The British journal of general practice : the journal of the Royal College of General Practitioners
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Meta Analysis
Preventive interventions to improve older people's health outcomes: systematic review and meta-analysis.
Systematic reviews of preventive, non-disease-specific primary care trials for older people often report effects according to what is thought to be the intervention's active ingredient. ⋯ Preventive primary care interventions are beneficial to older people's functional ability and SRH but not other outcomes. To improve primary care for older people, future programmes should consider delivering care in alternative settings, for example, home visits and phone contacts, and providing education to patients and health professionals as these may contribute to positive outcomes.
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Parkinson's disease is a multisystem condition that usually presents as a movement disorder in clinical practice. There is no objective method for its diagnosis and therefore the current diagnostic process is based on characteristic clinical signs and symptoms. As the presenting symptoms can be vague and non-specific, there is often a delay in diagnosis leading to mismanagement and delayed treatment initiation. In the UK, GPs identify and initially assess individuals with Parkinson's disease and refer them to specialists for formal diagnosis and treatment initiation. ⋯ This scoping review shows that there are no well-conducted studies assessing the accuracy of Parkinson's disease diagnoses when made by GPs. This calls for more focused research in this area as diagnostic delays and errors may lead to potentially harmful but preventable delays in treatment initiation resulting in decreased quality of life for individuals with Parkinson's disease.
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Randomized Controlled Trial
Increasing bowel cancer screening using SMS in general practice: the SMARTscreen trial.
Australia has one of the highest incidences of colorectal cancer (CRC) worldwide. The Australian National Bowel Cancer Screening Program (NBCSP) is a best-practice, organised screening programme, but uptake is low (40.9%) and increasing participation could reduce morbidity and mortality associated with CRC. Endorsement by GPs is strongly associated with increasing screening uptake. ⋯ The SMS intervention increased NBCSP kit return in 50-60-year-old patients in general practice. This finding informed a larger trial - SMARTERscreen - to test this intervention in a broader Australian population.
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GPs play an increasingly important role in proactively preventing dementia. Dementia in 40% of patients could be prevented or delayed by targeting 12 modifiable risk factors throughout life. However, little is known about how GPs perceive their role in dementia prevention and the associated barriers. ⋯ There needs to be a whole-systems shift towards prioritising brain health and supporting primary care professionals in their preventive role. Education is key to underpinning this role in dementia prevention.
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Accurate risk stratification identifying patients with hypertension at risk of future cardiovascular disease in primary care would be desirable. ⋯ In primary care patients with hypertension, BNP seems to be an important marker predicting future CVEs, especially heart failure, as well as all-cause mortality.