bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification and management of frailty in English primary care: a qualitative study of national policy
Authors: van Marwijk Harm , Blakeman Tom , Reeves David , Alharbi Khulud 
Published: June 2020

BackgroundPolicymakers are directing attention to addressing the needs of an ageing population. Since 2017, general practices in England have been contractually required to identify and code ‘frailty’ as a new clinical concept and, in doing so, support targeted management for this population with the aim of improving outcomes. However, embedding frailty policies into routine practice is not without challenges and little is currently known about the success or otherwise of the programme.AimTo explore the implementation of a national policy on frailty identification and management in English primary care.MethodSemi-structured interviews were conducted with GPs (n = 10), nurses (n = 6), practice managers (n = 3) and health advisors (n = 3). Normalisation Process Theory (NPT) and System Thinking provided sensitizing frameworks to support data collection and analysis.ResultsPrimary care professionals were starting to use the concept of frailty to structure care both within practices and across organisations, however, there was widespread concern about the challenge of providing expanded care for the identified needs within existing resources. Concerns were also expressed around how best to identify the frail subpopulation and the limitations of current tools for this, and there was a professional reticence to use the term ‘frailty’ with patients.ConclusionFindings suggest that additional focused resources and the development of a stronger evidence base are essential to facilitate professional engagement in policies to improve the targeted coding and management of frailty in primary care.
Study design of the Fasting In diabetes Treatment (FIT) trial: a randomised, controlled, assessor blinded intervention trial which examines the effect of intermittent use of a fasting mimicking diet in patients with type 2 diabetes
Authors: van den Burg Elske , Schoonakker Marjolein , van den Akker Elske , van Dijk Ko Willems , Lamb Hildo , Pijl Hanno , Numans Mattijs , van Peet Petra 
Published: June 2020

BackgroundCaloric restriction is an effective way to treat type 2 diabetes (DM2). However, chronic restriction of food intake is difficult to sustain. Intermittent total fasting exerts similar metabolic effects, but may be even more challenging for most patients. A fasting mimicking diet (FMD) was designed to achieve the metabolic benefits of total fasting, despite considerable calorie content. The effects of a FMD in DM2 patients are still unknown.AimTo determine the effect of intermittent use (5 consecutive days a month during a year) of a FMD in DM2 patients on metabolic parameters and DM2 medication use compared to usual care.MethodOne hundred DM2 patients from general practices in the Netherlands with a BMI ≥ 27 kg/m2, treated with lifestyle advice only or metformin, will be randomised to receive the FMD plus usual care or usual care only. Primary outcomes are HbA1c and DM2 medication dosage. Secondary outcomes are anthropometrics, blood pressure, plasma lipid profiles, quality of life, treatment satisfaction, metabolomics, microbiome, MRI (for example, cardiac function and fat distribution), cost-effectiveness, and feasibility in clinical practice.ResultsThe first 70 patients are included. Follow up will be completed in April 2021.ConclusionOur results will show whether monthly cycles of a FMD are feasible in clinical practice, if they improve metabolic parameters and/or reduce the need for medication in DM2 and if this is a cost-effective intervention.
Emergency Admission Risk Prediction (EARP) tools in primary care to reduce emergency admissions to hospital: clash of evidence and practice
Authors: Snooks Helen , Kingston Mark , Porter Alison , Hutchings Hayley , Russell Ian 
Published: June 2020

BackgroundPolicy initiatives have incentivised use of EARP tools in primary care to reduce emergency admissions. A recently published trial in South Wales found that EARP increased emergency admissions and emergency department attendances without clear benefits. This cost the NHS an additional £76 per patient per year. But the use of EARP in primary care across the UK was unknown.AimTo assess implementation and facilitators use of EARP tools in primary care across the UK.MethodStructured email survey of 235 UK primary care commissioners across the UK.ResultsThere were 148 (87%) of 171 responders (73%) who reported that EARP tools were available in their areas. We identified 39 different EARP tools in use. Access to EARP tools varied widely by country: Northern Ireland (100%), Scotland (91%), England (76%) and Wales (14%). Promotion by NHS commissioners, and engagement of clinical leaders and practice managers were identified as the most important factors in encouraging use of EARP tools. Research evidence was seen as less important. Nearly 40% of areas using EARP reported that they had revised services as a result, but few reported use of EARP for service evaluation.ConclusionThough EARP tools are widely available in primary care, new evidence shows that they are counter-productive. We estimate that by delaying the dissemination of EARP for evaluation NHS Wales saved >£200 million per year. We encourage further research and discussion about next steps in use of EARP tools in emergency admission prevention in the UK.
Vitamin D deficiency is associated with increased risk of postural hypotension in older men: a cross-sectional analysis from The British Regional Heart Study
Authors: Gilani Artaza , Ramsay Sheena , Welsh Paul , Papacosta Olia , Lennon Lucy , Whincup Peter , Wannamethee S Goya 
Published: June 2020

