bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit
Authors: Loots Feike J , Smits Marleen , van Steensel Carlijn , Giesen Paul , Hopstaken Rogier , van Zanten Arthur RH 
Published: June 2018

BackgroundSepsis is a life-threatening condition requiring urgent hospital treatment. The rates of recognition and doctors delay in primary care are currently unknown.AimTo explore the role of GP cooperatives in the pre-hospital care for sepsis patients.MethodA retrospective patient record study was conducted of sepsis patients admitted to an intensive care unit (ICU) in Ede, the Netherlands. Adult ICU patients admitted for community-onset sepsis between 2011 and 2015 were identified. Subsequently, all contacts with the co-located GP cooperative in the 72 hours before hospital admission were retrieved. Differences in mortality rates between subgroups were analysed using logistic regression analysis.ResultsOf 263 patients admitted to the ICU, 127 (48.3%) had prior GP cooperative contacts. These contacts concerned home visits (59.1%), clinic consultations (18.1%), direct ambulance deployment (12.6%) or telephone advice (10.2%). Patients assessed by a GP were referred in 64% after the first contact. The median delay to hospital arrival was 1.8 hours. In 43%, the GP had not suspected an infection. In this group the in-hospital mortality rate was significantly higher compared with patients with suspected infections (41.9% versus 17.6%). Mortality difference remained significant after correction for confounders.ConclusionGP cooperatives play an important role in pre-hospital management of sepsis and recognition of sepsis in this setting proved difficult. Efforts to improve management of sepsis in out-of-hours primary care should not be limited to patients with a suspected infection, but also include severely ill patients without clear signs of infection.
How can primary care help to reduce weight stigma?
Authors: Henderson Emily , Norenberg Allison , Cairns Joanne , Gadsby Erica , Henderson Emily 
Published: June 2018

BackgroundThe WHO recently recognised stigma as a fundamental cause for health inequalities. Weight stigma is associated with negative health consequences, and patients experience it commonly in healthcare settings. This study forms part of systematic review that aimed to understand how weight stigma can be reduced through the adoption of whole systems approaches.AimTo generate new understandings of the roles primary care can take in reducing weight stigma.MethodA systematic international literature review of peer-reviewed articles utilising EPPI guidance, and using PICOS terms in Web of Science searches. Recommendations for policy, practice and/or research were extracted and conceptually synthesised as guided by Research Unit for Research Utilisation.ResultsThe search identified 194 full texts with 540 total recommendations. Approximately 45% of recommendations (248 of 540) were coded under healthcare, of which 75% were in primary care including general practice (189 of 248). Findings indicate areas where weight stigma could be addressed in primary care: 1) Training; 2) Self-awareness; 3) Non-stigmatising approaches; 4) Formal patient assessments; 5. Coping strategies; 6) Organisational/structural support; 7) Cross-sector working; 8) Anti-discrimination legislation and classify obesity as a disease.ConclusionLiterature on reducing weight stigma focuses substantially on healthcare, and there is a range of approaches that could be taken. Tensions arise between the medicalisation of obesity and need to consider social determinants of obesity. Healthcare is only one of many settings in which the weight stigma needs to be addressed and whole systems approaches, for example working with local government, are required in particular to reduce health inequalities.
Learning from the introduction of ‘skill-mix’ changes in general practice: a qualitative process evaluation
Authors: Nelson Pauline , Martindale Anne-Marie , McBride Anne , Hodgson Damian 
Published: June 2018

Background‘Skill-mix’ change (changing mix of staff roles or introducing new ways of working) is increasingly promoted to relieve pressure in general practice teams. As part of a primary care workforce strategy, one locality in Greater Manchester is seeking to integrate three ‘non-medical’ roles – Advanced Practitioners (APs), Physician Associates (PAs) and Clinical Pharmacists (CPs) – to work alongside practice staff.AimA qualitative process evaluation studied the integration of these roles to: establish the aims and priorities of the new services; understand and compare the ways in which the roles are being established with identification of measurable impacts and unintended consequences.MethodA rapid scoping review of the primary care skill-mix literature was conducted to inform the evaluation. Purposive and ‘snowball’ sampling enabled semi-structured interviews (12) and focus groups (2) to be conducted with 27 key individuals (workforce/training leads for the new services; APs/PAs/CPs; GPs/practice managers), before being transcribed, anonymised and analysed thematically with a combination of a priori and grounded codes. Analysis of relevant service/training plans supplemented interview/focus group data.ResultsA number of organisational and operational factors affecting implementation success in early adopter sites were identified including: the intended scope and function of new roles with corresponding implications for measuring impacts; leadership/active management of workforce changes; appropriate training and education; inter-professional tensions; regulatory provisions, and sustainability.ConclusionThere is variation in how the three skill-mix initiatives are being implemented in early adopter sites, with implications for success. Key considerations for introducing skill-mix changes in general practice are being identified.
Patient feedback on a new method of consulting with the GP; an analysis of responses by users of online triage software
Authors: Eccles Abi , Hopper Mike , Atherton Helen 
Published: June 2018

