Search results
Found 4418 matches for
External validation of prognostic models predicting pre-eclampsia: individual participant data meta-analysis
Background Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early identification of women at risk during pregnancy is required to plan management. Although there are many published prediction models for pre-eclampsia, few have been validated in external data. Our objective was to externally validate published prediction models for pre-eclampsia using individual participant data (IPD) from UK studies, to evaluate whether any of the models can accurately predict the condition when used within the UK healthcare setting. Methods IPD from 11 UK cohort studies (217,415 pregnant women) within the International Prediction of Pregnancy Complications (IPPIC) pre-eclampsia network contributed to external validation of published prediction models, identified by systematic review. Cohorts that measured all predictor variables in at least one of the identified models and reported pre-eclampsia as an outcome were included for validation. We reported the model predictive performance as discrimination (C-statistic), calibration (calibration plots, calibration slope, calibration-in-the-large), and net benefit. Performance measures were estimated separately in each available study and then, where possible, combined across studies in a random-effects meta-analysis. Results Of 131 published models, 67 provided the full model equation and 24 could be validated in 11 UK cohorts. Most of the models showed modest discrimination with summary C-statistics between 0.6 and 0.7. The calibration of the predicted compared to observed risk was generally poor for most models with observed calibration slopes less than 1, indicating that predictions were generally too extreme, although confidence intervals were wide. There was large between-study heterogeneity in each model’s calibration-in-the-large, suggesting poor calibration of the predicted overall risk across populations. In a subset of models, the net benefit of using the models to inform clinical decisions appeared small and limited to probability thresholds between 5 and 7%. Conclusions The evaluated models had modest predictive performance, with key limitations such as poor calibration (likely due to overfitting in the original development datasets), substantial heterogeneity, and small net benefit across settings. The evidence to support the use of these prediction models for pre-eclampsia in clinical decision-making is limited. Any models that we could not validate should be examined in terms of their predictive performance, net benefit, and heterogeneity across multiple UK settings before consideration for use in practice.
Mental health in the UK during the COVID-19 pandemic: cross-sectional analyses from a community cohort study
Objectives Previous pandemics have resulted in significant consequences for mental health. Here, we report the mental health sequelae of the COVID-19 pandemic in a UK cohort and examine modifiable and non-modifiable explanatory factors associated with mental health outcomes. We focus on the first wave of data collection, which examined short-term consequences for mental health, as reported during the first 4–6 weeks of social distancing measures being introduced. Design Cross-sectional online survey. Setting Community cohort study. Participants N=3097 adults aged ≥18 years were recruited through a mainstream and social media campaign between 3 April 2020 and 30 April 2020. The cohort was predominantly female (n=2618); mean age 44 years; 10% (n=296) from minority ethnic groups; 50% (n=1559) described themselves as key workers and 20% (n=649) identified as having clinical risk factors putting them at increased risk of COVID-19. Main outcome measures Depression, anxiety and stress scores. Results Mean scores for depression (Embedded Image =7.69, SD=6.0), stress (Embedded Image =6.48, SD=3.3) and anxiety (Embedded Image = 6.48, SD=3.3) significantly exceeded population norms (all p<0.0001). Analysis of non-modifiable factors hypothesised to be associated with mental health outcomes indicated that being younger, female and in a recognised COVID-19 risk group were associated with increased stress, anxiety and depression, with the final multivariable models accounting for 7%–14% of variance. When adding modifiable factors, significant independent effects emerged for positive mood, perceived loneliness and worry about getting COVID-19 for all outcomes, with the final multivariable models accounting for 54%–57% of total variance. Conclusions Increased psychological morbidity was evident in this UK sample and found to be more common in younger people, women and in individuals who identified as being in recognised COVID-19 risk groups. Public health and mental health interventions able to ameliorate perceptions of risk of COVID-19, worry about COVID-19 loneliness and boost positive mood may be effective.
