Family practice
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Randomized Controlled Trial Clinical Trial
A randomized controlled trial of group aerobic exercise in primary care patients with persistent, unexplained physical symptoms.
The management of persistent, unexplained physical symptoms is challenging and often unsatisfactory for patients and doctors. Aerobic exercise training has benefited patients referred to secondary care with symptoms of chronic fatigue and fibromyalgia. It is not known if this approach is either possible or beneficial for patients with the broader range of persistent, unexplained symptoms found in primary care. ⋯ For primary care patients with persistent, unexplained physical symptoms willing to be involved in exercise training, aerobic exercise offers no benefits over non-aerobic exercise. Whilst the observed reduction in primary health care use following exercise training is potentially of practical importance in a group of patients characterized by high consultation rates, improvement in patients' subjective state was not clearly attributable to exercise training.
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Depression is a common problem, often being recurrent or becoming chronic. The National Service Framework for Mental Health (published by the Department of Health, 1999) states that people with depression should continue to be predominantly managed in primary care. There is much evidence that the detection and management of depression by GPs could be improved, but little work has focused on GPs' views of their work with depressed patients. ⋯ Depression is commonly presented to GPs who feel that the diagnosis often involves the separation of a normal reaction to environment and true illness. For those patients living in socio-economically deprived environments, the problems, and therefore the depression, are seen to be insoluble. This has an important implication for the construction of educational interventions around improving the recognition and treatment of depression in primary care: some doctors may be reluctant to recognize and respond to such patients in depth because of the much wider structural and social factors that we have suggested in this paper. That it is the doctors working with deprived populations who express these views, means that the 'Inverse care law' [Tudor Hart J. The inverse care Law. Lancet 1971; 1(7696): 405-412] operates in the management of depression.
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Although primary care is the major target of coronary heart disease (CHD) clinical recommendations, little is known of how community physicians view guidelines and their implementation. The REACT survey was designed to assess the views, and perceived implementation, of CHD and lipid treatment guidelines among primary care physicians. ⋯ Primary care physicians need more information and support on the implementation of CHD and cholesterol guideline recommendations. This need is recognized by clinicians.
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Patients sometimes have differences of > or =20/10 mmHg in their blood pressure depending on which arm is measured. The prevalence and prognostic value of this finding in general practice are unknown. If these differences are due to peripheral vascular disease, these patients may be at increased risk of cardiovascular or cerebrovascular events. ⋯ During a single assessment of blood pressure, there will be a minority of patients with a difference of > or =20/10 mmHg between their right and left arms. Measurement of both arms is therefore necessary to diagnose and treat hypertension accurately. This study suggests an association between blood pressure difference and increased morbidity and mortality. Priority should be given to managing other risk factors aggressively in those patients with a reproducible blood pressure difference of > or =20/10 mmHg.
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Within most western countries, suicide is the second leading cause of death amongst adolescents. ⋯ (i) Fifteen year olds more at risk from parasuicide can be found amongst frequent attenders at general practice. (ii) Consulting more than once for mental health concerns or URTI where there are no physical signs could be an indicator of suicide risk.