Abstract\r\nBackground: This paper describes and critically reflects on how children and young people (CYP) acted as public advisors to coproduce health information materials about Long Covid for younger audiences. This work was underpinned by the Lundy model, a framework which provides guidance on facilitating CYP to actively contribute to matters which affect them.\r\n\r\nMethods: Coproduction activity sessions took place with CYP in schools as well as video conferences with a CYP stakeholder group and CYP with Long Covid. Activities encouraged CYP to focus on the content, format, and design of materials and used problem-based and collaborative learning to encourage engagement with the project. Using a range of methods and open discussion, CYP codesigned a series of Long Covid health information materials for younger audiences.\r\n\r\nResults: Sixty-six CYP (aged 10-18), and two young adults were involved. CYP codesigned specifications for the final materials and provided feedback on early designs. The project led to the development of a series of health information materials targeted at CYP: a short social media campaign with six short videos and a 12-page illustrated leaflet about Long Covid; released on social media and distributed in local area. All the CYP were positive about the project and their involvement.\r\n\r\nDiscussion: Involving CYP led to the development of innovative and engaging information materials (influence). Developing rapport was important when working with CYP and this was facilitated by using approaches and activities to establish an environment (space) where the CYP felt comfortable sharing their views (voice) and being listened to (audience) by the adults in the project. Working with external groups who are willing to share their expertise can help the meaningful involvement of voices 'less heard'.\r\n\r\nPublic contribution: One CYP coapplicant contributed to the project design and facilitation of PPIE sessions, 64 CYP were involved in the PPIE sessions to design and feedback on materials. Two young adult media producers worked with CYP to produce these materials, another CYP supported this process. Three public contributors were involved in the preparation of this manuscript.
\n \n\n \n \nAbstract\r\nBackground: In 2019, the Additional Roles Reimbursement Scheme (ARRS) was introduced in England as a crucial component of the government\u2019s manifesto pledge to enhance access to general practice. The primary objective was to recruit 26,000 extra personnel through new roles into general practice. Aim: This study aimed to analyse the effects of ARRS staff on prescription rates and patient satisfaction. Design and Setting: The study was a retrospective panel data analysis combining data from the General Workforce Minimum Dataset and National Health Service (NHS) Digital datasets about primary care practices and their activity from 2018 until 2022. The study included data from more than 6000 general practices. Methods: A linear regression analysis was conducted to determine the association between ARRS staff and prescription rates and patient satisfaction, controlling for patient and practice characteristics. Results: The results showed that ARSS roles tend to be more frequent in larger general practices, with fewer full-time general practitioners per patient, and with more overseas trained general practitioners. The use of ARRS staff was significantly associated with lower prescription rates (\u03b2=-0.52, p<0.000) and higher patient satisfaction (\u03b2=3.2, p<0.000), after controlling for patient and practice characteristics. Conclusion: This study suggests that ARRS has the potential to have a positive role in primary care, notably through reduced prescription rates and improved patient satisfaction. Further research is needed to explore the long-term effects of ARRS on primary care, including patient outcomes and health care costs, and the potential barriers to its implementation.
\n \n\n \n \nAbstract\r\nObjective: As populations age globally, there is an increasing prevalence of dementia, with an estimated 153 million living with dementia by 2050. Up to 70% of people with dementia experience dementia-related psychosis (D-RP). Antipsychotic medications are associated with many adverse effects in older people. This review aims to evaluate the evidence of non-pharmacological interventions in managing D-RP.\r\n\r\nMethod: The search of Medline, EMBASE, Web of Science, CINAHL, PsycINFO, and Cochrane included randomised controlled trials that evaluated non-pharmacological interventions. Data extraction and assessment of quality were assessed independently by two researchers. Heterogenous interventions were pooled using meta-analysis.\r\n\r\nResults: A total of 18 articles (n = 2040 participants) were included and categorised into: sensory-, activity-, cognitive- and multi-component-orientated. Meta-analyses showed no significant impact in reducing hallucinations or delusions but person-centred care, cognitive rehabilitation, music therapy, and robot pets showed promise in single studies.\r\n\r\nConclusions and implications: Future interventions should be developed and evaluated with a specific focus on D-RP as this was not the aim for many of the included articles.
