bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Skeletal Hot Spots in Carcinoma Prostate Patients by Scintimetric Method
Authors: Naznin Afroza , Sultana Sadia , Nahar Kamrun , Sifat Taslima , Mutsuddy Pupree
Published: June 2018

Skeletal scintigraphy is a highly sensitive tool in the detection of metastatic disease from prostate cancer, but its specificity is relatively low. Various quantitative parameters have been introduced to improve the bone scan specificity. Scintimetric method based Dr. V. Siva’s retention ratio is one such parameter proposed to help in predicting malignant or metastatic nature of the skeletal hot spots in a bone scan non-invasively. This study was performed to evaluate the V. Siva’s ratio in a small sample of prostate cancer patients in Bangladeshi population. This prospective observational study was carried out at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) from July 2015 to June 2016. A total of 32 patients with diagnosed prostate cancer were enrolled. Each patient underwent two bone scans at 4 hours and 24 hours respectively after radiopharmaceutical injection. Focal hot spots reported by expert Nuclear Medicine specialists were identified in both scans and maximum counts were taken by drawing region of interest over the spots. Dr. V. Siva’s retention ratio was calculated by dividing the 4-hour count with 24-hour count. Finally statistical analysis was done. The mean V. Siva's ratio of metastatic group was 9.3 ± 2.2 (95% CI 8.5-10.1) and that of degenerative group was 8.2 ± 2.0 (95% CI 7.5-8.9). Statistically significant difference was observed between the two groups. So it can be said that V. Siva’s retention ratio might be useful as a quantitative parameter in adjunct to conventional bone scintigraphy for the skeletal survey of carcinoma prostate patients.

Bangladesh J. Nuclear Med. 20(1): 9-13, January 2017
Maffucci’s Syndrome –a Case Report of Rare Connective Tissue Disorder
Authors: Hossain Jamiul , Rahman Hosne Ara , Sharmin Samira , Ferdous Jesmine
Published: June 2018

Maffucci’s syndrome comprises of multiple venous malformations in combination with dyschondroplasia and a variety of cutaneous, vascular, chondro-osseous and other benign and malignant mesodermal growths. This report describes the case of a 20 -year-male patient with a clinical diagnosis of Maffucci syndrome with multiple lobulated sof tissue swelling with phleboliths in left upper and lower limbs. Significant findings were presence of multiple haemangiomas, enchondromas and pathological fractures- those were evaluated by X-ray, skeletal scintigraphy and ultrasound. Skeletal scintigraphy play an important role to see the extent of the disease.Early detection and surgical management of these tumors form the basis of its treatment and desirable outcome.

Bangladesh J. Nuclear Med. 20(1): 67-69, January 2017
National Cancer Diagnosis Audit: initial results on avoidable delays
Authors: Swann Ruth , Witt ÒJana , Shand Brian , Lyratzopoulos Georgios , Hiom Sara , Rubin Greg , McPhail Sean
Published: June 2018

Background

An earlier diagnosis of cancer can increase cancer survival and quality of life. Characterising avoidable delays to a patient’s diagnosis of cancer can help to direct quality improvement initiatives.

Aim

To evaluate avoidable delays to cancer diagnoses and the variation by cancer type and patient characteristics using primary care data collected as part of the National Cancer Diagnosis Audit (NCDA).

Method

English general practices participating in the NCDA (439) entered primary care data on patients (17,042) diagnosed with cancer in 2014. Using a taxonomy developed from the National Audit of Cancer Diagnosis in Primary Care (2011), GPs reported delays to the diagnosis that in their judgement were avoidable.

Results

In 22% of NCDA patient records (n = 3380), the GP considered there to be an avoidable delay to the patient receiving their cancer diagnosis. There was variation by cancer type; 7% of breast cancer patients experienced delays compared to 34% of stomach cancer patients. 49% of avoidable delays occurred in primary care and 38% in secondary or tertiary care. Of all delays, 28% were attributed to clinician factors and 34% to health care system factors. Results will be presented by patient characteristics.

Conclusion

Primary care data from the NCDA can be used to better understand potentially avoidable delays to diagnosis and identify possible solutions for improving the diagnostic pathway. Avoidable delays during cancer diagnosis occur for many reasons. These insights can inform quality improvement initiatives, which should be directed at both clinical and organisational factors in primary care and hospital settings.
Diagnostic timeliness in adolescents and young adults with cancer: Cross-sectional findings from the BRIGHTLIGHT cohort
Authors: Herbert Annie , Lyratzopoulos Georgios , Whelan Jeremy , Taylor Rachel M , Barber Julie , Gibson Faith , Fern Lorna A
Published: June 2018

Background

Adolescents and young adults (AYA) with cancer are thought to experience prolonged diagnostic intervals but robust evidence quantifying such associations is lacking.

Aim

To examine diagnostic timeliness in a cohort of young people, identifying sociodemographic factors and cancer sites associated with variation in timeliness.

