Abstract\r\nBackground: Electronic health records are increasingly used to conduct pregnancy-related research as pregnant women are under-represented in research. Creating a register of pregnancies by combining data from primary and secondary care will further facilitate research in pregnancy. This work describes the construction of an algorithm to create a unified pregnancy cohort in the QResearch database during the emergency phase of the COVID-19 pandemic.\r\n\r\nMethods: National primary care records in the QResearch\u00ae database were linked to patient-level data from Hospital Episode Statistics (HES) datasets. Females aged 15-50 years with a pregnancy outcome recorded between 30 December 2020 and 30 September 2022 were included. Pregnancy (delivery/loss) episodes were identified and cohort demographics reported using a three-stage algorithm. Pregnancy start dates were derived using a combination of HES and primary care data, or individually estimated where no corresponding date could be identified.\r\n\r\nResults: 266,758 women with 279,027 pregnancies are captured in the register. 232,673 pregnancies (83.4%) are deliveries (99.5% livebirths and 0.5% stillbirths) and 46,354 (16.6%) pregnancies are pregnancy losses. Pregnancy losses are highest amongst those of Caribbean (23.1%; n = 781) ethnicity and lowest in those of Pakistani ethnicity (13.9%, n = 1,579). 82.4% of pregnancies are derived from HES maternity records, 10.6% from primary care records, 3.4% from HES Admissions, and 3.6% from HES Procedures.\r\n\r\nConclusion: The construction of a pregnancy register in QResearch\u00ae offers a valuable resource for future research. Its methodology can be adapted to construct new cohorts over any period, providing a comprehensive resource on pregnancy outcomes and events.
\n \n\n \n \nAbstract\r\nBackground: Relational continuity - an ongoing therapeutic relationship between a patient and a clinician - has long been a hallmark of general practice. However, its prevalence in England has declined over the past decade amid increasing demand, workforce shortages, and structural changes in primary care delivery.\r\n\r\nAim: To explore patient and clinician views on continuity in general practice, and understand the factors influencing these perspectives.\r\n\r\nDesign and setting: A qualitative study using interviews and focus groups conducted in England between July 2024 and February 2025.\r\n\r\nMethod: Semi-structured interviews were conducted with 17 primary care staff, and six focus groups were held with 40 patients. Staff were recruited through team contacts and snowballing. Patients were recruited through adverts in general practices. Inductive thematic analysis was informed by theoretical models of continuity, Reeve and Byng's United Model of Generalism, and the biopsychosocial model of care. Data were coded using NVivo software.\r\n\r\nResults: Four themes were identified: many patients lack experience of continuity and struggle to understand its value; patients and clinicians often prioritise other elements of care, such as quick access, over continuity; views on the value of continuity are shaped by beliefs about the role of general practice; and there is scepticism about the feasibility of restoring continuity within current system constraints.\r\n\r\nConclusion: We may be reaching a tipping point, whereby a critical mass of patients views general practice solely as a method of accessing biomedical services from whichever staff member is available. If we want to improve continuity, we need to act before changes in attitudes and care delivery make change an impossibility.
\n \n\n \n \nAbstract\r\nBackground General practice (family medicine) experiences more violence and abuse by patients and the public than other healthcare settings. There is limited research on such experiences amongst non-clinical staff, and no direct comparisons between staff groups in general practice.\r\n\r\nAims To explore: The extent of violence and abuse from patients or the public towards general practice staff between 2020 and 2023; Staff correlates and environmental correlates for violence and abuse; Potential impacts of violence and abuse regarding staff feeling of safety and support at work.\r\n\r\nDesign and Setting An online survey of general practice staff was conducted across England between 11/7/23 and 30/11/23.\r\n\r\nMethods Questions covered demographics, physical violence and threats, verbal abuse, harassment, and inappropriate sexual behaviours experienced or witnessed between 2020 and 2023. It asked whether participants felt safe and supported at work.\r\n\r\nResults Participants (N=1,152, 44% clinical, 56% non-clinical) were aged 21-75 years (mean=47.3 years, SD=11.1). Overall, 93.7% reported violence and abuse, with 92.3% reporting verbal abuse, 47.7% reporting physical violence or threats, 60.5% reporting feeling harassed, and 23.7% reporting inappropriate sexual behaviours. Additionally, 21% of staff felt unsafe but only 57.1% felt supported at work. Non-clinical, younger or less experienced staff and those in urban and deprived areas experience more violence and abuse. Those experiencing it more frequently felt less safe and supported.\r\n\r\nConclusions Violence and abuse from patients and the public towards general practice staff may be prevalent and increased since the COVID-19 pandemic. Those at greater risk require more organisational support.