How do people who use drugs experience treatment? A qualitative analysis of views about opioid substitution treatment in primary care (iCARE study)
Objective: To understand the most significant aspects of care experienced by people in opioid substitution treatment (OST) in primary care settings. Design: Semistructured individual interviews were conducted, following the critical incidents technique. Interview transcripts were analysed following a thematic analysis approach. Participants: Adults aged 18 years or older, receiving OST in UK-based primary care services. Results: Twenty-four people in OST were interviewed between January and March 2019. Participants reported several aspects which were significant for their treatment, when engaging with the primary care service. These were grouped into 10 major themes: (1) humanised care; (2) individual bond/connection with the professional; (3) professionals’ experience and knowledge; (4) having holistic care; (5) familiarity; (6) professionals’ commitment and availability to help; (7) anonymity; (8) location; (9) collaborative teamwork; and (10) flexibility and changes around the treatment plan. Conclusions: This study included first-hand accounts of people who use drugs about what supports them in their recovery journey. The key lessons learnt from our findings indicate that people who use drugs value receiving treatment in humanised and destigmatised environments. We also learnt that a good relationship with primary care professionals supports their recovery journey, and that treatment plans should be flexible, tailor-made and collaboratively designed with patients.
GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study
Background: In the UK between 1998 and 2008, GPs’ recording of anxiety symptoms increased, but their recording of anxiety disorders decreased. The reason for this decline is not clear, nor are the treatment implications for primary care patients. Aim: To understand GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care. Design and Setting: In-depth interviews were conducted with 15 GPs and 20 patients, purposively sampled from GP practices in Bristol and the surrounding areas. Method: Interviews were held either in person or by telephone. A topic guide was used to ensure consistency across the interviews. The interviews were audio-recorded, transcribed verbatim and analysed thematically. Results: GPs reported preferring to use symptom rather than diagnostic codes in order to avoid assigning potentially stigmatising labels, and because they felt diagnostic codes could encourage some patients to adopt a ‘sick-role’. In addition, their decision to use a diagnostic code depended on symptom severity and chronicity, and these were hard to establish in a time-limited clinical consultation. In contrast, patients commented that receiving a diagnosis helped them to understand their symptoms, and encouraged them to engage with treatment. Conclusion: GPs may be reluctant to diagnose an anxiety disorder, but patients can find a diagnosis helpful in terms of understanding their symptoms and the need for treatment. As limited consultation time can discourage discussions between GPs and patients, follow up appointments and continuity of care may be particularly important for the management of anxiety in primary care.
Contribution of paramedics in primary and urgent care: a systematic review
Background: Within the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with many opting to move into primary care. Aim: To provide an overview of the types of clinical roles paramedics are undertaking in primary and urgent care settings within the UK. Design and setting: A systematic review. Method: Searches were conducted of MEDLINE, CINAHL, Embase, the National Institute for Health and Care Excellence, the Journal of Paramedic Practice, and the Cochrane Database from January 2004 to March 2019 for papers detailing the role, scope of practice, clinician and patient satisfaction, and costs of paramedics in primary and urgent care settings. Free-text keywords and subject headings focused on two key concepts: paramedic and general practice/primary care. Results: In total, 6765 references were screened by title and/or abstract. After full-text review, 24 studies were included. Key findings focused on the description of the clinical role, the clinical work environment, the contribution of paramedics to the primary care workforce, the clinical activities they undertook, patient satisfaction, and education and training for paramedics moving from the ambulance service into primary care. Conclusion: Current published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. More research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.
Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study
Background: To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. Aim: To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. Design and setting: Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. Method: Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices’ experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory. Results: There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. Conclusion: The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views
Background: Gestational diabetes (GDM) is an important risk factor for developing type 2 diabetes (T2DM) later in life. Postpartum screening provides an opportunity for early detection and management of T2DM, but uptake is poor. Aim: To explore barriers to screening from clinicians’ perspectives to guide future interventions to increase uptake. Design and Setting: Systematic review and qualitative synthesis. Method: We assessed qualitative studies included in a previous review, then searched five electronic databases from 2013 to May 2019 for qualitative studies reporting clinicians’ perspectives on postpartum glucose screening after GDM. Study quality was assessed against the Critical Appraisal Skills Programmes checklist. Qualitative data from the studies were analysed using thematic synthesis. Results: We included nine studies, containing views from 187 clinicians from both community and hospital care. Three main themes were identified: difficulties in handover between primary and secondary care (ambiguous roles and communication difficulties), short-term focus in clinical consultations (underplaying risk so as not to overwhelm patients and competing priorities) and patient-centric barriers. Conclusion: We identified barriers to diabetes screening at both system and individual levels. At the system level, clarification of responsibility for testing among healthcare professionals and better systems for recall are needed. These could be achieved through registers, improved clinical protocols, and automatic flagging and prompts within electronic medical records. At the individual level, clinicians should be supported to prioritise the importance of screening within consultations and better educational resources made available for women. Making it more convenient for women to attend may also facilitate screening.
