The British journal of general practice : the journal of the Royal College of General Practitioners最新文献

{"title":"'It's not just thrush, it's recurrent thrush': a qualitative study of patient and clinician perspectives on diagnosing recurrent vulvovaginal candidiasis.","authors":"Tori Ford, Sue Ziebland, Sarah Tonkin-Crine, Gail Hayward, Abigail McNiven","doi":"10.3399/BJGP.2025.0437","DOIUrl":"10.3399/BJGP.2025.0437","url":null,"abstract":"<p><strong>Background: </strong>Existing qualitative research reports patient dissatisfaction with diagnostic processes for recurrent vulvovaginal thrush in primary care. This dissatisfaction centres on perceived diagnostic delays and a lack of clinical awareness of guidelines.</p><p><strong>Aim: </strong>To understand how patients and healthcare professionals experience and perceive the diagnostic process for recurrent thrush in UK primary care and what can be learned to improve diagnostic pathways, clinical encounters, and patient experiences.</p><p><strong>Design and setting: </strong>A qualitative study of patient experiences with recurrent vulvovaginal thrush and healthcare professional perspectives about providing care was undertaken.</p><p><strong>Method: </strong>Qualitative interviews were conducted with 32 people who self-identified as having recurrent thrush and 25 healthcare professionals working in primary care and sexual health services in England. Data were analysed using reflexive thematic analysis to develop themes across and within the datasets. The Candidacy Framework was then applied to interpret findings in relation to access to diagnosis and care. Patient and public involvement informed topic guide development and interpretation of results.</p><p><strong>Results: </strong>Differing expectations, perceptions, or understanding of recurrent thrush led patients to perceive missed opportunities in diagnostic pathways. The diagnostic process by which patients and primary care professionals identified recurrent thrush is presented through the candidacy framework stages of: identifying candidacy; navigating services and permeability; (re)appearing at services; adjudication; and offers and resistance.</p><p><strong>Conclusion: </strong>Diagnosis was recognised as a complex process that involved identifying patterns of recurrence, documenting this recurrence, accessing testing, interpreting test results, and forming a diagnosis as a label that opened up management pathways. Implications for practice are presented.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e644-e653"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146109440","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":"Impact of structured medication reviews on prescribing in English primary care: a retrospective observational cohort study.","authors":"James P Sheppard, Paul A Bateman, Cynthia Wright-Drakesmith, Christopher Elles Clark, Rebecca K Barnes, Andrew Paul Clegg, Gary A Ford, Seema Gadhia, William Hinton, Fd Richard Hobbs, Sundus Jawad, Kamlesh Khunti, Gregory Yh Lip, Simon de Lusignan, Jonathan Mant, Deborah McCahon, Bernardo Meza-Torres, Rupert A Payne, Rafael Perera-Salazar, Claire Reidy, Anna Seeley, Samuel Seidu, Katherine Tucker, Rik van der Veen, Marney Williams, Richard J McManus","doi":"10.3399/BJGP.2025.0617","DOIUrl":"10.3399/BJGP.2025.0617","url":null,"abstract":"<p><strong>Background: </strong>Structured medication reviews (SMRs) were introduced in 2020 to address polypharmacy in patients most at risk of medicines-related harm.</p><p><strong>Aim: </strong>To evaluate the impact of SMRs on prescribing in primary care.</p><p><strong>Design and setting: </strong>Retrospective observational cohort study of electronic health records from patients aged ≥65 years, prescribed ≥1 medications, and fulfilling the specific eligibility criteria for an SMR, registered at practices contributing data to the Oxford Clinical Informatics Digital Hub, between 1 April 2020 and 30 September 2022.</p><p><strong>Method: </strong>The association between SMRs and prescription changes was examined by matching individuals who received an SMR to individuals who did not receive an SMR, according to age, sex, and primary care practice, using cumulative density sampling. Analyses were undertaken using adjusted logistic regression.</p><p><strong>Results: </strong>Of 635 698 eligible patients, 82 285 (12.9%, 95% confidence interval [CI] = 12.9 to 13.0) received ≥1 SMR during the study observation period. In those prescribed potentially inappropriate drug combinations prior to an SMR, between 12.5% and 40.0% were corrected up to 3 months later. In matched analyses, SMRs were most strongly associated with an increase in new prescriptions of angiotensin-converting enzyme inhibitors (adjusted odds ratio [aOR] 1.56, 95% CI = 1.35 to 1.81), statins (aOR 1.78, 95% CI = 1.57 to 2.02), and antidepressants (aOR 1.45, 95% CI = 1.28 to 1.63). SMRs were also most strongly associated with stopping these drug classes in those previously prescribed treatment.</p><p><strong>Conclusion: </strong>SMRs were associated with starting new medications and stopping existing prescriptions compared with usual care. Further work is needed to understand if these changes improved patient outcomes.