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Results for “Randomised Controlled Trial”

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PubMed1997

Antenatal perineal massage and subsequent perineal outcomes: a randomised controlled trial.

OBJECTIVE: To study the effects of antenatal perineal massage on subsequent perineal outcomes at delivery. DESIGN: A randomised, single-blind prospective study. SETTING: Department of Obstetrics and Gynaecology, Watford General Hospital. PARTICIPANTS: Eight hundred and sixty-one nulliparous women with singleton pregnancy and fulfilling criteria for entry to the trial between June 1994 and October 1995. RESULTS: Comparison of the group assigned to massage with the group assigned to no massage showed a reduction of 6.1% in second or third degree tears or episiotomies. This corresponded to tear rates of 75.1% in the no-massage group and 69.0% in the massage group (P = 0.073). There was a corresponding reduction in instrumental deliveries from 40.9% to 34.6% (P = 0.094). After adjustment for mother's age and infant's birthweight these reductions achieved statistical significance (P = 0.024 and P = 0.034, respectively). Analysis by mother's age showed a much larger benefit due to massage in those aged 30 and over and a smaller benefit in those under 30. CONCLUSION: Antenatal perineal massage appears to have some benefit in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above.

Adult↗

PubMed2004

A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease.

BACKGROUND: Physical activity is a major modifiable risk factor for cardiovascular disease, but it is unclear what combination of feasible approaches, using existing resources in primary care, work best to initiate increased physical activity. AIM: To assess three approaches to initiate increased physical activity. DESIGN OF STUDY: Randomised controlled (2 X 2 X 2) factorial trial. SETTING: Four general practices. METHOD: One hundred and fifty-one sedentary patients with computer documented risk factors for cardiovascular disease were randomised to eight groups defined by three factors: prescription by general practitioners (GPs) for brisk exercise not requiring a leisure facility (for example, walking) 30 minutes per day, 5 days per week; counselling by practice nurses, based on psychological theory to modify intentions and perceived control of behaviour, and using behavioural implementation techniques (for example, contracting, 'rehearsal'); use of the Health Education Authority booklet 'Getting active, feeling fit'. RESULTS: Single interventions had modest effects. There was a trend from the least intensive interventions (control +/- booklet) to the more intensive interventions (prescription and counselling combined +/- booklet) for both increased physical activity and fitness (test for trend, P = 0.02 and P = 0.05, respectively). Only with the most intense intervention (prescription and counselling combined) were there significant increases in both physical activity and fitness from baseline (Godin score = 14.4, 95% confidence interval [CI] = 7.8 to 21, which was equivalent to three 15-minute sessions of brisk exercise and a 6-minute walking distance = 28.5 m, respectively, 95% CI = 11.1 to 45.8). Counselling only made a difference among those individuals with lower intention at baseline. CONCLUSION: Feasible interventions using available staff, which combine exercise prescription and counselling explicitly based on psychological theory, can probably initiate important increases in physical activity.

Analysis of Variance↗

PubMed2002

Prophylaxis of nausea and vomiting after laparoscopic cholecystectomy with ramosetron: randomised controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of ramosetron (a 5-hydroxytryptamine type 3 receptor antagonist) for the prevention of nausea and vomiting after laparoscopic cholecystectomy. DESIGN: Prospective, randomised, double-blind, placebo-controlled study. SETTING: University and university-affiliated hospitals, Japan. SUBJECTS: 100 patients, 65 women and 35 men, who had laparoscopic cholecystectomy. INTERVENTIONS: Patients were given either placebo or ramosetron at 3 different doses (0.15 mg, 0.3 mg, 0.6 mg) intravenously at the completion of operation. The general anaesthetic technique and postoperative analgesia were standard. MAIN OUTCOME MEASURES: Vomiting and safety were assessed for 0 to 24 hours and 24 to 48 hours after anaesthesia. RESULTS: The number of patients who had a complete response (no nausea, no retching, no vomiting) during 0 to 24 hours after anaesthesia was 15/25 with placebo, 17/25 with ramosetron 0.15 mg, 23/25 with ramosetron 0.3 mg, and 23/25 with ramosetron 0.6 mg; The corresponding numbers from 24 to 48 hours were 16, 17, 23, and 23. No serious adverse events were observed in any of the groups. CONCLUSIONS: Ramosetron 0.3 mg was the minimum effective dose for preventing postoperative nausea and vomiting during 0 to 48 hours after anaesthesia in patients undergoing laparoscopic cholecystectomy.