Method

We analysed data from 830 patients with cancer aged 12–24 who completed BRIGHTLIGHT face-to-face interviews, for variation in the patient interval (time from symptom onset to first healthcare presentation); the number of pre-referral GP consultations; and the total interval (time from symptom onset to diagnosis). We present descriptive statistics of these outcomes by patient characteristics and cancer site and multivariable regression models for adjusted estimates of associations.

Results

Among participants, 27% experienced a patient interval of >1 month and 35% of those consulting a GP had 3 or more (3+) pre-referral consultations. The median total interval was 62 days. We hereafter highlight significant associations (<0.05). Females were more likely to have 3+ consultations and longer total intervals compared with males. Patients with lymphoma or bone tumours were most likely to have 3+ pre-referral consultations and those with melanoma least likely. Females and patients with bone tumours had the longest median total intervals and those with leukaemia the shortest.

Conclusion

These data benchmark diagnostic timeliness for young people with cancer and identify subgroups at higher risk of prolonged diagnostic journeys. Further work is now required to prioritise and stratify early diagnosis initiatives for these subgroups.

Funding

National Institute for Health Research (RP-PG-1209-10013); Teenage Cancer Trust; Cancer Research UK (A18180).
Development of a digital intervention to optimise cancer pain control
Authors: Adam Rosalind
Published: June 2018

Background

Pain is a frequent and distressing complication of cancer. Patients can have problems reporting pain, communicating about pain with professionals, using medications effectively, and seeking help.

Aim

To develop an intervention to support patients and professionals improve cancer pain control.

Method

An Intervention Mapping approach was taken to intervention development. Current challenges of managing cancer pain and potential solutions were investigated through systematic literature review and qualitative enquiries with patients, caregivers, and professionals. Behaviour change theory was applied systematically. A digital intervention was produced and prototypes were pre-tested. Patients were recruited with their linked Macmillan nurse and GP to feasibility test the intervention.

Results

A digital app was developed to help patients on strong opioids achieve personal treatment goals. The app includes a short film about pain management. It allows easy recording of short-acting analgesic doses, linked algorithmically to telephone help-screens. A weekly diary asks about pain, side effects, function, and medication adherence. App reports are automatically shared with linked professionals via NHS email. Early feasibility testing has been conducted with two patients, their linked GPs, and Macmillan nurses. Professionals found patient reports thought-provoking. Reports were used to inform clinical encounters, and seemed to promote a shared understanding of patient symptom management goals.

Conclusion

A digital intervention has been developed using a rigorous, theory-based methodological approach. There are early indications that the intervention could promote patient-centred care and shared decision making in patients with cancer pain. The intervention is ready to be tested on a larger scale.
Informal communication in integrated primary health clinics
Authors: Elmitt Nicholas , Douglas Kirsty , Phillips Christine , Hall Sally , Bookallil Marianne
Published: June 2018

Background

Effective integrated care requires healthcare professionals to collaborate across disciplines with and around the patient. The tribal nature of health professionals can make this a difficult task. Understanding how, when and where communication occurs in Integrated Primacy Health Clinics (IPHCs) can foster stronger integration, however communication patterns are not always predictable. Informal communication is often the most prominent form of communication in an IPHC, but is poorly understood due to its nature.

Aim

To articulate the role that informal communication plays in supporting integration, propose methods for measuring it, and discuss the results of our study in a community IPHC in Canberra, Australia.

Method

Aspects of informal communication are defined and their functions explained. The aspects of informal communication are: informal networks, informal relationships, and informal encounters. A mixed-methods approach to measuring and describing the role of informal communication is proposed: Social Network Analysis is a useful tool for examining key relationships across disciplines; ethnography is necessary to understand how these relationships emerged, what supports them, and how they contribute to integration.

Results

Our study revealed that informal communication is more prevalent and preferred to formal communication in the community IPHC we studied. Space, shared experiences and commitment to organisational ethos were key to building these relationships which allow for teams to more quickly respond to the needs of patients.

Conclusion

Informal mechanisms exist and influence both processes and outcomes in IPHC. The informal communications that occur within the IPHC are often vital to the process of integration as well as the outcomes of the patient. SNA can give us important insight, but we cannot see the entire picture unless this is complemented by focused qualitative research.
Passé or a time to pause? A phenomenological study of family physicians’ experiences of physical examination
Authors: Kelly Martina , Freeman Lisa
Published: June 2018

Background

Once the cornerstone of clinical family practice, the role of physical examination is changing. Patients and physicians alike express concern that emphasis on evidence-based medicine and increasing reliance of technology has relegated the role of physical examination in clinical practice.

Aim

To understand the role of physical examination in contemporary family practice.

Method

Qualitative phenomenological study, interpreted through the writings of Merleau-Ponty. Semi-structured interviews were conducted with a purposive sample of sixteen family physicians; men, women, recent graduates and experienced physician working in urban, rural and academic practices. Interviews were recorded, transcribed and examined using template analysis, complimented with researcher reflexivity.

