bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic Diversity and Phylogenetic Relationship of Human Norovirus Sequences Derived from Municipalities within the Sverdlovsk Region of Russia
Authors: Bykov Roman , Itani Tarek , Starikova Polina , Skryabina Svetlana , Kilyachina Anastasia , Koltunov Stanislav , Romanov Sergey , Semenov Aleksandr
Published: June 2024

Human noroviruses (HuNoVs) are highly contagious pathogens responsible of norovirus-associated acute gastroenteritis (AGE). GII.4 is the prevailing HuNoV genotype worldwide. Currently there are no studies on the molecular monitoring and phylogenetic analysis of HuNoVs in the territory of the Sverdlovsk region; therefore, it is not possible to objectively assess their genetic diversity. The aim of the study is to carry out genotyping and phylogenetic analysis of HuNoVs in the Sverdlovsk region from 2022 to 2023. Fecal samples (n = 510) were collected from children suffering from HuNoV-AGE in municipalities of the Sverdlovsk region and the capsid genotype was determined by amplifying the ORF1/ORF2 junction. Of the 196 HuNoVs typed, which represent 38% of the studied samples, the largest share of HuNoV genotypes belong to the GII genogroup—86%, followed by the GI genogroup—14%. Noroviruses GII.4 and GII.17 were the co-dominant capsid genotypes (33.2% each). Phylogenetic analysis demonstrates that the identified sequences on the territory of the Sverdlovsk region have the smallest genetic distance, which gives grounds for their unification into a common cluster. Routine monitoring and phylogenetic analysis of circulating norovirus pathogens spectrum will enable timely tracking of HuNoVs genetic diversity and evolutionary events. This will lead to the development of more effective anti-epidemic measures, ultimately reducing the burden of infectious diseases.
Genesis of Geothermal Waters in Zhongshan City, China: Hydrochemical and H-O-C Isotopic Implications
Authors: Li Yanan , Bai Ximin , Huang Changsheng , Chen Wei , Ma Chuanming , Huang Wei , Deng Gao , Qiu Xiangrong , Chen Shengnan , Yang Yongjun , Huang Ying , Wu Xuefeng , Ye Hailong
Published: June 2024

Investigations of the geochemical compositions of geothermal water, as well as their movements and geneses, are of great significance for the exploration and exploitation of hydrothermal resources. In Zhongshan City, a southern city in Guangdong Province, large amounts of geothermal heat have been discovered. The results of investigations show that the hydrochemical types of geothermal water in the study area are Cl-Na·Ca and Cl-Na. H-O isotopes are basically near the atmospheric precipitation line, and the calculated recharge elevation of geothermal water ranges from 716 to 822 m, which is close to the altitude of the North Peak Mountain in Taishan City. The deep thermal storage temperature ranges from 95.32 to 149.71 °C, and the depth of the thermal cycle ranges from 2638.57 m to 4581.07 m. The genetic model of the geothermal water in this area is that, at favorable structural positions with satisfied water storage conditions, the mixture of atmospheric precipitation and seawater that circulates deep in Earth is heated by terrestrial heat flow under actions such as deep heat exchange and water–rock reactions to leach the salt, finally forming the highly mineralized geothermal water that uplifts out of the surface along faults and crops. The formation of the genetic model of geothermal water will provide a geological basis and technical support for the efficient development and utilization of geothermal resources in Zhongshan City and the coastal area of Southeast China.
Novel Implications of the PARAFAC Model for Characterizing and Distributing DOM in Groundwater Networks by Using Spectroscopic Techniques
Authors: Alhaj Hamoud Yousef , Maqsood Abdullah , Zia-ur-Rehman Muhammad , Shaghaleh Hiba , Sahar Amna , Usman Muhammad , Rizwan Muhammad , Alharby Hesham F. , Abohassan Refaat A. , Abdulmajeed Awatif M.
Published: June 2024

