The British Journal of General Practice最新文献

{"title":"Diagnosing myeloma in general practice: how might earlier diagnosis be achieved?","authors":"L. Smith, J. Carmichael, G. Cook, B. Shinkins, R. Neal","doi":"10.3399/bjgp22X720737","DOIUrl":"https://doi.org/10.3399/bjgp22X720737","url":null,"abstract":"Smith et al describe the issues with the current diagnostic process for myeloma in general practice, explore the potential impact of the COVID-19 pandemic, and identify alternative strategies that may improve the early diagnosis. Around half of myeloma patients have three or more pre-referral consultations and around one-third are diagnosed through emergency presentation. Improving the timeliness of myeloma diagnosis is vital to improving patient outcomes, but is difficult to achieve because of complex, non-specific, and varied presentations. Improving GP education on the salient features of multiple myeloma presentation and the investigations required for diagnosis, alongside ensuring adequate safety netting for patients with persistent, unexplained symptoms, should be urgent priorities. Changes to general practice consultations following the COVID-19 pandemic have made myeloma diagnosis more difficult, and, over the longer term, research is required to develop intelligent and technological strategies that support physician decision making and reduce diagnostic delay.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84996506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-alcoholic fatty liver disease: leading the fight in primary care","authors":"M. Theodoreson, Richard Darnton, I. Rowe, R. Parker","doi":"10.3399/bjgp22x720917","DOIUrl":"https://doi.org/10.3399/bjgp22x720917","url":null,"abstract":"IN PRIMARY CARE GPs are no strangers to non-alcoholic fatty liver disease (NAFLD) and are commonly faced with non-specific liver function tests (LFTs) or an incidental finding of steatosis on ultrasound scan (USS). Interpreting these results and conveying their significance to the patient can be a challenge, with huge variation in practice. NAFLD is a spectrum of liver abnormalities from simple fat deposition (steatosis) to inflammation (non-alcoholic steatohepatitis, NASH). Steatohepatitis causes persistent hepatocellular inflammation leading to fibrosis that can, in some individuals, progress to cirrhosis. The disease burden of NAFLD is rising, now the most common liver disease globally, affecting up to 46% of all adults.1 Importantly, only 0.5% of patients are expected to progress to cirrhosis, which carries a risk of liver failure.2 Patients with NAFLD are at greater risk of all-cause mortality and, for most patients, the risk of non-hepatic ill health greatly outweighs the risk of liver-related morbidity.1–3 NAFLD is overwhelmingly associated with modifiable lifestyle factors, with obesity and metabolic syndrome the key drivers.1 This review describes how and when to make a diagnosis of NAFLD, the use of fibrosis markers to identify patients at risk of significant disease, and appropriate follow-up.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76803068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards new definitions of avoidable hospital admissions","authors":"M. Booker, S. Purdy","doi":"10.3399/bjgp22x720725","DOIUrl":"https://doi.org/10.3399/bjgp22x720725","url":null,"abstract":"often represents a major upheaval, with potential for physical, psychological, social, and economic consequences. Hospital admissions are also associated with an increased risk of adverse consequences to both physical and emotional wellbeing. Indeed, the broader negative impacts of the ‘allostatic stress’ of an admission may even outstrip those of physical illness in depleting reserves — a risk that persists beyond discharge.1 In patients with frailty, even a short so-termed ‘ambulatory’ admission is associated with increased mortality and subsequent use of health resources.2 While a hospital admission is rarely relished, there is evidence across international health systems that the COVID19 pandemic has heightened peoples’ desire to stay out of hospital, with an increasing trend of patients delaying or avoiding seeking urgent care altogether for fear of being admitted.3 While specific worries about hospitalacquired infection are undoubtedly a component, it appears that people may be more broadly re-evaluating the pros and cons of unscheduled hospital care as part of their re-framed priorities in the postpandemic era. These new sets of priorities, combined with a renewed urgency (driven by unprecedented demand) to explore alternative models of unscheduled care that don’t require inpatient stays, mean we may need to look again at how we conceptualise the avoidable admission. A major challenge of research in this area is the lack of a single, consistently applied definition of an avoidable admission.4 Academics and clinicians alike have long sought a concise and utilitarian way to define exactly who these patients might be, and in which circumstances alternative care is practical and appropriate. One approach is to define this cohort according to a disease or illness for which there exists a viable care pathway that does not require an inpatient stay. Ambulatory care sensitive conditions (ACSCs) are one such classification, defining conditions where effective person-centred community care may prevent the need for hospital admission.5 Along with others, we have previously utilised a nuanced version of this definition — primary care sensitive conditions (PCSCs) — in which the list of conditions is extended to include ‘situations’ that may not themselves be diagnoses or illnesses, but which may be amenable to timely and holistic primary care input to avoid an admission (for example, social care crises).6 Similarly, the term urgent