Results

Study participants described physical examination as core to practice, to diagnose, to communicate, and to validate patient and practitioner concerns. Performance of physical examination became routine over time but a disruption to the expected caused physicians to pause. Participants described this as a slowing of time where they became conscious of the body of the patient and their own body, intertwined in a moment. Physicians experienced affective, intellectual, and physical phenomena, which integrated to guide their behaviour, diagnosis, and management of the patient. The role of physical examination was to not only diagnosis as an evidence-based medical expert, but was experienced as a form of embodied, nonverbal communication, which expressed care.

Conclusion

Physical examination plays an important role to reassure and communicate trust in the doctor–patient relationship, enacted through the body of the physician. Complimenting diagnosis, the laying on of hands remains an essential element of patient care.
Management by the GP of patients with a suspected meniscal tear: a retrospective cohort study
Authors: Snoeker Barbara A.M. , Lindeboom Robert , Lucas Cees , Zwinderman Aeilko H , Beers Erna
Published: June 2018

Background

Although guidelines advocate conservative treatment, it is unclear how GPs manage patients with a suspected meniscal tear.

Aim

To provide a clear understanding of the frequency of patients that are conservatively treated or are referred to secondary care, and whether this management is associated with age, trauma and locking complaints, and varied between general practices.

Method

Data was extracted from a GP database of routinely collected data. Subjects of 18–75 years old who attended their GP from 2005 up to and including 2015 in the area of Amsterdam with suspected meniscal tear were included. Groups were defined as 1) conservative treatment, 2) referral to secondary care after conservative treatment and 3) instant referral.

Results

We retrieved 394 records. One hundred and twenty-two (31%) subjects were treated conservatively, 107 (27%) were referred after conservative treatment and 165 (42%) subjects were instantly referred to secondary care. This implies that of all subjects with a suspected meniscal tear, 69% were referred to secondary care of which more than 60% instantaneously. Subjects >40 years of age were more often referred than subjects ≤40 years (P = 0.013). Significant variation between GP practices occurred as initial referral and referral after conservative treatment ranged between 56% to 84% (P = 0.011).

Conclusion

In Dutch GP practices, the majority of patients with suspicion meniscal tear are referred to secondary care. Older subjects are more frequently referred than younger subjects. The management of such patients varies substantially between GP practices. Findings emphasize the need for individualized risk predictions to guide decisions regarding the management of suspected meniscal tears.
Effect and acceptability of AKI education using peer review audit in primary care
Authors: Asrar Mufaza , McKinnell Joanna , Kolhe Nitin , Woods Lynn , Bassett Sally , Selby Nick , Shaw Sue
Published: June 2018

Background

This was part of the Southern Derby shire CCG AKI awareness and improved management in primary and secondary care. The programme involved educating the primary care staff (GPs nurses) about AKI, identifying and early management in at risk groups. The secondary care aspect involved protocol development for AKI risk/identification to reduce morbidity.

Aim

As two-thirds of AKI originates in the community we aimed to increase awareness and knowledge levels of AKI in primary care via a CCG wide education programme. This included nephrology a peer review audit of cases with an evaluation of the programme’s acceptability and impact.

Method

Over a 12month period, peer review audit sessions were delivered to GPs and the primary care MDT. These sessions consisted of a short presentation by a consultant nephrologist followed by discussion of cases. Qualitative feedback was collected from all participants. Web-based, CCG-wide questionnaires incorporating factual and clinical questions were used to assess baseline and post-intervention knowledge level.

Results

93% of participants (94 responses) found the peer review audit sessions useful, particularly the presence of nephrologist. 45% of participants were anxious about group discussion of cases, although 36% thought they were the most useful component of the sessions. Formal presentations were ranked as the most popular format of receiving education. 996 individuals completed the questionnaires. At baseline 61% were GPs, 27% practice nurses and 8% Advanced Practitioners, with similar proportions at 1yr. Exposure to AKI teaching, self-reported awareness and confidence levels were higher in the second questionnaire and there was a significant improvement in test scores.

Conclusion

Primary care education can improve knowledge and awareness of AKI. Small group teaching with involvement of a nephrologist was popular. These results suggest that there is a need to tailor education styles to individual preferences, and peer review audit may not be universally acceptable in primary care.
Primary care improvement for patients with complex long-term conditions
Authors: Sheikh Zenobia , Crump Helen , Sherlaw-Johnson Chris , Gill Mike , Atkinson Colleen , Meaker Rob , John Jagan , Roberts Mike
Published: June 2018

Background

Patients with five or more long-term conditions have been shown in Barking, Havering and Redbridge Clinical Commissioning Groups to be the heaviest users of health and social care. An innovative new model of primary care, ‘Health 1000’ was thus established. Comprising a fully integrated multidisciplinary team (including third sector, a social worker and dual skilled ‘keyworkers’) this practice aligned the care of complex patients and endeavoured to avoid unnecessary hospital admissions.