Groundwater, a primary source of freshwater on Earth, is rapidly declining due to natural and anthropogenic activities. This study aimed to investigate the spatial distribution of dissolved organic matter (DOM) and heavy metals (HMs) in two municipal groundwater networks (A and B) from tube wells to taps in an industrial city, Faisalabad. The results showed that parameters such as color, turbidity, pH, EC, TDS, Ca2+, Mg2+, CO32−, HCO3−, Cl−, CaCO3, Na+, and NO3− were within the permissible limits set by the World Health Organization (WHO) and Pakistan Environmental Quality Standards (PEQSs). However, parameters like DO and COD exceeded standard values along the routes. Odor, taste, temperature, BOD, NH4+, T. coli, and F. coli surpassed acceptable levels at the tap end of both networks. Fluorescence EEM-PARAFAC spectra were analyzed at an excitation wavelength of 220–500 nm and emission wavelength of 240–550 nm, revealing UVA-humic-like (C1–C2) and UVC-humic-like (C3) components in the DOM. Based on fluorescence intensity, DOM was dominated by C2 > C1 > C3 compounds in both networks. The mean concentrations of HMs, including Cu, Zn, and Fe, fell below the prescribed limits in both networks. However, concentrations of Pb (A: 0.015–0.028 mg/L), (B: 0.013–0.027 mg/L), and Cd (A: 0.004–0.006 mg/L), (B: 0.005–0.008 mg/L) exceeded permissible limits from tube wells to taps. Moreover, C1 demonstrated a significant positive correlation with Cd and Cu in networks A and B, respectively. Furthermore, C2 displayed a significant positive correlation with Cd in network A. This study concludes that the groundwater in both networks (A and B) is contaminated by agricultural runoff, industrial and sewage water, plumbing materials, and eroded pipelines. As a result, the water is unsafe for cooking and drinking, posing risks of kidney, lung, and bladder cancers. Therefore, this study urgently recommends pipeline reconstruction and the implementation of proper groundwater remediation approaches before these sources are used for drinking.
What can we learn from speaking to asthma patients more than once? The power of qualitative longitudinal design in primary care research
Authors: Wanat Marta , Santillo Marta , Tonkin-Crine Sarah , Wang Kay
Published: June 2024

Background

Qualitative Longitudinal Research (QLR) has a long tradition in a variety of social science disciplines and is increasingly used in applied healthcare research. QLR can provide insights into the nature, causes and consequences of change (or its absence). However, its use in primary care research is limited.

Aim

Drawing on a recent study looking at experiences of asthma patients in the context of the COVID-19 pandemic over time, we highlight the opportunities in using longitudinal qualitative methods in primary care research.

Method

We conducted a qualitative longitudinal study using semi-structured interviews with patients with asthma from four GP practices across diverse regions including Thames Valley, Greater Manchester, Yorkshire, and North West Coast. The interviews were audio-recorded, transcribed, and analysed using inductive temporal thematic analysis and a trajectory approach.

Results

Forty-six interviews conducted with 18 patients over an 8-month period of the COVID-19 pandemic highlighted that patients felt less vulnerable as the pandemic subsided, but the process of making sense of risk was dynamic and influenced by multiple factors. Patients relied on self-management strategies, and with time, highlighted that they had limited opportunities to discuss their asthma with health professionals. As time progressed, face-to-face reviews appeared more necessary for certain aspects, such as physical examination and patient-led discussions of sensitive or broader issues associated with asthma, including mental health.

Conclusion

QLR has much to offer primary care research allowing exploration of views and experiences of a variety of participants over time and following them through important transitions.
Liver disease as new work in the context of protocolised primary care — do GPs have a role? A qualitative interview study
Authors: Jarvis Helen G , Sanders Tom , Hanratty Barbara
Published: June 2024

Background

Liver disease is common, but not part of routine chronic disease management in primary care.

Aim

The aim of this study was to explore the challenges of implementing pathways of care for liver disease within existing highly protocolised structures in primary care.

Method

Semi-structured interviews with 20 health professionals working in primary care. Interviews were informed by normalisation process theory (NPT) and boundary theory. Data were subject to thematic analysis.

Results

Three themes were identified relating to chronic disease work; definitions; need and worth, and roles. Participants identified that understanding and value of roles within chronic disease management were pre-defined by targets imposed on them as part of national incentives schemes. Structural boundaries constrained professional autonomy and the potential to influence this area of primary care management, including taking on new work.

Conclusion

The inability to influence care decisions blurs occupational boundaries and goes to the core of what it means to be a professional. Unless liver disease sits within this target-based system, it is unlikely to become part of routine work in primary care.
GP perspectives regarding suicide prevention: a systematic scoping review
Authors: Marshall Jack , Oliver Phillip , Hulin Joe , Huddy Vyv , Mitchell Caroline
Published: June 2024

Background

Suicide is a major public health issue and is the leading cause of death of men under the age of 50 in the UK. Patients are more likely to visit their GP in the month leading up to a suicide attempt, thus highlighting the key role GPs play in suicide prevention.

Aim

The aim of this systematic scoping review was to explore the current qualitative research on GPs’ perspectives of suicide prevention in primary care.

Method

This review was reported in accordance with PRISMA-ScR guidance. A three-step search strategy was used. Articles at full-text review were assessed for their inclusion in the study against predetermined eligibility criteria (English language, qualitative in nature, and a focus on GPs’ perspectives of suicide prevention). Data was extracted using a standardised form and a narrative approach was used to describe the main themes elicited from the studies.

Results

There were 2210 articles screened. Twelve studies from seven countries were included at full text review. The majority of studies used semi-structured interviews (n=9) and transcripts were analysed using variations of thematic analysis. Four main themes were elicited from the included studies: challenges to managing suicidal behaviour, fragmented relationships with mental health services, personal attitudes of GPs regarding suicidal behaviour, and identified needs to improve suicide prevention in primary care.