\n \n\n \n \nAbstract\r\nObjective To identify facilitators and barriers to fit note certification among nurses, occupational therapists, pharmacists and physiotherapists (NOPPs), and identify ongoing training needs.\r\n\r\nDesign An online survey informed by the Theoretical Domains Framework (TDF) was used to gather data from NOPPs to identify implementation barriers and personal, social and environmental influences on fit note certification.\r\n\r\nData were analysed using descriptive statistics. Mean TDF domain scores were calculated (mean scores \u22643.5 indicated barriers, \u22655 indicated facilitators). Free-text data were thematically analysed using the TDF.\r\n\r\nSetting United Kingdom.\r\n\r\nParticipants The survey was completed by 198 respondents: physiotherapists (n=66, 33%), occupational therapists (n=49, 25%), nurses (n=44, 22%), pharmacists (n=39, 20%).\r\n\r\nResults Only 47 (24%) of survey respondents had certified fit notes; 66 (37%) had completed training, most pharmacists had done neither. TDF analysis indicated three barriers: 1) \u2018skills\u2019 (being able to certify, review and practice completing fit notes) (mean=3.32, SD=0.75, 95% CI 1.84, 4.80); 2) \u2018goals\u2019 (the level of priority given to fit note completion) (mean=3.22, SD=0.51, 95% CI 2.21, 4.22); 3) \u2018memory, attention and decision processes\u2019 (disagreeing with the statement: \u2018certifying fit notes is something I do automatically\u2019) (mean=2.73, SD=0). Free-text comments suggested that low \u2018skills\u2019 rates may be due to lack of opportunity to do training. The low priority afforded to completing fit notes, which was not done automatically as part of their role, may reflect the lack of organisational policies/guidelines or priorities.\r\n\r\nThe only facilitator identified was \u2018belief about consequences\u2019 (mean=5.74, SD=0.12, 95% CI: 5.50, 5.98). Participants believed that certifying fit notes was useful and worthwhile.\r\n\r\nConclusions Legislation allowing NOPPs to undertake fit note certification does not appear to have been successfully implemented. Further resources are required to provide NOPPs with the necessary skills/confidence (e.g., via training) to certify fit notes, supporting more patients to return to and remain in work.