Aim

To test the hypothesis that Health 1000 (a multidisciplinary GP practice with consultant geriatrician support) would align and improve quality of care and health/social outcomes for complex patients with five-plus long-term conditions.

Method

Using anonymised disease registers, an eligible cohort was identified and invited by their existing practices to re-register with Health 1000. Each patient received comprehensive initial consultation at registration, encompassing reviews of pill burden and social need. Biweekly multidisciplinary discussion ensured their care was aligned and met to a high quality. Independent qualitative evaluation was undertaken by the Nuffield Trust using face to face/telephone interviews with staff/patients.

Results

408 patients (from an eligible cohort of approximately 2000) were registered. Most patients were extremely satisfied with the new service highlighting friendly welcoming atmosphere, speed of service, key workers’ responsiveness, availability of phone consultations with GPs, longer appointment slots and home visits.

Conclusion

Qualitative outcomes were very positive and suggest that there is benefit for patients with multiple long-term conditions from embedding a multidisciplinary team in primary care with specialist expertise.
Developing the capacity of general practice staff to support healthier weight status in children
Authors: Ahmad Raheelah , Cunningham Vida , Oki Bimpe , Sim Fiona
Published: June 2018

Background

Lambeth has implemented a healthy weight care pathway including capacity building of multi-agency staff. Successes include being the only borough in the country to see statistical reductions in childhood obesity over 5 years; but the challenge of 39.2% of 10–11-year olds leaving primary school as overweight/obese persists. When families approach GPs to validate the National Child Measurement Programme feedback, challenges include interpretation and explanation of body mass index (BMI). GPs have also felt uncomfortable raising the issue in routine consultations.

Aim

To understand potential enablers to raising the issue of unhealthy weight in children in general practice.

Method

70 staff (GPs 58%; Nurses 25%; GP registrar/trainee 7%; and HCA/other 10%) completed a bespoke childhood obesity capacity building workshop (accredited by the Royal College of GPs). Using scenario-based activities and end of session written questionnaire we gathered: knowledge and perceptions of weight measures, role of diet, nutrition and physical activity, as well as current blocks and potential enablers for brief intervention.

Results

Less than 5% of participants were able to identify a very overweight child by visual inspection. Confidence in raising the issue was reported due to enhanced knowledge of energy intake, physical activity and provision of a BMI wheel (40%), new ways of raising the issue (30%), understanding of supportive services in Lambeth (30%).

Conclusion

Supportive measures identified within a whole systems approach including role of schools, government, public health and the CCG are informing future planning.
Presenting primary care teams to the public: a qualitative exploration of general practice websites
Authors: Anderson Helen , Adamson Joy , Birks Yvonne
Published: June 2018

Background

Increasing demand and expanded primary care provision, coupled with a reduced GP workforce present challenges for primary care. New workforce models aim to reduce general practitioner workload by directing patients to a variety of alternative clinicians. Concurrently, the principle of patient choice in relation to healthcare providers has gained prominence. It is, therefore, necessary to provide patients with sufficient information to negotiate access to appropriate primary healthcare professionals.

Aim

To explore how practice websites present three exemplar healthcare professional groups (GPs, advanced nurse practitioners [ANPs], and practice nurses [PNs]) to patients and the implications for informing appropriate consultation choices.

Method

Qualitative thematic analysis of a sample of general practice websites. 79 accessible websites from a district in England were thematically analysed in relation to professional representation and signposting of the three identified professional groups.

Results

Information about each group was incomplete, inconsistent and sometimes inaccurate across the majority of general practice websites. There was a lack of coherence and strategy in representation and direction of website users towards appropriate primary healthcare practitioners.

Conclusion

Limited and unclear representation of professional groups on general practice websites may have implications for the direction of patients to the wider clinical healthcare team. Patients may not have appropriate information to make choices about consulting with different healthcare practitioners. This constitutes a missed opportunity to signpost patients to appropriate clinicians and enhance understanding of different professional roles. Potential for websites to disseminate information to the public is not being maximised.
Impact of practice based clinical pharmacist led medication reviews on ambulatory patients with hyper polypharmacy
Authors: Williams Steve , Brad Lawrence D
Published: June 2018

Background

Problematic polypharmacy is at the heart of medicines usage in patients with multimorbidity, and review by medicines experts in primary care is essential.

Aim

To assess the impact of medication reviews by a clinical pharmacist on ambulatory patients with hyper polypharmacy

Method

The study took place within a large urban practice in Dorset. Patients over ≥75 years old with ≥10 regular medicines were identified using the NHS Business Service Authority Polypharmacy database. Patients who were housebound, lived in a care home or with dementia were excluded and GP partners were asked to confirm the validity of these exclusions. Patients were sent a letter from their personalised GP inviting them to attend a 30-minute consultation with a clinical pharmacist prescriber employed by the practice. The age and frailty status of patients, number of medicines pre- and post-consultation, and the nature of medicines optimisation decisions were recorded. Patient satisfaction with the consultations was assessed using a 7-point Likert scale questionnaire.