Conclusion

The challenges experienced by GPs when managing suicidal behaviour are well documented. More work is needed to explore what approaches GPs find effective in managing suicidal behaviour, especially in younger patients.
Afghan refugees at risk in the UK: enhancing healthcare access and integration
Authors: Saxionis Ioannis , Fredericks Hannah , Pritchard Lucy , Barclay Dave , White Rebecca , Pickering Janine , Sealey Sara , O’Driscoll Louise , Wells Rachel , Aggarwal Pritti
Published: June 2024

Background

Following Kabul’s fall in August 2021, there was influx of Afghan refugees in the UK. Southampton’s Bridging Hotel provided temporary shelter to 22 families, totaling 116 individuals. The Living Well Partnership (LWP); assumed primary care provision for these vulnerable residents facing health inequalities.

Aim

Enhancing refugee healthcare access and integration into the NHS system. Improving healthcare education, boosting confidence in appropriate healthcare use, and utilisation of electronic consultations effectively.

Method

Working with the local authorities, primary care services were brought to the hotel. Regular 3-hour drop-in sessions with a health and wellbeing coach were established and attended by residents. Non-identifiable data was recorded in individual patient care records and summarised quantitatively.  Qualitative data was collected via a pre-established questionnaire during the sessions.  

Results

Identified issues included language barriers, mental health problems, infectious diseases, contraception, and healthcare access. Language barriers were addressed with interpreters. Fifty-nine patients accessed support services, with 13 benefiting from e-consultations, and nine requiring on-site medical consultations in a 3-month period. Mental health support and infectious disease referrals were facilitated. Access challenges were mitigated by transitioning to e-consultations or face-to-face appointments. Outcomes included improved patient independence, awareness of healthcare processes, familiarity with LWP services, and confidence in navigating the NHS.

Conclusion

A multifaceted approach is vital for addressing language and access barriers for refugees. Providing educational resources through facilitated groups empowered refugees and improved healthcare access. This initiative highlights the importance of organised support for vulnerable populations during crises and can be applied more widely.
Using inquiry based stress reduction to address self-stigma in severe spectrum obesity in general practice
Authors: O’Shea Brendan , MacDonald Steve , Wade Geraldine , France Nadine Ferris
Published: June 2024

Background

Obesity is a driver of multimorbidity. Knowledge regarding individual and population based solutions is evolving in primary care. Stigma/self-stigma are important in developing clinical solutions. Inquiry based stress reduction (IBSR) is emerging as a solution for self-stigma in a range of conditions. This study explores IBSR (also known as The Work of Byron Katie) in obesity self-stigma in the GP setting, with severe obesity, utilising a multidisciplinary approach.

Aim

Is it feasible/acceptable to utilise Inquiry Based Stress Reduction in the GP setting for obesity?

Method

Mixed-method pilot study including a convenience sample of people with severe spectrum obesity from a three-doctor general practice, including use of IBSR provided in both group, partner and individual settings, predominantly online, utilising certified and accredited IBSR facilitators, a clinical psychologist, and participating GPs. Outcomes include pre- and post-intervention surveys (Becks Depression Scale, HRQoL, Weight Bias Internalisation Scale, Weight Self-stigma Questionnaire) and qualitative data from participants.

Results

Of 22 initially invited to participate, 14 commenced and 10 completed the intervention. Mean BMI was 42.8, mean age 49 years, female:male = 7:3. Many believed obesity was their own fault, related very difficult interactions with healthcare professionals, and valued opportunity to engage with the intervention. While participants had alarming levels of comorbidity, they were far more concerned regarding stigma and self-stigma.

Conclusion

Results and experience in practice indicate this approach is feasible and acceptable. Results are valuable in planning a larger study in multiple practices.
‘Getting it write’ in a new era of patient online access to primary care health records
Authors: Davidge Gail , McMillan Brian , Brown Lindsey
Published: June 2024

Aim

To explore how to help make online consultation notes easier for patient audiences to understand.

Background

Most patients in England will soon be able to access all new prospective entries (including free-text) within their online primary care health record via the NHS App or other online services.

Method

We conducted interviews and focus group discussions with 26 patients from underserved communities. Participants responded to vignettes about fictional patient consultation scenarios and assessed the clarity of corresponding simulated records. Participants were then asked to identify potential comprehension issues, offensive content, or anxiety triggers.

Results

Most participants struggled to understand a large proportion of simulated notes, particularly medical acronyms, clinician shorthand, and non-clinical abbreviations. Participants also identified issues that may cause unintended offence or additional anxiety. Participants considered that most patients will struggle to fully understand the content of their consultation notes in their current format. They made a number of suggestions about how this service may be improved to meet the needs of patient audiences and maintain positive patient-clinician relationships.

Conclusion

Opening up online record access to include patient audiences necessitates a significant cultural shift in the way that consultation notes are written and used. To maximise NHS investment in this policy and avoid worsening health inequalities, it is essential to ensure that all patients can understand and access the benefits of online access to their notes. To do this, clinicians need to be supported to manage the challenges of writing for patient audiences, while continuing to maintain effective clinical care.
What interventions have addressed the inverse care law in general practice in Scotland over the last 20 years? A systematic scoping review
Authors: Bogie James , Bezzina Cara , Lunan Carey , Mercer Stewart , Blane David
Published: June 2024

Background

Recent evidence demonstrates persistence of the inverse care law (ICL), with fewer GPs and less funding in more deprived areas.