BackgroundThere is growing interest in the role of vitamin D in extra-skeletal health, including postural hypotension. Postural hypotension is found in 1 in 5 community-dwelling adults aged 60 years and above. It increases risk of falls, fractures, cardiovascular disease and all-cause mortality. Better understanding of the aetiology of postural hypotension may help yield more effective treatment options than those that are currently available.AimThe aim of this study was to investigate the association between circulating vitamin D, parathyroid hormone and postural hypotension.MethodThis was a cross-sectional analysis of 3620 community-dwelling men living in the UK (mean age 68.6 years; standard deviation 5.5 years). Vitamin D status (nmol/L) was categorised as sufficient (≥50), insufficient (≥25 – <50), or deficient (<25). Parathyroid hormone levels were categorised by quintiles. Postural hypotension was defined by consensus criteria as a decrease in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg that occurred within three minutes of standing.ResultsCompared to sufficient levels of vitamin D, vitamin D deficiency increased risk of postural hypotension that specifically occurred within one minute of standing (OR 1.51, 95% CI = 1.06 to 2.15) in multinomial, multiple logistic regression. Neither vitamin D insufficiency, nor elevated parathyroid hormone, were associated with postural hypotension.ConclusionIn this study, vitamin D deficiency was associated with increased risk of postural hypotension. Further research may help clarify whether treating vitamin D deficiency can reduce the degree of postural hypotension, or if preventing the progression to vitamin D deficiency can reduce the incidence of postural hypotension.
If GPs who teach medical students were assisted to be good role models might this influence the medical career the students choose?
Authors: White Jonathan 
Published: June 2020

BackgroundMost patients are cared for in the community by GPs, and workforce planning for the UK NHS suggests that 50% of medical school graduates need to train as GPs. While there is pressure on medical schools to provide more student teaching in general practice, general practice must be prepared for this increase in workload and teachers should have appropriate training.AimThis study examined the influence that teachers as role models can have on the development and career choices of medical students and whether GPs who teach medical students might benefit from assistance in developing positive attributes.MethodA literature search was carried out. Relevant papers were those that examined the influence of a doctor as teacher role model for medical students, both in assisting in professional development and clinical skills, and in influencing career choice.ResultsThe review identified eleven papers. There was evidence of association between a student having an influential role model as teacher and choosing specialty training in that area, although evidence of a causative connection is less convincing. A recurring theme is the recommendation that teachers should be aware of the influence they can have as role models, both positive and negative.ConclusionAs medical student teaching moves into general practice GPs who teach will need to be helped to understand and develop positive role model attributes, to promote general practice as an attractive career to the students. Further research needs to identify the extent of assistance required and whether medical schools are prepared for this extra responsibility.
In situ deteriorating patient simulation in general practice
Authors: Lawrence Joanna , Eastwick-Field Petronelle , Maloney Anne , Higham Helen 
Published: June 2020

BackgroundGP practices have limited access to medical emergency training and basic life support is often taught out of context as a skills-based event.AimTo develop and evaluate a whole team integrated simulation-based education, to enhance learning, change behaviours and provide safer care.MethodPhase 1: 10 practices piloted a 3-hour programme delivering 40 minutes BLS and AED skills and 2-hour deteriorating patient simulation. Three scenarios where developed: adult chest pain, child anaphylaxis and baby bronchiolitis. An adult simulation patient and relative were used and a child and baby manikin. Two facilitators trained in coaching and debriefing used the 3D debriefing model. Phase 2: 12 new practices undertook identical training derived from Phase 1, with pre- and post-course questionnaires. Teams were scored on: team working, communication, early recognition and systematic approach. The team developed action plans derived from their learning to inform future response. Ten of the 12 practices from Phase 2 received an emergency drill within 6 months of the original session. Three to four members of the whole team integrated training, attended the drill, but were unaware of the nature of the scenario before. Scoring was repeated and action plans were revisited to determine behaviour changes.ResultsEvery emergency drill demonstrated improved scoring in skills and behaviour.ConclusionA combination of: in situ GP simulation, appropriately qualified facilitators in simulation and debriefing, and action plans developed by the whole team suggests safer care for patients experiencing a medical emergency.
2017 Cancer Prevalence Dashboard for London
Authors: Zalin Amy , Jose Sophie , Petit Jason , Price Liz , Anastasiadis Tania 
Published: June 2020