Results

91 out of 17000 (0.5%) patients were receiving ≥ 10 medicines. 25 patients were excluded and to date 20/26 (77 %) patients invited had a consultation booked or been seen. Medicines optimisation changes varied in number and complexity and controversial changes discussed with patients’ individual GP. To date all patients rated the consultation as very good to outstanding (median score 6.5)

Conclusion

Ambulatory patients with hyper polypharmacy highly rated medication reviews with a clinical pharmacist and medication regimens in most were optimised through shared decision making.
Reproducibility of a simple cardiac output response to stress test to diagnose and monitor heart failure in a primary care setting
Authors: Jakovljevic Djordje , Charman Sarah J , Okwose Nduka C , Stefanetti Renae J , Bailey Kristian , Skinner Jane , Scott Mike , Mant Jonathan , Hobbs FD Richard , MacGowan Guy A
Published: June 2018

Background

We developed a simple non-invasive Cardiac Output Response to Stress (CORS) Test to improve diagnosis and monitoring of heart failure in primary care.

Aim

The aim of the present study was to assess test-retest reproducibility of the CORS test.

Method

Thirty-two healthy volunteers (age, 64±10, female n=18) were recruited. Cardiac output was measured continuously using bioreactance method in supine and standing position, and during a two 3-min stages of a step-exercise protocol (10 and 15 steps per minute) using a 15-cm height bench. The CORS test was performed twice i.e. Test 1 and Test 2.

Results

Cardiac output and stroke volume were not significantly different between the two tests at supine (6.2±1.4 versus 6.3±1.7 L/min, P = 0.84; 102±24 versus 108±32 ml/beat, P = 0.36), standing (5.7±2.1 versus 5.7±1.9 L/min, P = 0.99; 82±32 versus 83±29 ml/beat, P = 0.93), stage one step-exercise (8.5± 1.8 versus 8.2±1.9 L/min, P = 0.56; 104±26 versus 104±27 ml/beat, P = 0.99) and stage two step-exercise (9.9±1.7 versus 9.6±2.0 L/min, P = 0.51; 109±29 versus 111±26 ml/beat, P = 0.76). There was a significant positive relationship between Test 1 and Test 2 cardiac outputs (r=0.92, P<0.01 with coefficient of variation of 7.1%). The mean difference in cardiac output (with upper and lower limits of agreement) between Test 1 and Test 2 was 0.1 (−1.9 to 2.1) L/min, combining rest and exercise data.

Conclusion

The CORS test demonstrates acceptable reproducibility and can potentially be used in primary care to identify and monitor heart failure.
Making sense of sadness: eliciting illness meaning and experience of depression in rural Irish males
Authors: Creed Michael , Gijbels Harry
Published: June 2018

Background

To analyse and understand the illness experience of depression in rural Irish males. Secondary objectives are to identify their explanatory models of depression, inform mental health service provision in rural areas, and identify suitable interventions for future research.

Aim

Isolation and rural masculinities are thought to predispose rural Irish males to depression. Despite high levels of depressive symptoms among men in rural areas, lack of awareness and a different language around depression, coupled with stoicism, social isolation, and feminized mental health services, results in reduced help-seeking, under-reporting and under-treatment of depression in this population.

Method

A purposive sample, selected through the West Cork and Galway/Roscommon Mental Health Services, and General Practitioners, of fourteen men, aged between 25 and 64 years of age, were interviewed in their homes. Data was collected through face-to-face interviews, using the McGill Illness Narrative Interview schedule. These interviews were recorded, transcribed to text, and analysed using a thematic content analysis. Results were integrated using the model of qualitative description.

Results

Most of the fourteen men reported alcohol and social isolation as precipitating factors of their depression. Suicidal intent and a stubborn attitude were common. Recovery-promoting behaviours included good social and family support, peer-support groups, religious practice and, universally, physical work.

Conclusion

Rural Irish men view their depression as a disconnection from community, masculinity can be engaged in a positive way to improve mental health, and a sense of belonging is key to recovery. Future research should focus on the development of interventions incorporating these findings, such as community farming initiatives.
Testing the health literacy of twenty Bangladeshi patients before and 5 months after they begin to access their GP electronic record
Authors: Fitton Richard , Hannan Amir , Brindle Ingrid , Begum Shafia , Shah Sarwar
Published: June 2018

Background

Patients with higher health literacy enjoy better health outcomes and are more compliant with treatment. Health literacy is a product of memory, reason and imagination. Patients who can access their records have potentially more memory (knowledge) and make less phone calls to and have less consultations with their GP, practice nurse, HCA and other professionals.

Aim

The study aims to measure the knowledge that twenty Bangladeshi patients with poor English have of their medical history before and after access to their electronic record.