Aim

To map out interventions that aimed to address the ICL and the rationale behind them, and to review the impact and sustainability of these interventions — what has worked, for whom, and why?

Method

The authors searched Embase, Web of Science, MEDLINE, CINAHL, Cochrane, and BASE from 2000 to 2022 for articles describing interventions or policies that aimed to address the ICL in general practice in Scotland. A systematic grey literature search of government, NHS, and third-sector websites was also performed. All articles were double screened for inclusion. Quantitative and qualitative studies were included. Other forms of primary care, such as dental or pharmacy, were not included.

Results

There were 77 included articles (35 from the database search and 42 from the grey literature) reporting on 20 interventions. Interventions were categorised as: 1) enhancing financial or social support; 2) targeting specific health conditions; 3) holistic interventions targeting specific populations; and 4) enhancing generalist care. Seven key interventions accounted for over 70% of all included articles. Evidence of impact and sustainability was variable. Key lessons were summarised for each intervention and grouped by category.

Conclusion

To address the ICL, a key recommendation is for greater investment in general practice as part of the overall NHS spend, with graded additional resources for more deprived areas depending on local population need (a ‘proportionate universalism’ approach).
Supporting people in Early Intervention in Psychosis services: the role of primary care
Authors: Chew-Graham Carolyn , Rickett Michelle , Kingstone Tom , Gupta Veenu , Shiers David , French Paul , Lennox Belinda , Crawford Mike , Penington Ed , Hedges Anna , Ward Jo
Published: June 2024

Background

Early Intervention in Psychosis (EIP) services offer treatment to people experiencing a first episode of psychosis. Service users may be referred from primary care and discharged directly back at the end of their time in an EIP service.

Aim

To explore the role of primary care in supporting EIP service users (SUs) and to understand how to improve collaboration between primary and specialist care.

Method

Qualitative study comprising semi-structured interviews with SUs, carers, healthcare professionals (HCPs), managers, and commissioners. Interviews were conducted either online or by telephone. Thematic analysis was carried out using principles of constant comparison. Patient and public involvement were key to all stages, including data analysis.

Results

In total, 55 interviews were conducted with SUs (n= 13), carers (n= 10), and GPs, EIP HCPs, managers, and commissioners (n= 33). GPs reported difficulties in referring people into EIP services and little contact with SUs while in EIP services, even about physical health. GPs suggested they were not included in planning discharge from EIP to primary care. SUs and carers reported that transition from EIP can lead to uncertainty, distress, and exacerbation of symptoms. GPs reported only being made aware of patients on or after discharge, with no contact for 3 years. GPs described difficulty managing complex medication regimes, and barriers to re-referral to mental health services.

Conclusion

GPs have a key role in supporting people within EIP services, specifically monitoring and managing physical health. Inclusion of GPs in planning discharge from EIP services is vital.
‘There’s never really been an opportunity’: perspectives of those with long-term conditions on advance care planning, a qualitative interview study in primary care
Authors: Bushell Sonya , Murtagh Fliss
Published: June 2024

Background

Advance care planning (ACP), the process of discussing and documenting people’s wishes for future care, is increasingly researched within health and social care. However, it is sometimes assumed that ACP is only for those experiencing advanced cancer or those reaching the end of life. Little is known about how those living with other major conditions perceive ACP.

Aim

To explore attitudes towards ACP in this population.

Method

In-depth interview study in general practice. Inclusion criteria: adults living with major conditions other than cancer (diabetes, heart disease, chronic respiratory disease, and kidney disease). Interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Thematic analysis utilised a critical realist approach, underpinned by the COM-B Behaviour Change Model. NHS ethics approval (reference: 23/PR/0078).

Results

Eleven participants have been recruited (recruitment ongoing): aged 61–88 years, five males, and Rockwood Frailty Scores 1–5. Emergent COM-B themes relate to capability (wellbeing, organisational skills, and understanding); opportunity (setting, time, trust, involving others, and the ‘right’ moment); and motivation (motivating factors: helping loved ones, helping professionals, fearing undesirable outcomes, desiring a peaceful death, being organised, and valuing autonomy; and demotivating factors: trusting others with decisions, uncertainty regarding the future, distrusting health care, focusing on the present, and values-based objections). ACP is understood in three ways: as proactive planning, as anticipatory planning, and as acknowledgment of ill-health and mortality. Context influences understanding and understanding influences motivation. There is openness to discussing ACP as part of proactive care.