care sensitive conditions (UCSCs) has been used in the literature to describe when same-day urgent care may prevent further resource use,7 although the definition of urgent care is not itself universally agreed. Basing the study of avoidable admissions on ASCSs alone, however, results in an incomplete understanding of the phenomenon. Recent analysis identified a complex relationship between ACSCs, admissions, and ‘preventable’ emergency care.8 The potential ability of primary care to decrease the number of admissions due to ","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84839840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dealing with symptoms in the general population: lessons learned from the Danish Symptom Cohort","authors":"K. Balasubramaniam, S. Rasmussen, P. Haastrup, L. M. S. Sætre, J. Søndergaard, D. Jarbøl","doi":"10.3399/bjgp22x720713","DOIUrl":"https://doi.org/10.3399/bjgp22x720713","url":null,"abstract":"symptoms ranging from barely noticeable sensations to disturbing discomforts. The causes vary from normal physiological processes and self-limiting benign conditions to life-threatening diseases. Symptom experiences do not occur as stand-alone events but are influenced by an interchange of biological, psychological, and cultural factors, leading to various ways of interpreting and managing symptoms.1 Consequently, many symptoms are managed privately without consulting the healthcare system;2 however, some symptoms should lead to further investigation as they are alarming from a healthcare perspective and timely investigation is warranted.3,4 GPs play an important role in helping patients interpret symptoms;5 however, the healthcare-seeking process is not simple, and numerous factors, including previous experiences, social relations, and support, may contribute in deciding whether or not to seek health care.6 To elucidate how symptoms are interpreted and managed in the general population, we initiated the Danish Symptom Cohort (DaSC), a nationwide webbased survey. In 2012, we invited 100 000 randomly selected individuals aged >20 years to complete a questionnaire covering 44 predefined symptoms comprising both cancer symptoms as well as common symptoms, for example, back pain, urinary incontinence, and tiredness. If responders confirmed a symptom experience, followup questions were asked concerning onset, influence on daily activities, concerns about the symptom, whether the responder had consulted the GP regarding the symptom, and considerations about contacting the GP with the symptom in question. Responders were also asked about smoking status, alcohol intake, and physical activity. For the invitees, socioeconomic status (education, income, cohabitation status, ethnicity, and labour market affiliation) were then collected from national registers7–11 and linked to survey data. In this editorial we summarise the findings from the DaSC studies, highlighting the lessons learned but also pointing to what needs to be further explored in the 10-year follow-up questionnaire, DaSC II, which was distributed in May 2022. The 34 current publications deriving from the DaSC are available online,12 with details of the results and contextualisation of findings within the existing literature.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78005122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practice and the Medical Licensing Assessment","authors":"D. McKechnie, Neelam A. Parmar, Sarah Armstrong, Lucy Pratt, L. Pope, H. Alberti, Sophie Park","doi":"10.3399/bjgp22x720905","DOIUrl":"https://doi.org/10.3399/bjgp22x720905","url":null,"abstract":"","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85055612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actively tackling inactivity","authors":"Steve Haake, Simon Tobin","doi":"10.3399/bjgp22x720497","DOIUrl":"https://doi.org/10.3399/bjgp22x720497","url":null,"abstract":"","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80226389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video consultations: a potential gamechanger in clinical education","authors":"Richard Darnton, Richard Thomson, J. McKimm","doi":"10.3399/bjgp22x720509","DOIUrl":"https://doi.org/10.3399/bjgp22x720509","url":null,"abstract":"","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82916419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women.","authors":"Rebecca Landy, Tony Hollingworth, Jo Waller, Laura Av Marlow, Jane Rigney, Thomas Round, Peter D Sasieni, Anita Ww Lim","doi":"10.3399/BJGP.2021.0708","DOIUrl":"10.3399/BJGP.2021.0708","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer incidence and mortality are high in women aged ≥65 years, despite the disease being preventable by screening. Speculum-based screening can become more uncomfortable after the menopause.</p><p><strong>Aim: </strong>To examine test performance and acceptability of human papillomavirus (HPV) testing on clinician-collected vaginal samples without a speculum (non-speculum).</p><p><strong>Design and setting: </strong>Cross-sectional study in 11 GP practices and four colposcopy clinics in London, UK, between August 2017 and January 2019.</p><p><strong>Method: </strong>Non-speculum and conventional (speculum) samples were collected from women aged ≥50 years attending for a colposcopy (following a speculum HPV-positive screening result) or women aged ≥35 years (with confirmed cervical intraepithelial neoplasia (CIN) 2+), and women aged 50-64 years attending routine screening. Sensitivity to CIN2+ was assessed among women with confirmed CIN2+ (colposcopy). Specificity to HPV relative to speculum sampling and overall concordance was assessed among women with negative cytology (routine screening).