The European journal of general practice
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Randomized Controlled Trial
Early intervention with inhaled corticosteroids in subjects with rapid decline in lung function and signs of bronchial hyperresponsiveness: results from the DIMCA programme.
Asthma is generally accepted as an inflammatory disease that needs steroid treatment. However, when to start with inhaled steroids remains unclear. A study was undertaken to determine when inhaled corticosteroids should be introduced as the first treatment step. ⋯ In this study, the early introduction of inhaled corticosteroids in newly diagnosed asthmatic subjects with rapid decline in lung function did not prove to be either clinically relevant or statistically significant in reversing the decline in FEV(1). For PC(20), no significant changes were detected.
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To evaluate the ability of elbow extension, with the patient in a supine position, as a diagnostic test of an insignificant injury, with the purpose of avoiding unnecessary radiographs. ⋯ Elbow extension as a diagnostic test in a primary care setting can predict severe elbow injuries and can be safely used in practices with no radiology facilities.
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The pulse oximeter is a vital piece of equipment in secondary care for the non-invasive monitoring of oxygen saturation. With the increasing affordability of the oximeter and recognition of its clinical applications, there is an increasing interest in its role in primary care. ⋯ In this article, a selection of studies is presented looking into its clinical use and limitations. The role and potential of the oximeter as a screening tool and aid in the assessment of hypoxia in a variety of clinical situations in primary care is discussed.
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The national health service in the Republic of Ireland is one of a number of European health services currently undergoing significant reform. Out-of-hours primary care has been at the forefront of this process of change, and although patients appear satisfied, the complexity of their response to changes in out-of-hours care has not been fully explored. ⋯ Patients hold a range of views that suggests the complexity around patient satisfaction with out-of-hours care. A qualitative methodological approach can compliment current approaches to the evaluation of patient satisfaction, facilitating the exploration of the full range of patients' views and experiences.
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Comparative Study
Out-of-hours co-operatives: general practitioner satisfaction with governance and working arrangements.
General practice co-operatives have led to significant improvements in quality of life for general practitioners. Little is known about general practitioners' own experiences with the working arrangements and governance of co-operatives. This study investigates GP satisfaction, the working environment, governance and future developments in co-operatives. ⋯ While GP co-operatives are a success story for general practice, they will work better for general practitioners and their patients if nursing, mental health, dentistry, pharmacy and social services are improved. Support and training is needed in mental health, palliative and emergency care to increase competence and reduce stress. GPs are willing to work with health authorities in further co-operative development. More attention needs to be paid to the complaints and suggestions of GPs in the running and governance of their co-operatives.