bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a digital intervention to optimise cancer pain control
Authors: Adam Rosalind 
Published: June 2018

BackgroundPain is a frequent and distressing complication of cancer. Patients can have problems reporting pain, communicating about pain with professionals, using medications effectively, and seeking help.AimTo develop an intervention to support patients and professionals improve cancer pain control.MethodAn Intervention Mapping approach was taken to intervention development. Current challenges of managing cancer pain and potential solutions were investigated through systematic literature review and qualitative enquiries with patients, caregivers, and professionals. Behaviour change theory was applied systematically. A digital intervention was produced and prototypes were pre-tested. Patients were recruited with their linked Macmillan nurse and GP to feasibility test the intervention.ResultsA digital app was developed to help patients on strong opioids achieve personal treatment goals. The app includes a short film about pain management. It allows easy recording of short-acting analgesic doses, linked algorithmically to telephone help-screens. A weekly diary asks about pain, side effects, function, and medication adherence. App reports are automatically shared with linked professionals via NHS email. Early feasibility testing has been conducted with two patients, their linked GPs, and Macmillan nurses. Professionals found patient reports thought-provoking. Reports were used to inform clinical encounters, and seemed to promote a shared understanding of patient symptom management goals.ConclusionA digital intervention has been developed using a rigorous, theory-based methodological approach. There are early indications that the intervention could promote patient-centred care and shared decision making in patients with cancer pain. The intervention is ready to be tested on a larger scale.
Informal communication in integrated primary health clinics
Authors: Elmitt Nicholas , Douglas Kirsty , Phillips Christine , Hall Sally , Bookallil Marianne 
Published: June 2018

BackgroundEffective integrated care requires healthcare professionals to collaborate across disciplines with and around the patient. The tribal nature of health professionals can make this a difficult task. Understanding how, when and where communication occurs in Integrated Primacy Health Clinics (IPHCs) can foster stronger integration, however communication patterns are not always predictable. Informal communication is often the most prominent form of communication in an IPHC, but is poorly understood due to its nature.AimTo articulate the role that informal communication plays in supporting integration, propose methods for measuring it, and discuss the results of our study in a community IPHC in Canberra, Australia.MethodAspects of informal communication are defined and their functions explained. The aspects of informal communication are: informal networks, informal relationships, and informal encounters. A mixed-methods approach to measuring and describing the role of informal communication is proposed: Social Network Analysis is a useful tool for examining key relationships across disciplines; ethnography is necessary to understand how these relationships emerged, what supports them, and how they contribute to integration.ResultsOur study revealed that informal communication is more prevalent and preferred to formal communication in the community IPHC we studied. Space, shared experiences and commitment to organisational ethos were key to building these relationships which allow for teams to more quickly respond to the needs of patients.ConclusionInformal mechanisms exist and influence both processes and outcomes in IPHC. The informal communications that occur within the IPHC are often vital to the process of integration as well as the outcomes of the patient. SNA can give us important insight, but we cannot see the entire picture unless this is complemented by focused qualitative research.
Passé or a time to pause? A phenomenological study of family physicians’ experiences of physical examination
Authors: Kelly Martina , Freeman Lisa 
Published: June 2018

BackgroundOnce the cornerstone of clinical family practice, the role of physical examination is changing. Patients and physicians alike express concern that emphasis on evidence-based medicine and increasing reliance of technology has relegated the role of physical examination in clinical practice.AimTo understand the role of physical examination in contemporary family practice.MethodQualitative phenomenological study, interpreted through the writings of Merleau-Ponty. Semi-structured interviews were conducted with a purposive sample of sixteen family physicians; men, women, recent graduates and experienced physician working in urban, rural and academic practices. Interviews were recorded, transcribed and examined using template analysis, complimented with researcher reflexivity.ResultsStudy participants described physical examination as core to practice, to diagnose, to communicate, and to validate patient and practitioner concerns. Performance of physical examination became routine over time but a disruption to the expected caused physicians to pause. Participants described this as a slowing of time where they became conscious of the body of the patient and their own body, intertwined in a moment. Physicians experienced affective, intellectual, and physical phenomena, which integrated to guide their behaviour, diagnosis, and management of the patient. The role of physical examination was to not only diagnosis as an evidence-based medical expert, but was experienced as a form of embodied, nonverbal communication, which expressed care.ConclusionPhysical examination plays an important role to reassure and communicate trust in the doctor–patient relationship, enacted through the body of the physician. Complimenting diagnosis, the laying on of hands remains an essential element of patient care.
Management by the GP of patients with a suspected meniscal tear: a retrospective cohort study
Authors: Snoeker Barbara A.M. , Lindeboom Robert , Lucas Cees , Zwinderman Aeilko H , Beers Erna 
Published: June 2018

