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

{"title":"Books: The Golden Rule: Lessons in Living from a Doctor of Ageing.","authors":"Frances da Cunha","doi":"10.3399/bjgp26X746265","DOIUrl":"https://doi.org/10.3399/bjgp26X746265","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":"368-369"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633579","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":"So much universe, and so little time.","authors":"Andrew Papanikitas","doi":"10.3399/bjgp26X746169","DOIUrl":"10.3399/bjgp26X746169","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":"360"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633583","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":"Management and long-term serum urate control in gout: a population-based primary care cohort study.","authors":"Maria Antonia Pou, Carlen Reyes, Daniel Martinez-Laguna, Pau Satorra, Cristian Tebe, Nicola Dalbeth, Cesar Diaz-Torne","doi":"10.3399/BJGP.2025.0788","DOIUrl":"10.3399/BJGP.2025.0788","url":null,"abstract":"<p><strong>Background: </strong>Gout is a prevalent chronic inflammatory disease associated with a substantial clinical and cardiovascular burden. Despite the availability of effective urate-lowering therapies (ULTs), gout management remains suboptimal.</p><p><strong>Aim: </strong>To describe clinical characteristics and treatment patterns, and to identify factors associated with long-term serum urate (SU) control in gout.</p><p><strong>Design and setting: </strong>Retrospective population-based cohort study using the primary care research database 'Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària' (SIDIAP), covering >75% of the Catalan population within a universal healthcare system.</p><p><strong>Method: </strong>Individuals with incident gout diagnosed between 2012 and 2023 were included. Demographic, clinical, and ULT data were collected. Good SU control was defined as SU levels <6 mg/dL for ≥80% of follow-up time. Factors associated with SU control were analysed.</p><p><strong>Results: </strong>A total of 94 759 patients were included (mean age 66.25 [standard deviation 14.64] years; 79.58% male [75 412/94 759]; median follow-up 5.44 [interquartile range 2.54-8.24] years). In the 94 759 patients, hypertension (65.15%, <i>n</i> = 61 732), dyslipidaemia (50.58%, <i>n</i> = 47 932), diabetes (24.19%, <i>n</i> = 22 919), and chronic kidney disease (32.80%, 27 013/82 270 ) were common. Of the patients, 88.95% (<i>n</i> = 84 288) had ≥1 SU measurement. In total, 37.30% (35 343/94 759) had never received ULT. Allopurinol was the initial therapy in 96.09% of treated patients. Only 12.40% (10 453/84 288) achieved good SU control, with no improvement over time. Short ULT duration (≤25 days) occurred in 15.92% (9459/59 416) of patients. Good control was associated with longer treatment duration, higher allopurinol doses, febuxostat use, and better adherence, whereas delayed ULT initiation, male sex, obesity, chronic kidney disease, dyslipidaemia, and hypertension were associated with poor control.</p><p><strong>Conclusion: </strong>Long-term SU control in gout remains poor in primary care. Early initiation of ULT, appropriate dose optimisation, and improved adherence represent key modifiable targets to improve gout management.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e624-e633"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166840","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":"Medicines as infrastructure.","authors":"Nada Khan","doi":"10.3399/bjgp26X746109","DOIUrl":"10.3399/bjgp26X746109","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":"339"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633572","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":"Corrections.","authors":"","doi":"10.3399/bjgp26X745941","DOIUrl":"10.3399/bjgp26X745941","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":"348"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633591","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":"Evidence-based blood tests for monitoring adults with hypertension in primary care: rapid review, routine data analyses, and consensus study.","authors":"Martha M C Elwenspoek, Rachel O'Donnell, Catalina Lopez Manzano, Sarah Dawson, Lewis F Buss, Katie Charlwood, Christina Stokes, Francesco Palma, Alastair D Hay, Penny F Whiting, Jessica Watson","doi":"10.3399/BJGP.2025.0209","DOIUrl":"10.3399/BJGP.2025.0209","url":null,"abstract":"<p><strong>Background: </strong>Substantial variation in testing rates in adults with hypertension across UK primary care suggest that patients are not receiving optimal monitoring.</p><p><strong>Aim: </strong>To develop a minimal set of evidence-based blood tests for adults with hypertension.</p><p><strong>Design and setting: </strong>This was a rapid review, routine data analyses, and consensus study. It was set in primary care.