\n \n\n \n \nAbstract\r\nThe risk-benefit profile of COVID-19 vaccination in children remains uncertain. A self-controlled case-series study was conducted using linked data of 5.1 million children in England to compare risks of hospitalisation from vaccine safety outcomes after COVID-19 vaccination and infection. In 5-11-year-olds, we found no increased risks of adverse events 1\u201342 days following vaccination with BNT162b2, mRNA-1273 or ChAdOX1. In 12-17-year-olds, we estimated 3 (95%CI 0\u20135) and 5 (95%CI 3\u20136) additional cases of myocarditis per million following a first and second dose with BNT162b2, respectively. An additional 12 (95%CI 0\u201323) hospitalisations with epilepsy and 4 (95%CI 0\u20136) with demyelinating disease (in females only, mainly optic neuritis) were estimated per million following a second dose with BNT162b2. SARS-CoV-2 infection was associated with increased risks of hospitalisation from seven outcomes including multisystem inflammatory syndrome and myocarditis, but these risks were largely absent in those vaccinated prior to infection. We report a favourable safety profile of COVID-19 vaccination in under-18s.
\n \n\n \n \nAbstract\r\nBackground\r\nCervical cancer remains an important global public health concern. Understanding the factors contributing to a decline in screening uptake in high-income countries is fundamental to improving screening rates. We aimed to identify general practice and patient characteristics related to cervical screening coverage in England between 2013 and 2022.\r\n\r\nMethods\r\nWe analyzed a panel of 59 271 General Practice (GP)-years from 7881 GP practices. We applied correlated random effects regression to examine the association between cervical screening uptake and a rich set of GP practice workforce, size, quality and patient characteristics.\r\n\r\nResults\r\nOur results show a decline in overall screening rates from 2013/14 to 2021/22 from 77% to 72%. We find GP workforce and list size characteristics are strongly related to screening rates. An increase in 1 FTE Nurse per 1000 patients is related to a 1.94 percentage point increase in cervical screening rates. GP practices located in more deprived areas have lower screening rates.\r\n\r\nConclusions\r\nGP workforce and patient characteristics need to be considered by decision-makers to increase screening rates. The implementation of self-sampling screening methods could help address some of the current barriers to screening, including lack of healthcare staff and facilities.
\n \n\n \n \nAbstract\r\nObjective To investigate whether different anticholinergic drug treatments for overactive bladder have differential risks for incident dementia, in a large representative population of older adults in England.\r\n\r\nDesign Nested case-control study.\r\n\r\nSetting General practices in England providing data to the Clinical Practice Research Datalink (CPRD) GOLD database, with linked patient admission records from secondary care (Hospital Episode Statistics), 1 January 2006 and 16 February 2022\r\n\r\nParticipants 170\u2009742 patients aged \u226555 years, with a first reported diagnosis of dementia during the study period, matched by age, sex, and general practice with 804\u2009385 individuals without dementia (controls).\r\n\r\nInterventions Cumulative drug use (defined using total standardised daily dose) of different anticholinergic drugs used for the treatment of an overactive bladder, and a non-anticholinergic drug, mirabegron, in the period 3-16 years before a diagnosis of dementia (or equivalent date in matched controls).\r\n\r\nMain outcome measures Odds ratios for onset of dementia associated with the different anticholinergic drugs used for the treatment of an overactive bladder, adjusted for sociodemographic characteristics, clinical comorbidities, and use of other anticholinergic drug treatments.\r\n\r\nResults The study population comprised 62.6% women, and median age was 83 (interquartile range 77-87) years. 