11.Art.No.:CD006207. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

Harris 1980 a {published data only} * Harris B. Prospective trial of L-Tryptophan in maternity blues.

To promote the range of interventions for building family/general practice (family medicine) research capacity, we describe successful international examples. Such examples of interventions that build research capacity focus on diseases and illness research, as well as process research; monitor the output of research in family/general practice (family medicine); increase the number of family medicine research journals; encourage and enable research skills acquisition (including making it part of professional training); strengthen the academic base; and promote research networks and collaborations. The responsibility for these interventions lies with the government, colleges and academies, and universities. There are exciting and varied methods of building research capacity in family medicine. INTRODUCTIONI n this issue, we see how family/general practice (family medicine) research is necessary, and the different forms it might take. This article focuses on research capacity building, examining the barriers to research and the means of overcoming them.Family medicine research is important, not only for its own sake but also because it improves patient care, enables teachers to contribute to their discipline, and stimulates intellectual rigor and critical thinking.Gaps in the evidence that clinicians need in making decisions must be fi lled to best manage patient care problems. Research in family medicine will help fi ll these gaps by addressing specifi cally those areas where evidence is lacking.Good teachers contribute to the body of knowledge they teach, and research is the main avenue for this contribution. The following two barriers to this process are specifi c to family medicine: (1) family medicine academics and academic departments tend to be underfunded, and (2) there is less continuity between undergraduate and postgraduate training of family/general practitioners (family physicians), splitting the critical intellectual mass. This loss of continuity occurs structurally in several countries (United Kingdom, Australia, New Zealand, and South Africa), where the university teachers who taught the undergraduates do not provide postgraduate training. It also occurs functionally in many countries, because of the strong emphasis on hospital work in young physicians-a special problem for a discipline set in the community.Research stimulates intellectual rigor and critical thinking generally. A strong research tradition is the most direct route to enhance the intellectual rigor of the discipline and the individual physicians' critical thinking skills. Better critical thinking leads to more research, better quality care, and enhanced intellectual rigor. LEVELS OF RESEARCH ENGAGEMENTIt is worth establishing at what level family medicine wants to build research capacity, as shown in Figure 1. The highest order of users consciously seek the best available research evidence and appraise and combine it with clinical experience and patient values to inform their clinical decision making (the principals of evide...

ObjectiveTo pilot a single‐patient trials (SPTs) service in general practice, designed to improve decision‐making about long‐term medications for chronic conditions. Design12‐week within‐patient, randomised, double‐blind, placebo‐controlled, crossover comparison of ibuprofen with paracetamol for osteoarthritis, involving three pairs of two‐week treatment periods for each participating patient. Setting and patientsPatients attending an academic general practice with a clinical diagnosis of osteoarthritis, with pain of at least a month's duration severe enough to warrant consideration of long‐term non‐steroidal anti‐inflammatory drug (NSAID) use. Main outcome measuresPain and stiffness; measures of overall arthritis compared with previous fortnight; preference for NSAID at the end of each twoweek treatment period; use of escape analgesia; side effects; and management changes as a result of the SPTs. ResultsEight of 14 patients completed SPTs. One was a clear responder to NSAIDs, five were non‐responders, and two were indefinite. Of the five who were using NSAIDs before the SPT, two continued and three ceased using them. Clinically useful information assisted decision‐making for all eight participants. Medication management changed for six. ConclusionsSingle‐patient trials can be successfully implemented in general practice and might be a valuable method for GPs to identify patients who respond to medication for chronic stable conditions such as osteoarthritis, in which individual response to medication is variable.

BackgroundAlthough uncomplicated urinary tract infection (UTI) is commonly treated with antibiotics, the duration of symptoms without their use is not established; this hampers informed decision making about antibiotic use.AimTo determine the natural history of uncomplicated UTI in adults.Design and settingSystematic review.MethodPubMed was searched for articles published until November 2019, along with reference lists of articles identified in the search. Eligible studies were those involving adults with UTIs in either the placebo group of randomised trials or in single-group prognostic studies that did not use antibiotics and measured symptom duration. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were the percentage of patients who, at any time point, were symptom free, had symptom improvement, or had worsening symptoms (failed to improve). Adverse event data were also extracted.ResultsThree randomised trials (346 placebo group participants) were identified, all of which specified women only in their inclusion criteria. The risk of bias was generally low, but incomplete reporting of some details limited assessment. Over the first 9 days, the percentage of participants who were symptom free or reported improved symptoms was reported as rising to 42%. At 6 weeks, the percentage of such participants was 36%; up to 39% of participants failed to improve by 6 weeks. The rate of adverse effects was low and, in two trials, progression to pyelonephritis was reported in one placebo participant.ConclusionAlthough some uncertainty around the natural history of uncomplicated UTIs remains, some women appear to improve or become symptom free spontaneously, and most improvement occurs in the first 9 days. Other women either failed to improve or became worse over a variable timespan, although the rate of serious complications was low.