Method

55% of patients at Thornley House have access to their medical records. A simple questionnaire was given to 20 Bangladeshi patients before and 5 months after access to their electronic record. The questionnaires recorded the patients’ knowledge of their medical histories. The scores of the completed before and after questionnaires were compared to see if record access had increased patients’ knowledge.

Results

Five patients completed before and after questionnaires. Each achieved a higher score after record access. The differences in scores for the five patients were 2, 5, 1, 10, and 1, respectively.

Conclusion

Health literacy for patients is similar to medical literacy for doctors. It requires knowledge, skills and attitudes. We will see whether record access can increase knowledge. Further studies might measure whether that increased knowledge improves skills and attitudes.
‘I’m fine’: exploring patient and carer assertions of status in advanced chronic obstructive pulmonary disease (COPD) and implications for primary care
Authors: Gardener Carole , Moore Caroline , Farquhar Morag , Ewing Gail , Duschinsky Robbie
Published: June 2018

Background

Patients can be reluctant to say that they need support, telling clinicians they are ‘fine’ despite having unmet needs. Research in mental health settings suggests patients who do this they are less likely to follow treatment plans, and their carers are at a risk of depression. To-date these findings have not been explored in patients with advancing physical health conditions, or their carers.

Aim

To explore the presence, role and impact of assertions of ‘I’m Fine’ in patients with advanced chronic obstructive pulmonary disease (COPD) and their carers.

Method

Criteria based on Attachment Theory were used to identify ‘I’m Fine’ cases from the Living with Breathlessness Study (LwB) dataset of 235 patients and 115 carers. Quantitative analysis explored variables such as health service use between ‘I’m Fine’ and non ‘I’m Fine’ cases, whilst narrative analysis is being used to explore discourses within cases.

Results

21 patients and six carers asserted they were ‘fine’ despite unmet needs. Patients’ minimised disease impact and symptoms, avoided thinking about the future and used stoical language. Despite ‘I’m Fine’ cases being more likely to report no exacerbations and more likely to score less on the COPD Assessment Test (CAT), all wanted to see more of their GP. Carers focused on the needs of the patient whilst downplaying their own problems.

Conclusion

The existence of a sub-group of patients with advanced COPD who assert that they are ‘fine’ may have implications for primary care. This will be explored in planned focus groups with clinicians.
Validation of the Primary Care Patient Measure of Safety (PC PMOS) questionnaire
Authors: Giles Sally J , Parveen Sahdia , Hernan Andrea
Published: June 2018

Background

The Primary Care Patient Measure of Safety (PC PMOS) questionnaire was developed to collect patient feedback on 15 latent conditions in the primary care environment that influence safety incidents. It provides a way for primary care organisations to learn about safety from the patient perspective, and to then make service improvements with the aim of reducing harm in this setting.

Aim

To undertake validation testing PC PMOS questionnaire.

Method

490 adult patients from nine general practices completed the PC PMOS, and 81 practice staff completed the AHRQ medical office survey on patient safety culture. Confirmatory factor analysis (CFA) was undertaken to assess the reliability and validity of the 10 factor PC PMOS.

Results

CFA demonstrated data did not fit the model well (CMIN/DF = 5.68; GFI = 0.61, CFI = 0.57, SRMR = 0.13 and RMSEA = 0.10), thus post hoc model fitting was conducted. This resulted in the removal of 22 items on the basis of large MIs (above 10), and SRs > ±2.58, and assessment of item content. The resulting 9 factor model consisting of 28 items was found to fit the data satisfactorily (CMIN/DF = 2.51; GFI = 0.87, CFI = 0.91, SRMR = 0.04 and RMSEA = 0.05). The new factors demonstrated good internal reliability. The PC PMOS did not demonstrate good convergent validity with the correlation between total PC PMOS score and practice staff patient safety score failing to reach statistical significance (r = −0.64, k = 9, P = 0.06). It demonstrated good discriminant validity between primary care practices (F = 2.64, df = 72, P<0.001).

Conclusion

Validation of the PC PMOS has led to a reliable and valid 28 item patient measure of patient safety in primary care. It could enhance or complement current data collection methods used in primary care to identify and prevent error, and is also a practical response to the growing need to find appropriate and effective ways of involving patients in improving patient safety.
Doctors with dyslexia: researching experiences and support strategies
Authors: Locke Rachel , Kibble Sharon , Alexander Gail , Scallan Samantha , Mann Richard
Published: June 2018

Background

An increase in the number of medical students disclosing dyslexia as a specific learning difficulty on entering medical school is leading to an increasing number of doctors disclosing dyslexia in the workplace. The degree to which dyslexia has an impact on workplace performance depends on the individual doctor’s level of self-awareness and skill in developing supportive strategies or ‘workarounds’. There is little research on experiences and such strategies in the context of medical education and engaging in research poses challenges.

Aim

Research was conducted to identify effective workarounds and how they help to minimise the effects of dyslexia for doctors.