Antiemetics↗

PubMed2006

Impact of privacy legislation on the number and characteristics of people who are recruited for research: a randomised controlled trial.

BACKGROUND: Privacy laws have recently created restrictions on how researchers can approach study participants. METHOD: In a randomised trial of 152 patients, 50-74 years old, in a family practice, 60 were randomly selected to opt-out and 92 to opt-in methods. Patients were sent an introductory letter by their doctor in two phases, opt-out before and opt-in after introduction of the new Privacy Legislation in December 2001. Opt-out patients were contacted by researchers. Opt-in patients were contacted if patients responded by email, free telephone number or a reply-paid card. RESULTS: Opt-in recruited fewer patients (47%; 43/92) after invitation compared with opt-out (67%; 40/60); (-20%; [-4% to -36%]). No proportional difference in recruitment was found between opt-in and opt-out groups varied by age, sex or socioeconomic status. The opt-in group had significantly more people in active decision-making roles (+30%; [10% to 50%]; p = 0.003). Non-significant trends were observed towards opt-in being less likely to include people with lower education (-11.8%; [-30% to 6.4%]; p = 0.13) and people who were not screened (-19.1%; [-40.1% to 1.9%]; p = 0.08). Opt-in was more likely to recruit people with a family history of colorectal cancer (+12.7%; [-2.8%, 28.2%]; p = 0.12). CONCLUSIONS: The number of participants required to be approached was markedly increased in opt-in recruitment. Existing participants (eg, screening attendees) with a vested interest such as increased risk, and those preferring an active role in health decision making and with less education were likely to be recruited in opt-in. Research costs and generalisability are affected by implementing privacy legislation.

Age Factors↗

PubMed1986

A randomised controlled trial of adenine arabinoside 5'-monophosphate (ARA-AMP) in chronic hepatitis B virus infection.

Twenty-nine HBV carriers were randomised to receive ARA-AMP 10 mg/kg/day given as intramuscular injections 12 h apart for 5 days followed by 5 mg/kg/day for 23 days (15 patients) or no treatment (14 patients). Serum HBV-DNA polymerase and DNA decreased in all patients during therapy and 6 patients lost HBeAg. Five developed anti-HBe and 1 lost HBsAg and developed anti-HBs. No such changes occurred in the untreated control group over the 18-month period of observation. A 1-month course of ARA-AMP inhibits productive HBV replication and in some patients this is associated with a later loss of HBeAg and development of anti-HBe. However, intercurrent infection occurred in 3 of the treated patients with other hepatotrophic viruses known to inhibit HBV replication.

Adult↗

PubMed1999

Persistent nocturnal cough: randomised controlled trial of high dose inhaled corticosteroid.

OBJECTIVE: To investigate the effect of a short course of inhaled corticosteroid in the treatment of isolated and persistent nocturnal cough in children. DESIGN: Randomised double blind placebo controlled study. SETTING: Subjects' homes in east London, England. SUBJECTS: Consecutively referred children, 1-10 years old, with persistent nocturnal cough. INTERVENTIONS: Placebo or fluticasone propionate 1 mg twice daily for three nights and 500 microg twice daily for 11 nights. Videotaping of children at night: two nights' baseline, nights 3 and 4 after three days of inhaled corticosteroid, and nights 15 and 16. MAIN OUTCOME MEASURE: A fall in 75% of coughs from baseline. RESULTS: 50 subjects were recruited. The median number of coughs in the baseline period for the inhaled corticosteroid group and placebo group were 92 and 71, respectively (p = 0.43) and, on nights 15 and 16, 8 and 36, respectively (p < 0. 01). Compared to baseline, both groups of subjects improved significantly by nights 15 and 16 (p < 0.01; p < 0.01). Comparing the inhaled corticosteroid and placebo groups, coughs fell to a median of 22% and 57% of baseline totals on nights 3 and 4, respectively (p = 0.38), and 8% and 35% on nights 15 and 16, respectively (p = 0.02). 17 of 24 subjects on inhaled corticosteroid who completed the study and 8 of 23 on placebo improved by 75% after two weeks (p = 0.03). CONCLUSIONS: Children with persistent nocturnal cough improve in two weeks after referral on placebo. There is a modest benefit from a two week course of high dose inhaled corticosteroid.