\n \n\n \n \nABSTRACT\r\nObjective\r\nTo understand how the identification and management of binge-eating disorder (BED) and bulimia nervosa (BN) in primary care settings are perceived by both patients and healthcare professionals, and how rates of identification and referral for support may be improved.\r\n\r\nMethods\r\nA systematic review of qualitative studies was conducted. Eight databases were searched in August 2025. Studies were excluded if they focused on secondary or tertiary care, patients under the age of 16, or anorexia nervosa. Data on sample, type of eating disorder, year of publication, and country were extracted, and thematic synthesis was used to synthesize the data. The quality of studies was assessed using the Critical Appraisal Skills Programme checklist for qualitative research.\r\n\r\nResults\r\nTwenty-five studies were included. Four articles were of high quality; the rest (N\u2009=\u200921) were medium with a moderate risk of bias. Most of the studies were from the United Kingdom (N\u2009=\u20099), with 14 focusing on healthcare professionals' and 13 on patients' perspectives. The main factors influencing the identification and management of BED/BN were identified to be knowledge and understanding of the conditions, healthcare professional\u2013patient interactions, attitudes and emotions toward BED/BN and the healthcare system, and the existence and accessibility of treatment and referral pathways.\r\n\r\nDiscussion\r\nThe interaction of these factors is discussed in relation to the literature, and gaps in research and clinical practice are identified, such as a limited separation of eating disorder categories, which could help inform the development of strategies to improve the identification and management of BED and BN.\r\n\r\nSummary\r\n\r\nMany healthcare professionals in primary care do not feel confident identifying or managing binge-eating disorder and bulimia nervosa, partly due to limited knowledge, unclear guidance, and poor access to specialist services.\r\nPatients often feel dismissed or misunderstood when seeking help for these eating disorders, which can prevent them from getting the care they need and discourage them from continuing to seek support.\r\nImproving how these conditions are recognized and treated in primary care will require better training for healthcare professionals, clearer referral pathways, and more inclusive, accessible support services for patients.
\n \n\n \n \nAbstract\r\nObjective: To clarify who generalist physicians are and what characterizes their practice.\r\n\r\nData sources: MEDLINE, PsycInfo, SocINDEX, Embase, Ovid HealthSTAR, Scopus, and Web of Science.\r\n\r\nStudy selection: Empirical studies (quantitative, qualitative, mixed methods) that described the attributes of generalist physicians across various disciplines in the clinical literature.\r\n\r\nSynthesis: A total of 262 studies from 25 countries met inclusion criteria. Forty-seven percent of studies lacked essential participant information. The remaining studies primarily framed generalism in terms of an absence of specialist training, reflecting a \"deficit model\" of care. We identified 4 archetypes of generalist practice: broad-based knowledge, generalism as adaptive expertise, generalism as integrative expertise, and generalism as interpretive expertise.\r\n\r\nConclusion: Generalism lacks a consistent meaning across clinical disciplines in medicine. Four archetypes of practice are proposed to promote cross-disciplinary dialogue and guide the design of future health care systems and professional roles.
\n \n\n \n \nBackground Generalist physician care is associated with improved patient outcomes. Despite initiatives to promote generalism in educational settings, recruitment to generalist disciplines remains less than required to serve societal needs. Increasingly this impacts not just general practice but also generalist specialties such as internal medicine, surgery, and paediatrics. One potential factor for this deficit is a lack of explicit attention to generalism as a praxis, including clarifying key aspects of generalist expertise.\r\n\r\nAim To examine empirical clinical literature on generalism, and characterise how generalism is described and delivered by physicians in primary and secondary care.\r\n\r\nDesign & setting A systematic mixed studies review (SMSR) including quantitative, qualitative, mixed-methods studies, and systematic reviews of physician generalist practice.\r\n\r\nMethod MEDLINE, Psycinfo, SocINDEX, Embase, Ovid HealthSTAR, Scopus, and Web of Science will be searched for English language studies from 1999 to present, using a structured search. Given study heterogeneity, quality appraisal will not be performed. Two reviewers will perform study selection for each study. Data extraction will focus on how generalism is defined and characterised, including the clinical care provided by generalists and patient experiences of generalist care. Quantitative and qualitative data will be summarised in tabular and narrative form. Convergent synthesis design will then be used to synthesise quantitative and qualitative data.\r\n\r\nConclusion Findings will characterise generalism and generalist practice from a grassroots clinical perspective. By identifying similarities and differences across generalist disciplines, this work will inform more focused educational initiatives on generalism at undergraduate and postgraduate level, including collaborations between generalist disciplines.