BackgroundAlthough guidelines advocate conservative treatment, it is unclear how GPs manage patients with a suspected meniscal tear.AimTo provide a clear understanding of the frequency of patients that are conservatively treated or are referred to secondary care, and whether this management is associated with age, trauma and locking complaints, and varied between general practices.MethodData was extracted from a GP database of routinely collected data. Subjects of 18–75 years old who attended their GP from 2005 up to and including 2015 in the area of Amsterdam with suspected meniscal tear were included. Groups were defined as 1) conservative treatment, 2) referral to secondary care after conservative treatment and 3) instant referral.ResultsWe retrieved 394 records. One hundred and twenty-two (31%) subjects were treated conservatively, 107 (27%) were referred after conservative treatment and 165 (42%) subjects were instantly referred to secondary care. This implies that of all subjects with a suspected meniscal tear, 69% were referred to secondary care of which more than 60% instantaneously. Subjects >40 years of age were more often referred than subjects ≤40 years (P = 0.013). Significant variation between GP practices occurred as initial referral and referral after conservative treatment ranged between 56% to 84% (P = 0.011).ConclusionIn Dutch GP practices, the majority of patients with suspicion meniscal tear are referred to secondary care. Older subjects are more frequently referred than younger subjects. The management of such patients varies substantially between GP practices. Findings emphasize the need for individualized risk predictions to guide decisions regarding the management of suspected meniscal tears.
Effect and acceptability of AKI education using peer review audit in primary care
Authors: Asrar Mufaza , McKinnell Joanna , Kolhe Nitin , Woods Lynn , Bassett Sally , Selby Nick , Shaw Sue 
Published: June 2018

BackgroundThis was part of the Southern Derby shire CCG AKI awareness and improved management in primary and secondary care. The programme involved educating the primary care staff (GPs nurses) about AKI, identifying and early management in at risk groups. The secondary care aspect involved protocol development for AKI risk/identification to reduce morbidity.AimAs two-thirds of AKI originates in the community we aimed to increase awareness and knowledge levels of AKI in primary care via a CCG wide education programme. This included nephrology a peer review audit of cases with an evaluation of the programme’s acceptability and impact.MethodOver a 12month period, peer review audit sessions were delivered to GPs and the primary care MDT. These sessions consisted of a short presentation by a consultant nephrologist followed by discussion of cases. Qualitative feedback was collected from all participants. Web-based, CCG-wide questionnaires incorporating factual and clinical questions were used to assess baseline and post-intervention knowledge level.Results93% of participants (94 responses) found the peer review audit sessions useful, particularly the presence of nephrologist. 45% of participants were anxious about group discussion of cases, although 36% thought they were the most useful component of the sessions. Formal presentations were ranked as the most popular format of receiving education. 996 individuals completed the questionnaires. At baseline 61% were GPs, 27% practice nurses and 8% Advanced Practitioners, with similar proportions at 1yr. Exposure to AKI teaching, self-reported awareness and confidence levels were higher in the second questionnaire and there was a significant improvement in test scores.ConclusionPrimary care education can improve knowledge and awareness of AKI. Small group teaching with involvement of a nephrologist was popular. These results suggest that there is a need to tailor education styles to individual preferences, and peer review audit may not be universally acceptable in primary care.
Primary care improvement for patients with complex long-term conditions
Authors: Sheikh Zenobia , Crump Helen , Sherlaw-Johnson Chris , Gill Mike , Atkinson Colleen , Meaker Rob , John Jagan , Roberts Mike 
Published: June 2018

BackgroundPatients with five or more long-term conditions have been shown in Barking, Havering and Redbridge Clinical Commissioning Groups to be the heaviest users of health and social care. An innovative new model of primary care, ‘Health 1000’ was thus established. Comprising a fully integrated multidisciplinary team (including third sector, a social worker and dual skilled ‘keyworkers’) this practice aligned the care of complex patients and endeavoured to avoid unnecessary hospital admissions.AimTo test the hypothesis that Health 1000 (a multidisciplinary GP practice with consultant geriatrician support) would align and improve quality of care and health/social outcomes for complex patients with five-plus long-term conditions.MethodUsing anonymised disease registers, an eligible cohort was identified and invited by their existing practices to re-register with Health 1000. Each patient received comprehensive initial consultation at registration, encompassing reviews of pill burden and social need. Biweekly multidisciplinary discussion ensured their care was aligned and met to a high quality. Independent qualitative evaluation was undertaken by the Nuffield Trust using face to face/telephone interviews with staff/patients.Results408 patients (from an eligible cohort of approximately 2000) were registered. Most patients were extremely satisfied with the new service highlighting friendly welcoming atmosphere, speed of service, key workers’ responsiveness, availability of phone consultations with GPs, longer appointment slots and home visits.ConclusionQualitative outcomes were very positive and suggest that there is benefit for patients with multiple long-term conditions from embedding a multidisciplinary team in primary care with specialist expertise.
Developing the capacity of general practice staff to support healthier weight status in children
Authors: Ahmad Raheelah , Cunningham Vida , Oki Bimpe , Sim Fiona 
Published: June 2018

