The British journal of general practice : the journal of the Royal College of General Practitioners
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Opiate dependence is a major health and social issue in many countries. A mainstay of therapy has been methadone maintenance treatment, but other treatments, particularly buprenorphine, are increasingly being considered. ⋯ The literature supports the effectiveness of substitute prescribing with methadone or buprenorphine in treating opiate dependence. Evidence is also emerging that the provision of methadone or buprenorphine by primary care physicians is feasible and may be effective.
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Complexity theory has attracted considerable attention in recent years, both within medicine and in the wider world. Its themes of uncertainty and non-linearity resonate deeply with the experience of working in general practice. Describing the consultation as a complex, adaptive system provides a coherent theoretical basis for understanding the consultation, which has so far been lacking. Understanding the consultation as a complex, adaptive system offers insights into the consultation of that may prove to be of practical use to clinicians.
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Over the past 30 years, fetal movement counts have been recommended to women in the second half of pregnancy as a way of monitoring fetal wellbeing and providing an early warning of fetal distress. However, guidance from the National Institute of Clinical Excellence (NICE) recommends abandoning this. ⋯ The activity of monitoring movements has been favoured by the majority of women. The new NICE guidance is useful to clarify professional understanding of the limitation of counting fetal movements, but women who notice decreased movements will still need referral for human factors.
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Review Meta Analysis
The effectiveness of topical preparations for the treatment of earwax: a systematic review.
Earwax is a common problem in both primary and secondary care. There is uncertainty as to the most effective topical treatment. ⋯ On current evidence, there is little to choose between water-based and oil-based preparations; non-water-, non-oil-based preparations appear promising at both clearing earwax and facilitating successful syringing, but further large trials are needed. Although immediate ear syringing is effective and convenient for patients, it may be less cost-effective than using eardrops and perhaps avoiding syringing. Most of the evidence regarding such a common and time-consuming problem is not of high quality.
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Review Meta Analysis
The effectiveness of topical preparations for the treatment of earwax: a systematic review.
Earwax is a common problem in both primary and secondary care. There is uncertainty as to the most effective topical treatment. ⋯ On current evidence, there is little to choose between water-based and oil-based preparations; non-water-, non-oil-based preparations appear promising at both clearing earwax and facilitating successful syringing, but further large trials are needed. Although immediate ear syringing is effective and convenient for patients, it may be less cost-effective than using eardrops and perhaps avoiding syringing. Most of the evidence regarding such a common and time-consuming problem is not of high quality.