\n \n\n \n \nCardiovascular disease (CVD) is a leading cause of mortality globally and in the UK, with significant efforts focused on early risk identification and prevention. Elevated low-density lipoprotein cholesterol (LDL-C) is a key modifiable risk factor for cardiovascular disease (CVD), yet the impact of LDL-C monitoring frequency on major adverse cardiovascular events (MACE) remains unclear. This study evaluated the relationship between LDL-C measurement frequency and the risk of MACE in a large, nationwide cohort. A retrospective cohort study using anonymised electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum, linked to hospitalisation, social deprivation, and mortality data. The cohort included individuals registered for at least one year with at least one recorded low-density LDL-C measurement between 1 January 2000 and 31 December 2022. The primary outcome was MACE, defined as a composite of non-fatal coronary heart disease, non-fatal stroke, or cardiovascular death. Multivariable Cox proportional hazards models and Kaplan-Meier survival plot were used to estimate the incidence and hazard ratios (HRs) by LDL-C monitoring frequency. The study cohort comprised 5,133,574 individuals, with 2,733,144 (53.2%) being women. The median follow-up duration was 3.31 years (IQR: 7.39-12.11). Among the 5,133,574 individuals, the incidence of MACE declined with more frequent LDL-C monitoring, from 1937.0 (95% CI: 1928.2-1945.8) events per 100,000 person-years (one measurement) to 1615.4 (95% CI: 1605.8-1625.0), 1484.6 (95% CI: 1473.7-1495.6), and 1204.9 (95% CI: 1200.1-1209.6) for those with two, three, and four or more measurements, respectively. Compared to individuals with one LDL-C measurement, the adjusted HRs for MACE were 0.703 (95% CI: 0.698-0.709), for two measurements, 0.570 (95% CI: 0.565-0.575) for three, and 0.312 (95% CI: 0.310-0.314) for four or more. The Kaplan-Meier curve demonstrated improved event-free survival with increased LDL-C monitoring (log-rank p<0.0001). More frequent LDL-C monitoring was associated with a lower risk of MACE. These findings highlight the potential benefits of regular LDL-C monitoring as a potentially impactful strategy for CVD prevention and long-term risk management.
\n \n\n \n \nAbstract\r\nBackground: Social relationships are important for self-management and outcomes of multiple long-term conditions (MLTC). Previous research indicates MLTC negatively impacts social relationships and people living with MLTC do not feel adequately supported to manage their health. However, there is limited understanding of the processes and contextual factors that influence social relationships in the context of MLTC. This study explored experiences of social relationships for adults living with MLTC to improve understanding of their social relationship needs.\r\n\r\nMethods: Semi-structured telephone interviews were conducted with 22 people living with MLTC in Southern England. Participants were recruited through charity networks and GP practices. Eligibility criteria were: individuals aged \u2265 45 years living with MLTC within the community. Participants were purposively sampled to include diverse characteristics in terms of age, gender, and residential area deprivation. Transcribed interview data were analysed using reflexive thematic analysis.\r\n\r\nResults: Four themes were developed. 'There is no single route to meaningful social connection' reflected how participants achieved, valued, and maintained meaning in relationships in diverse ways. 'Change in sense of self' captured the mental load, nostalgia, low mood and depressive symptoms experienced because of MLTC, which was reported to negatively impact their relationships with others. 'A need to be seen and understood' described how participants valued social relationships that enabled them to talk about their conditions with others who have shared experiences. Participants experienced a sense of abandonment when they felt unable to share their needs and experiences with family and close friends. Some participants experienced distress around the need to self-manage their health, which was reinforced by limited health and care services. 'Altered interaction' reflected how MLTC required participants to find new ways to maintain social connection.\r\n\r\nConclusion: Meaningful connection may be achieved through diverse social relationships, including acquaintances and support groups. Further efforts to connect people to these forms of relationships could improve self-management of MLTC, though strategies may vary for adults with different characteristics and health needs. Interventions that target mental burden, nostalgia, low mood and depressive symptoms experienced because of MLTC could support appropriate and meaningful social connection. Further research is needed to test these relationships.\r\n\r\nPatient and public contribution: Three public contributors shaped the design of this study by sharing their experiences and views of key issues people who lack adequate social support may experience and how this might impact management of their health. They noted the importance of speaking to a range of people to understand social relationship needs of people living with MLTC, as experiences will vary. Two public contributors reviewed and helped refine the interview topic guide and commented on the importance of tone when conducting interviews, to encourage participants to share their experiences. One public contributor supported analysis of the transcripts through coding, discussion, and manuscript review. They highlighted the abandonment expressed by participants and how participants appeared to want to be seen as independent despite wanting and needing more support.
