Family practice最新文献

{"title":"A retrospective evaluation of antibiotic prescribing for recurrent urinary tract infection prophylaxis in adults in general practice.","authors":"Ryan A Hamilton, Zahra Mahomed, Amit Bharkhada, Avril Tucker, Akil Choudhary, Pravisha Ravindra, Jaskarn Rai, James Veater","doi":"10.1093/fampra/cmag068","DOIUrl":"https://doi.org/10.1093/fampra/cmag068","url":null,"abstract":"<p><strong>Background: </strong>Guidelines on the use of antibiotic prophylaxis in general practice for the prevention of recurrent urinary tract infection (UTI) are well established. However, these require regular clinical and microbiology review. Adherence to these guidelines in primary care is poorly understood.</p><p><strong>Objectives: </strong>To evaluate the prescribing of prophylactic antibiotics for recurrent UTIs in adult patients across general practices in Leicestershire (UK) and to identify potential clinical, demographic, or systemic drivers of prescribing variation.</p><p><strong>Methods: </strong>A retrospective audit was conducted across 18 general practices in Leicestershire. Adult patients prescribed antimicrobial prophylaxis for recurrent UTI (November 2021-January 2024) were identified and evaluated against three standards: (i) guideline-concordant therapy; (ii) review within 6 months of initiation; and (iii) modification following resistant urinary isolates. Associations with demographic and clinical variables were explored.</p><p><strong>Results: </strong>Among 256 patients (73.8% female; mean age 66.9 years), median prophylaxis duration was 2.2 years. Adherence to guideline regimens was 73.6%, 58.1% received review within 6 months, and 22.9% with resistant isolates had therapy modified. Nitrofurantoin and trimethoprim predominated, with frequent deviations in dose, formulation, and duration. Resistant urine isolates occurred in 24.7% and were associated with increased breakthrough infection, but rarely prompted treatment modification. Greater socioeconomic deprivation was associated with lower guideline adherence.</p><p><strong>Conclusions: </strong>This work has identified several opportunities to improve recurrent UTI management, including optimizing antimicrobial prescribing, ensuring regular clinical review, and accounting for resistant urinary isolates.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital gamification in chronic pain management in adulthood: a systematic review.","authors":"Jiafan He, Tyrone Tai On Kwok, Mimi Mun Yee Tse, Sukki Suk Ki Ho, Wanqin Hu, Ziji Chen","doi":"10.1093/fampra/cmag069","DOIUrl":"10.1093/fampra/cmag069","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is a leading cause of disability. Existing evidence on digital gamification remains mixed. This systematic review aims to explore the use of gamification in chronic pain interventions for adults.</p><p><strong>Methods: </strong>A systematic review of randomized controlled trials using digital gamification pain intervention for adults with chronic non-cancer pain was included. Data on gamification mechanisms, pain intensity, and user-related outcomes were extracted.</p><p><strong>Results: </strong>A total of 17 randomized controlled trials with 768 participants were included. The most common elements of gamification were feedback, challenges, and rewards. Twelve studies reported significant pain reduction, with virtual reality and sensor-based games showing immediate effects. Feedback and challenge-based designs were associated with improved pain outcomes and user engagement. However, adherence and long-term efficacy varied, and some studies reported adverse effects.</p><p><strong>Conclusion: </strong>Gamification, particularly virtual reality and feedback-driven interventions, shows promise in reducing chronic pain and enhancing motivation. However, heterogeneity in design, limited long-term data, and risk of bias highlight the need for interventions evaluated in high-quality randomized controlled trials with longer follow-up periods. Future research should explore personalized gamification strategies and underlying mechanisms to optimize chronic pain management.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploiting survey and online patient experience comments in general practice: validating a fine-tuned language model for automatic sentiment analysis.","authors":"Rebecka Maria Norman, Lilja Charlotte Storset, Petter Mæhlum, Hilde Hestad Iversen, Elma Jelin, Erik Velldal, Lilja Øvrelid, Øyvind Bjertnæs","doi":"10.1093/fampra/cmag071","DOIUrl":"10.1093/fampra/cmag071","url":null,"abstract":"<p><strong>Background: </strong>Automated sentiment analysis can be used to analyse free-text patient experience comments, but in health services research, it requires technical performance and methodological validity. Traditional models lack contextual understanding, whereas masked language models (MLMs) enable nuanced sentiment classification. This study is the first to fine-tune an MLM (NorBERT3large) on human-annotated data and evaluate the validity of four-category sentiment classifications across survey and online feedback in general practice.