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Devolving health and social care decisions to local politicians and professionals adds further complexity to an already complex system.
Discontinuation of menopausal hormone therapy and risk of fracture: nested case–control studies using routinely collected primary care data
Background Women 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.
Translating resources for activity pacing to primary care to support the management of chronic pain: a protocol
Purpose: 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.
Trauma‐Informed Principles in Practice: A Mixed‐Method Study of Co‐Producing Systems Change With People Who Have Experienced Multiple Disadvantage
Background Health 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‐traumatisation 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‐production within services and systems, to understand how people can be best supported and how involvement impacts them. Methods Sixteen IF members and three IF staff participated in semi‐structured interviews. A staff survey, at two time points, investigated how employees from Changing Futures partner organisations perceived their ability to embed co‐production within services, with 147 responses. Internal documentation was analysed to illustrate the diversity of co‐production work that IF contributed to. Results Putting trauma‐informed principles into practice facilitated personal growth, improved confidence and some work skills for IF members, who contributed to 65 different workstreams. However, embedding co‐production into wider services and systems proved challenging. Staff survey comments highlighted obstacles related to resources, time and hierarchical cultures. Conclusion Lived experience organisations can model trauma‐informed practice and influence systems. Embedding trauma‐informed 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. Public Contribution Statement This study was co‐produced 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.
Associations between burnout and career disengagement factors among general practitioners: a path analysis
Background: Burnout is associated with career disengagement among general practitioners (GPs), but the underlying mechanisms of this association remain poorly understood. Objective: This study examined the pathways linking burnout to career disengagement factors among GPs. Methods: An 11-item online questionnaire, including validated abbreviated measures of burnout outcomes (single items on emotional exhaustion (EE) and depersonalisation), career disengagement factors (intention to quit patient care, work–life balance, presenteeism and job satisfaction), and demographic information, was distributed to a random sample of GPs in England between December 2019 and April 2020. Correlations between burnout outcomes and disengagement factors were assessed, followed by a path analysis using a generalized structural equation model, to examine directional relationships between burnout outcomes and survey variables. Results: A total of 351 GPs from 57 different medical practices completed the questionnaire. Up to one in four GPs (22.5%) experienced emotional exhaustion, while up to one in three (27.4%) experienced depersonalisation on a weekly basis. In addition, one in three GPs (33.3%) expressed a moderate-to-high intention to quit patient care within the next 5 years. Moreover, one in five GPs (18.8%) reported job dissatisfaction, two in five GPs (40.7%) indicated poor work–life balance, and up to one in two GPs (27.4%) reported presenteeism in the past year. In the path analysis, intention to quit patient care had significant direct associations with both job satisfaction and burnout and significant indirect associations (via burnout) with work–life balance and presenteeism. GP demographics were excluded from the path analysis because they exhibited very weak correlations with dimensions of burnout and work engagement factors. Conclusion: These findings highlight the urgent need for interventions and policies aimed at addressing burnout and improving job satisfaction to retain GPs. In addition, improving work–life balance and reducing presenteeism could serve as effective early preventative measures to reduce burnout and job dissatisfaction and, in turn, retain GPs.
Trauma-Informed Principles in Practice: A Mixed-Method Study of Co-Producing Systems Change With People Who Have Experienced Multiple Disadvantage
Background Health 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-traumatisation 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-production within services and systems, to understand how people can be best supported and how involvement impacts them. Methods Sixteen IF members and three IF staff participated in semi-structured interviews. A staff survey, at two time points, investigated how employees from Changing Futures partner organisations perceived their ability to embed co-production within services, with 147 responses. Internal documentation was analysed to illustrate the diversity of co-production work that IF contributed to. Results Putting trauma-informed principles into practice facilitated personal growth, improved confidence and some work skills for IF members, who contributed to 65 different workstreams. However, embedding co-production into wider services and systems proved challenging. Staff survey comments highlighted obstacles related to resources, time and hierarchical cultures. Conclusion Lived experience organisations can model trauma-informed practice and influence systems. Embedding trauma-informed 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. Public Contribution Statement This study was co-produced 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.