Conclusion

Normalising ACP before ill-health may reduce distress. Public health campaigns and preventative healthcare consultations present opportunities for ACP signposting.
Could primary care records be used to identify women at risk of perinatal anxiety? A mixed-methods study
Authors: Fisher Tamsin , Archer Charlotte , Bailey James , Evans Jonathan , Kessler David Samuel , Kingstone Tom , Petersen Irene , Proctor Janine , Shivji Noreen , Spruce Amy , Silverwood Victoria , Smith Holly , Turner Katrina , Wu Pensee , Yu Dahai , Chew-Graham Carolyn
Published: June 2024

Background

Perinatal anxiety (PNA) occurs throughout the antenatal period or up to 1 year after childbirth, with a prevalence of 21%.

Aim

To investigate if primary care records could be used to identify women at ‘higher risk’ of PNA.

Method

Mixed-methods approach using quantitative and qualitative methods. Quantitative data analysis used Clinical Practice Research Datalink and IQVIA Medical Research Data to identify risk factors for PNA. Interviews explored the lived experiences of women with PNA about predisposing factors for PNA and acceptability of being informed of risk; and perspectives of primary healthcare professionals and Voluntary, Community, and Social Enterprise practitioners about risk communication. Interviews were conducted online, digitally recorded with consent, transcribed, and anonymised prior to analysis. Data were thematically analysed. Patient and clinical advisory groups informed each stage of the research.

Results

Women reflected on both positive and negative impacts of being identified at higher risk of PNA, a lack of understanding of how primary care records are used, and who has access to them. All interview participants suggested predisposing factors that would not be coded in primary care records. Quantitative analysis demonstrated that some predisposing factors for PNA can be identified in a woman’s primary care records. Initial analysis suggests associations between PNA and infant health and healthcare use.

Conclusion

While identification of higher risk of PNA may be acceptable, some factors that may contribute to PNA are not coded in primary care records. Identifying and managing PNA is needed to improve infant health.
Role of FeNO in predicting the responsiveness of inhaled corticosteroids in COPD: a systematic review.
Authors: Ramesh Reshma , Georgiou Andrea , Harries Timothy
Published: June 2024

Background

Fractional exhaled nitric oxide (FeNO) as a predictor of inhaled corticosteroid (ICS) response in asthma has been established. However, the same has not been established in chronic obstructive pulmonary disease (COPD). An optimal value of FeNO for prescribing and monitoring ICS response has not been quantified.

Aim

To examine the evidence for this association.

Method

A systematic review was conducted of randomised controlled trials and observational studies examining the association between FeNO level and response to ICS in COPD patients. All studies examining this association were included. Five databases were searched thoroughly. Systematic screening, full-text reviews, and data extraction were carried out based on eligibility criteria.

Results

A total of 8690 studies were identified, 342 texts were screened fully, and six studies were included for the final review. One was a randomised controlled trial and the other five were non-randomised interventional trials. One study was conducted in asthma–COPD overlap (ACO patients). After ICS use, three studies found statistically significant correlations between FeNO and lung function improvement (FEV1), and three studies also found significant correlations between FeNO and COPD quality-of-life scores.

Conclusion

Measurement of FeNO is non-invasive and standardised, with results available at the point of testing. Because of the small sample size and short duration of studies, exacerbation frequencies were not measured. Despite this, the review suggests that FeNO may be a potential biomarker for assessing ICS response in COPD. Further research that stratifies patients by FeNO levels and assesses the impact on acute exacerbations is needed to understand its potential value in routine clinical practice.
A retrospective, comparative analysis of A&E attendance paserns in Irish Traveller versus non-Traveller general practice patients
Authors: Welgamage Sandeepa , Speed Ewen , Turner-Moss Eleanor , Burrows Sally , Blumenfeld Tanya
Published: June 2024

Background

Very little is known about Gypsy, Roma, and Traveller health, or access to and utilisation of health care. They are not coded in NHS data systems and there are multiple barriers including illiteracy, digital exclusion, and discrimination.

Aim

To gain rare insight into Irish Traveller patients’ emergency healthcare utilisation and outcomes.

Method

A retrospective general practice review of A&E attendances was performed from January to December 2017, comparing Travellers with the rest of the practice patient population. A search was done for all A&E attendance letters and related admissions. Blind review of the diagnosis and management were assessed by two reviewers for appropriateness of attendance at A&E. The frequency and recurrence of A&E attendances, referral pathway toA&E, location of A&E, and age distribution were compared.

Results

Traveller patients attending A&E were younger. There were fewer repeat attendances in the travelling community but proportionally more in the Traveller under-20-year-old cohort. Only 38% of A&E attendances in Travellers (56% non-Travellers) were deemed appropriate (χ27.16,P= 0.007). Only 20% of Travellers (36% non-Travellers) attending A&E were admitted to hospital (χ26.33,P= 0.01). Further, 93% of A&E attendances in Irish Travellers (75% non-Travellers) did not follow initial contact with either a GP or NHS 111 (χ29.86,P<0.002). Finally, 51% of Irish Travellers (6% non-Travellers) attended A&E departments distant to their registered GP practice (χ289.5,P<0.001).