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e603-e612"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701565","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":"What deters GPs from talking about sexual assault?","authors":"Fiona E van Zyl-Bonk, Toine Lm Lagro-Janssen, Doreth Am Teunissen","doi":"10.3399/bjgp26X746145","DOIUrl":"10.3399/bjgp26X746145","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"347"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633593","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":"Letting the island come to you: can GPs be wayfinders?","authors":"Ben Hoban","doi":"10.3399/bjgp26X746301","DOIUrl":"10.3399/bjgp26X746301","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"372"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633584","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":"The Strait of Hormuz and global antibiotic security.","authors":"Seyed Aria Nejadghaderi, Sahar Saeedi Moghaddam, Mohammad Sharif Razai, Hamid Sharifi, Michael Stolpe","doi":"10.3399/bjgp26X746217","DOIUrl":"10.3399/bjgp26X746217","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"364"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633597","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":"The weight of ordinary things.","authors":"Jonathan Sunkersing","doi":"10.3399/bjgp26X746181","DOIUrl":"10.3399/bjgp26X746181","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"361"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633603","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":"Ambient scribes in general practice - help or hindrance?","authors":"Emma Ladds, Eleanor Barry, Sharon Dixon, Francesca H Dakin","doi":"10.3399/BJGP.2026.0097","DOIUrl":"10.3399/BJGP.2026.0097","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"376-379"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633578","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":"Adults with hypertension: recommendations for minimum standards rather than optimal monitoring?","authors":"Nicholas R Jones, Clare J Taylor, Fd Richard Hobbs","doi":"10.3399/BJGP.2026.0147","DOIUrl":"10.3399/BJGP.2026.0147","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"344-345"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633582","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":"Books: My Fourth Time, we Drowned: Seeking Refuge on the World's Deadliest Migration Route.","authors":"Rebecca Quinn","doi":"10.3399/bjgp26X746277","DOIUrl":"https://doi.org/10.3399/bjgp26X746277","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 769","pages":"369-370"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633588","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":"Point-of-care biomarkers or laboratory-based tests to reduce antibiotic prescribing for COPD exacerbations: a literature review and meta-analysis in primary care.","authors":"Mathieu Frénois, Roxane Fovet, David Wyts, Claire Collins, Matthieu Calafiore, Christophe Berkhout","doi":"10.3399/BJGP.2025.0593","DOIUrl":"10.3399/BJGP.2025.0593","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are frequently treated with antibiotics in primary care, leading to antibiotic resistance and adverse effects. Assessing biomarkers might assist in reducing unnecessary antibiotic prescribing when used alongside clinical assessment.</p><p><strong>Aim: </strong>To evaluate the benefit of reviewing biomarkers in point-of-care testing (POCT) within practices and through laboratory blood tests in efforts to decrease antibiotic prescribing for AECOPD.</p><p><strong>Design and setting: </strong>Systematic review of randomised controlled trials (RCTs) and non-randomised studies conducted in primary care from January 2022 to November 2025 assessing POCTs for chronic obstructive pulmonary disease (COPD).</p><p><strong>Method: </strong>The primary outcome was the rate of antibiotic prescribing or use, and secondary outcomes were biomarker thresholds for prescribing antibiotics and patient harm. Searches were conducted in four medical databases, six registers, and COPD academic societies. Data were extracted and assessed for quality and bias. A meta-analysis was performed whenever possible.</p><p><strong>Results: </strong>A total of seven studies were included: one RCT and four non-randomised studies for C-reactive protein (CRP) POCT; and two RCTs on procalcitonin (PCT) in laboratories. The meta-analysis of CRP POCT indicated a statistically significant reduction in antibiotic prescribing (odds ratio 0.41, 95% confidence interval = 0.32 to 0.53; <i>I</i>² = 36%; low certainty of evidence). No meta-analysis for PCT was feasible.</p><p><strong>Conclusion: </strong>CRP POCT reduced antibiotic prescribing for AECOPD in primary care settings when used alongside clinical assessment. There were insufficient data to draw conclusions about the PCT biomarker.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e681-e692"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849120","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}