The British journal of general practice : the journal of the Royal College of General Practitioners
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Randomized Controlled Trial
Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease.
Reducing the impact of chronic disease in minority ethnic groups is an important public health challenge. Lay-led education may overcome cultural and language barriers that limit the effectiveness of professionally-led programmes. We report the first randomised trial of a lay-led self-management programme - the Chronic Disease Self-Management Programme (CDSMP) (Expert Patient Programme) - in a south Asian group. ⋯ A culturally-adapted CDSMP improves self-efficacy and self-care behaviour in Bangladeshi patients with chronic disease. Effects on health status were marginal. Benefits were limited by moderate uptake and attendance.
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Review Meta Analysis
Educational and organisational interventions used to improve the management of hypertension in primary care: a systematic review.
The optimal way in which to organise and deliver care to patients with hypertension has not been clearly identified. ⋯ General practices and community-based clinics need to have an organised system of regular follow-up and review of their hypertensive patients. Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels. These findings have important implications for recommendations concerning implementation of structured delivery of care in hypertension guidelines.
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As morbidity registrations generally do not make distinct first and following myocardial infarctions, it is still unclear as to what extent the falling rates of myocardial infarctions are caused by lower incidences of first myocardial infarctions. ⋯ A slight, significant, decline in incidence of first myocardial infarctions was found. From the mid eighties a mean annual decline of 3.5% in death from first myocardial infarction was observed. Though the variance in rates of coronary heart diseases is not unambiguous, this may indicate an effect of primary prevention. The decline was more pronounced in men, with an increasing age of getting a first myocardial infarction.