Conclusion

This work throws light on health service utilisation patterns by Irish Travellers. A&E attendances may have been more suited to a non-emergency setting and there may have been missed opportunities for contact with primary care or NHS 111, which may have an impact on continuity, onward referral, and quality of care.
Opioid and dependence-forming medications co-prescription reduction and oversight: the OPIO-CHECK Quality Improvement Project (QIP) protocol and interim analysis
Authors: Zedan Yasmine , Wrigley Caroline
Published: June 2024

Background

Long-term opioid prescription to manage chronic non-cancer pain (CNCP) is rapidly rising, despite the lacking evidence supporting their safety and efficacy. Co-prescribing opioids with other dependence-forming medications (DFMs) causes fatal side effects. Clinicians are advised to avoid combinations of DFMs and, where suitable, deprescribe to improve patient safety.

Aim

To review the number of patients registered to the Grange Medical Centre (Nuneaton, Warwickshire) who are co-prescribed an opioid and either benzodiazepine/gabapentinoid for CNCP and to reduce usage of these DFMs.

Method

The ‘Model for Improvement’ is used as a QIP framework. A database search was conducted on 5 October 2023 to identify the cohort of interest. The introduced changes included devising a resource pack outlining the up-to-date non-pharmacological pain management, support channels, and a medication review invitation sent to the identified patients. A pain management template has also been developed to be used by GPs and clinical pharmacists to support the medication review. Guided by the Plan–Do–Study–Act cycle, data will be re-measured to detect incremental changes in practice.

Results

In total, 123 patients were receiving co-prescriptions of opioids along with either benzodiazepine/gabapentinoid for CNCP out of the enlisted 12 360 patients. The majority were in the 70–79 years age range. It was also noted that around 66% of patients were females. The QIP’s first cycle is currently being implemented.

Conclusion

This QIP addresses a pressing need to reduce the usage of DFMs. The interim results will guide the change model in the Grange Medical Centre GP surgery and inform scoping of relevant clinical questions to improve patient safety.
Student and educator experiences of a student-led clinic in general practice
Authors: Leslie Katie , McConville Kevin
Published: June 2024

Background

Giving students more responsibility for real patients during medical school may help prepare them for their transition to clinical practice. Student-led clinics (SLCs) may facilitate this. Within SLCs, students take the lead role in delivering patient care while being supported and supervised by qualified clinicians. A general practice SLC was established in Dundee, with four final-year medical students and one GP involved in each clinic.

Aim

This study aimed to explore students’ and educators’ experiences and perceptions of this SLC.

Method

This was an exploratory case study. Semi-structured interviews were conducted with 11 students and three educators, and 18 hours of observation were conducted over six clinics. Interview transcripts and fieldnotes were integrated and thematically analysed.

Results

Overall, students’ and educators’ experiences and perceptions were positive. Students thrived in their lead role in patient care, gaining a sense of empowerment and developing confidence in their abilities. Both students and educators felt comfortable with students having this level of responsibility due to the students’ stage of training and the supervision provided by educators. Teaching within the SLC involved individual discussions and group debriefs. Students felt a sense of belonging as a result of their relationships with their peers and educators. Challenges arose when the clinic ran behind schedule due to unexpected complex patients or lengthy individual discussions.

Conclusion

The findings suggest that giving students responsibility for real patients is beneficial and feasible when adequate support is provided, and that it is possible for one GP to supervise multiple students successfully.
Team climate, job satsfaction and burnout: results from a national survey of staff in general practice in England
Authors: Williams Peter , Jones Bridget , Aspen Carole , Bird Thomas , Smylie Jessica , Touray Morro , Gage Heather , de Lusignan Simon
Published: June 2024

Background

Measures are needed to address recruitment and retention problems in general practice. A good team climate (relational processes of team working) can mitigate the effects of pressured work environments, but little is known about it in British general practice.

Aim

To assess team climate, explore practice characteristics and workforce combinations associated with favourable team climates, and analyse associations between practice team climate and job satisfaction, intention to remain in post, burnout and measures of practice performance.

Method

An online questionnaire distributed to practices (for all their staff) via Clinical Research Networks, mid 2022, comprising validated measures: 14 item Team Climate Inventory (TCI) and single items on job satisfaction and emotional exhaustion/burnout; a question on intention to remain in post; participant role, age group, gender. Anonymous completion; submission through the Oxford RCGP RSC.

Results

Responses received from 4.8% of national staff headcount,n =9835, (21.6% GP, 22.9% nurse/direct patient care, 55.5% non-clinical). Mean TCI score, 3.73 (scale 1–5 best); 78.3% were satisfied in their jobs; 26.1% reported high burnout. GPs perceived significantly better team climate, and reported lower job satisfaction, higher burnout (especially male GPs) and lower intention to quit than other groups. After adjusting for practice and workforce characteristics, team climate was better in smaller practices and associated with more job satisfaction, less burnout, increased intention to remain and improved patient-reported experiences; climate was unrelated to QOF performance.

