bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed
Authors: Dolfini Luamar , Patel Yogesh 
Published: June 2020

BackgroundA considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.AimThe purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.MethodData was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.ResultsThere were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.ConclusionCertain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.
‘Would you like to join the NHS Organ Donor Register?’ A general practice feasibility study
Authors: Jones Catrin Pedder , Papadopoulos Chris , Randhawa Gurch , Asghar Zeeshan 
Published: June 2020

BackgroundA shortage of organ donors exists in the UK and targeting family consent is key for increasing donation consent rates. Registration on the NHS Organ Donor Register (NHS ODR) facilitates this, as it guides families on their loved ones donation preference. In general practice, an opportunity to register is provided, however only to new patients. To improve access to registration opportunities, an intervention was designed where general practice staff asked their patients if they wished to register as an organ donor.AimTo assess an organ donation registration intervention for feasibility and acceptability in a UK general practice setting.MethodOne general practice, in Luton, UK, conducted the intervention for 3 months (April to July 2018). Training was held in March 2018, and leaflets and posters were displayed for the 3-month period. An embedded experimental mixed-methods design was used, with data collected via SystmONE questionnaires, surveys and focus groups.ResultsThe intervention was found to be feasible and acceptable to conduct with some patients by some staff members. During the 3 months, patients were asked in 12.4% of face-to-face consultations (n=812). Nurses and healthcare assistants were more able to conduct the intervention than doctors. Lack of time, telephone consultations, and it not being appropriate were the most common reasons for not asking. Finally, 244 patients joined the NHS ODR; 30.4% of those asked.ConclusionThis study demonstrates that general practice could be a feasible location in which an intervention designed to increase NHS ODR registration could be conducted
What do patients want? A qualitative exploration of patients’ needs and expectations regarding online access to their primary care record
Authors: Davidge Gail , Sanders Caroline , Hays Rebecca , Morris Rebecca , Atherton Helen , Mold Freda , McMillan Brian 
Published: June 2020

BackgroundPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. GP contracts in England state practices must promote and offer registered patients online access to their primary care record and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access.AimTo explore patients’ views about accessing online primary care records and to find out how patients would like to interact with their records and what support they may need.MethodInterviews and focus groups with a sample of 50 patients from a variety of socio-demographic backgrounds who were either; eligible for the NHS Health Check; had multimorbidities or were carers. Thematic analysis of data identified major themes impacting upon patients’ wishes and needs as well as highlighting population-specific issues.ResultsParticipants highlighted a wide range of views about the benefits and drawbacks of accessing their records online. The majority of participants indicated that they would be more likely to access their online primary care record if improvements were made to the design, reliability and functionality of existing online record services. Carers found accessing online records particularly useful.ConclusionConsultation with patients and carers about their experiences of accessing online records; support needs and preferred functions can provide useful insights to inform the future design of online record services.
GPs’ experience of safeguarding in care homes: what do they see and what do they do?
Authors: Alton Elisabeth , White Caroline 
Published: June 2020

BackgroundAbuse of older people in care homes is an on-going problem. GPs, as the most frequent practitioner group visiting care homes, have an important role in detecting and reporting abuse. However, there is little research about GPs’ experiences of working in care homes and how they work to safeguard residents.AimTo explore the challenges experienced by GPs working in this unique environment and how these impact on safeguarding.MethodAn online survey collected qualitative data about GPs’ experiences as visiting professionals to care homes, with an emphasis on safeguarding. A thematic analysis identified key themes.ResultsIn total, 58 completed surveys were returned, with a range of practitioner experience represented (1–30 years). Approximately 70% were GP partners, with the remainder salaried and locum doctors. Over one third reported they had witnessed signs of definite or possible abuse within care homes. Emerging themes related to the complex care home context, in which residents had multiple health needs and GPs had to build multiple relationships with managers, carers, families, and residents. Difficulties in accessing information were reported; residents could not always provide information, GPs had to rely on others for information, and rarely had access to electronic records.ConclusionGP work in care homes is a complex and skilled role, in which GPs encounter evidence of poor care and abuse. Key themes in respect of barriers and facilitators of good care were highlighted. The reliance on others for information and the need to build relationships with staff/managers may raise tensions in respect of safeguarding practice.
Quantifying empathy levels among UK undergraduate medical students: an online survey
Authors: Garnett Sarah , Dambha-Miller Hajira , Stuart Beth 
Published: June 2020