Combining patient talk about internet use during primary care consultations with retrospective accounts. A qualitative analysis of interactional and interview data
Despite widespread acknowledgement of internet use for information about health, patients report not disclosing use of online health information in consultations. This paper compares patients' reported use of the internet with matched video recordings of consultations. The concepts of doctorability and epistemics are employed to consider similarities and differences between patients’ reports in interviews and actions in the consultation. Data are drawn from the Harnessing Resources from the Internet study conducted in the UK. The data set consists of 281 video-recorded general practice consultations, with pre-consultation questionnaires completed by all patients, interviews with all 10 participating doctors and 28 selected patients. We focus on the 28 patient interviews and associated consultation recordings. A conversation analytic (CA) approach is used to systematically inspect both the interview and consultation data. In interviews patients presented use of the internet as associated with appropriate self-management and help-seeking. In consultations patients skilfully translated what they had found on the internet in order to provide grounds for the actions they sought. We conclude that patients translate and utilise what they have found on the internet to assert the doctorability of their presenting problems. Furthermore, patients design their talk in both interviews and consultations to accord with their understanding of the epistemic rights of both doctors and patients. Patients search the internet so they are informed about their medical problem, however they carefully manage disclosure of information to avoid disrupting the smooth running of medical interactions.
Test‐guided dietary management of eczema in children: A randomized controlled feasibility trial (TEST)
Background: Parents commonly ask about food allergy tests, to find a cause for their child's eczema, yet the value of routine testing is uncertain. Objective: To determine whether a clinical trial comparing test‐guided dietary advice versus usual care, for the management of eczema, is feasible. Methods: Children (>3 months and <5 years) with mild‐to‐severe eczema, recruited via primary care, were individually randomized (1:1) to intervention or usual care. Intervention participants underwent structured allergy history and skin prick tests (SPT) with dietary advice for cow's milk, hen's egg, wheat, peanut, cashew and codfish. All participants were followed up for 24 weeks. A sample of doctors and parents was interviewed. Registration ISRCTN15397185. Results: From 1059 invitation letters sent to carers of potentially eligible children, 84 were randomized (42 per group) with mean age of 32.4 months (SD 13.9) and POEM of 8.7 (4.8). Of the 42, 6 (14%) intervention participants were advised to exclude one or more foods, most commonly egg, peanut or milk. By participant, 1/6 had an oral food challenge (negative); 3/6 were told to exclude until review in allergy clinic; and 6/6 advised a home dietary trial (exclusion and reintroduction of food over 4–6 weeks) – with 1/6 partially completing it. Participant retention (four withdrawals) and data completeness (74%–100%) were acceptable and contamination low (two usual care participants had allergy tests). There were three minor SPT‐related adverse events. During follow‐up, 12 intervention and 8 usual care participants had minor, unrelated adverse events plus one unrelated hospital admission. Conclusions: It is possible to recruit, randomize and retain children with eczema from primary care into a trial of food allergy screening and to collect the outcomes of interest. Changes to recruitment and inclusion criteria are needed in a definitive trial, to ensure inclusion of younger children from more diverse backgrounds.
Views and experiences of people with acne vulgaris and healthcare professionals about treatments: systematic review and thematic synthesis of qualitative research
Objectives: The objective of this study was to systematically review and synthesise qualitative papers exploring views and experiences of acne and its treatments among people with acne, their carers and healthcare professionals (HCPs). Design: Systematic review and synthesis of qualitative papers. Methods: Papers were identified through Medline, EMBASE, PubMed, PsychINFO and CINAHL on 05 November 2019, forward and backward citation searching, Google Scholar and contacting authors. Inclusion criteria were studies reporting qualitative data and analysis, studies carried out among people with acne, their carers or HCPs and studies comprising different skin conditions, including acne. The title and abstracts of papers were independently screened by three researchers. Appraisal was carried out using the adapted Critical Appraisal Skills Programme tool. Thematic synthesis was used to synthesise findings. Results: A total of 20 papers were included from six countries. Papers explored; experiences living with acne, psychosocial impact of acne, views on causation of acne, perceptions of acne treatments, ambivalence and ambiguity in young people’s experience of acne and HCPs’ attitudes towards acne management. Findings suggest that people often viewed acne as short-term and that this had implications for acne management, particularly long-term treatment adherence. People often felt that the substantial impact of acne was not recognised by others, or that their condition was ‘trivialised’ by HCPs. The sense of a lack of control over acne and control over treatment was linked to both psychological impact and treatment adherence. Concerns and uncertainty over acne treatments were influenced by variable advice and information from others. Conclusions: People need support with understanding the long-term management of acne, building control over acne and its treatments, acknowledging the impact and appropriate information to reduce the barriers to effective treatment use.