\n \n\n \n \nAbstract\r\nBackground\r\nPrevious longitudinal studies have linked multimorbidity to loneliness (feeling alienated) and social isolation (having reduced social contact). However, the nature of these associations over time is unclear.\r\nObjective\r\nTo examine bidirectional associations of multimorbidity with loneliness and social isolation over a 14-year follow-up in a nationally representative cohort of adults aged \u2265 50 years.\r\nMethods\r\nThis retrospective cohort study used seven waves of data (collected between 2004/2005 and 2018/2019) from adults in the English Longitudinal Study of Ageing. Multimorbidity was defined as the presence of \u22652 long-term conditions. Loneliness was measured using the 3-item University of California Los Angeles (UCLA) scale. Social isolation was derived based on cohabitation status, frequency of contact with children, relatives, and friends, and social organisation membership. We used Cox proportional hazards models adjusted for social isolation or loneliness, demographic and health behaviour variables.\r\nResults\r\nThe cohort consisted of 6031 adults with baseline and follow-up data on loneliness, social isolation, multimorbidity, and other covariates. Loneliness was associated with increased risk of incident multimorbidity [aHR (95 % CI): 1.38 (1.15\u20131.65)], whereas social isolation was not [aHR (95 % CI): 0.97 (0.81\u20131.16)]. Multimorbidity was associated with increased risk of incident loneliness [aHR (95 % CI): 1.55 (1.30\u20131.84)], but not significantly associated with subsequent risk of incident social isolation [aHR (95 % CI): 1.09 (0.92\u20131.28)].\r\nConclusions\r\nAn independent bidirectional association exists between loneliness and multimorbidity. Interventions targeting loneliness may prevent or delay multimorbidity and also improve wellbeing for people with multimorbidity.
\n \n\n \n \nAbstract\r\nChildren and adolescents with type 1 diabetes mellitus (T1D) are less active than recommended and than their peers without T1D. Several barriers to physical activity have been reported, including lack of confidence in the support received from those who facilitate physical activity such as sports coaches and PE teachers (physical activity providers). This study aims to explore the experiences and needs of physical activity providers in supporting children and adolescents with T1D to engage in structured physical activity. A mixed-methods study, including an online survey and semi-structured interviews, was conducted to provide a broad understanding of the current context along with more in-depth exploration of strategies implemented. Thirty-four participants completed the survey and nine participated in semi-structured interviews. Survey data were summarised descriptively. Qualitative data were analysed using a reflective thematic approach. Fewer than one-third of respondents had received T1D-related training, and only 12% were aware of relevant policies at their institution. Despite moderate confidence among half of the respondents in supporting children and adolescents with T1D, nearly all expressed a need for specific training. Two overarching themes emerged from the interviews: the existing context within which providers operate and effective strategies to support T1D-related physical activity.\r\n\r\nConclusion: Findings suggest improvements can be made to (1) training for physical activity providers to allow them to better support children and adolescents with T1D to participate in physical activity and (2) policies to help ensure a supportive and safe environment for children and adolescents with T1D.
