Articles: professional-practice.
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Randomized Controlled Trial Multicenter Study
Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial.
Decreasing the prevalence of severe postpartum haemorrhages (PPH) is a major obstetrical challenge. These are often considered to be associated with substandard initial care. Strategies to increase the appropriateness of early management of PPH must be assessed. We tested the hypothesis that a multifaceted intervention aimed at increasing the translation into practice of a protocol for early management of PPH, would reduce the incidence of severe PPH. ⋯ This educational intervention did not affect the rate of severe PPH as compared with control units, although it improved some practices.
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Randomized Controlled Trial
More than measurement: practice team experiences of screening for type 2 diabetes.
The feasibility, cost-effectiveness and best means to implement population screening for type 2 diabetes remain to be established. ⋯ Although those developing screening programmes attempt to standardize them, primary care teams need to adapt the work to fit local circumstances. Staff need a sense of ownership, training, well-designed information technology systems and protected time. Furthermore, screening is more than measurement; at the individual level, it is a complete health care interaction, requiring individual explanations, advice on health-related behaviour and appropriate follow-up. The UK 'NHS Health Checks' programme should embrace these findings.
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Randomized Controlled Trial Multicenter Study
Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised trial.
GPs commonly see patients with knee problems. Magnetic resonance imaging (MRI) of the knee is an accurate diagnostic test for meniscus and ligament injuries of the knee, but there is uncertainty about the appropriate use of MRI and when it should enter the diagnostic pathway for patients with these problems. ⋯ GP access to MRI yielded small, but statistically significant, benefits in patients' knee-related quality of life but non-significant improvements in physical functioning.
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Randomized Controlled Trial Comparative Study
Low back pain in general practice: cost-effectiveness of a minimal psychosocial intervention versus usual care.
An intervention that can prevent low back pain (LBP) becoming chronic, may not only prevent great discomfort for patients, but also save substantial costs for the society. Psychosocial factors appear to be of importance in the transition of acute to chronic LBP. The aim of this study was to compare the cost-effectiveness of an intervention aimed at psychosocial factors to usual care in patients with (sub)acute LBP. ⋯ However, the complete case analysis and the sensitivity analyses with imputed cost data were inconsistent with regard to the statistical significance of this difference in cost data. This study presents conflicting points of view regarding the cost-effectiveness of MIS. We conclude that (Dutch) general practitioners, as yet, should not replace their usual care by this new intervention.
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Journal of women's health · Jul 2007
Randomized Controlled TrialPatient gender and physician practice style.
Patient and physician gender may impact the process of medical care and its outcomes. Our objective was to investigate the influence of patient gender on what takes place during initial primary care visits while controlling for other variables previously demonstrated to affect the physician-patient interaction, such as physician gender and specialty, patient health status, pain, depression, obesity, age, education, and income. ⋯ There are significant differences in the process of care between female and male patients. Physicians may be making medical decisions based on gender-related considerations. Strategies for implementing knowledge about these gender differences are crucial for the delivery of gender-sensitive care.