15\u2009418 (9.0%) patients with dementia and 63\u2009369 (7.9%) controls without dementia had used anticholinergic drugs for the treatment of an overactive bladder in the 3-16 years before diagnosis (or equivalent date for controls). The adjusted odds ratio for dementia associated with the use of any anticholinergic drug used to treat an overactive bladder was 1.18 (95% confidence interval (CI) 1.16 to 1.20), and was higher in men (1.22, 1.18 to 1.26) than women (1.16, 1.13 to 1.19). The risk of dementia was substantially increased with the use of oxybutynin hydrochloride (adjusted odds ratio 1.31, 95% CI 1.21 to 1.42 and 1.28, 1.15 to 1.43 for use of 366-1095 and >1095 total standardised daily doses, respectively), solifenacin succinate (1.18, 1.09 to 1.27 and 1.29, 1.19 to 1.39), and tolterodine tartrate (1.27, 1.19 to 1.37 and 1.25, 1.17 to 1.34). No significant increases in the risk of dementia associated with darifenacin, fesoterodine fumarate, flavoxate hydrochloride, propiverine hydrochloride, and trospium chloride were found. The association between mirabegron, a non-anticholinergic drug, and dementia was variable across the dose categories and might be caused by previous use of anticholinergic drugs for the treatment of an overactive bladder in these individuals.\r\n\r\nConclusions Of the different anticholinergic drugs used to treat an overactive bladder, oxybutynin hydrochloride, solifenacin succinate, and tolterodine tartrate were found to be most strongly associated with the risk of dementia in older adults. This finding emphasises the need for clinicians to take into account the possible long term risks and consequences of the available treatment options for an overactive bladder in older adults, and to consider prescribing alternative treatments that might be associated with a lower risk of dementia.
\n \n\n \n \nBackground\r\nDementia has a major impact on individuals, their families and caregivers, and wider society. Some individuals experience a faster decline of their function and health compared to others. The objective of this systematic review was to determine prognostic factors, measurable in primary care, for poor outcome in people living with dementia.\r\n\r\nMethods\r\nCohort studies set in the community or primary care, and examining prognostic factors for care home admission, cognitive decline, or palliative care were included. Databases were searched from inception to 17th June 2022. Identified papers were screened, the risk of bias assessed using Quality in Prognostic Studies (QUIPS) tool, and data extracted by 2 reviewers, with disagreements resolved by consensus or a 3rd reviewer. A narrative synthesis was undertaken, informed by GRADE, taking into consideration strength of association, risk of bias and precision of evidence. Patient and Public Involvement and Engagement (PPIE) and stakeholder input was obtained to prioritise factors for further investigation.\r\n\r\nResults\r\nSearches identified 24,283 potentially relevant titles. After screening, 46 papers were included, 21 examined care home admission investigating 94 factors, 26 investigated cognitive decline as an outcome examining 60 factors, and 1 researched palliative care assessing 13 factors. 11 prognostic factors (older age, less deprived, living alone, white race, urban residence, worse baseline cognition, taking dementia medication, depression, psychosis, wandering, and caregiver\u2019s desire for admission) were associated with an increased risk of care home admission and 4 prognostic factors (longer duration of dementia, agitation/aggression, psychosis, and hypercholesterolaemia) were associated with an increased risk of cognitive decline. PPIE and other stakeholders recommended further investigation of 22 additional potential prognostic factors.\r\n\r\nConclusions\r\nIdentifying evidence for prognostic factors in dementia is challenging. Whilst several factors highlighted as of relevance by our stakeholder groups need further investigation, inequalities may exist in care home admission and there is evidence that several prognostic factors measurable in primary care could alert clinicians to risk of a faster progression.\r\n\r\nRegistration\r\nPROSPERO CRD42019111775.