\n \n\n \n \nABSTRACT\r\nIntroduction\r\nLong Covid, the patient-preferred term, describes symptoms persisting after an acute Covid-19 infection. Understanding the importance and meaning of a Long Covid diagnosis to children and young people (CYP), their families and professionals associated with their care can give insight into the way that these diagnoses are used across these groups to support care and needs of the patient. This study explores the meaning and importance of a Long Covid diagnosis from the perspectives of CYP with Long Covid, their parents and relevant professionals.\r\n\r\nMethods\r\nCYP and their parents or carers were invited to interview following participation in an initial cohort study. Professionals with experience working with CYP with Long Covid were invited to participate in a focus group. Interviews were carried out with four CYP with Long Covid (all female, aged 10\u201317 years); parents were present at three interviews. Seven professionals with experience in the care of CYP or Long Covid participated in one of two focus groups. Data were analysed thematically using constant comparison techniques.\r\n\r\nResults\r\nThe three main themes presented are as follows: the importance of receiving a diagnosis, diagnosis facilitates access to support and perspectives of discordance between family and professionals. The diagnosis of Long Covid has different meanings and significance for parents and professionals. Families described the diagnosis as a legitimisation of their experiences and a way to access support, but professionals questioned some of the ways families use the diagnosis, focusing instead on appropriate treatment according to CYP's needs.\r\n\r\nConclusion\r\nFor families, Long Covid diagnoses are important for validating and legitimising symptoms, removing uncertainty, and supporting access and participation, particularly in school. While these uses differ from those of professionals, understanding the importance of a Long Covid diagnosis to families may ensure effective communication, negotiation of an acceptable management plan, and ongoing support for this group.\r\n\r\nPatient or Public Contribution\r\nPatients and the public contributed throughout this project and had input on the study design, topic guides, and dissemination of findings.
\n \n\n \n \nAbstract\r\nObjectives\r\nMost adult patients in England now have access to their primary care electronic health record (EHR), including free-text consultation notes, via the NHS App or other online services. As EHRs were not designed for patient audiences, this study aimed to explore patients\u2019 and carers\u2019 perspectives and understanding of simulated consultation notes.\r\nMethods\r\nOne interview and five focus groups were conducted with 26 patients and carers from a purposive sample of underserved communities in England between April and May 2023. Participants\u2019 understanding and views were elicited regarding five vignettes about patient consultation scenarios and corresponding simulated primary care EHR entries. Verbatim transcripts were analysed inductively using thematic analysis.\r\nResults\r\nMost participants struggled to fully understand the simulated consultation notes, particularly medical acronyms, clinician shorthand and non-clinical abbreviations. Participants also identified issues which may cause unintended offence or anxiety, and made suggestions about how EHRs may be improved to meet the needs of patient audiences and maintain positive patient-clinician relationships.\r\nConclusions\r\nOpening up online record access to include patient audiences necessitates a significant cultural shift in the way that consultation notes are written and used. Participants proposed technological and documentation adaptations to enhance understanding, support diverse patient needs and maintain positive patient-clinician relationships.
\n \n\n \n \nOn 24 July 2025, Pulse reported the death of a Devonshire man who had been removed from mainstream general practice.1 Although no further details were given, the coroner\u2019s investigation has suggested that the man, diagnosed with autism spectrum disorder, had been receiving insufficient care through the \u2018Special Allocation Scheme\u2019 (SAS). Previously known as the \u2018violent patient service\u2019, the SAS is a national (England-wide) service for patients who have been removed from their regular GP provider after being reported for violence or aggression. It was developed in an attempt to maintain the safety of GP staff, while providing continued primary care to patients in a secure setting.2 Since the introduction of the scheme in 2004, levels of violence and aggression in general practice have been escalating and remain a pressing concern.3\r\n\r\nWhile the SAS has received little attention in the wider media and research, the patient\u2019s death has prompted calls for tighter protocols and safeguarding measures when general practices consider referring patients to the SAS. In July 2024, NHS England updated its guidance recommending that general practices consider disabilities, neurodiversity, and safeguarding before making such referrals.1,2 However, questions remain about when SAS registration is the appropriate course of action, if the service itself is unsuitable for many patients with complex needs.