Testing the activity pacing questionnaire for validity, reliability and responsiveness: An outcome measure validation study
Abstract Activity pacing aims to manage symptoms of chronic pain and improve function by modifying pain-related behaviours: avoidance, overdoing and overdoing-underdoing cycling. Research regarding the effectiveness of activity pacing is unclear, and hindered by the absence of a validated scale. The previously developed 28-item Activity Pacing Questionnaire (APQ-28) comprises five domains: Activity adjustment, Activity planning, Activity consistency, Activity progression and Activity acceptance. This study aimed to shorten the APQ and provide evidence for its validity, reliability and responsiveness. Paper-based questionnaires collected data from patients with chronic pain attending healthcare services in England, UK, at baseline (n=347), and again at 2-weeks (n=130) and 12-weeks (n=121). Outcome measures included the APQ-28, and other measures of pacing, avoidance, overdoing, pain, self-efficacy, quality of life, physical/mental function, depression and anxiety. Statistical analyses explored validity, reliability, responsiveness and measurement error. Factor analysis (n=347) showed poor model fit for the previous five-factor model, leading to selecting a four-factor model (removing Activity acceptance) with three items per domain, forming the APQ-12 (CFI=0.995, TLI=0.992, RMSEA=0.052, SRMR=0.050). The four domains showed satisfactory internal consistency (Cronbach’s alpha=0.70–0.84) and test-retest reliability (n=130, ICC=0.53–0.64). Only Activity consistency showed significant responsiveness (n=121, Rho=0.27, 95% CI=0.1–0.43). Measurement error of the APQ-12 domains included smallest detectable change (range=1.55–1.76), standard error of measurement (range=0.56–0.63) and minimally important change (range=-0.17–0.33). Confirmatory factor analysis on external data supported the four-domain structure (CFI=0.983, TLI=0.977, RMSEA=0.071, SRMR=0.106). The APQ-12 shows promise as a multi-domain measure of activity pacing for use in clinical practice and future research.
Associations between gestational diabetes and cardiovascular disease largely operate independently of postpartum causal pathways: A population-based cohort study in England
Background Gestational diabetes mellitus (GDM) is associated with increased risk of developing type 2 diabetes and cardiovascular disease (CVD). Here we explore whether the associations are mediated by development of type 2 diabetes and other CVD risk factors. Methods The Exploring Long-term Outcomes following PrEgnancy affected by GDM (ELOPE-GDM) study is a population-based matched cohort study, containing 43 572 records of women diagnosed with GDM matched with 174 288 records of non-GDM women. We used Cox proportional hazards models to assess the risk of GDM on CVD, ischemic heart disease (IHD) and stroke/TIA and quantified the proportions of these effects mediated by the progression to type 2 diabetes, hypertension or dyslipidaemia using causal mediation analysis. Results There were significant associations between GDM and CVD; (adjusted HR 1.58 (95% CI 1.27–1.97)), IHD (1.83 (1.35–2.49)) and stroke/TIA (1.43 (1.06–1.95)). There were strong associations between GDM and developing type 2 diabetes (OR 13.90 (95% CI 13.19–14.51)), hypertension (1.87 (1.781–1.92)), dyslipidaemia (1.80 (1.76–1.84)) or any of these postpartum mediators (1.67 (1.63–1.71)). However, most of the effect of GDM on CVD was not attributed to the overall mediating effects of type 2 diabetes (36% (95% CI 8%–64%)), hypertension (15% (5%–24%)), dyslipidaemia (37% (18%–55%)) or a combination of these conditions (32% (11%–53%)) which developed after pregnancy. Conclusion These findings emphasise the need for comprehensive cardio metabolic screening following a pregnancy affected by GDM.
