The British journal of general practice : the journal of the Royal College of General Practitioners
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized controlled trial of antibiotics on symptom resolution in patients presenting to their general practitioner with a sore throat.
Sore throat is a common symptom presented to general practitioners (GPs), and there remains controversy about the appropriate use of antibiotics. ⋯ Compared with placebo, cefixime can improve the rate of resolution of symptoms in patients with a sore throat who are selected for antibiotic treatment by their GP. The unexpected finding that cefixime was of benefit compared with placebo for patients without GABHS suggests that bacteria other than GABHS may be important in the pathogenesis of sore throat.
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Urinary tract infections (UTIs) in childhood are common and may be difficult to diagnose because of non-specific symptoms and technical problems with urine collection. Active management is important because UTIs may cause permanent renal scarring in young children. ⋯ There is a wide variation in clinical practice by GPs. Some always appropriately collect and test urine samples, treat without delay and refer for imaging after one proven UTI. Some never collect urines, treat blindly and refer only young infants with recurrent UTIs. Many vary their standards of practice from weekdays to weekends. The provision for GPs of clear, local, practical guidelines, drawn up between paediatricians and GPs and backed up with study days, might produce a consistent improvement in standards.
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The management of atrial fibrillation (AF) has changed substantially in recent years, especially with a greater appreciation of the prophylactic role of antithrombotic therapy against stroke. There is therefore a need for further information on the prevalence of AF in Britain, the prevalence of (and contraindications to) anticoagulant treatment, and the factors that influence doctors' decisions in treating AF, including the investigation of patients with this arrhythmia. ⋯ Atrial fibrillation is a common arrhythmia in general practice, and is commonly associated with hypertension, ischaemic heart disease and heart failure. There is a suboptimal application of standard investigations and use of antithrombotic therapy or attempted cardioversion; and few patients have presented to hospital practice. Guidelines on the management of this common arrhythmia in general practice are required.
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A Quality Assurance and Continuing Education Program has been developed in Australian general practice over the past nine years. This effectively integrates audit and education within a coherent strategy for quality improvement. ⋯ This report describes the operation of the programme and an analysis of the effects of the scheme. A similar quality assurance strategy is proposed for the UK, which would address many of the criticisms of postgraduate education and may provide a realistic model for reaccreditation.