Family practice
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Randomized Controlled Trial
'DNA' may not mean 'did not participate': a qualitative study of reasons for non-adherence at home- and centre-based cardiac rehabilitation.
Cardiac rehabilitation (CR) has been shown to improve prognosis and function following an acute myocardial infarction or revascularization. However, participation in CR programmes is low and adherence is poor. ⋯ Reasons for non-participation/non-adherence were generally multifactorial and individualistic. Many patients who had not attended or not adhered to their CR programme had participated in rehabilitative activities in other ways. Social characteristics, individual patient needs and preferences and the location of CR programmes need to be taken into account in programme design to maximize participation.
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Recruitment targets of patients to multi-centre primary care-based randomized controlled trials (RCT) are often not met. A critical step in the pathway is whether an eligible patient will give consent. ⋯ The strong association of consent with year of recruitment may be due to changes in trial procedures and investigator training. If so, this has important implications for the conduct of future trials.
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The level of participation in research by GPs is low internationally. Previous reports of the reasons why practitioners decline opportunities for research participation have tended to recount the barriers that they describe as if they are objective accounts. ⋯ The findings should inform the design and interpretation of future quantitative surveys to identify how common the attitudes that we report are. Doctors with the attitudes of those whom we interviewed will not be drawn into research by measures predicated on the assumption that it is intrinsically, clinically or professionally valuable. If they cannot be convinced of its utility, value could be conferred by payment for participation.
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People of South Asian (SA) origin have an increased risk of premature coronary heart disease. In children of SA origin, there is an increased prevalence of obesity and evidence of insulin resistance. Risk factors for cardiovascular disease in children often persist into adulthood. Low levels of physical activity are likely to be linked to the rise in obesity. ⋯ There is an urgent need for those with responsibility for young people's health, including parents, schools and community health providers, to consider and address the need for effective interventions to encourage increased physical activity levels.
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Randomized Controlled Trial Multicenter Study
Lower inhaled steroid requirement with a fluticasone/salmeterol combination in family practice patients with asthma or COPD.
Previous studies on inhaled steroid and long-acting beta2-agonist combination products may not be representative for the asthma and chronic obstructive pulmonary disease (COPD) patients in family practice. ⋯ In family practice patients diagnosed with asthma, several treatment goals were better achieved with a lower dose of fluticasone and salmeterol in a combination product than with a higher dose of fluticasone. We found no differences between the two approaches for patients with COPD.