\n \n\n \n \nBackground:\r\nPrevious studies have explored the association between social media use and mental health among adolescents. However, few studies using nationally representative longitudinal data have explored this relationship for adults and how the effect might change depending on how people use social media.\r\n\r\nObjective:\r\nThis study investigated the longitudinal relationship between the frequency of viewing and posting on social media and mental health problems among UK adults.\r\n\r\nMethods:\r\nThis study included 15,836 adults (aged 16 years and older) who participated in Understanding Society, a UK longitudinal survey. Social media use was measured with questions about the frequency of viewing social media and posting on social media in Understanding Society Wave 11 (2019-2021). We explored viewing and posting separately, as well as a combined exposure: (1) high viewing, high posting; (2) high viewing, low posting; (3) low viewing, high posting; and (4) low viewing, low posting. Mental health problems were measured in Wave 12 (2020-2022) using the General Health Questionnaire (GHQ-12), a validated scale for identifying symptoms of common mental health problems, where higher scores indicated more mental health problems (0 to 36). Unadjusted and adjusted linear regression models were estimated for viewing social media and posting on social media, adjusting for the baseline GHQ score, gender, age, ethnicity, employment, and education. We found no evidence for effect modification by gender and age so overall associations were reported.\r\n\r\nResults:\r\nIn our adjusted models, we found no evidence of an association between the frequency of viewing social media and mental health problems in the following year. We found that adults who posted daily on social media had more mental health problems than those who never posted on social media, corresponding to a 0.35-point increase in GHQ score (\u03b2=0.35, 95% CI 0.01-0.68; P=.04). When we considered both social media behaviors, we found that those who frequently viewed and posted on social media scored 0.31 points higher on the GHQ score (\u03b2=0.31, 95% CI 0.04-0.58; P=.03) in the following year compared to those who rarely viewed or posted on social media.\r\n\r\nConclusions:\r\nWe found that a high frequency of posting on social media was associated with increased mental health problems a year later. However, we did not find evidence of a similar association based on the frequency of viewing social media content. This provides evidence that some types of active social media use (ie, posting) have a stronger link to mental health outcomes than some types of passive social media use (viewing). These results highlighted that the relationship between social media use and mental health is complex, and more research is needed to understand the mechanisms underlying these patterns to inform targeted interventions and policies.
\n \n\n \n \nObjectives This study aims to examine the proportions of patients referred to mental health, social and voluntary, community and social enterprise (VCSE) services and general practice and to assess care gaps among people presenting to the hospital following self-harm.\r\n\r\nDesign Population-based observational study. Data were extracted from hospital records.\r\n\r\nSetting Three emergency departments (EDs) in Manchester, UK.\r\n\r\nParticipants 26\u2009090 patients aged 15+ years\u2009who presented to participating EDs following self-harm and who received a psychosocial assessment by a mental health specialist.\r\n\r\nPrimary and secondary outcome measures Primary outcome measures are as follows: care gaps, estimated from the proportion of patients with evidence of social and mental health needs with no new or active referral to mental health, social and VCSE services. Secondary outcome measures are as follows: proportions of referrals by groups of patients, estimated mental health and social needs of patients. Indicators of mental health and social need were developed with academic clinicians (psychiatrist, general practitioner and social worker) and expert lived experience contributors.\r\n\r\nResults 96.2% (25 893/26 909) of individuals were estimated as having mental health needs. Among this group, 29.9% (6503/21 719) had no new or active referral to mental health services (indicating a care gap). Mental healthcare gaps were greater in men and those who were aged under 35 years, from a black, South Asian or Chinese ethnic group, living in the most deprived areas and had no mental health diagnosis, or alcohol, substance misuse, anxiety or trauma-related disorder. 52.8% (14 219/26 909) had social needs, with care gaps greater for men, individuals aged 45\u201364 and those who were unemployed or had a diagnosed mental disorder.\r\n\r\nConclusions Care gaps were higher among hospital-presenting groups known to have increased risks of suicide: men, those in middle age, unemployed individuals and those misusing substances. Improved access to mental health, social and VCSE services and general practice care is vital to reduce inequities in access to self-harm aftercare.