\n \n\n \n \nPurpose: Prostate cancer (PCa) is the most common cancer among UK men, with Black men twice as likely to develop it and 2.5 times more likely to die from it than White men. This study identifies the barriers and facilitators to PCa healthcare in UK Black men and suggests ways to improve engagement and experiences across the care pathway.\r\n\r\nMethods: We conducted semi-structured interviews with: (i) 12 UK Black men living with and beyond PCa. (ii) 15 UK Black men aged 45 or above. (iii) 15 UK multi-disciplinary healthcare professionals (HCPs). Interview transcripts were coded and analysed thematically, using the socioecological model to map barriers and facilitators.\r\n\r\nResults: Barriers include mistrust of Western medicine, experiences of racism, fear and stigma around PCa, inadequate culturally sensitive information, underrepresentation of Black HCPs and Black men in healthcare spaces, limited culturally sensitive psychological support, and masculinity constructs affecting open discussions and preferences for minimally invasive treatments. Facilitators include racially concordant HCPs, culturally sensitive care, continuity of care and support from partners, peers, and local community groups.\r\n\r\nConclusion: Our findings underscore the need for tailored culturally sensitive information, community partnerships, and Black representation in both healthcare spaces and public health campaigns to improve healthcare engagement, foster trust and improve prostate cancer outcomes for Black men.
\n \n\n \n \nBackground Postural hypotension is associated with excess mortality, falls, and cognitive decline. Postural hypotension is poorly recorded in routine general practice records. Few studies have explored measurement and diagnosis of postural hypotension in general practice.\r\n\r\nAim To understand how postural hypotension is measured, diagnosed, and managed in general practice.\r\n\r\nDesign and setting This was an online survey of general practice staff in England.\r\n\r\nMethod Clinical research networks distributed the survey to practices, seeking individual responses from any clinical staff involved in routine blood pressure (BP) measurement. Responses were analysed according to role and demographic data using descriptive statistics. Multivariable modelling of checking for postural BP measurements was performed.\r\n\r\nResults There were 703 responses from 243 general practices (mean practice-level response rate 17%). Half (362; 51%) of responders were doctors, 196 (28%) nurses, and 77 (11%) healthcare assistants (HCAs). In total, 8% (58/703) did not routinely check for postural hypotension, usually citing time constraints. For the remaining 92%, postural symptoms were the predominant reason for checking (97% responders, 627/645); only 24% cited any other guideline indication for postural hypotension testing. The study found that 77% used sit-to-stand BP measurements; approximately one-quarter measured standing BP for >1 min. On regression modelling, other professionals tested less for postural hypotension than doctors (odds ratios: nurses 0.323, 95% confidence interval [CI] = 0.117 to 0.894, HCAs 0.102, 95% CI = 0.032 to 0.325, and pharmacists 0.099, 95% CI = 0.023 to 0.411).\r\n\r\nConclusion Awareness of reasons, besides symptoms, and adherence to guidelines for postural hypotension testing, are low. Time is the key barrier to improved testing for postural hypotension. Clarity on pragmatic methods of measuring postural hypotension in general practice would also facilitate measurement uptake.