Conclusion

Team climate could be used to improve morale and patient experience. Micro teams might be beneficial in larger practices.
The influence of GPs’ personal experience on perceived competence in depression management
Authors: Madelpuech Eline , Simonis Virginie , Sawadogo Younoussa , Richelle Lou , Libert Gael , Offermans Anne-Marie
Published: June 2024

Background

Managing depression in general practice is a multifaceted task, influenced by factors such as the condition’s characteristics, patient-specific variables, and the personal habits of attending physicians. A study by Dumesnil et al. in France highlighted the impact of GPs’ personal experiences with depression on their patient care approaches.

Aim

This study investigated how the personal experiences of Belgian GPs influence their self-perceived competence in managing patients with depression.

Method

This transversal study was conducted through questionnaires distributed in a GP training (2020–2022). Statistical analyses (Chi-square test/multivariate logistic regression) were conducted using STATA-SE 17.0.

Results

Out of 325 GPs, 30.46% of GPs had experienced depression and 16.62% had taken antidepressants. After categorisation and adjustment, the personal experience of GPs does not influence self-efficacy in diagnosing and supporting depressed patients. Higher self-efficacy scores were associated with an advanced age (60–64y/o) (aOR:7,9;IC95%), working in a multidisciplinary practice (aOR:3,4), prior training on the issue (aOR:2,1), and male gender (aOR:0,5). GPs with personal experiences of depression (aOR:2,6), advanced age (aOR:4,1) and working in multidisciplinary practices (aOR:3,4) had more appropriate responses to the proposed clinical situations than other groups.

Conclusion

This study reveals that the personal experience of depression among GPs does not influence their perceived competencies, contrary to having received prior training on the issue. However, experiencing depression is associated with more appropriate responses to clinical situations. These results are consistent with existing literature regarding socio-demographic factors and practice type. In the future, it is important to consider these factors when developing continuing education programs.
Determinants of medical student’s perception of general practice
Authors: Madelpuech Eline , Richelle Lou , Vanderhofstadt Quentin
Published: June 2024

Background

Enhancing the attractiveness of a career in general practice is a significant public health concern, given the current shortage in Belgium.

Aim

The objective of this study is to determine the factors that influence students’ decisions to pursue a career in general practice and their perceptions of it.

Method

This prospective study was conducted in May 2023. A questionnaire, based on existing literature, was distributed to final-year medical students. Quantitative data were analysed using descriptive and bivariate tests (chi2test).

Results

Out of the 142 participating students (response rate: 45%), 29.3% expressed a preference for general practice, while 70.7% opted for other specialties. These groups exhibited significant differences (p < 0.05) not only in terms of socio-demographic factors (nationality, parent’s education) but also in their perceptions ofgeneral practice. The latter group associated it with routine work (89.2%) and feelings of loneliness (58.5%), in contrast to the former (36.1% and 24.3%, respectively). Moreover, 76.6% of students reported a shift in their perception ofgeneral practiceduring their medical education.General practiceinternships (71.9%), GPs (78.2%), and interactions with patients (68.9%) had a positive influence on their perception, while instructors in hospital settings (72.9%) and peers (37%) often portrayedgeneral practiceas a less favourable career option.

Conclusion

Perceptions ofgeneral practiceare significantly shaped by interactions with role models from the medical sector who convey either a positive or negative image ofgeneral practice. To address the shortage issue, it is imperative to increase positive interactions with GPs within the curriculum and work towards changing the institutional culture at this level.
Crisis Rescue Foundation Vaxi Taxi/health and wellbeing pop-ups project
Authors: Raymond Sharon
Published: June 2024

Background

Established by Crisis Rescue Foundation in 2021 to support the missing and vulnerable to access health and wellbeing help.

Aim

Address health and wellbeing needs of people experiencing barriers to accessing NHS and allied care by delivering pop-ups in the hearts of communities, outside GP surgery and hospital walls, in a warm, inclusive environment.

Method

Forty pop-ups so far across London delivering bespoke, individualised health information and signposting, joining up NHS, allied and local community services at key sites, including asylum seeker/homeless/faith/refugee/drug and alcohol support/food bank/sex worker support/youth club and education centres. A ‘Medical Glastonbury’ with background music, plus free food, toiletry goodie bags and clothes. Drug and alcohol/heart/oral/foot/sexual and mental health; support for carers; BLS; violence reduction; youth mentoring; housing; vaccination; wellbeing and more, information and signposting offered to local people by professionals, supporting and empowering people to access trusted guidance and care. Cardio and mental health check cards to record health information and guide next steps in appropriate care.

Results

Around 2000 Londoners were given health and wellbeing information. 80% of service users were from ethnic minority backgrounds. Over 99% of service users rated pop-ups highly. Over 1/3 had raised BP and nearly 2/3 had raised BMI detected and the individuals were signposted to appropriate information and care.