BackgroundEmpathy is a key health care concept and refers to care that incorporates understanding of patient perspective’s, shared decision making, and consideration of the broader context in which illness is experience. Evidence suggests experiences of doctor empathy correlate with improved health outcomes and patient satisfaction. It has also been linked to job satisfaction, and mental wellbeing for doctors. To date, there is a paucity of evidence on empathy levels among medical students. This is critical to understand given that it is a key point at which perceptions and practices of empathy in the longer term might be formed.AimTo quantify the level of empathy among UK undergraduate medical studentsMethodAn anonymised cross-sectional online survey was distributed to medical students across three universities. The previously validated Davis’s Interpersonal Reactivity Index was used to quantify empathy. The survey also collected information on age, sex, ethnicity, year of medical school training and included a free-text box for ‘any other comments’.ResultsData analysis is currently underway with high response rates. Mean empathy scores by age, sex, year of study and ethnic group are presented. A correlation analysis will examine associations between age and year of study, and mean empathy sores.ConclusionThese data will help to provide a better understanding of empathy levels to inform the provision of future empathy training and medical school curriculum design. Given previous evidence linking experiences of empathy to better health outcomes, the findings may also be significant to future patient care
Missed acute coronary syndrome during telephone triage at out-of-hours primary care: lessons from a case-control study
Authors: Erkelens Carmen , Rutten Frans , Wouters Loes , de Groot Esther , Damoiseaux Roger , Hoes Arno , Zwart Dorien 
Published: June 2020

BackgroundSerious adverse events (SAE) at out-of-hours services in primary care (OHS-PC) are rare. It most often concerns missed acute coronary syndromes (ACS). Root cause analyses highlighted errors in the triage process, but these analyses are hampered by hindsight bias.AimTo compare triage calls at the OHS-PC of missed ACS with matched controls with chest discomfort but without a missed ACS; and to assess predictors of missed ACS.MethodA case-control study with triage recordings of calls of a missed ACS registered between 2013–2017. Controls were from the same period. Cases were matched 1:8 with controls based on age and gender. Clinical, patient and call characteristics were assessed, and 15 expert GPs rated the triage safety and quality, being blinded to the final diagnosis. We applied conditional logistic regression analysis.ResultsFifteen missed ACS calls and 120 matched control calls were included. Cases used less cardiovascular medication (38.5% versus 64.1%, P = 0.05), and more often experienced retrosternal chest pain (63.3% versus 24.7%, P = 0.02) than controls. Consultation of the supervising GP (86.7% versus 49.2%, P = 0.02) occurred more often in cases than controls. Experts rated the triage of cases more often as ‘poor’ (33.3% versus 10.9%, P = 0.001), and ‘unsafe’ (73.3% versus 22.5%, P<0.001) than that of controls.ConclusionIt seems nearly impossible to differentiate missed ACS at the OHS-PC from others with chest discomfort based on symptom presentation.
Interpreter costs across clinical commissioning groups in England 2017–2018: a cross sectional survey using ‘freedom of information’ requests
Authors: Lehane David , Oliver Philip , Mitchell Caroline , Burton Christopher 
Published: June 2020

BackgroundProfessional interpreters are considered to be the gold standard when meeting the needs of patients with limited English proficiency (LEP) in primary care. The models by which CCGs supply interpreting services (IS) vary. Many CCGs use external commercial IS, while other CCGs commission ‘not for profit’ services such as the Advocacy and Interpreting Service in Tower Hamlets, the Sussex Interpreting Service, and the decommissioned Sheffield Community Access and Interpreting Service. Research on comparative costs and needs of the LEP population is lacking.AimTo compare the costs of interpreting services between CCG’s in England.MethodA cross-sectional study involving CCGs in England. A standardised request was sent to 195 CCGs inviting comment on how much the CCG spent (2017–2018) on IS. The data were plotted against a number of demographic variables (https://fingertips.phe.org.uk) and analysed using regression analysis.ResultsSurvey response rate: 86% of CCGs (n = 169). Of those CCGs who responded, 39% (n = 66) did not hold IS cost data. NHS England spent £2 951 348.16 for IS services for the year 2017–2018. A positive correlation was noted with increased cost of interpreting services when plotted against increasing percentage BME or percentage birth to non-UK parents. However, there were wide variations around correlation of best fit indicating variation in spending between CCGs for similar populations.ConclusionInter CCG variation in correlations between demographic variables and expenditure suggests further research is needed to determine how to optimise and resource safe and equitable IS across the UK population.
Motivating factors behind skill mix change: results from a practice managers’ survey in England
Authors: Gibson Jon , Spooner Sharon , Sutton Matt , McDermott Imelda , Goff Mhorag , Checkland Kath , Hodgson Damian , McBride Anne , Hann Mark 
Published: June 2020