</p><p><strong>Results: </strong>The sensitivity of non-speculum sampling for detecting CIN2+ was 83.3% (95% confidence interval [CI] = 60.8 to 94.2) (<i>n</i> = 15/18). There was complete concordance among women with positive CIN2+ who had a speculum sample ≤91 days prior to the non-speculum sample (<i>n</i> = 12). Among 204 women with negative cytology, the specificity to HPV was 96.4% (95% CI = 92.7 to 98.5), with 96.6% concordant results (κ 72.4%). Seventy-one percent (<i>n</i> = 120/170) of women preferred a non-speculum sample for their next screen.</p><p><strong>Conclusion: </strong>HPV testing on non-speculum clinician-taken samples is a viable approach that warrants further exploration in larger studies. Overall test performance was broadly comparable with that of self-sampling.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9183459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84128446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological impact of the COVID-19 pandemic on primary care workers: a cross-sectional study.","authors":"Enric Aragonès, Isabel Del Cura-González, Lucía Hernández-Rivas, Elena Polentinos-Castro, Maria Isabel Fernández-San-Martín, Juan A López-Rodríguez, Josep M Molina-Aragonés, Franco Amigo, Itxaso Alayo, Philippe Mortier, Montse Ferrer, Víctor Pérez-Solà, Gemma Vilagut, Jordi Alonso","doi":"10.3399/BJGP.2021.0691","DOIUrl":"10.3399/BJGP.2021.0691","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has had a major impact on the mental health of healthcare workers, yet studies in primary care workers are scarce.</p><p><strong>Aim: </strong>To investigate the prevalence of and associated factors for psychological distress in primary care workers during the first COVID-19 outbreak.</p><p><strong>Design and setting: </strong>This was a multicentre, cross-sectional, web-based survey conducted in primary healthcare workers in Spain, between May and September 2020.</p><p><strong>Method: </strong>Healthcare workers were invited to complete a survey to evaluate sociodemographic and work-related characteristics, COVID-19 infection status, exposure to patients with COVID-19, and resilience (using the Connor-Davidson Resilience Scale), in addition to being screened for common mental disorders (depression, anxiety disorders, post-traumatic stress disorder, panic attacks, and substance use disorder). Positive screening for any of these disorders was analysed globally using the term 'any current mental disorder'.</p><p><strong>Results: </strong>A total of 2928 primary care professionals participated in the survey. Of them, 43.7% (95% confidence interval [CI] = 41.9 to 45.4) tested positive for a current mental disorder. Female sex (odds ratio [OR] 1.61, 95% CI = 1.25 to 2.06), having previous mental disorders (OR 2.58, 95% CI = 2.15 to 3.10), greater occupational exposure to patients with COVID-19 (OR 2.63, 95% CI = 1.98 to 3.51), having children or dependents (OR 1.35, 95% CI = 1.04 to 1.76 and OR 1.59, 95% CI = 1.20 to 2.11, respectively), or having an administrative job (OR 2.24, 95% CI = 1.66 to 3.03) were associated with a higher risk of any current mental disorder. Personal resilience was shown to be a protective factor.</p><p><strong>Conclusion: </strong>Almost half of primary care workers showed significant psychological distress. Strategies to support the mental health of primary care workers are necessary, including designing psychological support and resilience-building interventions based on risk factors identified.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9037185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78482608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Melanoma risk assessment and management: a qualitative study among Australian GPs","authors":"Balakumar Anandasivam, Michael Tam, K. McGeechan, K. Price, Katrina Mclean, M. Tracy, J. Hall, Andrew Knight, K. Vuong","doi":"10.3399/BJGP.2021.0668","DOIUrl":"https://doi.org/10.3399/BJGP.2021.0668","url":null,"abstract":"Background Preventive guidelines for melanoma recommend that patients at high risk of melanoma receive targeted screening; however, this requires careful selection of those at high risk. To the authors’ knowledge, there has been no previous research into how all physicians approach the selection and management of high-risk individuals. Melanoma risk-prediction models are available to assist in the identification of high-risk patients but are not routinely used clinically. Aim To examine how GPs assessed and managed melanoma risk, and the opportunities for using melanoma risk-prediction models in primary care. Design and setting Semi-structured telephone interviews were conducted with 20 Australian GPs. Method GPs who had completed a cross-sectional online questionnaire study on melanoma risk were purposively sampled and recruited. Semi-structured telephone interviews were conducted with Australian GPs between 9 July and 10 September 2019. Interviews were audiorecorded, professionally transcribed, and analysed using grounded theory. Results Melanoma risk assessment and its management can be understood as a linear workflow consisting of five clinical process domains with patient selection as the entry point. There was variation between GPs on the identification of melanoma risk factors, melanoma risk estimation, management, and patient education because of intuitive and analytical processes guiding risk assessment, and the influence of patient factors. GPs were largely receptive towards melanoma risk-prediction models, sharing facilitators for and barriers to their potential implementation. Conclusion Further primary care interventions sensitive to existing workflow arrangements may be required to standardise melanoma risk-assessment and management processes.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82185476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}