Value of using artificial intelligence derived clusters by health and social care need in primary care: A qualitative interview study with patients living with multiple long-term conditions, carers and health care professionals
Abstract Background People living with MLTCs attending primary care often have unmet social care needs (SCNs), which can be challenging to identify and address. Artificial intelligence (AI) derived clusters could help to identify patients at risk of SCNs. Evidence is needed on views about the use of AI-derived clusters, to inform acceptable and meaningful implementation within interventions. Method Qualitative semi-structured interviews (online and telephone), including a description of AI-derived clusters and a tailored vignette, with 24 people living with MLTCs and 20 people involved in the care of MLTCs (carers and health care professionals). Interviews were analysed using Reflexive and Codebook Thematic Analysis. Results Primary care was viewed as an appropriate place to have conversations about SCNs. However, participants felt health care professionals lack capacity to have these conversations and to identify support. AI was perceived as a tool that could potentially increase capacity but only when supplemented with effective, clinical conversations. Interventions harnessing AI should be brief, be easy to use and remain relevant over time, to ensure no additional burden on clinical capacity. Interventions must allow flexibility to be used by multidisciplinary teams within primary care, frame messages positively and facilitate conversations that remain patient centered. Conclusion Our findings suggest that implementing AI-derived clusters to identify and support SCNs in primary care is perceived as valuable and can be used as a tool to inform and prioritse effective clinical conversations. But concerns must be addressed, including how AI-derived clusters can be used in a way that considers personal context.
Temporal trends in primary care-recorded psychiatric diagnoses and psychotropic medication prescribing among children and young people in the UK: a population-based study
Abstract Background Despite growing concerns about young people’s mental health, it remains unclear how rates of psychiatric diagnoses and psychotropic medication prescribing have changed. Aim To investigate temporal trends in UK primary care-recorded incidence of (1) psychiatric diagnoses: attention deficit hyperactivity disorders (ADHD), autism spectrum conditions, anxiety disorders, depression, substance misuse, and personality disorders, and (2) psychotropic medication prescribing, in individuals aged 1–24 years. Design and setting This was a population-based study using primary care data from the Clinical Practice Research Datalink. Method The monthly incidence of each outcome from January 2010 to March 2022 were calculated. Negative binomial regression was used to predict expected incidence rates when the COVID-19 pandemic began in March 2020, based on antecedent trends. Observed and predicted (that is, expected) rates were compared. Results In the 2 years following March 2020, the incidence of ADHD diagnoses in females was 24.7% (95% confidence interval = 11.9 to 38.9%) greater than the expected incidence rate predicted from the trends before the pandemic. The increase in ADHD diagnoses occurred more commonly for females aged 20–24 years, followed by those aged 17–19 years, as well as among females from less deprived areas. Similar trends were observed for ADHD medications. Observed rates of other outcomes, including common mental illnesses, were below or close to the expected levels, with the differentials between observed and expected rates being greater for males than females. Conclusion Increased ADHD awareness may partly explain the study's findings. However, the fall in other diagnoses may reflect barriers to accessing health services at the height of the pandemic. Early identification and timely treatment of mental health difficulties and neurodevelopmental conditions are crucial.
The Experiences of Endometriosis Patients During Primary Healthcare Encounters: A Systematic Review of Qualitative Evidence
Abstract Endometriosis affects 10% of those assigned-female-at-birth worldwide. Diagnosis typically takes between 5–12 years. This qualitative systematic review explored endometriosis patients’ experiences with primary healthcare professionals from presentation before diagnosis to post-diagnosis follow-up. Six electronic databases were searched: CINAHL, MEDLINE, Embase, PubMed, Scopus, and PsycINFO. A total of 37 articles were included and synthesized thematically. Findings showed common issues that patients were experiencing during their interactions with primary healthcare professionals, including dismissal regarding their symptoms, delayed referral to secondary care, and lack of knowledge regarding endometriosis. This review highlights a need for improved education and awareness surrounding endometriosis amongst primary healthcare professionals.