BackgroundThe expansion of the primary care workforce by employing a varied range of practitioners (‘skill mix’) is a key component of the General Practice Forward View (GPFV). The extent of skill mix change and where that has occurred has been examined using publicly available practice level workforce data. However, such data does not provide information regarding specific motivating factors behind employment decisions for individual practices nor future workforce plans.AimTo identify key motivating factors behind practice workforce decisions and their future workforce plans.MethodAn online questionnaire was sent to practice managers in England. Data collection is ongoing; however, 1000 practices have responded to the survey so far. The questionnaire was composed of questions related to current workforce, motivating factors behind employment decisions, planned future workforce changes, financial assistance with employing staff (for example, HEE or CCG funding) and ideal workforce.ResultsEarly results indicate that practices that have employed physician associates have done so to increase appointment availability (78% of practices) and release GP time (68%). Sixty-six per cent of practices who have employed pharmacists have received some form of financial assistance with 21% of practices still receiving assistance. When asked to construct an ideal workforce, ‘new’ roles accounted for 20% of that workforce on average, which is a significantly larger proportion than those roles currently account for.ConclusionAlthough data collection and analysis are ongoing, the results of the survey provide novel insights into the underlying motivating factors behind employment decisions, specifically for new roles such as pharmacists, PAs and paramedics.
Continuing professional development for GPs in Myanmar: a pilot programme
Authors: Kandola Kerran , Oo Myint 
Published: June 2020

BackgroundThe quality of general practice in Myanmar is currently highly variable. No formalised system of revalidation yet exists and so engagement with continuing professional development (CPD) activities and motivation to further one’s own knowledge is sporadic.AimTo train GPs in three key areas; 1) recording CPD activities and maintaining a portfolio logbook; 2) reflecting on learning; and 3) what a future formalised CPD credit system may involve.MethodSixty-one GPs were recruited in March 2019 and given training on the above. Logbooks were issued, which were completed by the GPs while attending a simultaneous 3-month ‘GP CPD Refresher’ course, organised by the GP Society of Myanmar. The logbooks were then marked and individualised feedback given before issuing CPD accredited certificates.ResultsAll GPs agreed the pilot helped them to better understand how to maintain a CPD logbook and the importance of doing so (retention rate = 67%). All GPs also reported they would now be more likely to continue to keep a portfolio. Finally, all GPs surveyed felt a credit reward system, used as tangible evidence of CPD participation, would positively influence their future engagement with CPD.ConclusionImproving general practice is a key component in helping Myanmar develop its healthcare system; one step required is making engagement with CPD compulsory for the revalidation of clinicians. This pilot has highlighted existing inadequacies within current training of GPs, as well as the potential benefits of implementing a CPD credit reward system.
Antibiotic resistance of uropathogenic Escherichia coli and ESBL prevalence in general practice patients over 10 years
Authors: van Driel Antoinette 
Published: June 2020

BackgroundBacterial susceptibility to antibiotics changes over time. Knowledge of the susceptibility is important for antibiotic treatment guidelines in general practices.AimTo determine the antibiotic-susceptibility of E. coli from uncomplicated UTI among women in general practices in the Netherlands and to compare the results with those collected in 2004 and 2009.MethodUrine samples were collected from women with symptoms of uncomplicated UTI, in 30 sentinel GP practices of the Nivel Primary Care database. Patient characteristics, E. coli susceptibility and ESBL prevalence were analysed.ResultsIn total, 689 samples were collected. E. coli was the most isolated uropathogen (83%). Antibiotic susceptibility was stable over time except for ciprofloxacin (96%, 97% and 94% in 2004, 2009 and 2014, respectively; P<0.05). The susceptibility to co-amoxiclav was 88%, 87% and 92% in 2004, 2009 and 2014, respectively. The prevalence of ESBL producing E. coli increased from 0.1% in 2004, to 2.2% in 2014 (P<0.05). Susceptibility for co-trimoxazole was the highest in the West (88%) and the lowest in the North (72%, P = 0.021). Ciprofloxacin susceptibility was related to antibiotic use in the past 3 months (97% no use versus 90% use, P = 0.002) and those aged >70 years (P = 0.005). In 2014, prescription of fosfomycin increased compared to 2009 (14.3% versus 5.6%) at the expense of co-amoxiclav, co-trimoxazole and ciprofloxacin (P<0.05).ConclusionThe antibiotic susceptibility percentages to the agents tested were stable over the 10-year period, except for ciprofloxacin as was the prevalence of ESBL producing E. coli. Surveillance with regular intervals is warranted.
Revolutionising participants’ health and wellbeing through neuro-reprogramming via the Slimpod® app: a randomised controlled trial
Authors: Kyle Richard , Jones Stephen , Roycroft-Davis Sandra 
Published: June 2020