Administration, Topical↗

PubMed2000

Internal fixation or arthroplasty for displaced cervical hip fractures in the elderly: a randomised controlled trial of 208 patients.

208 patients aged over 70 years with a displaced cervical hip fracture were admitted to a prospective randomised trial of internal fixation using 3 parallel cannulated screws or an uncemented Austin Moore hemiarthroplasty. All surviving patients were followed for a minimum of 3 years. Functional assessment of survivors at 1, 2 and 3 years from injury showed no significant difference between groups. Patients treated by the fixation had a marginally lower mortality rate. Other outcomes which favoured internal fixation were a lower risk of wound infection, reduced length of surgery (22 minutes versus 47 minutes), lower operative blood loss (23 mL versus 172 mL), and lower transfusion requirements (4/102 patients versus 18/106). However, internal fixation had a significantly greater re-admission rate (24/102 versus 7/106) and re-operation rate. Following internal fixation, 44 re-operations were required in 36 patients, while re-operation was required in only 4 patients treated with arthroplasty. The results of this randomised trial indicate that both procedures produce comparable final functional outcomes for the survivors.

Aged↗

PubMed2002

Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn's disease: a randomised controlled trial with Lactobacillus GG.

BACKGROUND AND AIMS: Experimental studies have shown that luminal bacteria may be involved in Crohn's disease. Probiotics are a possible alternative to antibiotics. The aim of this randomised placebo controlled study was to determine if Lactobacillus GG, given by mouth for one year, could prevent Crohn's recurrent lesions after surgery or to reduce their severity. METHODS: Patients operated on for Crohn's disease in whom all of the diseased gut had been removed were randomly allocated to receive 12 billion colony forming units of Lactobacillus or identical placebo for one year. Ileocolonoscopy was performed at the end of the trial or at the onset of symptoms. Endoscopic recurrence was defined as grade 2 or higher of Rutgeerts scoring system. RESULTS: Eight of 45 patients were excluded from the trial (three for non-compliance and five for protocol violations). Clinical recurrence was ascertained in three (16.6%) patients who received Lactobacillus and in two (10.5%) who received placebo. Nine of 15 patients in clinical remission on Lactobacillus (60%) had endoscopic recurrence compared with six of 17 (35.3%) on placebo (p=0.297). There were no significant differences in the severity of the lesions between the two groups. CONCLUSIONS: Lactobacillus GG seems neither to prevent endoscopic recurrence at one year nor reduce the severity of recurrent lesions.

Adult↗

PubMed2004

The effect of a distance-learning programme on patient self-management of Lower Urinary Tract Symptoms (LUTS) in general practice: a randomised controlled trial.

OBJECTIVE: To determine whether a distance-learning programme on LUTS provided to the general practitioner affected patient self-management. METHODS: A randomised trial was performed to examine the effects of the distance-learning programme (an educational package for the GP and a patient information leaflet) compared with written guidelines on LUTS mailed to the GP. In 63 general practices (32 intervention and 31 control) across the Netherlands all patients older than 50 years presenting LUTS for the first time were invited to participate. Main outcome measures were patient evaluation of quality of care received and perceptions of enablement. RESULTS: A total of 151 patients was included. The intervention increased patient enablement regarding maintenance of independence (OR = 3.14) and coping with illness (OR = 2.21). Overall enablement scores were not changed. Patients in the intervention group had more positive evaluations of general practice care received (OR = 2.28 to 3.95). An explorative analysis suggested that the effects of the intervention were mediated in particular by handing out of patient information leaflets. CONCLUSIONS: A distance-learning programme on LUTS for general practitioners had positive effects on patient self-management. Handing out leaflets appeared to be a crucial mediating factor.

Aged↗

PubMed1984

Oral zinc supplementation improves hepatic encephalopathy. Results of a randomised controlled trial.