BackgroundAs cancer incidence increases and survival improves, the number of people living with a cancer diagnosis is increasing. People living with cancer have 50% more contact with GPs 15 months after diagnosis than a population of similar age, sex and locality; 70% have another long-term condition.AimTo aid service providers’ understanding of the cancer prevalent population by creating a publicly available visualisation tool that both describes patients’ demographics and length of time lived with cancer, and compares counts of nationally registered cancer survivors to GP-maintained registers.MethodUsing National Cancer Registration and Analysis Service (NCRAS) data, prevalence rates and counts were generated for London patients diagnosed 1995–2017 and alive 31 December 2017, overall and for lower-level geographies. GP-recorded Quality and Outcomes Framework (QOF) prevalence at Clinical Commissioning Group (CCG) level was compared to NCRAS counts for the same period.ResultsOn 31 December 2017, 231 740 (2.6%) people were living with cancer in London; 33% were diagnosed 5–9 years prior and 31% were diagnosed ≥10 years prior. Prevalence was higher in women (P<0.001) and dramatically increased with age for London (P<0.001); >12% of >75 year olds were living with a cancer diagnosis in every lower-level geography. Completeness of GP QOF cancer registers against NCRAS prevalence counts ranged from 75–108% across CCGs.ConclusionLocal understanding of the cancer prevalent population is needed, with a concerted effort to interpret large discrepancies between QOF and NCRAS registers, which may arise from differences in coding practice. Ensuring patients are identified in primary care is a first key step to managing cancer as a long-term condition.
The prevalence of musculoskeletal presentations in general practice: an epidemiological study
Authors: Keavy Ruairi 
Published: June 2020

BackgroundIt is estimated that 28.9% (17.8 million) of the UK population live with a musculoskeletal (MSK) condition. They are a major cause of morbidity, and a significant reason for presentation to primary care.AimThe primary aim of this study was to determine the prevalence of MSK conditions presenting for consultation in general practice. The secondary aim was to determine specifically which MSK conditions present most frequently in general practice.MethodA total of 545 consultations were reviewed at an urban community general practice, which included evaluating morning consultations over a 1-week period taken from each of January, April, July and October 2018. This encompassed all morning consultations from all GPs present. The number of MSK consultations were recorded and, within that, the different presentations and their management plan.ResultsA total of 115 of all consultations were regarding an MSK presentation yielding an overall prevalence of 21.1%. The commonest MSK presentations included the lumbosacral spine (18.3%) and the knee (17.4%). Re-presentations of original condition accounted for 73.9% of all MSK consultations. Steroid injections were administered in 33% of knee related consultations.ConclusionThis study demonstrates that MSK presentations account for a large proportion of GP workload. There are no current mandatory training requirements in orthopaedics as part of the GP curriculum. Structured MSK education for GPs is important and would reduce the burden of re-presentations, particularly that of the lumbosacral spine and knee. Competency in joint injection is also a valuable skill for GPs.
A scoping review of community holistic interventions for older people with multimorbidity
Authors: Smith Timothy , Patel Tahera , Akpan Asangaedem , Clegg Andrew , Watkins Dame Caroline , Lightbody Catherine Elizabeth , Chauhan Umesh 
Published: June 2020

BackgroundIn many areas, new regional community-based services have been established to provide holistic care to patients with high physical, mental and social needs. Older people represent a group with multimorbidity and high healthcare needs that may benefit from holistic care, although uncertainty remains whether such an approach is effective.AimTo review evidence for community holistic interventions in older people with multimorbidity.MethodThe authors screened studies referenced by an earlier Cochrane Review and Academy of Medical Sciences report, both of which looked at interventions and populations more broadly, and their own searches of Medline, EMBASE, trial registration databases and hand-searching of journals since 2015. The authors included controlled community-based studies of holistic interventions with data for people aged at least 60 years.ResultsStudies found (five published, two ongoing) were heterogeneous. The only significant improvement relating to physical or mental outcomes occurred in self-rated health scores, seen in two studies. One consisting entirely of diabetics showed developing a self-management plan improved self-rated health (P = 0.023), and Mental Component Summary (P = 0.03). The other used a multidisciplinary-team-guided personal care plan and found self-rated overall health improved (P = 0.02). Three studies looked at service usage, only one seeing a benefit, and only in the second year.ConclusionCommunity-based holistic interventions for people with multimorbidity tended to focus on disease management or medication modification, and resulted in few significant benefits, almost entirely in self-rated health measures. Research into interventions focused on those with the highest needs, for example, multimorbidity with frailty; high number of comorbidities may be more likely to demonstrate meaningful benefits.
A case study evaluation of a community multidisciplinary team in South East England using a mixed-method approach
Authors: Muscat Jessica Wyatt 
Published: June 2020