\n \n\n \n \nIntroduction\r\nDepression and alcohol use disorder (AUD) in people living with Type 2 diabetes mellitus (T2DM) are associated with worse health outcomes. AUD is strongly associated with depression and anxiety, but it is not known how these conditions cluster in people with T2DM. We investigated rates of new episodes of depression and anxiety following T2DM diagnosis in people with and without prior AUD among an English primary care population.\r\n\r\nMethods\r\nThe study population was people diagnosed with T2DM between 2004 and 2019. We used the Clinical Practice Research Datalink (CPRD) Aurum database and linked Hospital Episode Statistics Admitted Patient Care (HES APC) and Office for National Statistics (ONS) mortality data. We examined incidence of new episodes of anxiety or depression in people with T2DM with and without AUD. AUD was defined as any of i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm (physical or mental) using SNOMED-CT or ICD-10 codes. People were excluded if they had codes for depression/anxiety 12 months prior to T2DM diagnosis. Poisson regression models were fitted adjusting sequentially for a) age, gender, calendar time; b) region, Index of Multiple Deprivation, ethnicity, body mass index, smoking status, Charlson co-morbidity index; and c) history of a mental health condition.\r\n\r\nResults\r\nOur study population was 479,447 people of whom 10,983 (2.3%) had an AUD code prior to T2DM diagnosis.\r\n\r\nAfter adjusting for all measured confounders except history of a mental health condition, IRR for depression was 2.00 (95% CI 1.93, 2.06) for people with AUD compared to without AUD. This reduced to 1.45 (95% CI 1.41, 1.50) after further adjustment for history of a mental health condition.\r\n\r\nFindings for anxiety were substantially similar to those for depression (adjusted for all measured confounders except history of a mental health condition, IRR 2.08 95% CI 1.99, 2.18 fully adjusted IRR 1.48 95% CI 1.41, 1.55).\r\n\r\nConclusions\r\nPeople with AUD have over double the rates of depression and anxiety following T2DM diagnosis than those without AUD. This was only partially explained by pre-existing diagnoses of mental health conditions. A holistic approach incorporating mental health support is needed to improve health outcomes for people with AUD who develop T2DM.
\n \n\n \n \nBackground\r\nMany older people from minority ethnic groups experience inequalities towards the end of life, including barriers to accessing palliative care. With levels of international migration increasing, there is a need to understand these differences and consider the needs of minority ethnic groups in healthcare policies. This review aimed to map evidence on how older people from minority ethnic groups access and utilise palliative and end of life care, preferences for palliative and end of life care, experiences of palliative and end of life care, and how this varies between minority ethnic groups in different countries, and with different health conditions.\r\n\r\nMethods\r\nScoping review, following Joanna Briggs Institute (JBI) guidance. Searches of eight online databases (MEDLINE, Embase, Web of Science, CINAHL, PsycInfo, Assia, Scopus, and the Cochrane Library) and grey literature were undertaken in 2024. Qualitative sources that focused on older people from minority ethnic groups\u2019 and carers\u2019 access to and use of palliative and end of life care were included, as well as those focusing on healthcare professionals\u2019 experiences.\r\n\r\nResults\r\nTwenty-three sources were included in the review, the majority of which were interview studies from the USA. Findings reflect a range of preferences, inequalities, facilitators and barriers to accessing palliative and end of life care, with themes relating to: (1) Knowledge of hospice and palliative care, (2) societal and structural issues, (3) language and health literacy, (4) migratory experiences, (5) trust in healthcare services and professionals, (6) religion and hope, and (7) cultural values.\r\n\r\nConclusions\r\nThis review identified areas for healthcare providers to consider developing more culturally appropriate palliative and end of life care practice, including building trust and improving communication, sharing information, reducing language barriers, addressing stigma, and, if relevant, acknowledging the importance of culture and religion. Further qualitative research from an intersectional perspective, such as geographical location or socio-economic status, rather than race, ethnicity, and culture alone, is needed in more diverse geographical settings and on specific health conditions.