22 cirrhotic patients with chronic encephalopathy were given oral zinc supplementation or placebo in a double-blind randomised trial. In the group which received zinc acetate 600 mg a day for 7 days, serum zinc had been restored to normal by day 8. On day 8 hepatic encephalopathy, as assessed by a trailmaking test, was improved in the supplemented group but not in the placebo group. There was also a significant increase in blood urea nitrogen in the supplemented group. Short-term oral zinc supplementation probably improved hepatic encephalopathy by correcting the zinc deficiency that compromises conversion of ammonia to urea. The duration of this improvement requires further investigation.

Acetates↗

PubMed1989

A controlled, prospective, randomised trial of adjuvant chemotherapy or radiotherapy in resectable gastric cancer: interim report. British Stomach Cancer Group.

A prospective, randomised controlled trial of surgery, surgery with adjuvant radiotherapy and surgery with adjuvant chemotherapy (5-fluorouracil, adriamycin and mitomycin C) in operable gastric cancer is described. Four hundred and thirty-six patients were randomly allocated to one of three treatment groups. With 12 months' minimum follow-up, 334 patients have died, 292 from recurrent cancer. The median survival for all patients was 15 months. Neither form of adjuvant therapy provides any survival advantage. Surgery remains the principal treatment for operable gastric cancer. Care should be taken to standardise surgical treatment and any adjuvant treatments must be compared within the confines of controlled, randomised trials.

Adenocarcinoma↗

PubMed2001

Randomised controlled trial of use by hypercholesterolaemic patients of a vegetable oil sterol-enriched fat spread.

Plant sterols may be a useful additive therapy in the treatment of hypercholesterolaemic patients. The purpose of this study was to determine the effect of a fat spread enriched with vegetable oil sterols on plasma lipid, lipoprotein and apolipoprotein concentrations. A randomised double blind placebo-controlled crossover trial with two consecutive periods of 8 weeks was conducted. 30 patients with heterozygous familial hypercholesterolaemia treated concurrently with an HMG-CoA reductase inhibitor (statin) and 32 patients with type IIa primary hypercholesterolaemia with a total cholesterol concentration >6.5 mmol/l not taking lipid-lowering drug therapy were recruited from a hospital lipid clinic. The active treatment was a fortified fat spread (25 g/day) providing 2.5 g of plant sterols. The control spread was indistinguishable in taste and appearance. Comparison at the end of the two 8-week trial periods showed a statistically significant reduction in total and LDL-cholesterol with use of the fortified spread but the results were confounded by a carry-over effect, which was partly explained by changes in the background diet. Because a carry-over effect was present, further analyses were restricted to the parallel arms of the first treatment period and were conducted on an intention to treat basis. After 4 weeks, LDL-cholesterol had decreased by 0.04 mmol/l ([0.8%] 95% confidence interval -0.44-0.37 NS) in the placebo group and decreased by -0.76 mmol/l ([15.0%] 95% CI -1.03--0.48, P<0.0001) in the active treatment group. After 8 weeks, the corresponding results were 0.0 mmol/l ([0.0%] 95% CI -0.26-0.24 NS) and -0.51 mmol/l ([10.0%] 95% CI -0.73--0.29 P<0.0001). There were no significant changes in apolipoprotein AI or B concentrations in the placebo group, but there was a small but statistically significant increase in apolipoprotein AI and a decrease in apolipoprotein B in the active treatment group. HDL cholesterol and triglyceride concentrations were unchanged. There was no difference in response between patients with statin-treated familial hypercholesterolaemia and patients with type IIa hyperlipoproteinaemia. We conclude that a fortified fat spread enriched with vegetable oil sterols reduces LDL-cholesterol by 10-15% with no difference in response between hypercholesterolaemic patients prescribed statins and those not taking lipid-lowering drug therapy.

Adult↗

PubMed2004

Systematic assessments of need and care planning in severe mental illness: cluster randomised controlled trial.

BACKGROUND: Surveys have shown high levels of unmet need in representative samples of people with severe mental illness. Introducing standardised needs assessment into the care planning process might reduce these needs and improve outcome. AIMS: To determine whether feedback from a standardised assessment of need enhances the effectiveness of care planning and whether exposing care coordinators to feedback on some patients improves their care of other patients. METHOD: A single-blind, cluster randomised trial involving a within-cluster individually randomised arm: patients' needs were evaluated using the Cardinal Needs Schedule and the findings were fed back to their care coordinators under the care programme approach. A total of 304 patients were recruited from 72 care coordinators and 242 patients (79.6%) were reassessed at 12 months. RESULTS: The only significant effect of the intervention was on patient satisfaction. Patients cluster-randomised to receive feedback were more satisfied than controls, but patients individually randomised to receive feedback were not. CONCLUSIONS: Standardised needs assessment did not substantially enhance care planning in this trial. However, giving care coordinators some experience of feedback from a standardised assessment of need could improve satisfaction.

