The British journal of general practice : the journal of the Royal College of General Practitioners
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Meta Analysis
Effectiveness of different post-diagnostic dementia care models delivered by primary care: a systematic review.
Global policy recommendations suggest a task-shifted model of post-diagnostic dementia care, moving towards primary and community-based care. It is unclear how this may best be delivered. ⋯ Partnership models may impact on some clinical outcomes and healthcare costs. More rigorous evaluation of promising primary care-led care models is needed.
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Meta Analysis
Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds.
Centor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis. ⋯ Both Centor and McIsaac scores provide only fair discrimination of those with and without GABHS, and appear broadly equivalent in performance. The poor calibration for a positive test result suggests other point-of-care tests are required to rule in GABHS; however, with both Centor and McIsaac scores, a score of ≤0 may be sufficient to rule out infection.
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Meta Analysis
Increased fluid intake to prevent urinary tract infections: systematic review and meta-analysis.
Approximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives. ⋯ Given the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.
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The overall clinical impression ('clinical gestalt') is widely used for diagnosis but its accuracy has not been systematically studied. ⋯ The accuracy of the overall clinical impression compares favourably with the accuracy of CDRs. Studies of diagnostic accuracy should routinely include the overall clinical impression in addition to individual signs and symptoms, and research is needed to optimise its teaching.
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Meta Analysis
Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis.
Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about investigation in primary care. ⋯ A primary care clinician's decision to code for weight loss is highly predictive of cancer. For such patients, urgent referral pathways are justified to investigate for cancer across multiple sites.