The British journal of general practice : the journal of the Royal College of General Practitioners
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In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice. ⋯ A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain.
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Several advantages have been claimed for general practitioners having direct access to physical therapy (defined as having a practice-based physical therapist or open access to a hospital-based physical therapist), and general practice fundholders are increasingly committing resources to ensure such services are available to their patients. This may lead to potential increases in costs as a larger total number of patients are treated owing to improved access and awareness of such services. ⋯ The main advantages are significant reductions in waiting times, convenience, reduced costs for the patient and a lower cost per treated patient. There is also some evidence that the recovery time may be slightly better for patients who have direct access to a physical therapist.
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Considerable evidence suggests that infant feeding practices are associated with variations in health. This paper reviews research relating to the health of infants who receive breast milk, and of women who breastfeed, in the developed world. Obstacles to breastfeeding are examined, and current initiatives to increase breastfeeding levels are discussed.
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Although a number of randomized controlled trials of treatment for herpes zoster have been performed, there is no consensus on how it should be managed in general practice. A systematic review of existing trials, including meta-analysis, was performed to determine the efficacy of available therapies in reducing the incidence of postherpetic neuralgia. The treatments studied included antiviral agents, corticosteroids and other drugs which had been studied in randomized trials. ⋯ Many clinical trials in this area have been too small to give reliable results. Variations in the definition and reporting of postherpetic neuralgia create difficulties in combining data from different studies. Firm recommendations for clinical practice are not possible because existing evidence neither confirms nor refutes the hypothesis that treatment during the acute phase of herpes zoster reduces pain later.
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Review
Review of 39 years of randomized controlled trials in the British Journal of General Practice.
Randomized controlled trials are being used increasingly to evaluate the effectiveness of health care interventions, including those in primary care. ⋯ Some imaginative solutions to the logistic difficulties of conducting randomized trials in general practice were noted. These may serve as an incentive to those undertaking such studies in the future.