Adult↗

PubMed2003

Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial.

This trial evaluated the clinical impact and cost-effectiveness of strategies promoting screening and brief alcohol intervention (SBI) by nurses in primary care. Randomisation was at the level of the practice and the interventions were: written guidelines (controls, n=76); outreach training (n=68); and training plus telephone-based support (n=68). After 3 months, just 39% of controls implemented the SBI programme compared to 74% of nurses in trained practices and 71% in trained and supported practices. Controls also screened fewer patients and delivered fewer brief interventions to risk drinkers than other colleagues. However, there was a trade-off between the extent and the appropriateness of brief intervention delivery with controls displaying the least errors in overall patient management. Thus cost-effectiveness ratios (cost per patient appropriately treated) were similar between the three strategies. Given the potential for anxiety due to misdirected advice about alcohol-related risk, the balance of evidence favoured the use of written guidelines to promote SBI by nurses in primary care.

Adult↗

PubMed2006

Atomoxetine for weight reduction in obese women: a preliminary randomised controlled trial.

BACKGROUND AND OBJECTIVE: Atomoxetine is a potent central norepinephrine uptake inhibitor, currently marketed for treatment of attention-deficit/hyperactivity disorder (ADHD). With the understanding that noradrenergic agents could be useful in assisting obese individuals to lose weight, we conducted this preliminary study to evaluate short-term efficacy and safety of atomoxetine in obese adults. DESIGN: At 12-week randomised, double-blind, placebo-controlled trial, conducted at Duke University Medical Centre, USA, from May 2004 to December 2004. PARTICIPANTS: A total of 30 obese women (mean (s.e.) body mass index of 36.1 (0.6) kg/m2). INTERVENTIONS: Participants were randomly assigned to receive atomoxetine (n=15) or placebo (n=15). All participants were advised to follow a balanced hypocaloric diet (500 kcal/day deficit). Atomoxetine therapy was started at 25 mg/day orally, with gradual increase to 100 mg/day over 1 week. Placebo dosing was identical. MEASUREMENTS: Body weight in kilograms was the primary outcome measure. Other measurements included waist circumference, blood pressure and heart rate, fasting plasma glucose and lipids, and depressive symptoms. RESULTS: Last-observation-carried-forward analysis of the available data for participants who had completed at least one post-randomisation assessment, demonstrated that the atomoxetine group (n=12) lost more body weight over the 12-week period than the placebo (n=14) group (mean (s.e.) -3.6 (1.0) kg (-3.7% loss) vs 0.1 (0.4) kg (0.2% gain); F (4,96)=11.9; P<0.0001). Three participants in the atomoxetine group and none in the placebo group lost >or=5% weight. Side effects were minimal. CONCLUSION: Atomoxetine demonstrated modest short-term weight loss efficacy relative to placebo in this preliminary study of obese women.

Adolescent↗

PubMed2002

A randomised controlled trial of the effectiveness of providing free fluoride toothpaste from the age of 12 months on reducing caries in 5-6 year old children.

