BJGP Open最新文献_第3页

Recognition and management of acute functional decline in older people living in care homes: a qualitative interview study with UK care home staff. 认识和管理急性功能衰退的老年人生活在养老院：一个定性访谈研究与英国养老院工作人员。

IF 2

BJGP Open Pub Date : 2025-09-24 DOI: 10.3399/BJGPO.2024.0252

Abigail Moore, Margaret Glogowska, Christopher Butler, Gail Hayward

{"title":"Recognition and management of acute functional decline in older people living in care homes: a qualitative interview study with UK care home staff.","authors":"Abigail Moore, Margaret Glogowska, Christopher Butler, Gail Hayward","doi":"10.3399/BJGPO.2024.0252","DOIUrl":"10.3399/BJGPO.2024.0252","url":null,"abstract":"Background: Older people living in care homes who experience acute functional decline pose a diagnostic challenge to GPs.Aim: We aimed to explore beliefs, practices, and experiences of UK care home staff who first recognise and respond to acute functional decline, including in the context of the COVID-19 pandemic.Design & setting: Qualitative interview study with 25 UK care home staff.Method: Semi-structured interviews were conducted by telephone between January 2021 and April 2022. Thematic analysis was facilitated by NVivo software.Results: Care home staff recognised acute functional decline as subtle changes from normal, which required knowing a resident well. However, it could be difficult to differentiate between an 'off day' and a more significant deviation, particularly for residents with a variable baseline. Acute functional decline caused anxiety to care home staff, in part due to the uncertainty about illness trajectory and outcome. They commonly considered urinary tract infection (UTI) to be a likely underlying cause. Some participants described a watch-and-wait approach or trying simple interventions, while others preferred escalating directly to outside clinical support. Triggers for escalation included perceived severity of illness, gut feeling, or failure to respond to initial supportive management.Conclusion: This study has highlighted the complexities around the identification and management of a care home resident experiencing acute functional decline. There was variation in interpretation and responding to these episodes within the care home. More work is needed to understand the physiology and risk profiles of acute functional decline, as well as any relationship to UTI.","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031270","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}

引用次数: 0

Artificial intelligence-driven exercise programmes in personalising the management of multimorbidity. 人工智能驱动的运动项目在个性化多病管理中的应用。

IF 2

BJGP Open Pub Date : 2025-09-24 DOI: 10.3399/BJGPO.2025.0094

Jacob Keast, Glenn Simpson, Lucy Smith, Hajira Dambha-Miller

引用次数: 0

Risk factors for poor prognosis in adult outpatient urinary tract infection: a meta-analysis. 成人门诊尿路感染预后不良的危险因素：meta分析。

IF 2

BJGP Open Pub Date : 2025-09-24 DOI: 10.3399/BJGPO.2024.0298

Peter K Kurotschka, Felix Kannapin, Andreas Klug, Maria Chiara Bassi, Ildikó Gágyor, Mark H Ebell