</p><p><strong>Objective(s): </strong>To evaluate a fine-tuned MLM against human-annotated sentiment labels, compare its performance with traditional methods and a large language model, and assess convergent and known-groups validity using survey and online comments.</p><p><strong>Methods: </strong>NorBERT3large was fine-tuned on human-annotated free-text survey comments. Performance was evaluated using F1-scores. The model classified unseen online data. Construct validity was assessed per COSMIN guidelines through correlations with patient experience scores and subgroup analyses.</p><p><strong>Results: </strong>The fine-tuned NorBERT3large achieved high F1-scores on held-out survey test data and outperformed traditional models used in prior patient experience research, as well as a zero-shot large language model reference. On unseen online reviews, performance was high in the random sample and strongest for mixed and positive sentiment in the balanced evaluation set, while the rare neutral comments were difficult to classify reliably. Construct validity was supported by expected correlations with patient experience scores and known subgroup differences.</p><p><strong>Conclusion: </strong>Beyond good classification performance, the findings support automated sentiment analysis as a valid patient experience measure in general practice. The sentiment classifications may complement traditional patient experience measures and help identify areas for quality improvement.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative artificial intelligence in clinical decision support: navigating uncharted ethical, legal, and clinical terrain.","authors":"Graham J MacLeod, Hüsna Sarıca Çevik, Azar Varahra, Keith A Thompson","doi":"10.1093/fampra/cmag063","DOIUrl":"https://doi.org/10.1093/fampra/cmag063","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Situational analysis.","authors":"Adam Christianson, Patricia Thille","doi":"10.1093/fampra/cmag070","DOIUrl":"10.1093/fampra/cmag070","url":null,"abstract":"<p><p>Situational analysis is a qualitative method that allows the analyst to examine highly complex and locally specific situations. As primary care evolves to include increasingly specialized and varied interprofessional collaborative and person-centered care teams, this method may prove valuable to understanding how such teams operate. Situational analysis, an offshoot of grounded theory, provides an accessible but robust methodology for analyzing the situations researchers are interested in and the kind of differences that exist within them, such as situations where groups intersect while working together to deliver healthcare, while holding different views. Situational analysis involves three analytic steps, specifically, mapping data in three different ways. The outcomes of a situational analysis can, i.e. highlight the groups that are included in the given situation, those that are only spoken about, and those that are neglected entirely, as well as the values, preferences, and evidence that may be emphasized differently across given healthcare or policy contexts. In this methods brief, we describes situational analysis, its strengths, and assumptions and illustrated how it has been used successfully in health and social care research settings.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bringing telepsychiatry to rural primary care: a 12-month observational evaluation in severe mental illness.","authors":"Emre Yalcintas, Ibrahim Taymur, Cetin Turan, Ersin Budak, Hakan Demirci","doi":"10.1093/fampra/cmag076","DOIUrl":"10.1093/fampra/cmag076","url":null,"abstract":"<p><strong>Background: </strong>Specialist psychiatric access and continuity remain difficult in rural communities, particularly for adults with severe mental illness.</p><p><strong>Objectives: </strong>To describe 12-month clinical, functional, and risk changes during a family physician-led telepsychiatry model embedded in rural primary care.</p><p><strong>Methods: </strong>This prospective uncontrolled cohort was conducted in rural Türkiye in 2018-9. Of 37 adults enrolled, six relocated to urban areas. Two of these participants had shown marked clinical improvement and obtained employment before moving. One additional participant with schizophrenia died from myocardial infarction. Thirty completed assessments at baseline and months 3, 6, 9, and 12. A joint home assessment was followed by quarterly mobile visits with synchronous psychiatric consultation. Linear mixed-effects models with Holm adjustment evaluated longitudinal changes.