\n \n\n \n \nAbstract\r\nThere is a place for the use of benzodiazepines/z-hypnotics on adult mental health wards, but they are often continued beyond a length of time where they are beneficial. This can result in dependence and withdrawal effects if stopped. Timely deprescribing of these medicines is encouraged, but there is limited evidence available as to what can be a facilitator or barrier to deprescribing benzodiazepines/z-hypnotics on these wards. Semi-structured interviews, with twenty-nine NHS healthcare professionals from eleven different NHS organisations, involved in the use of benzodiazepines/z-hypnotics on adult mental health wards, were conducted and recorded on Microsoft Teams and transcribed. Themes were generated via thematic analysis on NVIVO software, informed by a grounded, inductive approach, to identify similarities and differences in participants perceptions. The four main themes identified from participants\u2019 experiences were: Culture (shared values, beliefs and practices). Patient factors. Practical measures to facilitate deprescribing of benzodiazepines/z-hypnotics on adult mental health wards. Primary/secondary care interface. Deprescribing culture, rather than being led nationally, is more influenced by local factors. Some patient behaviour patterns can be a barrier to deprescribing but many of these can be overcome by promoting patient-centred care, allowing patients to feel involved and enabled to make informed decisions around their care. Access to non-pharmacological methods to de-escalate behaviour, promote wellbeing and improve sleep on adult mental health wards can support deprescribing. Cohesive multi-disciplinary team working aids deprescribing, but staff pressures can hinder this by reducing access to appropriately trained staff. Effective discharge planning is important but not always achieved. Good communication post discharge can facilitate continued deprescribing. Overcoming the barriers and developing the facilitators identified could improve benzodiazepine/z-hypnotic deprescribing on adult mental health wards. Changes to national NHS culture and priorities are required to influence local culture. Otherwise, deprescribing practices will remain greatly influenced by local factors on individual wards. Good practice exists but further research and funding is needed to disseminate this throughout the NHS.
\n \n\n \n \nBackground\r\nWomen benefit from reduced fracture risk while using menopausal hormone therapy. However, information on risks after stopping menopausal hormone therapy is scarce and inconsistent, with no information on longer-term fracture risk as women age. We aimed to produce robust estimates of fracture risk among past users for the longest possible period after discontinuing therapy.
\n \n\n \n \nPurpose: Chronic pain (pain >3 months) affects 35-50% of UK adults. People with chronic pain (for example, chronic back pain, fibromyalgia and osteoarthritis) commonly present to primary care to manage distressing symptoms of pain, depression, anxiety, reduced function and reduced quality of life.
\n \n\n \n \nBackground\r\nHealth and social care services increasingly recognise the value of involving people with lived experience in service design and delivery. For people who have experienced multiple disadvantage (combinations of homelessness, mental ill health, addiction, involvement with the criminal justice systems or domestic violence/abuse), participating in professional settings may be challenging and can risk re\u2010traumatisation and greater disillusionment. However, gaining confidence and competency to do this offers opportunities for personal and professional development, contributing to meaningful change. It is necessary that individuals with lived experience can engage safely and effectively in these settings. This study analyses how an organisation of people who have experienced multiple disadvantage, Independent Futures (IF), enabled co\u2010production within services and systems, to understand how people can be best supported and how involvement impacts them.\r\n\r\nMethods\r\nSixteen IF members and three IF staff participated in semi\u2010structured interviews. A staff survey, at two time points, investigated how employees from Changing Futures partner organisations perceived their ability to embed co\u2010production within services, with 147 responses. Internal documentation was analysed to illustrate the diversity of co\u2010production work that IF contributed to.\r\n\r\nResults\r\nPutting trauma\u2010informed principles into practice facilitated personal growth, improved confidence and some work skills for IF members, who contributed to 65 different workstreams. However, embedding co\u2010production into wider services and systems proved challenging. Staff survey comments highlighted obstacles related to resources, time and hierarchical cultures.\r\n\r\nConclusion\r\nLived experience organisations can model trauma\u2010informed practice and influence systems. Embedding trauma\u2010informed principles requires flexibility, openness and willingness that is sustainable only when everyone adopts and commits to these principles. Any evidence of tokenism destroys trust and undermines the endeavour.\r\n\r\nPublic Contribution Statement\r\nThis study was co\u2010produced with people with lived experience of multiple disadvantage and staff participants. Two lived experience IF members were involved in: developing the funding bid, designing the research including designing the staff survey, developing interview topic guides, commenting on information sheets and developing interview arrangements to ensure comfort and safety of IF members. Four lived experience IF members and three members of staff contributed to writing the paper, including reviewing key literature, refining the analysis and developing the discussion and conclusion.
\n \n\n \n \n