\n \n\n \n \nIntroduction\r\nTrauma-informed approaches acknowledge the impact of trauma on the health of patients and staff, and the ways in which health care is accessed and experienced.1 There is growing interest in these approaches in both a UK and international primary care context.2 Intrinsic to a trauma-informed approach (although rarely achieved in practice)2 is the co-production of health services with those with relevant lived experience.\r\n\r\nExisting models of patient involvement in primary care tend to rely significantly on feedback forms or surveys, which do not facilitate an ongoing dialogue between patients and healthcare providers. Patient participation groups (PPGs) can provide a more meaningful space in which services can be truly co-produced, in particular where careful attention is given to power dynamics in the room.3 There is, however, an increasing understanding of the need for flexibility in our approaches to patient involvement, which should incorporate multiple models, recognising individuals\u2019 diverse experiences, preferences, and capacity for participation.3 The Care Quality Commission (CQC) suggests that we may have \u2018\u2026 more effective conversations through engaging with different community groups at different times and in different places\u2019.4 The need for provision of protected spaces with careful attention to sociocultural backgrounds and power dynamics is echoed within the principles of trauma-informed care.1\r\n\r\nThe current authors have worked proactively with specific community groups who are often poorly served by our health services. We have sought to create protected spaces and mitigate existing power dynamics to support the free communication of ideas, working together with partnership organisations to improve local primary care provision.
\n \n\n \n \nAbstract\r\nBackground After testing, ensuring test results are communicated and actioned is important for patient safety, with failure or delay in diagnosis the most common cause of malpractice claims in primary care worldwide. Identifying interventions to improve test communication from the decision to test through to sharing of results has important implications for patient safety, GP workload, and patient engagement.\r\n\r\nAim To assess the factors around communication of blood test results between primary care providers (for example GPs, nurses, reception staff) and their patients and carers.\r\n\r\nDesign & setting A mixed methods systematic review including primary studies involving communication of blood test results in primary care.\r\n\r\nMethod The review will use a segregated convergent synthesis method. Qualitative information will be synthesised using a meta-aggregative approach, and quantitative data will be meta-analysed or synthesised if pooling of studies is appropriate and data are available. If not, data will be presented in tabular and descriptive summary form.\r\n\r\nConclusion This review has the potential to provide conclusions about blood test result communication interventions and factors important to stakeholders, including barriers and facilitators to improved communication.
\n \n\n \n \nObjectives\r\nCollaborative and integrated (C + I) working between general practice and community pharmacies has the potential to increase accessibility to services, improve service efficiency and quality of care, and reduce health care expenditures. Many existing studies report challenges and complexities inherent in establishing effective C + I ways of working. The aim of our review is to understand how, when and why working arrangements between General Practitioners (GP) and Community Pharmacists (CP) can provide the conditions necessary for effective communication, decision-making, and C + I working.\r\nMethods\r\nWe conducted a realist review to explore the key contextual factors and mechanisms through which GP-CP C + I working may be achieved. MEDLINE, Embase, CINAHL, PsycINFO, HMIC, Web of Science, IBSS, ASSIA, Sociological Abstracts, Sociology Database and the King\u2019s Fund Library Database were searched for articles and grey literature published between January 2000 and April 2022.\r\nResults\r\nA total of 136 documents were included in the final synthesis. Our findings highlight the importance of mutually beneficial remuneration models to support effective integration of services; supportive organisational cultures and values; flexible and agile IT systems/technologies; adequate physical infrastructure and space design to support multidisciplinary teamworking; the importance of establishing patient\u2019s trust in collaborative processes between GP-CP; and the need to acknowledge, support and utilise effective triadic relationships.\r\nConclusions\r\nOur research generates new insights regarding how, why and in which contexts C + I working can be achieved between GPs and CPs. The findings of our review can be used to inform future policy, research and clinical practice guidelines for designing and delivering C + I care.
