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General Medical Practice (general + medical_practice)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Use of Oral Corticosteroids and Risk of Fractures

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2000
T. P. Van Staa
Abstract Treatment with oral corticosteroids is known to decrease bone density but there are few data on the attendant risk of fracture and on the reversibility of this risk after cessation of therapy. A retrospective cohort study was conducted in a general medical practice setting in the United Kingdom (using data from the General Practice Research Database [GPRD]). For each oral corticosteroid user aged 18 years or older, a control patient was selected randomly, who was matched by age, sex, and medical practice. The study comprised 244,235 oral corticosteroid users and 244,235 controls. The average age was 57.1 years in the oral corticosteroid cohort and 56.9 years in the control cohort. In both cohorts 58.6% were female. The most frequent indication for treatment was respiratory disease (40%). The relative rate of nonvertebral fracture during oral corticosteroid treatment was 1.33 (95% confidence interval [CI], 1.29,1.38), that of hip fracture 1.61 (1.47,1.76), that of forearm fracture 1.09 (1.01,1.17), and that of vertebral fracture 2.60 (2.31,2.92). A dose dependence of fracture risk was observed. With a standardized daily dose of less than 2.5 mg prednisolone, hip fracture risk was 0.99 (0.82,1.20) relative to control, rising to 1.77 (1.55,2.02) at daily doses of 2.5,7.5 mg, and 2.27 (1.94,2.66) at doses of 7.5 mg or greater. For vertebral fracture, the relative rates were 1.55 (1.20,2.01), 2.59 (2.16,3.10), and 5.18 (4.25,6.31), respectively. All fracture risks declined toward baseline rapidly after cessation of oral corticosteroid treatment. These results quantify the increased fracture risk during oral corticosteroid therapy, with greater effects on the hip and spine than forearm. They also suggest a rapid offset of this increased fracture risk on cessation of therapy, which has implications for the use of preventative agents against bone loss in patients at highest risk. [source]

Community participation in organising rural general practice: Is it sustainable?

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2006
Judy Taylor
Abstract Objective:,We analysed community participation in organising rural general medical practice in order to suggest ways to extend and sustain it. Design:,A multisite, embedded case-study design collecting data through semistructured interviews, non-participation observation and a document analysis. Setting:,One remote and two rural communities in Australia. Participants:,Community members, GPs, health professionals, government officers and rural medical workforce consultants. Results:,High levels of community participation in recruiting and retaining GPs, organising the business model, and contributing to practice infrastructure were evident. Community participation in designing health care was uncommon. Participation was primarily to ensure viable general practice services necessary to strengthen the social and economic fabric of the community. There were factors about the decision-making and partnership processes in each of the communities that threatened the viability of community participation. Conclusions:,We recommend that a concept of community development and explicit facilitation of the processes involved is necessary to strengthen participation, create effective partnerships and ensure inclusive decision-making. [source]

Testing the effect of including oral health in general health checks for elderly patients in medical practice , a randomized controlled trial

COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 1 2007
C. Lowe
Abstract,,, Aim:, To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner. Objectives:, To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist. Setting:, Three general medical practices in east Cheshire, UK. Design:, A randomized controlled trial. Method:, Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured. Results:, Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC. Conclusions:, The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met. [source]

Spousal concordance and reliability of the ,Prudence Score' as a summary of diet and lifestyle

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2009
Sanjoti Parekh
Abstract Objectives: This paper describes a composite ,Prudence Score' summarising self-reported behavioural risk factors for non-communicable diseases. If proved robust, the ,Prudence score' might be used widely to encourage large numbers of individuals to adopt and maintain simple, healthy changes in their lifestyle. Methods: We calculated the ,Prudence Score' based on responses collected in late 2006 to a postal questionnaire sent to 225 adult patients aged 25 to 75 years identified from the records of two general medical practices in Brisbane, Australia. Participants completed the behavioural, dietary and lifestyle items in relation to their spouse as well as themselves. The spouse or partner of each addressee completed their own copy of the study questionnaire. Results: Kappa scores for spousal concordance with probands' reports (n = 45 pairs) on diet-related items varied between 0.35 (for vegetable intake) to 0.77 (for usual type of milk consumed). Spousal concordance values for other behaviours were 0.67 (physical activity), 0.82 (alcohol intake) and 1.0 (smoking habits). Kappa scores for test-retest reliability (n = 53) varied between 0.47 (vegetable intake) and 0.98 (smoking habits). Conclusion: The veracity of self-reported data is a challenge for studies of behavioural change. Our results indicate moderate to substantial agreement from life partners regarding individuals' self-reports for most of the behavioural risk items included in the ,Prudence Score'. This increases confidence that key aspects of diet and lifestyle can be assessed by self-report. Implications: The ,Prudence Score' potentially has wide application as a simple and robust tool for health promotion programs. [source]