Improving referrals for glue ear from primary care: are multiple interventions better than one alone?

Objectives: To evaluate the effect of a risk factor checklist and training video for general practitioners in reducing inter-practice variation and improving the appropriateness of referrals (assessed by their positive predictive value or PPV) of patients with suspected otitis media with effusion (OME or 'glue ear') to secondary care.

Methods: Fifty general practices (177 practitioners) from the NHS Trent region and the West of Scotland were cluster-randomised either to a control group (n = 12) or to one of three intervention groups (training video (n = 16), checklist (n = 11), or both (n = 11)). Data on all paediatric ear, nose and throat (ENT) referrals and diagnostic results at ENT clinics were collected for a one-year period pre- and post-intervention.

Treating aerophagia with contingent physical guidance.

Contingent physical guidance was used to treat chronic aerophagia. This consisted of guiding the participant's hand over her mouth following each attempt to engage in aerophagia. A wristwatch was then correlated with the contingent physical guidance procedure.

Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms.

Objectives: To compare the efficacy of antidepressant drugs and generic counselling for treating mild to moderate depression in general practice. To determine whether the outcomes were similar for patients with randomly allocated treatment and those expressing a treatment preference.

Design: Randomised controlled trial, with patient preference arms.

Do the attitudes and beliefs of young teenagers towards general practice influence actual consultation behaviour?

Background: Teenagers are believed to have health concerns that are not adequately addressed in primary care because of perceived barriers that inhibit them from consulting a general practitioner (GP). We report the results of a study examining links between potential attitudinal barriers and actual help-seeking behaviour.

Aim: To determine whether the attitudes of teenagers towards general practice are associated with differences in consultation patterns.

Treating depression in general practice: factors affecting patients' treatment preferences.

We performed a cross-sectional survey of general practice attenders to determine their preferences regarding treatment for depression and characteristics associated with such preferences. Counselling was more popular than drug therapy (antidepressants), particularly among women, those who believed antidepressants are addictive, and those who had received such treatment in the past.

Assessing effectiveness of treatment of depression in primary care. Partially randomised preference trial.

Background: There is a mismatch between the wish of a patient with depression to have counselling and the prescription of antidepressants by the doctor.

Aims: To determine whether counselling is as effective as antidepressants for depression in primary care and whether allowing patients to choose their treatment affects their response.

Method: A partially randomised preference trial, with patients randomised to either antidepressants or counselling or given their choice of either treatment.

Selective serotonin reuptake inhibitors versus tricyclic and heterocyclic antidepressants: comparison of drug adherence.

Background: Selective serotonin reuptake inhibitors are thought to have better discontinuation rates (i.e. less people dropping out) than tricyclic and heterocyclic antidepressant drugs.

Changing patterns in the use of the Mental Health Act 1983 in England, 1984-1996.

Background: The Mental Health Act 1983 (MHA) is due to be revised by Parliament in the near future.

Aims: To explore changes in the use of the Act since its introduction.

Method: The Department of Health and the Home Office routinely collect data on the numbers of patients admitted to psychiatric hospitals under the MHA.

The floating knee in the pediatric patient. Nonoperative versus operative stabilization.

The results of nonoperative and operative or rigid stabilization of ipsilateral femur and tibia fractures in children and adolescents were evaluated. Twenty-nine consecutive patients with open physes (30 affected extremities) were reviewed. Their mean followup was 8.

An exploratory study of type II [3 + 4] cycloadditions between vinylcarbenoids and dienes.

The intramolecular type II [3 + 4] cycloaddition between vinylcarbenoids and furans is a practical method for the construction of 5-oxo-10-oxatricyclo[6.2.1.

Carbamazepine for cocaine dependence.

Background: Cocaine dependence has become a substantial public health problem, developing a significant number of medical, psychological and social problems, including the spread of infectious diseases (e.g. AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure.

Should general practitioners refer patients with major depression to counsellors? A review of current published evidence. Nottingham Counselling and Antidepressants in Primary Care (CAPC) Study Group.

Major depression can be treated effectively with antidepressants. However, in the United Kingdom, patients with depression are often referred to counsellors, and surveys indicate that public opinion favours this approach. We carried out a literature review to determine the evidence for the effectiveness of counselling for depression in primary care.

Pragmatic randomised controlled trials in psychiatry.

Background: Randomised controlled trials (RCTs) are the most important method of evaluating new treatments and treatment policies. Despite this, there are relatively few large pragmatic RCTs in psychiatry.

Aims: To explore the main advantages of large pragmatic RCTs and the obstacles to performing them in psychiatry.

Managing injuries of the great toe.

Most of the common great-toe injuries that affect active people are self-limiting and easily treated if detected early. Reviewed here are the causes, symptoms, diagnosis, and treatment of hallux valgus, turf toe, hallux rigidus, sesamoid dysfunction, nail abnormalities, dislocations and fractures, calluses, and blisters. Conservative treatment will usually enable patients to return to activity relatively quickly.

Posterior tibial tendon insufficiency. Its Diagnosis, Management, and Treatment.

Posterior tibial tendon dysfunction, once thought to be a rare clinical entity, has been observed to be a major cause of acquired flatfoot deformity in adults. Several risk factors have been identified, ranging from inflammatory conditions to obesity. A physical examination using a series of tests, including the single-limb rise, first-metatarsal rise sign, and the "too-many-toes" sign, used in combination with selected radiographic imaging techniques, allows classification of the severity of disease.

Strategies for the prevention of psychiatric disorder in primary care in south London.

Study Objective: To compare the potential impact of high risk and population based approaches to the prevention of psychiatric disorder, using a representative sample of general practice attenders as the target population.

Design: This was a prospective cohort study.

Setting: A health centre in south London.

Infection control challenges in child-care centers.

The child-care environment predisposes young children to infection with a variety of pathogens. Factors contributing to increased incidence of certain infections include age-specific hygiene behaviors, immunologic immaturity of young children, and exposure to pathogens with high infectivity. Respiratory tract and enteric pathogens are responsible for most illnesses, but a number of other agents are also important.

Do socio-economic risk factors predict the incidence and maintenance of psychiatric disorder in primary care?

In a prospective cohort study of consecutive primary care attenders in south London, the estimated prevalence of non-psychotic psychiatric disorder was 45.6%, using the Revised Clinical Interview Schedule (CIS-R). The estimated 12-month incidence rate was 15.

Fibrodysplasia (myositis) ossificans progressiva.

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary connective tissue disorder. Patients with FOP develop progressive ossification of muscle and connective tissue associated with pain and disability. Onset is typically in childhood, and congenital anomalies of the feet are an early sign of this condition.