advantages and limitations of the different designs are discussed.
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Angina is a common chronic condition, largely managed in primary care in the UK. Mortality data are predominately from population or hospital studies with little known about the prognosis of angina in general practice settings. ⋯ The primary studies have value in determining the prognosis of patients with angina recruited in general practice; however, the studies are old, have small numbers of events and are clinically heterogeneous. The contemporary prognosis of angina in primary care remains a key question, and further research is, therefore, required to estimate the prognosis of angina in this setting and its determinants.
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Osteoarthritis (OA) of the knee is common and disabling. Exercise is effective in reducing pain and disability, but long-term adherence to exercise regimens is disappointing, and motivation to exercise in those with OA knee is poorly understood. ⋯ Several physical, cognitive and contextual factors, and a typology of exercise behaviour were identified that could be addressed in primary care consultations. The importance of gyms and GP referral schemes for people who are exercising for the first time, and the high level of patient satisfaction associated with these were highlighted.