BackgroundObesity is a global pandemic that threatens the health of the population and the sustainability of publicly funded health care. This randomised controlled trial addresses the gap in the literature surrounding unconscious persuasion and its use in weight loss and weight management. The Slimpod® tool is unlike any of those currently available on the market. Using breakthrough research in ‘nudge’ thinking, it is designed to retrain an adult’s habitual and emotional response to foodstuffs. This therapeutic model allows unconscious thought to be shaped into a manner more consistent with a healthy lifestyle. Candidates can then take control of their eating behaviours to induce a holistic state of wellbeing.AimTo assess the effectiveness of an audio unconscious-persuasion weight loss/weight management intervention (Slimpod®) compared with audio relaxation (control).MethodEighty-two overweight adults were randomised to intervention (n = 41) and control groups (n = 41). Weight was assessed at trial commencement, mid-trial (12 weeks), and trial end (24 weeks). Secondary outcomes were assessed using the Eating Self-Efficacy Scale (ESES), Exercise Confidence Scale (ECS), and Quality of Life Index Generic Version III (QLI-G3) at the start and end of the trial.ResultsReports found a statistically significant difference in mean weight loss between intervention group (1.7 kg at 12 weeks and 4.3 kg at 24 weeks) versus control (0.6 kg and 1.2 kg respectively) at P<0.001. ESES scores showed greater self-efficacy (P = 0.008) in intervention at 24 weeks. No significant differences in ESES negative affect sub-scale score or ECS were observed.ConclusionSlimpod® was effective at reducing weight and increasing eating self-efficacy in overweight adults.
In Vitro Anti-Helicobacter Pylori and Antimycobacterial Activity Evaluation Of Selected Plants From Turkey
Authors: KARADAĞ Ayşe Esra , ÇAŞKURLU Ayşegül , TOSUN Fatma 
Published: June 2020

In this study, the extracts of Ulmus minor Mill. subsp. minor (Ulmaceae), Lathyrus pratensis L. (Leguminosae), Glaucium leiocarpum Bois. (Papaveraceae), and Echium vulgare L. (Boraginacea) were investigated for their in vitro anti-Helicobacter pylori and anti-mycobacterial activity.
The air-dried plant material was powdered and extracted with 70% ethanol by maceration. The extract was filtered and evaporated to dryness under the vacuum and then dissolved in a water-ethanol (90:10) mixture and extracted with dichloromethane and ethyl acetate, respectively. Antibacterial activity was investigated by microdilution method against Helicobacter pylori ATCC 43504, Mycobacterium smegmatis ATCC 14468 and Mycobacterium avium ATCC 25291.
The ethyl acetate extract of U. minor showed activity with MIC of 250 µg / mL against H. pylori. The other extracts showed no or weak inhibitory activity at >2000 µg/mL concentrations against the tested microorganisms. In conclusion, ethyl acetate extract of U. minor may be used for the treatment of H. pylori infections.
ACPA IN SALIVA AND THEIR ASSOCIATION WITH PERIODONTITIS AND RHEUMATOID ARTHRITIS
Authors: Bolyarova-Konova Theodora Nikolaeva , Stefanov Lubomir Deyanov , Kolarov Zlatimir Gospodinov , Tanev Dobromir Ivanov , Yankova Petya Stefanova 
Published: June 2020

Anti-cyclic citrullinated peptide antibodies (ACPA) are formed by the action of host-generated antigens and are part of the etiology of rheumatoid arthritis (RA). They are a sensitive and highly specific indicator of RA.
MATERIALS AND METHODS
In the study involved 105 subjects aged 32 to 85 years (Mean age 50,6 ±13,07), divided into four groups: Group I – with periodontitis (P) and without RA, with diagnosed osteoarthritis – 26 patients; Group II – with P and RA – 28 patients; Group III – without P and with RA – 26 patients; Group IV – without P and without RA – 25 individuals. All patients underwent clinical and laboratory tests for the diagnosis of RA and osteoarthritis, a clinical periodontal examination, and unstimulated whole saliva was collected.
RESULTS
We found significantly higher salivary ACPA levels in RA patients compared to healthy subjects (p <0.0001). In P patients we found significantly higher levels of ACPA in saliva than in healthy subjects (p <0.0001). Among P patients, we found a significant correlation between ACPA concentration in saliva and the following indicators: PISA; PD; BOP, respectively (p<0.001), (p =0.003), (p =0.007). Among RA patients, our results showed a significant correlation of ACPA concentration in saliva with the following indicators: serum ACPA concentration (p <0.0001); serum RF concentration (p <0.0001); DAS-28 (CRP) (p=0.009).
CONCLUSION
Based on the established correlation between salivary ACPA levels and RA indicators, a high concentration of ACPA in saliva may be suggested as an easily accessible indicator of RA, but further studies are needed to ascertain this possibility. The established association between periodontal parameters and salivary ACPA levels confirms the effect of periodontal inflammation on salivary ACPA concentration and justifies the treatment of P as a way of preventing and controlling RA.