Method

Data was collected in stages: a systematic review, FOI requests and primary data collection. Fourteen doctors took part in the primary data collection through interviews and surveys. Five key informants with knowledge about the support available participated in semi-structured interviews.

Results

Although most participants had experienced difficulties they had found individualised ways of coping to overcome the challenge presented by dyslexia. The main ones were to assist with revision and exams, writing and spelling, reading, memory, time management and organisation.

Conclusion

The ability to develop such personal strategies can be seen as a positive attribute of dyslexia: ‘The dyslexic learns to adapt and cope and create systems for themselves to get by’ (interviewee).
Improving vaccine uptake: a new uptake reporting tool
Authors: Tessier Elise , Pebody Richard , Boddington Nicki , Edelstein Michael , White Joanne , Rafeeq Sonia , Hopson Tim
Published: June 2018

Background

Vaccine uptake data is automatically extracted from all GP practices in England via the web-based reporting system, ImmForm, on behalf of Public Health England. In 2016/17, an Uptake Summary Tool was introduced on ImmForm for practice managers, clinical commissioning groups (CCGs) and screening and immunisation teams (SCRIMMS) to help facilitate local and regional management of the influenza programme. The tool allows practices to view and evaluate influenza uptake rates by target cohorts, comparing them against the previous season and CCG average/overall national uptake each week.

Aim

To assess how many practices use the Uptake Summary Tool and whether there is a difference in vaccine uptake among practices that use the tool compared with those that don’t during the 2016/17 and 2017/18 influenza seasons.

Method

Practice level use of the Uptake Summary Tool was examined for the 2016/17 influenza season and vaccine uptake compared between practices that used the tool and those that did not.

Results

An average of 1272 practices used the tool each week during the 2016/17. Vaccine uptake was on average 2.9% greater for targeted cohorts in practices that used the tool than practices that did not during the 2016/17 season.

Conclusion

When used on a regular basis the Uptake Summary Tool can help GP practices, CCGs and SCRIMMS monitor vaccine and may be associated with increased vaccine uptake. Uptake for the 2017/18 season will be monitored and assessed throughout the current season. We aim to expand the tool to other vaccine collections in the near future.
The Learning Disabilities Mortality Review (LeDeR) programme
Authors: Heslop Pauline , Hoghton Matt
Published: June 2018

Background

Since the 1990s reports have consistently highlighted health inequalities faced by people with learning disabilities. Data from the Primary Care Research Database suggests an all-cause standardised mortality ratio for people with learning disabilities of 3.18, and that people with learning disabilities die approximately 20 years sooner than people without learning disabilities.

Aim

This presentation will provide an overview of the Learning Disabilities Mortality Review (LeDeR) programme. LeDeR aims to contribute to improvements in the quality of health and social care for people with learning disabilities in England through retrospective mortality reviews.

Method

Initial reviews are undertaken of all deaths notified to the LeDeR programme of people with learning disabilities aged 4 years and over. Where indicated, a full multiagency review is conducted. Deaths of young people aged 18–24, and of people from Black and Minority Ethnic communities are subject to priority themed review; each of these receive a full multiagency review.

Results

The LeDeR programme will be fully rolled out across England by the end of 2017. In this presentation we will share some of the learning from reviews that are particularly pertinent to GPs, and some of the service improvements that have resulted.

Conclusion

To our knowledge, this is the first national programme of mortality reviews of people with learning disabilities in the world. Its focus is service improvement: it is about learning lessons and making changes to improve the lives of, and support for people with learning disabilities.
Uncertainty about cellulitis and unmet patient information needs: a mixed methods study
Authors: Lalonde Anna , Teasdale Emma , Muller Ingrid , Chalmers Joanne , Smart Peter , Hooper Julie , El-Gohary Magdy , Thomas Kim S , Santer Miriam
Published: June 2018

Background

Cellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.

Aim

To explore patients’ perceptions of cellulitis and their information needs.

Method

Mixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.

Results

Thirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).

Conclusion

There is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.
Impact of telephone triage in managing patient demand for same-day appointments? A before-after study in a UK general practice
Authors: Lau Jeffrey Chirk Fan , Rashid Sadia
Published: June 2018

Background

Telephone consultations are increasingly being utilised to manage patient demand for GP appointments. It’s true impact on patient care remains to be answered as existing evidence has shown mixed results.

Aim

To report the impact of telephone triage on: number of face-to-face (F2F) appointments offered; unplanned re-consultations with GP or urgent care services within 24 hours; and total consultation duration per patient episode.

Method

A retrospective cohort study in a single suburban practice in Kent, comparing outcomes between the new telephone triage and old walk-in F2F appointment systems in managing patient requests for same-day appointments. Data was sampled across 1 week, at 3-monthly intervals over each 12-month period before and after the system change-over in April 2016.

