Efficacy and tolerability of controlled-release trazodone in depression: a large multicentre study in general practice.

A double-blind, parallel-group study was carried out to compare the efficacy and tolerability of a controlled-release tablet formulation of trazodone with the standard trazodone tablet. Three hundred and forty-seven general practice patients with depressive symptoms were recruited into the trial. Patients were randomly allocated to receive either 1 controlled-release trazodone (150 mg) tablet at night or 1 standard trazodone (150 mg) tablet at night for a period of 6 weeks. Assessments of efficacy, tolerability and compliance were made at study entry and after 1, 2, 4 and 6 weeks of study medication. Seventy-seven patients withdrew from the study of whom 44 were in the standard trazodone tablet group and 33 were in the controlled-release trazodone tablet group. There were no statistically significant differences between treatment groups in any of the measures of efficacy (global severity, global improvement and Hamilton Depression Rating Scales 17- and 21-item). Major improvements in patients' condition were shown in all efficacy measures by the end of the study in comparison with study entry. Treatment differences were small but were numerically in favour of the controlled-release tablet formulation. As expected, a greater proportion of side-effects were reported during the first 2 weeks of treatment in both groups. Treatment differences, revealed in a five symptom adverse event checklist used throughout the study, were small, although in favour of the controlled-release tablet in the majority of cases, but not statistically significant.

The outcome of menorrhagia: a retrospective case control study.

One hundred and three women who were known to have complained of menorrhagia at some time in their lives were compared with a control group drawn from the practice's age-sex index.The results indicated that the women in the menorrhagia group were more likely to have had antidepressant medication prescribed for them at some time in their lives than the women in the control group. Furthermore, their case folders were thicker than those of the controls. The age at which menorrhagia was first reported was the only factor studied which was associated with increased likelihood of hysterectomy.

Attendance for contraception and termination of pregnancy--a comparison of two practices.

PIP: 2 populations of women, aged 17-45 years, consulting their general practitioners for contraceptive advice are compared. The age profile of the 2 groups revealed that the 600 women attending practice A during the study period tended to be younger and single (70%) compared to the 305 women attending practice B (20% single). In practice A, only 20% sought contraceptive advice, compared to 46% in practice B. Retrospective analysis of National Health Service records suggests that an additional 6% may have sought advice elsewhere. 433 women in practice A completed questionnaires and of these 63% were single. The proportion was relatively constant until the age of 32 years when it dropped to 50%. In practice B, the predominance of single women dropped after the age of 22. In practice A, 23% had terminated a pregnancy; in practice B, the percentage was only 7.5. The difference was especially noted in women between the ages of 23-34 years. Outside this range, the proportions were roughly equivalent. Above the age of 22 women in practice B had fewer terminations probably because of the greater proportions of married women for whom unplanned pregnancies are less likely to be terminated. Research has indicated that a significant proportion of terminations in single women occur when no contraceptives have been used. Once contraception begins, motivation to limit family size, personality traits, and the stability of the relationship affect the reliability of the method. Whatever the reasons, practices with populations similar to practice A have greater termination rates and fewer women attending for contraceptive advice, indicating the need for health education to be directed toward such patients.^ieng

Contraceptive behaviour and fertility patterns in an inner London group practice.

PIP: 458 of 600 questionnaires handed out to women aged 17 to 40 attending the surgery for contraceptive advice were completed, a take-up rate of 76%. The survey revealed a relatively high proportion of young IUD users (15% compared with national figures of approximately 5%). It also showed that the population used contraception reasonable effectively. The proportion of unplanned pregnancies (58%) represented a true contraceptive failure rate of 2.5/100 women-years. 50% of all unplanned pregnancies and 29% of all conceptions ended as terminations. The most common contraceptive first choice was the pill. Contraception was not considered by many younger women until they realized they were pregnant. The findings are applicable only within the practice, and cannot be applied to society in general. Research problems encountered during the study are responder compliance, need for control data, difficulties in interpretation of skewed figures, problems of analyzing subjective data, multi-observer studies, and observer bias.^ieng

Learning general practice--the experience of one trainee.

I report my experiences in learning general practice as a vocational trainee with 12 months divided between two general practices at the end of a three-year course. A parallel between developmental milestones and a trainee's educational development is drawn and the reasons which brought patients to me as a trainee are analysed.I suggest the trainee year should be a dynamic time of learning and that trainees should be in an educational environment including progressively less authority. The trainer/trainee relationship, like the doctor/patient relationship, is all important.