BackgroundLambeth has implemented a healthy weight care pathway including capacity building of multi-agency staff. Successes include being the only borough in the country to see statistical reductions in childhood obesity over 5 years; but the challenge of 39.2% of 10–11-year olds leaving primary school as overweight/obese persists. When families approach GPs to validate the National Child Measurement Programme feedback, challenges include interpretation and explanation of body mass index (BMI). GPs have also felt uncomfortable raising the issue in routine consultations.AimTo understand potential enablers to raising the issue of unhealthy weight in children in general practice.Method70 staff (GPs 58%; Nurses 25%; GP registrar/trainee 7%; and HCA/other 10%) completed a bespoke childhood obesity capacity building workshop (accredited by the Royal College of GPs). Using scenario-based activities and end of session written questionnaire we gathered: knowledge and perceptions of weight measures, role of diet, nutrition and physical activity, as well as current blocks and potential enablers for brief intervention.ResultsLess than 5% of participants were able to identify a very overweight child by visual inspection. Confidence in raising the issue was reported due to enhanced knowledge of energy intake, physical activity and provision of a BMI wheel (40%), new ways of raising the issue (30%), understanding of supportive services in Lambeth (30%).ConclusionSupportive measures identified within a whole systems approach including role of schools, government, public health and the CCG are informing future planning.
Presenting primary care teams to the public: a qualitative exploration of general practice websites
Authors: Anderson Helen , Adamson Joy , Birks Yvonne 
Published: June 2018

BackgroundIncreasing demand and expanded primary care provision, coupled with a reduced GP workforce present challenges for primary care. New workforce models aim to reduce general practitioner workload by directing patients to a variety of alternative clinicians. Concurrently, the principle of patient choice in relation to healthcare providers has gained prominence. It is, therefore, necessary to provide patients with sufficient information to negotiate access to appropriate primary healthcare professionals.AimTo explore how practice websites present three exemplar healthcare professional groups (GPs, advanced nurse practitioners [ANPs], and practice nurses [PNs]) to patients and the implications for informing appropriate consultation choices.MethodQualitative thematic analysis of a sample of general practice websites. 79 accessible websites from a district in England were thematically analysed in relation to professional representation and signposting of the three identified professional groups.ResultsInformation about each group was incomplete, inconsistent and sometimes inaccurate across the majority of general practice websites. There was a lack of coherence and strategy in representation and direction of website users towards appropriate primary healthcare practitioners.ConclusionLimited and unclear representation of professional groups on general practice websites may have implications for the direction of patients to the wider clinical healthcare team. Patients may not have appropriate information to make choices about consulting with different healthcare practitioners. This constitutes a missed opportunity to signpost patients to appropriate clinicians and enhance understanding of different professional roles. Potential for websites to disseminate information to the public is not being maximised.
Impact of practice based clinical pharmacist led medication reviews on ambulatory patients with hyper polypharmacy
Authors: Williams Steve , Brad Lawrence D 
Published: June 2018

BackgroundProblematic polypharmacy is at the heart of medicines usage in patients with multimorbidity, and review by medicines experts in primary care is essential.AimTo assess the impact of medication reviews by a clinical pharmacist on ambulatory patients with hyper polypharmacyMethodThe study took place within a large urban practice in Dorset. Patients over ≥75 years old with ≥10 regular medicines were identified using the NHS Business Service Authority Polypharmacy database. Patients who were housebound, lived in a care home or with dementia were excluded and GP partners were asked to confirm the validity of these exclusions. Patients were sent a letter from their personalised GP inviting them to attend a 30-minute consultation with a clinical pharmacist prescriber employed by the practice. The age and frailty status of patients, number of medicines pre- and post-consultation, and the nature of medicines optimisation decisions were recorded. Patient satisfaction with the consultations was assessed using a 7-point Likert scale questionnaire.Results91 out of 17000 (0.5%) patients were receiving ≥ 10 medicines. 25 patients were excluded and to date 20/26 (77 %) patients invited had a consultation booked or been seen. Medicines optimisation changes varied in number and complexity and controversial changes discussed with patients’ individual GP. To date all patients rated the consultation as very good to outstanding (median score 6.5)ConclusionAmbulatory patients with hyper polypharmacy highly rated medication reviews with a clinical pharmacist and medication regimens in most were optimised through shared decision making.
Reproducibility of a simple cardiac output response to stress test to diagnose and monitor heart failure in a primary care setting
Authors: Jakovljevic Djordje , Charman Sarah J , Okwose Nduka C , Stefanetti Renae J , Bailey Kristian , Skinner Jane , Scott Mike , Mant Jonathan , Hobbs FD Richard , MacGowan Guy A 
Published: June 2018