BackgroundCommunity multidisciplinary teams (MDTs) represent a model of integrated care comprising health, social care, and the voluntary sector where members work collaboratively to coordinate care for those patients most at risk.AimThe evaluation will answer the question, ‘What are the enablers and what are the restrictors to the embedding of the case study MDT into the routine practice of the health and social care teams involved in the project?’MethodThe MDT was evaluated using a mixed-method approach with normalisation process theory as a methodological tool. Both quantitative and qualitative data were gathered through a questionnaire consisting of the NoMAD survey followed by free-form questions.ResultsThe concepts of the MDT were generally clear, and participants could see the potential benefits of the programme, though this was found to be lower in GPs. Certain professionals, particularly mental health and nursing professionals, found it difficult to integrate the MDT into normal working patterns because of a lack of resources. Participants also felt there was a lack of training for MDT working. A lack of awareness of evidence supporting the programme was shown particularly within management, GP, and nursing roles.ConclusionSpecific recommendations have been made in order to improve the MDT under evaluation. These include adjustments to IT systems and meeting documentation, continued education as to the purpose of the MDT, and the engagement of GPs to enable better buy-in. Recommendations were made to focus the agenda with specialist attendance when necessary, and to expand the MDT remit, particularly in mental health and geriatrics.
Evaluation of a novel anxiety and trauma intervention at the Edinburgh Fringe
Authors: Ashworth Andrew 
Published: June 2020

BackgroundAnxiety and psychological trauma are common presentations in general practice and may lead to long-term prescribing and/or time-consuming talking therapies.AimTo assess the efficacy and acceptability of short ‘Gazetherapy’ interventions.Method‘The Anxiety Experiment’ was delivered as a show at the Edinburgh Fringe Festival from 1–25 August 2019. Gazetherapy interventions were explained using props to describe polyvagal theory and cranial nerve and cerebellar/hippocampus anatomy and function. BabyGaze (reducing anxiety in the moment), da Vinci Gaze (attenuating stress), and Accessory Gaze (resolving simple trauma) were delivered to audiences of between six and 51 people during <10 minutes of the 50-minute presentation. Subjects were given a card bearing a QR code to link to an online survey containing validated short screening questionnaires: GAD-2 for probable anxiety disorder and PC-PTSD for probable post-traumatic stress disorder (PTSD).ResultsEfficacy: 73 (9.8%) attendees completed the survey, of whom 39% screened positive for anxiety and 26% screened positive for PTSD. Those screening negative in both tests (52%) were designated a control group, with 36% of them feeling better after the presentation. Fifty-nine per cent of probable anxiety ‘cases’ and 68% of probable PTSD cases felt better after the presentation; none felt worse. Acceptability: 95% reported a ‘definite’ or ‘probable’ intent to use the techniques in the future, with 5% (all non-cases) stating that they probably would not. No responder said they would definitely not use the techniques.ConclusionThe acceptability and effectiveness of a new therapeutic approach were demonstrated by presenting them in a show at the Edinburgh Fringe.
Decision making on clinical care choices including end-of-life decision making for older adults in an acute care setting
Authors: O’Reilly Sinead 
Published: June 2020

BackgroundThe Scottish Government’s vision for older people is that ‘Older people are valued as an asset; their voices are heard and they are supported to enjoy full and positive lives.’ In the health and social care setting in Scotland it is increasingly recognised that there is a need for careful planning of care for older patients with complex comorbidities, and that this should involve the patient where possible via a process of shared decision making (SDM).AimTo establish what future planning for healthcare decision making and end-of-life care was undertaken in the care of the older patients in a secondary care facility, and how much they participate in this process.MethodAn audit was conducted across four wards in the care of the older patient setting in a hospital for older patients in Scotland. Over a 2-week period, all patients’ charts (n = 82) were reviewed, and evidence was examined on whether the following documents were in place: a do not resuscitate order; an escalation of medical care plan; and an assessment of capacity/incapacity.ResultsThe majority of patients (55%) had a resuscitation plan in place. An Incapacity Statement was also in place for the majority of patients who required it (90%). The escalation of medical care plan was only completed for a minority of patients, mainly those on the palliative care ward.ConclusionPlans for decision making around resuscitation were reasonably well developed. However, planning for other, more complex, future medical care needs was less well defined or explored with older patients.
Analisis Persepsi Mahasiswa Terhadap Metode Pengajaran Kreasi Bisnis
Authors: Palesangi Muliadi , Wijanarti Sri Widya , Agustiawan Sonny 
Published: June 2020

In the world of entrepreneurship education, it is important for educators to find the combination of entrepreneurial teaching methods that relevant to the learning goals and students’ needs. This quantitative research aims to get an overview from students' perceptions of Business Creation’s teaching methods in Prasetiya Mulya University, S1 Business Program. The results of the study revealed that discussion about STDP, Marketing Mix and BMC perceived as three important topics in starting a business in the aspect of conceptual lecture. The first and final phases of the competition are perceived to have a positive impact to fostering an entrepreneurial spirit in aspects of competition simulation. Whereas in the aspect of group dynamics, the factors that greatly influence group performance are communication and collaboration. The most interesting discussion topics for students are Opportunity, BMC, and Operation Skill.