OBJECTIVE: To assess the impact of regularly supplying free fluoride toothpaste regularly to children, initially aged 12 months, and living in deprived areas of the north west of England on the level of caries in the deciduous dentition at 5-6 years of age. A further aim was to compare the effectiveness of a programme using a toothpaste containing 440 ppmF (Colgate 0-6 Gel) with one containing 1,450 ppmF (Colgate Great Regular Flavour) in reducing caries. DESIGN: Randomised controlled parallel group clinical trial. Clinical data were collected from test and control groups when the children were 5-6 years old. SETTING: A programme of posting toothpaste with dental health messages to the homes of children initially aged 12 months. Clinical examinations took place in primary schools. PARTICIPANTS: 7,422 children born in 3-month birth cohorts living in high caries areas in nine health districts in north west England. Within each district children were randomly assigned to test or control groups. INTERVENTIONS: Toothpaste, containing either 440 ppmF or 1450 ppmF, and dental health literature posted at three monthly intervals to children in test groups until they were aged 5-6 years. MAIN OUTCOME MEASURES: The dmft index, missing teeth and the prevalence of caries experience. RESULTS: An analysis of 3,731 children who were examined and remained in the programme showed the mean dmft to be 2.15 for the group who had received 1,450 ppmF toothpaste and 2.49 for the 440 ppmF group. The mean dmft for the control group was 2.57. This 16% reduction between the 1,450 ppmF and control group was statistically significant (P<0.05). The difference between the 440 ppmF group and control was not significant. Further analyses to estimate the population effect of the programme also confirmed this relationship. CONCLUSION: This study demonstrates that a programme distributing free toothpaste containing 1,450 ppmF provides a significant clinical benefit for high caries risk children living in deprived, non-fluoridated districts.

Analysis of Variance↗

PubMed2002

Effects on serum retinol of multi-micronutrient supplementation and multi-helminth chemotherapy: a randomised, controlled trial in Kenyan school children.

OBJECTIVE: To assess the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on serum retinol concentration, using schools as a health delivery system. STUDY AREA AND POPULATION: From 19 primary schools in Bondo District, western Kenya, 977 children between 9 and 18 y were included in the trial. The 644 (65.9%) children on whom baseline serum retinol was available were included in this study. DESIGN: A randomised, placebo-controlled, double-blind, two-by-two factorial trial on the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on serum retinol after 8 months. INTERVENTION: Single treatment with albendazole (600 mg) and praziquantel (40 mg/kg of body weight) and daily multi-micronutrient supplementation with tablet containing 1000 microg vitamin A. RESULTS: Micronutrient supplementation (0.08 micromol/l, 95% CI 0.01, 0.14; P=0.025), but not treatment (0.03 micromol/l, 95% CI -0.04, 0.10; P=0.38), increased serum retinol. However, treatment did increase serum retinol in S. mansoni-infected (0.09, 95% CI 0.02, 0.16; P=0.009), but not in uninfected children (-0.07, 95% CI -0.18, 0.03; P=0.18; interaction, P=0.01). Similarly, reduction in egg output of S. mansoni, but none of the geohelminth, was a predictor, corresponding to a 0.008 micromol/l (95% CI 0.00002, 0.02; P=0.049) increase in serum retinol per 100 epg reduction. Interestingly, interactions were found between age and sex (P=0.046), and malaria parasitaemia and sickle cell phenotype (P=0.04). CONCLUSION: Multi-micronutrient supplementation and reduction in S. mansoni egg output increased serum retinol, irrespective of initial serum retinol. SPONSORSHIP: The Danish International Development Assistance.

Adolescent↗

PubMed1998

Diabetes care in general practice: meta-analysis of randomised control trials.

OBJECTIVE: To assess the effectiveness of care in general practice for people with diabetes. DESIGN: Meta-analysis of randomised trials comparing general practice and shared care with follow up in hospital outpatient clinic. IDENTIFICATION: Trials were identified from searches of eight bibliographic and research databases. RESULTS: Five trials identified included 1058 people with diabetes, overall mean age 58.4 years, receiving hospital outpatient follow up for their diabetes. Results were heterogeneous between trials. In shared care schemes featuring more intensive support through a computerised prompting system for general practitioners and patients, there was no difference in mortality between care in hospital and care in general practice (odds ratio 1.06, 95% confidence interval 0. 53 to 2.11); glycated haemoglobin tended to be lower in primary care (weighted difference in means of -0.28%, -0.59% to 0.03%); and losses to follow up were significantly lower in primary care (odds ratio 0.37, 0.22 to 0.61). However, schemes with less well developed support for family doctors were associated with adverse outcomes for patients. CONCLUSIONS: Unstructured care in the community is associated with poorer follow up, worse glycaemic control, and greater mortality than in hospital care. Computerised central recall, with prompting for patients and their family doctors, can achieve standards of care as good as or better than hospital outpatient care, at least in the short term. The evidence supports provision of regular prompted recall and review of selected people with diabetes by willing general practitioners. This can be achieved if suitable organisation is in place.

Blood Pressure↗