Conclusion

Effective, bespoke and personalised information, and signposting to support were well-received at the pop-ups. Professionals working with service users experiencing inequalities of allied and local voluntary organisations to enhance equity by addressing the unmet health and wellbeing needs of the missing and the vulnerable.
Barriers to identifying, diagnosing, and treating vulval lichen sclerosus in primary care: a mixed methods survey study
Authors: Clarke Louise , Simpson Rosalind , Crew Arabella , Leatherland Rheanne
Published: June 2024

Background

Vulval lichen sclerosus (VLS) is a skin condition which causes pain, itching, anatomical changes, and increases vulval cancer risk by up to 22 times. VLS is treatable, with use of topical steroids allowing symptom resolution and complication prevention. Diagnostic delay and misdiagnosis of VLS is common. Previous studies found that women attribute this to poor interactions with and knowledge of clinicians. Most VLS is diagnosed in primary care.

Aim

To investigate primary care clinicians’ views on confidence in identifying and managing vulval skin disease and VLS, barriers to diagnosis, education on vulval skin disease, and diagnostic criteria for VLS.

Method

A mixed methods survey was distributed via professional events and networks. Qualitative data was analysed in NVivo using inductive thematic analysis. Spearman’s rank correlation was used to correlate participant characteristics and confidence.

Results

There were 122 responses, the majority from GP trainees (48%) and GPs (43%). Confidence in diagnosing, identifying, and treating VLS positively correlated with female gender, time in role, and examination frequency. Themes identified include patients not knowing normal, male clinicians: deskilling and reluctance, lack of clinician knowledge, and uncertainty around diagnosis and treatment. 38% of participants never participated in teaching or learning on vulval skin disease. Almost all (98%) participants feel diagnostic criteria would be helpful.

Conclusion

This study illuminates the multiple barriers to diagnosis and treatment of VLS. The results confirm that clinicians share patient concerns that knowledge is poor, highlight the importance of developing clear diagnostic criteria, and will allow us to target training to those lacking in confidence.
Can remote testing for chronic kidney disease improve outcomes without widening existing health inequalities? A collaborative quality improvement project in primary care
Authors: Griffiths Kathryn , Taylor Sheila , Bramham Kate , Molokhia Mariam
Published: June 2024

Background

In the UK, chronic kidney disease (CKD) is a prevalent, silent and strong predictor of cardiovascular disease. Identification of CKD is poor in primary care, particularly in minority ethnic and socio-economically deprived groups.

Aim

To investigate feasibility of remote ACR testing to improve the detection and management of CKD in underserved groups.

Method

13 591 tests were sent out across South East London. Individuals with diabetes and no ACR in the past year were offered a remote ACR test to complete at home with a smartphone using a validated app (Healthy.io). We extracted data on demographics, medical comorbidities and medication. Analyses (Stata) describe who completed the test.

Results

Twenty-seven practices agreed to participate. Analyses of 6082 tests sent show the test completion rate was 46.8%. Adjusted odds ratios demonstrated that people were less likely to complete testing if over 70 years (OR 0.71, 95% CI 0.57 to 0.89) and over 80 (OR 0.43, CI 95% 0.33 to 0.56) compared to <40 years old; people from CORE20 groups (most deprived quintile) were also less likely to complete testing (OR 0.68, 95% CI 0.61 to 0.76) and those with missing data and those with no recorded healthcare interactions within the last 5 years were also less likely to complete testing.

Discussion

Remote ACR testing presents an opportunity to diagnose early CKD but there is still inequity in who completes testing. Engagement with stakeholders is needed to explore innovative ways to implement remote ACR testing to achieve equitable CKD screening.
Gender incongruence in primary care: are GPs trained?
Authors: Ozoran Hakan , Amiry Jack
Published: June 2024

Background

GP confidence and competence in relation to gender diversity and the discussion of related matters remains relatively unknown. Despite increasing demand on primary care in dealing with matters of gender identity; contention and confusion are unfortunately widely reported amongst doctors.

Aim

We sought to formally evaluate the level of GP training and gauge desire for further training in relation to the discussion of pronouns with patients.

Method

We used a structured questionnaire that was sent out to GPs in Oxfordshire, facilitated by a mailing list used by the Primary Care Undergraduate Teaching Department at the University of Oxford. Additionally, we performed structured individual interviews with GPs in Oxford, who provided their contact details and expressed interest when completing the questionnaire.

Results

Fourty-four GPs responded and completed the questionnaire, five of whom agreed to participate in a structured interview. Most GPs (61%) had not received any formal training. Despite this, 68% of GPs did not want more formal training in the field of gender incongruence and pronoun usage. Only one GP routinely asked patients their pronouns (2%).

Conclusion

Our findings highlight that a significant proportion of GPs have no formal training in relation to discussing pronouns and gender incongruence. We believe GPs should have the skills necessary to appreciate, understand and provide structured support to those with concerns in relation to their gender identity. With waiting times for gender clinics frequently exceeding 2 years, our findings emphasise the increasing importance of GP specific training in the field of gender identity.