{"title":"Risk factors for poor prognosis in adult outpatient urinary tract infection: a meta-analysis.","authors":"Peter K Kurotschka, Felix Kannapin, Andreas Klug, Maria Chiara Bassi, Ildikó Gágyor, Mark H Ebell","doi":"10.3399/BJGPO.2024.0298","DOIUrl":"10.3399/BJGPO.2024.0298","url":null,"abstract":"Background: Risk factors for poor prognosis in outpatient urinary tract infection (UTI) vary across studies and clinical guidelines.Aim: To review the evidence on risk factors for poor prognosis in adults' UTI.Design & setting: Systematic review and meta-analysis of observational studies performed in the outpatient setting.Method: Five databases and citations of included studies were searched. Two reviewers independently screened studies, abstracted data, and assessed risk of bias (RoB). Random-effects meta-analysis of relative risks (RR) and adjusted odds ratios (aORs) were performed for risk factors reported by ≥3 studies.Results: Thirty-five cohort studies including 1 532 790 adults with cystitis or pyelonephritis (PN) were included. Ten were at moderate to high RoB. Increasing age was the only independent predictor of re-consultation (aOR 1.18 per decade). Hospitalisation was associated with high procalcitonin (PCT) (aOR 5.12), increasing age (aOR 3.51 if aged ≥65 years; aOR 1.27 per decade), hypotension (aOR 3.29), fever >38°C (aOR 2.08), elevated C-reactive protein (CRP) (aOR 1.62), creatinine ≥1.2 mg/dl (aOR 1.56), male sex (aOR 1.41), and diabetes (aOR 1.34). In the only study on mortality, among patients aged ≥65 years with cystitis, this outcome was associated with no antibiotics; older age; hospitalisation or antibiotics in prior month; higher comorbidity index; and smoking.Conclusion: Older age, male sex, elevated CRP, and diabetes are predictors of adverse outcomes in both patients with cystitis and PN. Elevated PCT, creatinine, hypotension, and fever predict hospitalisation in patients with PN only. These findings support risk stratification and patient management, but further studies are needed to consolidate knowledge on risk factors, especially for patients with cystitis.","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015495","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}

引用次数: 0

Attainment of medical student learning outcomes following general practice specialty trainee supervision: a pilot study. 在全科实习专业实习生监督下医学生学习成果的实现：一项试点研究。

IF 2

BJGP Open Pub Date : 2025-09-24 DOI: 10.3399/BJGPO.2024.0264

Julie Carson, Anna Frain, Heidi Emery, Edward Tyrrell, Daniel Crowfoot, Gurvinder Sahota, Emma Wilson, Jaspal Taggar

{"title":"Attainment of medical student learning outcomes following general practice specialty trainee supervision: a pilot study.","authors":"Julie Carson, Anna Frain, Heidi Emery, Edward Tyrrell, Daniel Crowfoot, Gurvinder Sahota, Emma Wilson, Jaspal Taggar","doi":"10.3399/BJGPO.2024.0264","DOIUrl":"10.3399/BJGPO.2024.0264","url":null,"abstract":"Background: Innovative training approaches are needed to address the lack of capacity in primary care for undergraduate medical student clinical placements. Near peer teaching (NPT) by general practice specialty trainees (GPSTs) is one possible solution.Aim: To compare the attainment of intended learning outcomes (ILOs) for students taught by GPSTs and qualified GPs.Design & setting: Quantitative pilot study of medical students undertaking clinical training in general practice at the University of Nottingham.Method: Year 3 GPSTs were trained to supervise first-year graduate-entry medical students undertaking 6 half-day GP visits (2022-2023). Using Likert-scale post-training questionnaires, self-reported attainment of ILOs was compared for supervision provided to students by GPSTs and GPs. Secondary outcomes included student, GPST, and GP views about NPT.Results: Of 112 medical students, seven were supervised by GPSTs and 105 by GPs. In total, 101 students responded (seven [100%] from GPST supervision; 94 [90%] from GP supervision). There was no significant difference between groups in attainment of seven ILOs with significantly greater attainment for students supervised by GPSTs for receiving feedback (P = 0.018) and self-reflection (P = 0.015). GPSTs reported improved organisation, communication, feedback skills, and desire for future student supervision. Medical students and GPs reported enthusiasm for future NPT by GPSTs.Conclusion: Attainment of ILOs during undergraduate GP placements was at least equivalent when students were supervised by GPSTs compared with GPs. GPSTs are an important group for building supervisory capacity for undergraduate education and this study adds confidence in enabling GPST supervision of undergraduates.","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040402","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}

引用次数: 0

GPs' views on green social prescribing in Scotland: analysis of a national cross-sectional survey. 苏格兰全科医生对绿色社会处方的看法：一项全国性横断面调查的分析。

IF 2

BJGP Open Pub Date : 2025-09-24 DOI: 10.3399/BJGPO.2024.0259

Helen Frost, Tricia R Tooman, Bruce Mason, Eddie Donaghy, Katie Hawkins, Sue Lewis, Maria Wolters, Stewart W Mercer