\n \n\n \n \nBackground Early detection could reduce the duration of untreated psychosis. GPs are a vital part of the psychosis care pathway, but find it difficult to detect the early features. An accurate risk prediction tool, P Risk, was developed to detect these.\r\n\r\nAim To externally validate P Risk.\r\n\r\nDesign and setting This retrospective cohort study used a validation dataset of 1 647 934 UK Clinical Practice Research Datalink (CPRD) primary care records linked to secondary care records.\r\n\r\nMethod The same predictors (age; sex; ethnicity; social deprivation; consultations for suicidal behaviour, depression/anxiety, and substance misuse; history of consultations for suicidal behaviour; smoking history; substance misuse; prescribed medications for depression/anxiety/post-traumatic stress disorder/obsessive compulsive disorder; and total number of consultations) were used as for the development of P Risk. Predictive risk, sensitivity, specificity, and likelihood ratios were calculated for various risk thresholds. Discrimination (Harrell\u2019s C-index) and calibration were calculated. Results were compared between the development (CPRD GOLD) and validation (CPRD Aurum) datasets.\r\n\r\nResults Psychosis risk increased with values of the P Risk prognostic index. Incidence was highest in younger age groups and, in the main, higher in males. Harrell\u2019s C was 0.79 (95% confidence interval = 0.78 to 0.79) in the validation dataset and 0.77 in the development dataset. A risk threshold of 1.0% gave sensitivity of 65.9% and specificity of 86.6%.\r\n\r\nConclusion Further testing is required, but P Risk has the potential to be used in primary care to detect future risk of psychosis.
\n \n\n \n \nBackground\r\nResistance to antibiotics is rising and threatens future antibiotic effectiveness. \u2018Antibiotic targeting\u2019 ensures patients who may benefit from antibiotics receive them, while being safely withheld from those who may not. Point-of-care tests may assist with antibiotic targeting by allowing primary care clinicians to establish if symptomatic patients have a viral, bacterial, combined, or no infection. However, because organisms can be harmlessly carried, it is important to know if the presence of the virus/bacteria is related to the illness for which the patient is being assessed. One way to do this is to look for associations with more severe/prolonged symptoms and test results. Previous research to answer this question for acute respiratory tract infections has given conflicting results with studies has not having enough participants to provide statistical confidence.\r\n\r\nAim\r\nTo undertake a synthesis of IPD from both randomised controlled trials (RCTs) and observational cohort studies of respiratory tract infections (RTI) in order to investigate the prognostic value of microbiological data in addition to, or instead of, clinical symptoms and signs.\r\n\r\nMethods\r\nA systematic search of Cochrane Central Register of Controlled Trials, Ovid Medline and Ovid Embase will be carried out for studies of acute respiratory infection in primary care settings. The outcomes of interest are duration of disease, severity of disease, repeated consultation with new/worsening illness and complications requiring hospitalisation. Authors of eligible studies will be contacted to provide anonymised individual participant data. The data will be harmonised and aggregated. Multilevel regression analysis will be conducted to determine key outcome measures for different potential pathogens and whether these offer any additional information on prognosis beyond clinical symptoms and signs.
\n \n\n \n \nPurpose: Electronic health records (EHR) are valuable resources for health research; however, their use is challenging. A validated alcohol use disorder (AUD) codelist for UK primary care is needed to improve population-based research in this patient group. We aimed to develop an AUD codelist for use in the Clinical Practice Research Datalink (CPRD) Aurum database, a UK EHR primary-care database.\r\nMethods: The CPRD code browser was searched using keywords related to alcohol use using a previously developed search strategy. The resulting codes were categorised as AUD if they were: a) diagnostic of AUD, b) indicated alcohol withdrawal, or c) indicated chronic alcohol-related harm (physical or mental). Codes related to alcohol use but not used to define AUD were also classified into relevant categories (alcohol status, acute harm, and alcohol screening). All codes were categorised independently by at least two reviewers (one person reviewed all codes and five reviewers (all practising GPs) each reviewed a subset of codes (100\u2013 200 codes each). Disagreements in categorisation were discussed by at least three coders and a consensus was reached. The reliability of categorisation was assessed using kappa statistics.\r\nResults: In total, 556 potential codes related to alcohol use were identified. The Kappa for reliability between coders was moderate for both AUD (0.72) and across all categories (0.62), with substantial variability between coders (AUD: 0.33\u2013 0.97; all categories 0.36\u2013 0.74). In the final codelist, 138 codes were included as indicating AUD: 38 codes identified which indicated diagnosis of AUD, 14 indicating withdrawal plus 85 codes indicating chronic alcohol-related harm (41 physical health and 44 mental health).\r\nConclusion: Many codes are used in primary care to record alcohol use and associated harms, and there is substantial variability in how clinicians categorise them. While future work formally validating the codelist against gold standard clinical reviews and qualitative work with General Practitioners is needed for a deeper understanding of coding processes, we have documented here the process used for the development of an AUD codelist within primary care which can be used as a reference for future research.