</p><p><strong>Results: </strong>Disability, CGI-Severity, PANSS General Psychopathology, and four CMHC risk-domain scores changed significantly over time (all Holm-adjusted P < 0.001). Model-estimated month-12 versus baseline differences were -12.63 for the Sheehan Disability Scale [95% confidence interval (CI) -14.70 to -10.57], -2.17 for CGI-Severity (95% CI -2.49 to -1.85), and -29.90 for PANSS General Psychopathology (95% CI -34.52 to -25.28). Self-harm, harm to others, vulnerability, and relapse risks also decreased. CGI-Improvement and side-effect scores showed no significant overall time effects; Time × Diagnosis and Time × Gender interactions were not significant.</p><p><strong>Conclusion: </strong>Disability, clinical severity, general psychopathology, and risk scores improved over time. Without a control group and standardized, fully recorded treatment components, these findings indicate temporal associations rather than effectiveness and require confirmation in adequately powered controlled studies.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging perspectives on antimicrobial resistance: a survey of Belgian general practitioners, dentists, and infectious disease specialists.","authors":"Claudia Mann, Febe Verhulst, Bart Vandenberghe, Sabine D Allard, Johan Van Laethem","doi":"10.1093/fampra/cmag078","DOIUrl":"https://doi.org/10.1093/fampra/cmag078","url":null,"abstract":"<p><strong>Introduction: </strong>Antibiotics revolutionized medicine, but their overuse has led to antimicrobial resistance (AMR), a major global public health threat. Globally, ambulatory antibiotic consumption remains high despite ongoing antimicrobial stewardship initiatives. This study explored the perceptions and approaches of Belgian general practitioners (GPs), dentists, and infectious disease (ID) specialists toward AMR and antibiotic prescribing, with the aim of identifying challenges and opportunities relevant to broader stewardship efforts.</p><p><strong>Methods: </strong>A self-designed questionnaire was distributed via email to Belgian GPs, ID specialists, and dentists between July 2023 and February 2024. It assessed demographics, perceptions of AMR, prescribing behavior, proposed solutions, and willingness for collaboration. Exploratory logistic regression analysis was performed for selected key questions.</p><p><strong>Results: </strong>A total of 260 participants were included: 104 GPs, 103 dentists, and 53 ID specialists. Most agreed that AMR poses a serious threat to Belgian healthcare and acknowledged their contribution to the problem. Around half admitted to occasional inappropriate prescribing, mainly driven by prevention concerns and fear of complications. Interdisciplinary collaboration was widely endorsed as key to improving antibiotic use, and education was the most preferred intervention to enhance prescribing practices.</p><p><strong>Conclusion: </strong>This study highlights both shared concerns and differing perspectives regarding AMR among three major outpatient stakeholders involved in antibiotic use. Despite broad awareness of AMR, important gaps remain in stewardship knowledge, prescribing perceptions, and confidence in current interventions. To our knowledge, this is among the first studies to directly compare GPs, dentists, and ID specialists within a single framework.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of patient-reported outcome questionnaires in patients with post-COVID-19 condition: a systematic review and meta-analysis.","authors":"Jana Khawandi, Husam Kivan, Sahar Al Hussein, Muayad Azzam, Jamil Nazzal, Andrea Vasquez Camargo, Rejina Kamrul, Aseel Al Khader, Hassan Kawtharany, Mohammad Amin Al Zabibi, Jood Ahmad, Khushi Patel, Aqeeb Ur Rehman, Zayna Ahmed, Alain Piché, Candace D McNaughton, Grace Y Lam, Gavin Y Oudit, Samia Afzal, Holger Schunemann, Wojtek Wiercioch, Robby Nieuwlaat, Romina Brignardello-Petersen, Emilia Liana Falcone, Reem A Mustafa","doi":"10.1093/fampra/cmag054","DOIUrl":"10.1093/fampra/cmag054","url":null,"abstract":"<p><strong>Background and objective: </strong>Post-COVID-19 condition (PCC) is a complication of acute COVID-19, which often presents with a variety of symptoms. It can also impact individuals' overall well-being, capacity to carry out daily activities, engage in physical exercise, maintain employment, and their general quality of life. Therefore, this review aimed to examine the role of patient-reported outcome measures (PROMs) questionnaires in assessing patients with PCC through prevalence of abnormal tests.</p><p><strong>Methods: </strong>We searched three databases. Two reviewers independently screened articles using Laser Al and extracted relevant data using a piloted Google Sheets. We performed a meta-analysis using OpenMeta and RevManWeb and conducted a subgroup analysis based on the setting of the patients during their acute COVID-19 infection. We assessed the risk of bias using a modified ROBINS-I tool and the certainty using the Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>No studies reported diagnostic test accuracy measures for questionnaires in PCC. However, 23 comparative studies reported on the prevalence of abnormal questionnaire results in patients with PCC. Outcomes showed that patients with PCC have higher abnormal results than controls, regardless of their setting during acute COVID-19 infection. The overall certainty of the evidence was low due to the high risk of bias, indirectness, and imprecision.