BackgroundOnline triage software is a new way to triage patients online that allows patients to describe their problem via an online form. A GP then contacts the patient to arrange either a face-to-face or telephone consultation.AimThis study aimed to explore use of online consultation software and gain insight into patients’ experiences of using online consultations, identifying potential barriers and facilitators to use.MethodThis is a mixed methods retrospective study analysing data about patient users and their associated feedback. Data from a sample of 5591 patients were quantitatively analysed to describe characteristics of users. 576 out of the 5591 users left free-text feedback comments on their experience of use. These were thematically analysed.ResultsThe highest levels of use were observed in 25–35-year olds and lowest from those aged >65. Key themes identified included convenience, consultation quality, appropriateness, resource-use and functionality. Within each, a range of subthemes were present representing both positive and negative perceptions, suggesting that experiences of using online triage varied and were often context-dependentConclusionThere are various advantages to online triage software, but these are context-dependent. Therefore, such applications should be offered as an additional way to contact the GP surgery, rather than a replacement for more established methods, to ensure appropriate and equal access for patients.
From Soundwaves to BrainWaves: The effects of choral singing on recovery from stroke and aphasia
Authors: Marley John , Matthias Bernadette , Worrall Linda , Guest Maya , Allan Christopher 
Published: June 2018

BackgroundStroke is a leading cause of death and disability. Recovery is frequently compromised by reduced well-being, mood, socialisation and quality of life. Music and singing are recognised as enhancing well-being and benefit people with chronic illness. Evidence suggested that choir singing may improve the fluency of people with aphasia. Choirs existed for people with brain impairment; no studies had robust design and outcome measurement.AimTo conduct a pilot study in Newcastle, Australia in a collaboration between Hunter New England Health and the University of Newcastle. To explore the effects of choral singing on quality of life, well-being, mood, social participation and communication skills of community-dwelling stroke survivors including people with aphasia.MethodA mixed methods waitlist control design was used. 39 people at least 6 months post-stroke were assessed before and after a 12-week choir rehearsal period. Carers were invited to participate. Subjects were interviewed at the end of the period.ResultsMeasures of communication improved significantly and a trend to improvement in overall quality of life was seen. Depression and disability were significant in their impact on overall quality of life scores. Qualitative work reported increased quality of life, confidence, independence, mood and socialization and improvements in speech and communication were also reported.ConclusionOur pilot showed that a 12-week choir program for stroke survivors and carers is feasible and benefits quality of life, well-being, mood, community participation and communication in people with aphasia.
Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers
Authors: Jones Leah Ffion , Cooper Emily , McNulty Cliodna 
Published: June 2018

BackgroundEscherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.AimTo help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.MethodFocus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.ResultsCarers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurseConclusionA final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/
Identifying signs and symptoms preceding the diagnosis of Alzheimer’s Disease: a retrospective medical record review
Authors: Bature Fidelia , Pang Dong , Pappas Yannis , Guinn Barbara 
Published: June 2018