Sex, Age, and Socioeconomic Differences in Nonfatal Stroke Incidence and Subsequent Major Adverse Outcomes
Background and Purpose: Data about variations in stroke incidence and subsequent major adverse outcomes are essential to inform secondary prevention and prioritizing resources to those at the greatest risk of major adverse end points. We aimed to describe the age, sex, and socioeconomic differences in the rates of first nonfatal stroke and subsequent major adverse outcomes. Methods: The cohort study used linked Clinical Practice Research Datalink and Hospital Episode Statistics data from the United Kingdom. The incidence rate (IR) ratio of first nonfatal stroke and subsequent major adverse outcomes (composite major adverse cardiovascular events, recurrent stroke, cardiovascular disease-related, and all-cause mortality) were calculated and presented by year, sex, age group, and socioeconomic status based on an individual’s location of residence, in adults with incident nonfatal stroke diagnosis between 1998 and 2017. Results: A total of 82 774 first nonfatal stroke events were recorded in either primary care or hospital data—an IR of 109.20 per 100 000 person-years (95% CI, 108.46–109.95). Incidence was significantly higher in women compared with men (IR ratio, 1.13 [95% CI, 1.12–1.15]; P<0.001). Rates adjusted for age and sex were higher in the lowest compared with the highest socioeconomic status group (IR ratio, 1.10 [95% CI, 1.08–1.13]; P<0.001). For subsequent major adverse outcomes, the overall incidence for major adverse cardiovascular event was 38.05 per 100 person-years (95% CI, 37.71–38.39) with a slightly higher incidence in women compared with men (38.42 versus 37.62; IR ratio, 1.02 [95% CI, 1.00–1.04]; P=0.0229). Age and socioeconomic status largely accounted for the observed higher incidence of adverse outcomes in women. Conclusions: In the United Kingdom, incidence of initial stroke and subsequent major adverse outcomes are higher in women, older populations, and people living in socially deprived areas.
D-MannosE to prevent Recurrent urinary tract InfecTions (MERIT): protocol for a randomised controlled trial
Introduction: Recurrent urinary tract infections (RUTIs) have a significant negative impact on quality of life and healthcare costs. To date, daily prophylactic antibiotics are the only treatment which have been shown to help prevent RUTIs. D-mannose is a type of sugar which is believed to inhibit bacterial adherence to uroepithelial cells, and is already being used by some women in an attempt to prevent RUTIs. There is currently insufficient rigorous evidence on which to base decisions about its use. The D-mannose to prevent recurrent urinary tract infections (MERIT) study will evaluate whether D-mannose is clinically and cost-effective in reducing frequency of infection and symptom burden for women presenting to UK primary care with RUTI. Methods and analysis: MERIT will be a two-arm, individually randomised, double blind placebo controlled, pragmatic trial. Participants will be randomised to take D-mannose powder or placebo powder daily for 6 months. The primary outcome will be the number of medical attendances attributable to symptoms of RUTI. With 508 participants we will have 90% power to detect a 50% reduction in the chance of a further clinically suspected UTI, assuming 20% lost to follow-up. Secondary outcomes will include: number of days of moderately bad symptoms of UTI; time to next consultation; number of clinically suspected UTIs; number of microbiologically proven UTIs; number of antibiotic courses for UTI; quality of life and healthcare utilisation related to UTI. A within trial economic evaluation will be conducted to examine cost-effectiveness of D-mannose in comparison with placebo. A nested qualitative study will explore participants’ experiences and perceptions of recruitment to, and participation in a study requiring a daily treatment.
