Family practice
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The diagnosis of a chronic disease such as diabetes generally evokes strong emotions and often brings with it the need to make changes in lifestyle behaviours, such as diet, exercise, medication management and monitoring clinical and metabolic parameters. The diagnosis thus affects not only the person diagnosed but also the family members. Chronic illnesses are largely self-managed with approximately 99% of the care becoming the responsibility of patients and their families or others involved in the daily management of their illnesses. ⋯ A comprehensive search using the MEDLINE and Cinahl databases was conducted. Key search terms included peer mentors, peer leaders, peer educators, lay health workers and community health workers. Studies that clearly identified behavioural strategies used by peers were included.
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According to current guidelines, spirometry should be performed in patients suspected of chronic obstructive pulmonary disease (COPD) by the results of history taking and physical examination. However, little is known about the diagnostic value of patient history and physical examination for COPD. ⋯ There is insufficient evidence to assess the value of history taking and physical examination for diagnosing COPD.
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Although overweight and obesity are major risk factors for ill health and premature death, leading to significant increases in workload and prescribing costs, primary health care providers continue to find managing overweight and obesity a difficult business. ⋯ The gap between primary care and public health in reducing overweight and obesity can be closed, but it requires sustained political support and investment.
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Review Meta Analysis
Humidified air inhalation for treating croup: a systematic review and meta-analysis.
Croup (laryngotracheobronchitis) is a common cause of upper airway obstruction in children. Treatment with humidified air was previously widely used and is still commonly recommended as home treatment. ⋯ The croup score of children managed in an emergency setting with mild to moderate croup probably does not improve greatly with inhalation of humidified air. There is insufficient evidence to exclude either a small beneficial or a harmful effect.
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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.