Developing the PATH-GP (Prevention and Testing for HIV in General Practice) intervention: a Person-Based Approach intervention development study to increase HIV testing and PrEP access
Background Testing for HIV, linkage to treatment and access to pre-exposure prophylaxis (PrEP) (medication which reduces the risk of acquiring HIV) is essential for early HIV diagnosis, treatment, and prevention. General practice could play a key role in maximising H IV testing opportunities and supporting access to PrEP. Aim To develop an intervention for general practice to increase HIV testing and facilitate access to PrEP. Design and setting A person-based approach (PBA) intervention development study using the Capability, Opportunity, Motivation, Behaviour (COM-B) Model in South West England. Method A scoping review and semi-structured interviews with healthcare professionals (HCPs) and local organisation representatives with an interest in HIV prevention/healthcare) were conducted to understand the challenges and find potential solutions to increase HIV testing and facilitate access to PrEP in general practice. Intervention development used focus groups with HCPs and the public. Purposive sampling ensured diversity of practices and participants. Data was analysed using the PBA table of planning and CLIP-Q approach. Results Barriers identified included lack of clinician knowledge of HIV and PrEP, concern about stretched resources and a lack of systematic testing methods. Proposed strategies included simpler testing methods to normalise testing and reduce HIV stigma. The intervention developed consists of: education, a prompt to test, simplified and standardised testing and PrEP signposting processes, patient information, and practice champions. Conclusion Research is needed to explore the feasibility and the effectiveness of this multicomponent intervention to increase testing and access to PrEP within general practice. Funding barriers also need to be addressed.
Moral injury prevention and intervention
Background: Those working in high-risk occupations may often face ethical dilemmas that violate their moral code which can lead to moral injury (MI). While research into the impact of MI is growing, evidence for effective treatment interventions and prevention approaches remains limited. Objective: To review recent developments in treatment and prevention approaches for MI-related mental health difficulties. Method: We synthesised emerging treatments, including trauma focused therapies and spiritual approaches, as well as possible prevention strategies. Results: Conventional treatments for post-traumatic stress disorder (PTSD) (e.g. prolonged exposure) often inadequately address MI and may exacerbate symptoms. Adapted or novel approaches, including Impact of Killing, Adaptive Disclosure, and Restore and Rebuild, show promise, particularly when co-produced with patients and clinicians. Spiritual interventions demonstrate mixed outcomes. Prevention research remains very limited but highlights the potential of systemic reforms, leadership fostering psychological safety, preparedness training, structured reflection, and peer support. Evidence remains constrained by small samples, military-focused populations, and inconsistent measurement of MI. Conclusions: While no gold-standard intervention exists, values-based and compassion-focused approaches appear promising. Prevention strategies targeting organisational culture and fostering preparedness are urgently needed, particularly for civilian and diverse occupational groups, to better support and protect those exposed to potentially morally injurious events.
Predicting hypotension, syncope, and fracture risk in patients indicated for antihypertensive treatment: the STRATIFY models
Abstract Antihypertensives are associated with increased risk of syncope, hypotension, and fractures, but the highest-risk individuals are unclear. This study aimed to develop and validate three models to predict these outcomes in patients with an indication for antihypertensive treatment. A cohort study was conducted using data from Clinical Practice Research Datalink (CPRD). Patients aged 40+ with systolic blood pressure 130-179 mmHg were included. Outcomes were first hypotension, syncope, or fracture leading to hospitalization or death within 10 years. Models were derived from CPRD GOLD data (n = 1,773,224) and validated with CPRD Aurum data (n = 3,805,366). Each model had 31-37 predictors. Validation demonstrated strong discriminative ability (10-year C-statistic: hypotension 0.824; syncope 0.819; fracture 0.790), with close agreement between predicted and observed risks for the hypotension and syncope models. Some underprediction was observed for the fracture model. These models could be used to help reassure patients about the relatively low risk of harm from antihypertensive treatment, or identify the small number of individuals with a higher risk where additional monitoring may be indicated.