Anticipatory syringe pumps: benefits and risks
We welcome the Association of Supportive and Palliative Care Pharmacy’s (ASPCP) recent position statement that the perceived benefit of the anticipatory prescribing of a syringe pump (driver) does not outweigh potential risks.1 This is an area of practice which has needed clear national guidance for some time.2 The committee cited the following specific risks: - A lack of individualisation. - No anticipation of dose/drug changes between prescribing and initiation. - Administration errors. Given these risks, it is of concern that anticipatory syringe pump prescribing appears relatively common in some areas of the UK and is perhaps increasing during the COVID-19 pandemic.
Coroners’ concerns to prevent harms: a series of coroners’ case reports to serve patient safety and educate the public, clinicians and policy-makers
Understanding the causes of deaths and how they can be prevented is critical for improving healthcare outcomes. At a population level, over-reporting or under-reporting of deaths can have a profound impact on policy decisions, which in turn affect global economies and the day-to-day lives of citizens. At the individual level, understanding how and why deaths occur may prevent similar deaths or serious harms from occurring in the future. One in 20 people are exposed to preventable harms in medical settings globally, and 12% of preventable harms result in disability or death.1 Coroners’ reports hold a wealth of information on the circumstances of individual deaths. In England and Wales, the law requires coroners to report and communicate a death when the coroner believes that action should be taken to prevent deaths.2 These reports, named Prevent Future Deaths (PFDs), are mandated under paragraph 7 of schedule 5 of the Coroners and Justice Act 2009, and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.3 4 Under these regulations, individuals or organisations that receive a PFD report are required under statue to respond to the coroner within 56 days of receiving the report, to outline actions proposed or taken to address the coroner’s concerns. The Courts and Tribunals Judiciary website hosts the PFD reports and responses to the reports.5
Engaging with diverse audiences to raise awareness about childhood eczema: reflections from two community events
Background: Eczema is a common childhood condition, causing dry and itchy skin which can be difficult to manage. We have been undertaking eczema and food allergy research to address previously prioritised research questions. We obtained funding to trial novel approaches to reach diverse audiences to raise awareness of childhood eczema, research, and public involvement in research. Methods: This paper reflects on two public engagement events held in collaboration with stakeholders in two settings of ethnic diversity in East Bristol, UK. We invited parents and children to attend the events by public display of posters. We created novel activities related to the research and involved artists to engage parents/carers and children about eczema and the research we are doing into its management. Results: Attendance at the first event was lower than expected. Lessons learned were incorporated into the second event, to use a more structured approach and attract greater numbers of parents/carers from more diverse backgrounds. Creative approaches such as using artists at both events made the subject more accessible for diverse audiences, including children. Conclusion: We successfully delivered two public engagement events. The success of the events has generated individual interest in PPI and enquiries about future events from neighbouring community groups. Reflections from the events have also been fed back to inform the research.
The implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study
Background: To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video or online consultation platforms. Aim: To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. Design and Setting: Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. Methods: Quantitative: Longitudinal observational analysis comparing volume and type of consultations in April-July 2020 with April-July 2019. Negative binomial models were used to identify if changes differed amongst different groups of patients. Qualitative: 87 practice staff longitudinal interviews in four rounds investigated practices experience of the move to remote consulting, challenges faced and solutions. A thematic analysis utilised Normalisation Process Theory. Results: There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April-July 2020 compared to 2019; GPs/nurses maintained a focus on older patients, shielding patients and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. Conclusions: The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
Measuring the complexity of general practice consultations: development and validation of a complexity measure
Background: The complexity of general practice consultations may be increasing and vary in different settings. Testing these hypotheses requires a measure of complexity. Aim: To develop a valid measure of general practice consultation complexity applicable to routine medical records. Design: Delphi study to select potential indicators of complexity followed by cross-sectional study to develop and validate a complexity measure. Setting: English general practices. Method: An online Delphi study over two rounds involved 32 general practitioners to identify potential indicators of consultation complexity. The cross-sectional study used an age-sex stratified random sample of 173,130 patients and 725,616 general practice face-to-face consultations from 2013/14 in the Clinical Practice Research Datalink. We explored independent relationships between each indicator and consultation duration using mixed effects regression models, and revalidated findings using data from 2017/18. We assessed the proportion of complex consultations in different age-sex groups. Results: After two rounds, the Delphi panel endorsed 34 of 45 possible complexity indicators. In the cross-sectional study, after excluding factors because of low prevalence or confounding, 17 indicators were retained. Defining complexity as the presence of any of these factors, 308,370 consultations (42.5%) were complex. Mean duration of complex consultations was 10.49 minutes, compared to 9.64 minutes for non-complex consultations. The proportion of complex consultations was similar in men and women but increased with age. Conclusion: Our consultation complexity measure has face and construct validity. It may be useful for research, management and policy, informing decisions about the range of resources needed in different practices.