{"title":"GPs' views on green social prescribing in Scotland: analysis of a national cross-sectional survey.","authors":"Helen Frost, Tricia R Tooman, Bruce Mason, Eddie Donaghy, Katie Hawkins, Sue Lewis, Maria Wolters, Stewart W Mercer","doi":"10.3399/BJGPO.2024.0259","DOIUrl":"10.3399/BJGPO.2024.0259","url":null,"abstract":"Background: Green social prescribing (GSP) aims to link patients to nature-based health interventions (NBHIs) through GPs. However, knowledge of GPs' views on GSP is limited.Aim: To explore GPs' views on GSP and the factors influencing these views.Design & setting: National cross-sectional survey of GPs' working lives in Scotland, conducted in 2023, which included four questions about GSP.Method: Descriptive analysis of GPs' views of GSP and univariate and multivariate (binary logistic) analysis of factors influencing these views.Results: The survey found 79.6% (n = 1098) of GPs had heard of GSP, 81.3% (n = 1106) would be happy to refer patients to NBHIs, 67.8% (n = 931) thought GSP was suitable for older patients with multimorbidity, and 43.7% (n = 599) felt that patients living in deprived areas would access GSP. Greater knowledge of GSP was associated with White ethnicity (adjusted odds ratio [aOR] 2.04; 95% confidence interval [CI] = 1.30 to 3.22, P = 0.002) and the number of clinical sessions worked per week (aOR 0.90; 95% CI = 0.82 to 0.99, P = 0.034). Higher job satisfaction was associated with more positive views about the suitability of GSP for older patients with multimorbidity (aOR 1.14; 95% CI = 1.00 to 1.30; P = 0.043) as were views on whether patients living in deprived areas would access GSP (aOR 1.20; 95% CI = 1.03 to 1.33, P = 0.013). GPs working in deprived areas also had more positive views regarding whether patients living in deprived areas would access GSP (aOR 1.24; 95% CI = 1.06 to 1.45, P = 0.159).Conclusion: GPs in Scotland are aware of and willing to refer to GSP but have concerns about accessibility for patients from deprived areas. Views were influenced by personal and practice characteristics.","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031157","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}

引用次数: 0

'It gives a sense of purpose': a survey exploring GP registrars' views on relational continuity of care. “它给人一种使命感”——探索全科医生注册者对护理关系连续性的看法：一项调查。

IF 2

BJGP Open Pub Date : 2025-09-24 DOI: 10.3399/BJGPO.2025.0001

Helen Leach, Helen Atherton, Jeremy Dale

{"title":"'It gives a sense of purpose': a survey exploring GP registrars' views on relational continuity of care.","authors":"Helen Leach, Helen Atherton, Jeremy Dale","doi":"10.3399/BJGPO.2025.0001","DOIUrl":"10.3399/BJGPO.2025.0001","url":null,"abstract":"Background: Relational continuity of care has been shown to improve patient outcomes and clinician satisfaction. However, little is known about how GP registrars, the future workforce in general practice, experience this continuity, especially in the context of evolving workforces and increasing use of remote consultations.Aim: To explore GP registrars' views on relational continuity of care and identify personal, training, and practice factors that may influence these views, including the impact of digital or remote consulting.Design & setting: A cross-sectional online survey was conducted among GP registrars in the West Midlands, England. The survey explored registrars' experiences and attitudes towards relational continuity, including the impact of remote consulting.Method: The survey combined Likert-scale and multiple-choice questions with free-text responses. Quantitative data were analysed using descriptive statistics with logistic regression to identify personal and training factors that might influence views. Content analysis was used for qualitative data.Results: In total, 246 responses were received (estimated 14.5% response rate). Registrars valued relational continuity, particularly for patients with long-term conditions. Barriers such as rotational training, high workload, and limited appointment access were reported. Remote consulting was seen as challenging for building relationships but helpful for follow-up encounters. Few personal or training factors influenced views on relational continuity.Conclusion: Despite significant barriers, GP registrars highlighted the importance of relational continuity for patient care and clinician satisfaction. Further research is needed to explore how training models impact continuity, and how training and remote consulting can support the experience of relational continuity in practice.","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988262","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}