\n \n\n \n \nAbstract\r\nBackground Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them.\r\n\r\nSetting and sample UK primary care. 95 safety incidents (complaints, settled indemnity claims and reports) involving remote interactions. Separately, 12 general practices followed 2021\u20132023.\r\n\r\nMethods Multimethod qualitative study. We explored causes of real safety incidents retrospectively (\u2018Safety I\u2019 analysis). In a prospective longitudinal study, we used interviews and ethnographic observation to produce individual, organisational and system-level explanations for why safety and near-miss incidents (rarely) occurred and why they did not occur more often (\u2018Safety II\u2019 analysis). Data were analysed thematically. An interpretive synthesis of why safety incidents occur, and why they do not occur more often, was refined following member checking with safety experts and lived experience experts.\r\n\r\nResults Safety incidents were characterised by inappropriate modality, poor rapport building, inadequate information gathering, limited clinical assessment, inappropriate pathway (eg, wrong algorithm) and inadequate attention to social circumstances. These resulted in missed, inaccurate or delayed diagnoses, underestimation of severity or urgency, delayed referral, incorrect or delayed treatment, poor safety netting and inadequate follow-up. Patients with complex pre-existing conditions, cardiac or abdominal emergencies, vague or generalised symptoms, safeguarding issues, failure to respond to previous treatment or difficulty communicating seemed especially vulnerable. General practices were facing resource constraints, understaffing and high demand. Triage and care pathways were complex, hard to navigate and involved multiple staff. In this context, patient safety often depended on individual staff taking initiative, speaking up or personalising solutions.\r\n\r\nConclusion While safety incidents are extremely rare in remote primary care, deaths and serious harms have resulted. We offer suggestions for patient, staff and system-level mitigations.
\n \n\n \n \nBackground\r\nAnxiety symptoms and disorders are common in the UK. Whilst waiting for, or alongside, treatments such as anxiolytics or psychological therapies, people often self-manage anxiety symptoms with products purchased over-the-counter (OTC), such as herbal medicines or dietary supplements. However, the evidence for these products is often presented across different reviews and is not easy for patients or healthcare professionals to compare and understand.\r\n\r\nAims\r\nTo determine the nature and size of the evidence base available for these products.\r\n\r\nMethods\r\nA scoping review. CENTRAL, MEDLINE, EMBASE, PsycInfo, and AMED (inception\u2014Dec 2022) were searched for RCTs assessing OTC products in people aged 18\u201360 with symptoms or a diagnosis of anxiety.\r\n\r\nResults\r\nIn total 69 papers assessing a range of products were found, which mostly focussed on kava, lavender, saffron, probiotics, Galphimia glauca and valerian. Studies used varying dosages. Compared to herbal medicine studies, there were much fewer dietary supplement studies and homeopathic remedy studies, despite some of use of these by the general public.\r\n\r\nConclusion\r\nFuture research needs to investigate commonly used but less evaluated products (e.g. chamomile, St John\u2019s Wort) and to evaluate products against or alongside conventional treatments to better reflect patient decision making.
\n \n\n \n \nAntimicrobial resistance remains a global high-priority public health challenge. With around 80% of all health service antibiotics prescribed in primary care and strong evidence that most patients will not benefit, there is an urgent need to identify the minority of patients who could benefit.\r\n\r\nUnderstanding the microbiological cause seems an obvious approach, but samples are rarely sent to laboratories from primary care because (a) results are too slow to inform management, (b) costs, and (c) the inappropriateness of taking invasive samples from sterile body sites. Thus, alternative methods are necessary if microbiology is to be used to inform the use of antibacterials and antivirals in primary care.
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