Results

1198 patient encounters matched the inclusion criteria. F2F appointments were offered to 34.7% of patients after telephone triage. Although unplanned re-consultations were four times more prevalent since the system changed compared to the previous year (P<0.001), no difference was seen between those consulted by telephone only, or offered a F2F appointment after telephone triage. Overall, patient consultations by telephone triage were 2.37 minutes shorter than consultations under its predecessor (P <0.001).

Conclusion

Telephone triage was able to manage majority of patient problems by telephone alone, with significant reduction in consulting time per patient episode. Telephone consulting was not shown accountable for the increase in unplanned re-consultations.
Wales Interventions and Cancer Knowledge about Early Diagnosis (WICKED): findings of work package 2 of the WICKED research programme
Authors: Nafees Sadia , Law Rebecca-Jane , Hendry Maggie , Hiscock Julia , Stanciu Marian A , Lewis Ruth , Surgey Alun , Goulden Nia , Hoare Zoe , Brain Katherine , Smits Stephanie , Yeo Seow T , Edwards Rhiannon Tudor , Williams Lynne , Williams Nefyn , Wilkinson Clare , Neal Richard D
Published: June 2018

Background

Cancer outcomes in the UK are worse than many countries with similar health structures. GPs play a pivotal role in improving cancer outcomes through earlier diagnosis.

Aim

To develop and evaluate a behavioural intervention to enable GPs to expedite cancer diagnosis.

Method

This ongoing programme is divided into four inter-related Work Packages (WPs) using a mixed methods approach. WP 2 comprises an all-Wales online GP questionnaire, 20 GP telephone interviews, and 4 practice-team focus groups. The questionnaire examined GPs’ perceptions and attitudes towards cancer diagnosis, and influences on cancer referral-related behaviour change. GPs’ individual beliefs and behaviours were explored in interviews; practice systems and norms were investigated in focus groups. Quantitative data were analysed descriptively, with conventional content analysis for free-text responses, and Framework analysis was used for qualitative data-sets.

Results

Early findings show that 269/1993 (13.5%) GPs completed the survey. Most agreed that ‘timelier diagnosis leads to better survival’, perceived themselves to be knowledgeable, confident and capable in managing cancer symptoms, reported recent changes in their cancer-related diagnostic activity, and believed in their ability to influence timely diagnosis. However, many thought that, if given the opportunity and support, there was still room to improve early cancer diagnosis. Preliminary analysis of six interviews revealed 5 themes including; ‘wanting referral behaviour to fit, ‘feeling untrusted by secondary care’, ‘practicing over-defensive medicine’, ‘support from colleagues, and ‘difficulty referring patients with vague symptoms’.

Conclusion

These findings will inform the development (WP3), and evaluation (WP4) of a behavioural intervention to expedite referral and diagnosis.
Primary care direct access cerebral imaging in Lothian, Scotland: a 5-year retrospective analysis of referrals, assessment of utility of referral guidelines, and determination of incidence of abnormalities
Authors: Zienius Karolis , Ip Chak , Ozawa Mio , Grant Robin , Ben-Shlomo Yoav , Brennan Paul M
Published: June 2018

Background

Direct Access Cerebral Imaging (DACI) from Primary Care has been recommended by NICE for patients with symptoms suspicious of cancer.

Aim

We analysed the predictive value of the NICE (2005) and Kernick referral guidance for suspicion of brain tumour in a real-world setting

Method

DACI referrals from Lothian-based GPs (31/3/2010 to 1/4/2015) were categorised according to the symptom classifications of NICE 2005 and Kernick referral guidelines. Radiological findings were grouped into 1) normal/non-significant-incidental, 2) abnormal-significant, 3) intracranial tumour.

Results

In total, 3257 head scans were performed, and after exclusions, 2938 records were analysed. Mean age was 55.6 (SD 18.56), 1748 (60%) females. Forty-two scans (1.43%) revealed significant intracranial tumours, including 17 (40%) metastases, 10 primary intracerebral tumours (24%), 8 pituitary (19%), 7 meningioma (17%). Non-significant incidental findings were observed on 571 (19%) scans, of which 175 (6%) correlated with symptoms. Based on NICE (2005) guidelines, 39% referrals were for ‘symptoms related to the CNS’, 16% for ‘Headache of raised ICP’, 18% for ‘Sub-acute deficits’ and 27% for ‘Unexplained headache’. Kernick guidelines classified 39% referrals red-flag, 25% orange-flag, and 36% yellow-flag symptoms. NICE ‘Symptoms related to CNS’ (OR 5.21, 95% CI = 1.81 to 14.9; PPV 2.9, 95% CI 2.0 to 4.0) and Kernick’s red-flag symptoms (OR 5.73, 95% CI =2.21 to 14.84; PPV 2.8, 95% CI = 1.9 to 3.9) were the only features to have significantly increased risk of brain tumour.

Conclusion

Referral guidelines confirm the urgency for rapid access head imaging for symptoms ‘highly suspicious’ of brain tumour. We are now assessing diagnostic value of different symptom complexes for intracranial tumour including headache-plus.