BackgroundEarly diagnosis of Alzheimer’s disease (AD) is beneficial as interventions work well at this stage.AimThe study sought to identify patterns in signs and symptoms as reported by patients, 10 years preceding the clinical diagnosis of AD and suggest a predictive model for the early detection of the disease.MethodA retrospective medical record review and nested case-control design were carried out on the charts of 109 individuals (37 cases and 72 in the control group) in three GP surgeries in Milton Keynes and Luton, diagnosed between the year 2006–2016. Data extracted included the demographic and clinical data (signs and symptoms preceding the diagnosis of the disease). Logistic regression and correlation coefficient was used for analysis of variables to identify patterns.ResultsAuditory disturbances (tinnitus), a symptom that has not been reported in AD, could have a diagnostic value with 3.03 increased odds for associating with AD and a P-value of ≤0.05; the symptom was presented with a mean age of 14.5 years before the clinical diagnosis of the disease. There was a positive correlation between auditory disturbance and AD; episodic memory and AD; the female gender and AD all at 1% level (2tailed).ConclusionAuditory disturbance in the form of tinnitus has not been fully investigated in AD apart from auditory hallucinations and, as this symptom has been associated with other conditions. While further research is advocated in a large scale due to the insufficiency of the sample to initiate subgroup analysis, the result suggests that auditory disturbance could be a confounding factor to support future plans to improve the early diagnosis of AD.
Sensitivity of chest X-ray for lung cancer: systematic review
Authors: Bradley Stephen , Bradley Stephen , Abraham Sarah , Grice Adam , Lopez Rocio Rodriguez , Wright Judy , Farragher Tracey , Shinkins Beth , Neal Richard D 
Published: June 2018

BackgroundLung cancer is a leading cause of premature death. Early diagnosis is associated with improved outcomes. While chest X-ray remains the first line investigation, individual studies have indicated that a proportion of lung cancers are not identified (false negatives); this is one cause of delayed diagnoses.AimTo estimate the proportion of patients with lung cancer who have had a chest X-ray in the year prior to diagnosis which was not interpreted as having features suspicious for lung cancer.MethodA broad search strategy was devised including several synonyms for chest X-ray and lung cancer. Screening and paediatric data, studies from before 1999 and studies based on retrospective interpretation of radiology were excluded. A 20% random sample screened by a second reviewer to ensure consistency.ResultsAnalysis is almost complete: 8362 studies were identified. Twenty-nine studies met the inclusion criteria. Heterogeneity precluded meta-analysis, however the combined population was 1557 patients of whom 954 (61.27%) had a positive chest X-ray. In four studies with a lower risk of bias, comprising 1052 patients, sensitivity ranged from 73.5% to 79.3% (mean 76.19%).ConclusionThis review suggests that chest X-ray does not identify approximately 25% of cases, although the findings may be affected by publication bias. This finding needs replicating in a high-quality study that could also demonstrate the potential consequences on diagnostic intervals and stage at diagnosis. The findings also suggest that studies to evaluate the effectiveness and cost-effectiveness of other modalities (e.g. low-dose CT scan) are needed.
Extended training to prepare GPs for future workforce needs: a qualitative investigation of a 1-year fellowship in urgent care
Authors: Aiello Matthew 
Published: June 2018

BackgroundIt has been argued that UK general practice specialist training should be extended, to better prepare GPs for challenges facing 21st-century health care. Evidence is needed to inform how this should occur.AimTo investigate the experience of recently trained GPs undertaking a 1-year full-time fellowship programme; in particular, workforce impact and career development potential. The fellowship was designed to provide advanced skills training in urgent care, integrated care, leadership, and academic practice.MethodSemi-structured interviews conducted longitudinally over 2 years, augmented by observational data in West Midlands, England. Participants were interviewed on at least three occasions: twice while undertaking the fellowship, and at least once post-completion. Participants’ clinical and academic activities were observed. Data were analysed using a framework approach.ResultsSeven GPs participated in the pilot scheme. The fellowship was highly rated and felt to be balanced in terms of the opportunities for skill development, academic advancement, and confidence building. GPs experienced enhanced employability on completing the scheme, and at follow-up were working in a variety of primary care/urgent care interface clinical and leadership roles. Participants believed the fellowship made general practice a more attractive career option for newly qualified doctors.ConclusionThe fellowship provides a defined framework for training GPs to work in an enhanced manner across organisational interfaces, with the skills to support service improvement and integration. The fellowship model appears appropriate to prepare GPs for portfolio roles. Its impact on NHS service delivery continues to be investigated by Health Education England.
What can be done to promote resilience in GPs?
Authors: Waters Aine , Gonzalez Olivia , Keogh James , Kavanagh Nora , O’Neill Claire , Kelly ME , McGuire Genevieve , Regan Anne-Marie 
Published: June 2018