BackgroundWe developed a simple non-invasive Cardiac Output Response to Stress (CORS) Test to improve diagnosis and monitoring of heart failure in primary care.AimThe aim of the present study was to assess test-retest reproducibility of the CORS test.MethodThirty-two healthy volunteers (age, 64±10, female n=18) were recruited. Cardiac output was measured continuously using bioreactance method in supine and standing position, and during a two 3-min stages of a step-exercise protocol (10 and 15 steps per minute) using a 15-cm height bench. The CORS test was performed twice i.e. Test 1 and Test 2.ResultsCardiac output and stroke volume were not significantly different between the two tests at supine (6.2±1.4 versus 6.3±1.7 L/min, P = 0.84; 102±24 versus 108±32 ml/beat, P = 0.36), standing (5.7±2.1 versus 5.7±1.9 L/min, P = 0.99; 82±32 versus 83±29 ml/beat, P = 0.93), stage one step-exercise (8.5± 1.8 versus 8.2±1.9 L/min, P = 0.56; 104±26 versus 104±27 ml/beat, P = 0.99) and stage two step-exercise (9.9±1.7 versus 9.6±2.0 L/min, P = 0.51; 109±29 versus 111±26 ml/beat, P = 0.76). There was a significant positive relationship between Test 1 and Test 2 cardiac outputs (r=0.92, P<0.01 with coefficient of variation of 7.1%). The mean difference in cardiac output (with upper and lower limits of agreement) between Test 1 and Test 2 was 0.1 (−1.9 to 2.1) L/min, combining rest and exercise data.ConclusionThe CORS test demonstrates acceptable reproducibility and can potentially be used in primary care to identify and monitor heart failure.
Making sense of sadness: eliciting illness meaning and experience of depression in rural Irish males
Authors: Creed Michael , Gijbels Harry 
Published: June 2018

BackgroundTo analyse and understand the illness experience of depression in rural Irish males. Secondary objectives are to identify their explanatory models of depression, inform mental health service provision in rural areas, and identify suitable interventions for future research.AimIsolation and rural masculinities are thought to predispose rural Irish males to depression. Despite high levels of depressive symptoms among men in rural areas, lack of awareness and a different language around depression, coupled with stoicism, social isolation, and feminized mental health services, results in reduced help-seeking, under-reporting and under-treatment of depression in this population.MethodA purposive sample, selected through the West Cork and Galway/Roscommon Mental Health Services, and General Practitioners, of fourteen men, aged between 25 and 64 years of age, were interviewed in their homes. Data was collected through face-to-face interviews, using the McGill Illness Narrative Interview schedule. These interviews were recorded, transcribed to text, and analysed using a thematic content analysis. Results were integrated using the model of qualitative description.ResultsMost of the fourteen men reported alcohol and social isolation as precipitating factors of their depression. Suicidal intent and a stubborn attitude were common. Recovery-promoting behaviours included good social and family support, peer-support groups, religious practice and, universally, physical work.ConclusionRural Irish men view their depression as a disconnection from community, masculinity can be engaged in a positive way to improve mental health, and a sense of belonging is key to recovery. Future research should focus on the development of interventions incorporating these findings, such as community farming initiatives.
Testing the health literacy of twenty Bangladeshi patients before and 5 months after they begin to access their GP electronic record
Authors: Fitton Richard , Hannan Amir , Brindle Ingrid , Begum Shafia , Shah Sarwar 
Published: June 2018

BackgroundPatients with higher health literacy enjoy better health outcomes and are more compliant with treatment. Health literacy is a product of memory, reason and imagination. Patients who can access their records have potentially more memory (knowledge) and make less phone calls to and have less consultations with their GP, practice nurse, HCA and other professionals.AimThe study aims to measure the knowledge that twenty Bangladeshi patients with poor English have of their medical history before and after access to their electronic record.Method55% of patients at Thornley House have access to their medical records. A simple questionnaire was given to 20 Bangladeshi patients before and 5 months after access to their electronic record. The questionnaires recorded the patients’ knowledge of their medical histories. The scores of the completed before and after questionnaires were compared to see if record access had increased patients’ knowledge.ResultsFive patients completed before and after questionnaires. Each achieved a higher score after record access. The differences in scores for the five patients were 2, 5, 1, 10, and 1, respectively.ConclusionHealth literacy for patients is similar to medical literacy for doctors. It requires knowledge, skills and attitudes. We will see whether record access can increase knowledge. Further studies might measure whether that increased knowledge improves skills and attitudes.