引用次数: 0

Acne management in Norway: GP and dermatologist prescriptions (2012-2019): a nationwide overview. 挪威的痤疮管理：全科医生和皮肤科医生处方（2012-2019），全国概况。

IF 2

BJGP Open Pub Date : 2025-09-24 DOI: 10.3399/BJGPO.2024.0211

Cathrine S Christiansen, Sigurd Høye, Morten Lindbaek, Jon Anders Halvorsen, Louise Emilsson

{"title":"Acne management in Norway: GP and dermatologist prescriptions (2012-2019): a nationwide overview.","authors":"Cathrine S Christiansen, Sigurd Høye, Morten Lindbaek, Jon Anders Halvorsen, Louise Emilsson","doi":"10.3399/BJGPO.2024.0211","DOIUrl":"10.3399/BJGPO.2024.0211","url":null,"abstract":"Background: Acne is common and associated with negative psychosocial health and risk of permanent skin alterations. GPs prescribe the main portion of antibiotics used for acne. Increased isotretinoin prescription by GPs can potentially reduce overall antibiotic use, but prescription practice and trends are unknown.Aim: To examine acne treatment in Norway and quantify prescription and initiation of isotretinoin and tetracyclines.Design & setting: An observational study linking data from health registries. Data were collected from the Norwegian Prescription Database (NorPD), the national GP claims register (KUHR database), and the Regular General Practitioner (RGP) registry.Method: All patients aged 12-39 years who received an acne diagnosis or were prescribed acne medication in Norway 2012-2019 were included. Linear regression was used to explore time trends.Results: In total, 316 075 patients were included (63% female). Yearly prevalence of systemic treatment increased from 1.9 in 2012 to 2.4% in 2019; isotretinoin increased by +123%, tetracyclines by +4% as measured in defined daily doses (DDDs). Topical treatment increased by +13% as measured by number of prescriptions. GP prescription of tetracyclines decreased 11%; however, courses had a mean duration of 160 days, which is longer than the recommended 90 days, and only 26% had a co-occurring topical treatment prescription. GPs initiated 5% of isotretinoin courses in 2012, versus 10% in 2019, and 19% (n = 1339) of GPs initiated isotretinoin at least once during the study period.Conclusion: GPs reduced their prescription of tetracyclines, but our data still show potential for further improvements in prescribing practice. Increased isotretinoin prescription by GPs may lead to reduced antibiotic use and better treatment regimens for moderate-to-severe acne.","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110894","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}

引用次数: 0

Remote versus in-person consultations for acute cystitis: antibiotic treatment and clinical outcomes, a retrospective cohort study. 急性膀胱炎的远程与现场咨询：抗生素治疗和临床结果，一项回顾性队列研究

IF 2

BJGP Open Pub Date : 2025-09-24 DOI: 10.3399/BJGPO.2025.0009

Lars Emil Aga Haugom, Knut Erik Emberland, Ingrid Keilegavlen Rebnord, Guri Rørtveit, Knut Eirik Ringheim Eliassen

