Current medical research and opinion
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The usual mode of communication with the specialist in the UK is a referral letter. Letters now primarily document the GPs' concerns for the patient and are no longer required to persuade the specialist to offer an appointment. The content of referral letters from GPs has failed to satisfy specialists responding to a series of surveys. Evidence suggests that GPs who improve their letters to specialists also refer more cases with significant pathology. ⋯ GPs only have very short consultations in which to address many and complex issues. Pre-referral assessment in colorectal cases includes intimate examination of the patient. Therefore the writing of the letter of referral is often postponed until long after the patient has left the GP's office. Some GPs do not believe the consultant reads the letter of referral. However, GPs are keen to provide best care and welcome feedback about the quality of their letters. They acknowledge the responsibility to communicate with colleagues effectively and have differing ideas about what constitutes an adequate referral letter.
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Comparative Study
Differences in lipid profiles of patients given rosiglitazone followed by pioglitazone.
To compare the effects of rosiglitazone and pioglitazone on patient lipid levels in a clinical practice setting, we retrospectively examined charts of 20 patients in our practice. The patients had been treated for type 2 diabetes for 3 or more months with rosiglitazone (4 mg b.i.d.) followed immediately by 3 or more months' treatment with pioglitazone (45 mg once daily). Glycaemic control was excellent and essentially equivalent during the two treatments. ⋯ One patient receiving rosiglitazone and one receiving pioglitazone developed oedema that resolved without therapy discontinuation. Liver enzyme levels and blood pressure were unaffected in this group of patients. Because patients with diabetes are at risk for coronary artery disease, physicians should consider each agent's effects on lipid levels when choosing a specific thiazolidinedione.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Functional, cognitive and behavioral effects of donepezil in patients with moderate Alzheimer's disease.
To investigate the efficacy and safety of donepezil in a subgroup of patients with Alzheimer's disease (AD) of moderate severity from a previous trial. ⋯ The significant treatment responses observed with donepezil in these patients reinforce the findings from earlier studies that show donepezil to have important benefits, compared wih placebo, across functional, cognitive, and behavioral symptoms, with good tolerability, in patients with AD of moderate severity.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy and tolerability profile of etoricoxib in patients with osteoarthritis: A randomized, double-blind, placebo and active-comparator controlled 12-week efficacy trial.
To evaluate the efficacy of 12 weeks of treatment with etoricoxib, a selective COX-2 inhibitor, in patients with osteoarthritis (OA) of the knee or hip. ⋯ Etoricoxib showed rapid and durable treatment effects in patients with OA of the knee or hip. Etoricoxib was generally well tolerated.
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A retrospective audit was carried out to investigate triptan usage over a period of one year among 360 adult patients with migraine in nine GP practices in the UK and the Republic of Ireland. Data from patient records were analysed, in conjunction with replies to a questionnaire about patients' perceptions of their migraine and its treatment. The majority of patients included in the audit were women (83%), and most patients (81%) were aged between 35 and 64 years. ⋯ The high usage predictors could be developed into a checklist of potential indicators for GPs to identify patients who may become high users if prescribed triptans and who might require closer monitoring. We recommend that patients identified as having a potential for high usage should be routinely reviewed, every 3-6 months, to ensure that they are using triptans appropriately to treat migraine. Although triptans are generally safe and well tolerated, unnecessary use of any medication should be avoided.