</p><p><strong>Conclusion: </strong>This review sheds light on the importance of testing PROMs in patients with PCC using these questionnaires and the need for further testing their validity in this condition.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of an artificial intelligence-based drawing platform against the Clock Drawing Test for cognitive screening: a comparative study between Alzheimer's disease and healthy controls.","authors":"Ülkü Sur Ünal, Halil Alper Karabaş, Aybora Yadigar, Ahsen Simanur Turnalı, Elifnur Demir","doi":"10.1093/fampra/cmag066","DOIUrl":"10.1093/fampra/cmag066","url":null,"abstract":"<p><strong>Background: </strong>Traditional manual Clock Drawing Tests (CDTs) are widely used for cognitive screening but are constrained by human subjectivity and alphanumeric literacy or cultural barriers.</p><p><strong>Objective: </strong>This study validated an open-source artificial intelligence (AI)-based drawing platform utilizing universal, pre-linguistic Lea symbols against manual CDT metrics for cognitive screening and differentiating Alzheimer's disease (AD) from healthy controls (HCs).</p><p><strong>Methods: </strong>In this cross-sectional validation study, 111 participants aged ≥65 years, 55 clinically diagnosed AD patients and 56 HCs, were evaluated. Participants completed manual CDTs (6-point and 10-point scoring) and the AI-based drawing task on a tablet. Diagnostic accuracy was evaluated using receiver operating characteristic curve analysis, Cohen's kappa (κ), and multivariable logistic regression adjusted for age and gender.</p><p><strong>Results: </strong>The AI model demonstrated clear diagnostic accuracy (area under the curve = 0.868), with overall accuracy comparable to the 10-point manual scale. An optimal diagnostic cut-off of <27.00 points, identified in this study, achieved 83.6% sensitivity and 75.0% specificity, demonstrating substantial agreement with clinical diagnosis (κ = 0.586, P < 0.001). Crucially, the AI-based drawing platform flagged 14 HCs (25.0%) as at-risk who were classified as intact by conventional manual CDT scales. Multivariable regression confirmed the AI score as a powerful independent predictor of AD status after adjusting for demographics (odds ratio: 0.940, 95% confidence interval: 0.904-0.979, P < 0.001).</p><p><strong>Conclusion: </strong>The AI-based drawing platform provides an objective, automated alternative to traditional CDTs. Its sensitivity to subtle visuoconstructional variations positions it as an effective, low-cost triage tool to optimize early neurological referrals in primary care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert-informed and stakeholder-reviewed interprofessional triage model for primary care practices: a mixed-method study.","authors":"Maya Zumstein-Shaha, Tanja Siegenthaler, Cécile JeanRichard, Charlotte Müller, Sophie Karoline Brandt","doi":"10.1093/fampra/cmag062","DOIUrl":"10.1093/fampra/cmag062","url":null,"abstract":"<p><strong>Background: </strong>To date, traditional primary care practices are often organized around the capacities of one or more physicians. New models of primary care practices involving other health professionals such as advanced practice nurses (APNs) require modified triage models for more adequate patient allocation.</p><p><strong>Objective: </strong>Therefore, a modified triage model was developed, informed by experts and reviewed by stakeholders.</p><p><strong>Methods: </strong>A convergent mixed-method design with four phases was employed. The study was conducted in Swiss primary care practices. Readiness for change of health professionals working in these primary care practices was surveyed. Triage was reviewed and modified according to expert recommendations, and its feasibility explored in two Delphi rounds with health professionals and stakeholders.</p><p><strong>Results: </strong>Health professionals in primary care practices were interested in improving access to care. Observed triage continued to focus primarily on physicians. The modified triage model was viewed to be practicable, offering a potential way to support more systematic allocation of patients to physicians, APNs, and other health professionals depending on the reason for consultation.</p><p><strong>Conclusions: </strong>Drawing on international guidelines on triage in primary care practices, expert opinion on who seeks care in these practices, and review by stakeholders led to a modified triage model to include other health professionals than primary care physicians.</p><p><strong>Trial registration: </strong>This study did not involve patients but focused on triage in primary care practices. Hence, no trial registration was obtained.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}