{"title":"Remote versus in-person consultations for acute cystitis: antibiotic treatment and clinical outcomes, a retrospective cohort study.","authors":"Lars Emil Aga Haugom, Knut Erik Emberland, Ingrid Keilegavlen Rebnord, Guri Rørtveit, Knut Eirik Ringheim Eliassen","doi":"10.3399/BJGPO.2025.0009","DOIUrl":"10.3399/BJGPO.2025.0009","url":null,"abstract":"Background: The COVID-19 pandemic brought a surge of remote consultations in Norwegian primary care with unknown implications for antibiotic treatment and outcomes of acute cystitis.Aim: To examine whether there were differences in antibiotic treatment or repeat contacts for acute cystitis between remote and in-person consultations.Design & setting: A retrospective cohort study was undertaken. For the 4-year period from 2018-2021, we linked individual registry data on all contacts for cystitis by women aged ≥16 years in general practice and out-of-hours (OOH) services in Norway with registry data on dispensed antibiotics.Method: Index consultations for cystitis episodes were identified when there had been no urinary tract infection-related contacts or antibiotics dispensed at least 2 weeks before the consultation. We compared index remote versus index in-person consultations by antibiotic treatment within 3 days and repeat contacts within 14 days. Remote consultations were defined as consultations by text, telephone, or video.Results: Remote consultations for acute cystitis increased markedly, from 0.5% of acute cystitis consultations in 2018 to 15.2% in 2021. Index remote consultations were associated with more second-line antibiotic treatment (adjusted relative risk [aRR] 1.04, 95% confidence interval [CI] = 1.02 to 1.06, P<0.001), and more repeat contacts (aRR 1.11, 95% CI = 1.09 to 1.12, P<0.001) than in-person consultations.Conclusion: For acute cystitis, index remote consultations are associated with more second-line antibiotic treatment and more repeat contacts than in-person consultations. The unique time-period of the COVID-19 pandemic and the regular GP scheme in Norwegian primary care must be considered when interpreting these findings.","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754656","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}

引用次数: 0

Correction: Exploring patients' and carers' experiences, understandings and expectations of COPD exacerbations: an interview study. 更正：探讨患者和护理人员对COPD恶化的经历、理解和期望：一项访谈研究。

IF 2

BJGP Open Pub Date : 2025-09-18 DOI: 10.3399/BJGPO.2025.9998

引用次数: 0

Enhancing understanding of interventions to increase relational continuity in general practice: a realist review protocol. 加强对干预措施的理解，以增加全科实践中的关系连续性：现实主义审查方案。

IF 2

BJGP Open Pub Date : 2025-09-10 DOI: 10.3399/BJGPO.2025.0119

Serge Engamba, Jane Smith, Nada Khan, Kate Sidaway-Lee, Patrick Burch, Tom Marshall, Phil Evans, Denis Pereira Gray, Rob Anderson

{"title":"Enhancing understanding of interventions to increase relational continuity in general practice: a realist review protocol.","authors":"Serge Engamba, Jane Smith, Nada Khan, Kate Sidaway-Lee, Patrick Burch, Tom Marshall, Phil Evans, Denis Pereira Gray, Rob Anderson","doi":"10.3399/BJGPO.2025.0119","DOIUrl":"10.3399/BJGPO.2025.0119","url":null,"abstract":"Background: Relational continuity of care (RCC), which is characterised by an ongoing therapeutic relationship between patients and their primary care providers, is critical for ensuring high-quality care in general practice. Despite its importance, challenges such as staffing shortages, policy shifts, and evolving patient needs often impede its consistent delivery. With the new GP contract in England highlighting the need for primary care providers to monitor and deliver relational continuity, it is more than ever crucial to understand how best to achieve it.Aim: This realist review aims to explore how, why, and under what conditions interventions to improve relational continuity are successfully implemented in general practice.Design & setting: The review will be supported by an expert stakeholder panel and a patient advisory group to consider the diverse and dynamic settings of general practice, and generate contexts, mechanisms and outcomes configurations exploring how interventions to enhance RCC in general practice work.Method: Through the synthesis of diverse international evidence sources, including qualitative, quantitative, mixed-methods studies, and grey literature, the review will develop an understanding of the mechanisms that produce relational continuity, the contexts in which these mechanisms operate, and the outcomes they produce for the health system, practices, practitioners, and patients.Conclusion: The findings will provide data to inform future research and refine strategies and policies that support the effective delivery of relational continuity, which in turn may lead to improved patient outcomes and enhanced care experiences.","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765621","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}

引用次数: 0