BackgroundMedicine is a challenging career. There are reports of high rates of exhaustion, burn out and maladaptive coping strategies amongst doctors, GPs in particular. Accordingly, the issue of GP resilience is extremely topical.AimTo explore perspective of GPs and GP registrars regarding what can be done to promote resilience.MethodThis was a qualitative study involving face-to-face, semi-structured, recorded interviews with GPs and GP registrars in the West of Ireland. Data analysis was done by six stages of thematic analysis based on Braun and Clarke.ResultsThree major themes emerged from data analysis: a) Within the person, b) Within the profession and society, and c) Within the healthcare system. Subthemes within the person were ‘What resilience means to me’, ‘Me as a doctor’ and ‘Me as a human’. Within the profession and society, the subthemes were ‘Traditional view of GP’, ‘Societal expectations of the GP’, ‘Formal supports’ and ‘Education and training’. The healthcare system theme incorporated three subthemes ‘Finances’, ‘Manpower’ and ‘Relationship with the healthcare system’.ConclusionIdentifying means to promote resilience in GPs involves an in-depth understanding of the challenges to resilience at various levels. From this research, it is evident that there is no “one size fits all” with regard to promoting resilience at a personal level. Views differed as to where resilience training would be best placed regarding formal resilience education. As to solutions within the health care system, GPs need to be adequately resourced to meet the evolving demands of general practice.
Local implementation of AMS initiatives: a mixed-methods study
Authors: Allison Rosalie , Lecky Donna , Beech Elizabeth , Costelloe Ceire , Ashiru-Oredope Diane , Owens Rebecca , McNulty Cliodna 
Published: June 2018

BackgroundThe NHS English Quality Premium recommends that inappropriate antibiotic prescribing is reduced; there are a range of national antimicrobial stewardship (AMS) initiatives to support this.AimThe aim of this study is to assess AMS activities in primary care across England. The findings will be used to inform how the RCGP, PHE and NHS can help optimise stewardship activities.MethodQualitative interviews: with AMS leads within Clinical Commissioning Groups’ (CCGs) and Commissioning Support Units’ (CSUs) medicines management teams. Questionnaire: informed by the qualitative data, sent to all 209 CCGs in England in 2017.ResultsIn total, 89% (187/209) of CCGs returned a questionnaire; 82% of AMS leads reported spending only 0.1 whole-time equivalent on AMS activities, as it was only one role within a wider remit, so dedicating time is challenging. 99% (167/169) of CCGs had delivered AMS education in the last 2 years: 140 face-to-face; 121 via e-learning. 99% (184/186) actively promoted the TARGET Antibiotics Toolkit; 94% (175/187) actively promoted TARGET patient leaflets: 92% The Treating Your Infection (TYI) leaflet. 90% (166/185) used the PHE managing common infections guidance: 81% (149/185) modify or localise; 41/185 (22%) signpost directly to it. Eighty-six CCGs reported using CCG audit tools and 82 CCGs reported using TARGET’s audit tools. 85% (142/168) fed back antimicrobial prescribing data to the CCG/CSU board; 100% (169/169) to general practices and 33% (56/169) to out-of-hours providers.ConclusionAlthough CCGs reported promoting these AMS activities, there was little evaluation of uptake by primary care practitioners. Future work should focus on measuring AMS uptake; having staff dedicated solely to AMS could facilitate this.
A scoping review of the role of GPs in the management of obesity
Authors: Elmitt Nicholas , Sturgiss Elizabeth , Haesler Emily , van Weel Chris , Douglas Kirsty 
Published: June 2018

BackgroundGPs are caring for more adults with obesity. Research in primary health care has provided insight on the components of effective interventions. However, the most appropriate and effective role for GPs in these interventions remains unclear.AimA scoping review was undertaken to examine the literature for descriptions of the role of the GP in managing adults who are overweight or have obesity in: primary research interventions, guidelines, and the role expectations expressed by opinion leaders.MethodBlack and grey literature were searched based on the terms ‘obesity’, ‘doctor’ and ‘primary care’. A customised data extraction tool was used to identify the specific role of GPs and the explicit use of general practice values, including whole person care and person-centred care.Results282 articles were reviewed in full, with a majority of the interventions originating in the US. Poor description of the involvement of healthcare professionals made it difficult to determine if GPs had been involved. When described, GPs were rarely actively involved. Most guidelines explicitly name GPs in obesity management and suggest wide ranging roles for them. Opinions from experts on GP involvement have become more positive in recent years.ConclusionGPs are minimally involved in obesity interventions in primary care research, but are promoted in obesity guidelines as essential to patient care. There is a need for an international standard on how to accurately describe which healthcare professionals were involved in intervention delivery and their specific role.