Practitioners’ views on the measurement and management of postural hypotension in general practice: a qualitative inquiry
Background Postural hypotension is associated with cognitive decline, falls, and all-cause mortality, representing a substantial burden on the NHS. Postural hypotension is often asymptomatic, making detection and treatment difficult. Currently, there is no systematic approach to measuring and managing postural hypotension in UK general practice. Aim To explore barriers to and facilitators of improving postural hypotension measurement and management. Design and setting This was a qualitative interview study with healthcare practitioners (HCPs) in general practices in England. Method Individual, remote, semi-structured interviews were conducted with a range of HCPs who measure blood pressure in general practice to explore their views and experiences of measuring and managing postural hypotension. Participants were identified from expressions of interest during a national survey. Interviews were video- and audio-recorded, transcribed verbatim, and analysed thematically. Results In total, 26 HCPs in 24 practices across nine clinical research networks in England were interviewed between March and July 2023. HCPs checked for postural hypotension when patients were older, reported dizziness, fatigue, or had chronic conditions. Despite awareness of clinical guidelines, various diagnostic definitions were provided and measurement protocols varied between participants. Sit-to-stand rather than supine-to-stand measurements were considered more feasible owing to time constraints and patient mobility. Education and training, as well as incentives and specialist clinics, were suggested as methods to improve postural hypotension measurement and management. Conclusion This is the first study, to our knowledge, to explore barriers to and facilitators of postural hypotension measurement in English general practice. Findings suggest a more systematic approach to measurement is needed to improve detection and management of postural hypotension in general practice.
Implementing trauma-informed practice across services to support people experiencing multiple disadvantage: a mixed method study
Background People facing multiple disadvantage have often experienced extensive trauma. Changing Futures Bristol was part of a national programme to improve outcomes for people who face multiple disadvantage, such as combinations of homelessness, substance misuse, mental ill-health, domestic violence and abuse or contact with the criminal justice system. Aims were to understand how services could be improved, with more trauma-informed approaches at individual, service and system levels. An in-depth mixed method evaluation of Changing Futures Bristol examined how trauma-informed approaches were implemented and linked across services supporting people experiencing multiple disadvantage. Methods The study followed a participatory action research approach, involving research conducted in collaboration with people who have experienced multiple disadvantage, and staff partners. Collaborators actively contributed to securing funding, research design, data analysis, and write-up. A staff survey was conducted using existing measures and some tailored questions, to assess perceptions of trauma-informed approaches, equality, diversity and inclusion, and co-production. One hundred and seventeen staff responded, with 30 staff completing the survey again after one year to track any changes. Twenty-three staff members were interviewed. Qualitative data were analysed thematically, guided by trauma-informed principles and implementation domains. Results Movement toward more trauma-informed approaches was detected, although these changes were not found to be statistically significant after one year. Barriers included short-term funding and commissioning cycles and difficulties in staff retention, due to short-term contracts, vicarious trauma, stress and pressures of the job. Managers had to hold contradicting drivers to deliver targets and manage finances whilst creating space for relational support and trauma-informed practice. To create psychological safety, staff needed to feel trust and transparency. 73% of staff reported lived experience of at least one domain of multiple disadvantage or trauma. Support for staff is needed at all levels of the organisation. Conclusions A long-term, collaborative, and trauma-informed approach is needed at all levels, including leaders, managers, policymakers, and central government. Government and public service reforms that focus on cross-sector collaboration and devolution of power will support trauma-informed practices. Stable, long-term funding and planning will help create a motivated, skilled workforce that can build on existing good practice.
Distribution and quality of privately-funded general practices in England: a cross-sectional analysis
Abstract Background Public surveys indicate demand for privately-funded general practice services in England has increased. However, little is known regarding the number, location and quality of private general practices. Aim To examine: 1) the geographical distribution of private general practices across England; 2) the relationships between access, continuity of care and funding of NHS general practices with nearby private practices; and 3) the quality ratings of NHS and private general practices. Design & setting Cross-sectional analysis of NHS and private general practices in England as of April 2024. Method We used the Care Quality Commission (CQC) Primary Medical Services Inspectorate to identify all private general practices in England. We used multilevel logistic regression to examine associations between NHS practice characteristics and the presence of a private general practice nearby. We then compared available CQC ratings. Results As of April 2024, England had 358 private and 5,976 NHS practices. Private general practices are primarily in London and other urban areas. NHS practices with higher patient satisfaction with waits for appointments (odds ratio 1.08 (95% CI: 1.03–1.13)) and more GPs per 10,000 patients (1.04 (1.01–1.06)) were more likely to have a private practice nearby. There was no association with continuity of care or funding. Quality ratings were similar, although 44% of private practices were unrated by the CQC. Conclusion Private general practices are more common in London, as well as areas with better access to NHS GPs. The growth in private general practices may have widened inequalities in access to primary care.