</p><p><strong>Method: </strong>This study examined the rationale and evidence for tests recommended by guidelines or used commonly in adults with hypertension using stepwise rapid evidence reviews. A consensus group, including clinicians and patients, voted to include or exclude each test in the testing panel based on the evidence. If there was no consensus (>80%), additional evidence was sought through rapid reviews or analyses of primary care records, which was subject to further voting.</p><p><strong>Results: </strong>Sixteen routinely ordered tests were identified. The study found consistent, good evidence that estimated glomerular filtration rate (eGFR) to detect chronic kidney disease and glycosylated haemoglobin (HbA1c) to detect diabetes is beneficial for patients. The study found no or inconsistent evidence of the benefit of routinely measuring lipids, electrolytes, haemoglobin, thyroid function, clotting biomarkers, calcium, ferritin, folate acid, or vitamin B12. Good evidence was found that there is no benefit in routinely monitoring liver function, inflammation markers, or brain natriuretic peptide.</p><p><strong>Conclusion: </strong>A minimal set of evidence-based blood tests to monitor adults with hypertension was identified. This panel includes eGFR, HbA1c, potassium, and sodium. Implementing these recommendations could reduce harms associated with unwarranted variation in care. Further research is needed to clarify the role of tests with inconsistent evidence and determine the optimal frequency of testing.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e663-e672"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914543","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 treatment duration on the effectiveness of opioid analgesia: a systematic review and meta-analysis.","authors":"Liesbeth S Froentjes, Catherine Am Barrington, Rodger A Craig, Mareiz Morcos, Dawn M Wedman, Christina S Korowynk, Michael D Kelmer, Farah N Campbell, Scott R Garrison","doi":"10.3399/BJGP.2025.0705","DOIUrl":"10.3399/BJGP.2025.0705","url":null,"abstract":"<p><strong>Background: </strong>Opioid use can heighten pain perception over time.</p><p><strong>Aim: </strong>To determine whether the effectiveness of opioid analgesia diminishes with treatment duration in those with chronic low back pain or osteoarthritis.</p><p><strong>Design and setting: </strong>Systematic review of randomised trials comparing opioids with placebo/opioid-minimised pain management strategies in those with chronic low back pain or osteoarthritis.</p><p><strong>Method: </strong>A random-effects meta-analysis using MEDLINE, Embase, CENTRAL, and Scopus databases was undertaken in January 2025. The primary outcome was attainment of clinically important pain relief ('moderate' or ≥30% improvement). The secondary outcome was on-treatment pain (100-point scale). The primary analysis was difference in primary/secondary outcomes across short-term (≤4 weeks), intermediate-term (4-12 weeks), and long-term (≥12 weeks) duration subgroups.</p><p><strong>Results: </strong>In total, 27 trials were eligible for inclusion. Clinically important pain relief differed significantly between short-, intermediate-, and long-term treatment durations (<i>P</i> = 0.05). Opioid recipients were more likely to be responders in short-term trials (eight trials, risk ratio [RR] 1.42, 95% confidence interval [CI] = 1.08 to 1.89, moderate-certainty evidence), but not in intermediate-term trials (three trials, RR 1.04, 95% CI = 0.84 to 1.30, low-certainty evidence), or long-term trials (nine trials, RR 0.91, 95% CI = 0.73 to 1.14, moderate-certainty evidence), which trended in favour of controls. The mean difference in pain scores failed to reach this review's definition of clinical significance (≥10 points) for any timepoint, but was statistically significant in the short and intermediate term.</p><p><strong>Conclusion: </strong>Although opioids likely provide meaningful pain relief over short durations (≤4 weeks), they appear to provide little or no benefit beyond placebo over longer periods, and may worsen pain control beyond 12 weeks.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e634-e643"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848217","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: Immune health: a Myth-Busting guide.","authors":"Andrew Papanikitas","doi":"10.3399/bjgp26X746289","DOIUrl":"https://doi.org/10.3399/bjgp26X746289","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":"371"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633585","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":"Exhibition.","authors":"Hector Watson, Elizabeth Walton","doi":"10.3399/bjgp26X746253","DOIUrl":"10.3399/bjgp26X746253","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":"366-367"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633574","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":"Structured medication reviews: prescribing change is not the same as medicines optimisation.","authors":"Kinan Mokbel","doi":"10.3399/bjgp26X746121","DOIUrl":"10.3399/bjgp26X746121","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":"346"},"PeriodicalIF":5.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633589","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}