Context, context, context: how has covid-19 changed implementation globally and how can we ‘lock in’ learning?
In our recent editorial [1] we discussed the importance of knowledge mobilization (KM; defined as ‘a proactive process that involves efforts to transform practice through the circulation of knowledge within and across practice domains’ [2]) to the implementation of best practice to drive up the quality of care for patients. We acknowledged the role and importance of recognizing real-world context, providing examples of individual, organizational and national contextual factors that influence KM. Since the publication of that editorial, the context of healthcare both nationally and internationally has changed substantially. The covid-19 pandemic has, and will continue to have, a significant impact on KM and the design and delivery of healthcare services. The commonly cited conclusion in KM is that ‘context is everything’, and we would like to add to this discussion and build upon our previous editorial in light of the covid-19 situation. This piece explores the impact of covid-19 on KM, in the context of musculoskeletal services, and the ways in which organizations can ‘lock in’ learning, after arguably the biggest challenge that healthcare services have ever experienced.
Implementation research: making better use of evidence to improve healthcare
It is estimated that 85% of healthcare research is ‘wasted’, avoidably, due to inadequacies in research design, conduct and dissemination [1]. Such inadequacies in implementing healthcare research lead to health, economic and opportunity costs. A major review investigating the use of healthcare research identified two ‘gaps’ in research translation, the first being between bench and bedside and the second relating to ‘implementing … products and approaches into clinical practice’ [2]. So, whilst we know there is a problem in this area, what can the growing field of research into implementation do to help healthcare professionals, patients and carers improve outcomes and quality of care?
Timing of GP end-of-life recognition in people aged ≥75 years: retrospective cohort study using data from primary healthcare records in England
Background: High-quality, personalised palliative care should be available to all, but timely recognition of end of life may be a barrier to end-of-life care for older people. Aim: To investigate the timing of end-of-life recognition, palliative registration, and the recording of end-of-life preferences in primary care for people aged ≥75 years. Design and setting: Retrospective cohort study using national primary care record data, covering 34% of GP practices in England. Method: ResearchOne data from electronic healthcare records (EHRs) of people aged ≥75 years who died in England between 1 January 2015 and 1 January 2016 were examined. Clinical codes relating to end-of-life recognition, palliative registration, and end-of-life preferences were extracted, and the number of months that elapsed between the code being entered and death taking place were calculated. The timing for each outcome and proportion of relevant EHRs were reported. Results: Death was recorded for a total of 13 149 people in ResearchOne data during the 1-year study window. Of those, 6303 (47.9%) records contained codes suggesting end of life had been recognised at a point in time prior to the month of death. Recognition occurred ≥12 months before death in 2248 (17.1%) records. In total, 1659 (12.6%) people were on the palliative care register and 457 (3.5%) were on the register for ≥12 months before death; 2987 (22.7%) records had a code for the patient’s preferred place of care, and 1713 (13.0%) had a code for the preferred place of death. Where preferences for place of death were recorded, a care, nursing, or residential home (n = 813, 47.5%) and the individual’s home (n = 752, 43.9%) were the most common. Conclusion: End-of-life recognition in primary care appears to occur near to death and for only a minority of people aged ≥75 years. The findings suggest that older people’s deaths may not be anticipated by health professionals, compromising equitable access to palliative care.
Latest news
NIHR Be Part of Research | SPCR RAPID IMMUNE TEST study
20 May 2025
As part of this year’s NIHR Be Part of Research campaign, 20 May to 12 June, Andrew Turner and Emily Brown from the University of Bristol shares details of her SPCR-funded research involving participants.
New Mental Elf Video Series to Mark Mental Health Awareness Week
16 May 2025
The Mental Elf, in partnership with the NIHR Mental Health Research Initiative, is launching a new video series for Mental Health Awareness Week, spotlighting key priorities in mental health research.
SPCR-Funded Research Wins 2025 Sage Prize for Innovation and Excellence
15 May 2025
Congratulations to SPCR colleagues Louise Laverty, Katherine Checkland, and Sharon Spooner, who are joint winners of the 2025 Sage Prize for Innovation and Excellence.