Calcium and Albumin Blood Tests, Ethnicity, and Cancer Incidence in Primary Care in the UK
Simple Summary For many common blood tests, typical values differ for patients from different ethnic groups. Although it is known that albumin and calcium tests may be useful in identifying patients with a higher-than-average cancer risk, the evidence is limited and does not take into account patient ethnicity. Examining the blood test results in a large English primary care dataset demonstrated that having either low albumin or high calcium was predictive of cancer risk, and more specifically risk of myeloma. Having low albumin was also predictive of liver cancer. There were no differences in how effective these blood tests are at estimating cancer risk for patients from different ethnic groups. Abstract Objectives: This study aimed to assess any ethnic differences in blood calcium and albumin levels for patients receiving these tests in primary care, and to investigate how this affects the use of these markers in assessing cancer risk. Methods: The analysis was based on a primary care dataset comprising patients in England. Multilevel logistic regression was used to investigate the relationship between blood test results and cancer risk by ethnic group. Results: A total of 4,632,856 patients were eligible for the albumin analysis, and 1,979,763 for the calcium analysis. Raised calcium levels were indicative of an increased risk of cancer, with diagnostic odds ratios (ORs) ranging from 2.0 to 2.7 for the different ethnic groups. ORs for myeloma were between 6.6 and 13.6. Similarly, low albumin was associated with an increased risk of cancer with an OR of between 3.2 and 3.8, myeloma (OR between 8.7 and 10.0), and liver cancer (OR between 9.2 and 15.7). Conclusions: Albumin and corrected calcium were effective indicators of cancer risk, and more specifically of risk of myeloma. Albumin levels were also linked with liver cancer risk. While there are some differences in typical corrected calcium and albumin levels between ethnic groups, there was no evidence that this had an effect on the usefulness of these markers to infer cancer risk.
Understanding and improving compound pressures in general practice: a realist review protocol
Abstract Background Compound Pressures (CP) significantly impact the role of General Practice (GP) in supporting human health. These pressures include climate change, pandemics, and financial crises. CP can be predictable, pre-determined, or unpredictable in nature and scope. Strategies to address the demands arising from CP range from short-term initiatives to buffering existing GP systems to ensure flexible and agile resources. Interventions designed to prevent, identify, and manage CP may result in both intended and unintended outcomes. Aim To conduct a realist appreciative inquiry, realist review, and three embedded studies within a review (SWAR) about CP affecting GP and the delivery of effective, equitable patient care. Design & setting Realist appreciative inquiry, realist review, and three SWARS. Method We will conduct a realist appreciative inquiry facilitating patient and stakeholder input into the review scope, focus, and initial programme theory development. This approach emphasises the identification of assets, successes, hopes, and aspirations to enable positive change. Based on these insights, we will conduct a realist review of empirical and grey literature. This project includes three elements of methodological innovation (SWARs). First, evaluation of how appreciative inquiry can inform initial programme theory development. Two further SWARs will examine how artificial intelligence might a) support the identification of relevant resources at title and abstract, and full-text stages, and b) support data extraction and analysis in future realist reviews. Conclusion Our research aims to understand the effects of CP on GP, supporting preparation and solutions that can inform future policies, interventions, and support systems.
Regression towards the mean—a plea for civility in peer review
Peer review is integral to the ongoing publication of high quality research. In pursuit of this aim, reviewers are expected to provide constructive feedback that helps authors improve their manuscripts. All too often, however, peer reviewers fall into the trap of harsh criticism rather than critical evaluation. Common pitfalls include reviews that are overly negative or incredibly brief, give little acknowledgment of the strengths of the manuscript, and use an unfriendly or insulting tone
Social prescribing for children and young people
Mental ill health in children and young people is a global problem. In 2019, one in seven children and young people had diagnosed mental health conditions. The drivers for this high burden are complex and include home-based and school-based risks, lifestyle factors, and vulnerabilities due to disability, discrimination, and socioeconomic circumstances.