British Journal of General Practice最新文献

{"title":"Evidence-based tests to monitor adults with type 2 diabetes mellitus in primary care: rapid reviews and consensus process.","authors":"Martha Maria Christine Elwenspoek, Rachel O'Donnell, Joni Jackson, Sarah Dawson, Katie Charlwood, Alastair D Hay, Jessica Watson, Penny Whiting","doi":"10.3399/BJGP.2024.0744","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0744","url":null,"abstract":"<p><p>Background When monitoring long-term conditions both over- and undertesting risk patient harm and increased healthcare costs. Aim To evaluate the evidence base for type 2 diabetes mellitus (T2DM) monitoring tests and develop methods for creating evidence-based testing strategies. Design and setting Rapid reviews, consensus process. Primary care. Method We identified tests that are recommended or used commonly to monitor T2DM. We created filtering questions to examine the rationale of each test, which were answered by stepwise rapid reviews of evidence cited by guidelines, systematic reviews, and individual studies. A consensus group of patient representatives and clinicians voted whether tests should be included or excluded based on the evidence or whether further evidence was needed. Results Of 15 tests, only HbA1c, to monitor disease progression and treatment response, and eGFR, to detect chronic kidney disease, have a strong evidence base. Based on available evidence and consensus group feedback, routinely testing for fructosamine to monitor disease progression; thyroid function, vitamin B12, ferritin, folate, clotting, bone profile, C-reactive protein, erythrocyte sedimentation rate, and B-type natriuretic peptide; and liver function for adverse treatment effects of metformin was deemed unnecessary. We found insufficient evidence for vitamin B12 to screen for adverse treatment effects, and lipids and haemoglobin for secondary conditions. Conclusion We found that the evidence-base for most T2DM monitoring tests is weak or absent. Clinicians should avoid non-evidence based tests unless there are additional clinical indications for testing. Standardised evidence-based testing panels for T2DM and other long-term conditions could reduce unnecessary testing.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of the general practice receptionist role and online services: qualitative study.","authors":"Stephanie Stockwell, Helen Atherton, Carol Bryce, John Campbell, Christine Marriott, Emma Pitchforth, Bethan Mair Treadgold, Rachel Winder, Jennifer Newbould","doi":"10.3399/BJGP.2024.0677","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0677","url":null,"abstract":"<p><p>Background General practice receptionists are perceived as the 'gatekeepers' to primary care services and are central to managing patient demand and facilitating patient care. This role is evolving and becoming increasingly complex in a digital world. Aim To consider the growing role of patient facing online services and the impact these have on the role of the general practice receptionist. Design and setting A focused ethnographic case study in eight general practices across England and 19 stakeholder interviews. Method Focused ethnographic case study and stakeholder interviews were conducted between September 2021 and July 2022. Results The receptionist role looks different across practices, but is now more varied and less repetitive than it has been historically. The volume of patients and number of channels by which patients contact the practice means that receptionists are dealing with increasingly complex demand management and navigation to appropriate services. This now includes online services, which has created a new element to the receptionist role - digital facilitation. The role is also largely navigated by the receptionists without any formal training and staff are mostly expected to learn on the job from other receptionists, leading to inconsistent practices. Conclusion The digitalisation of healthcare services impacts the workflow and consistency in task completion of general practice receptionist staff and has potential implications regarding job satisfaction and retention. In addition, the knowledge and skills required to fulfil this role are evolving and therefore may have recruitment and training implications.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is NICE failing to prioritise environmentally sustainable health care?","authors":"Emma Radcliffe, Sophie von Heimendahl","doi":"10.3399/bjgp25X741453","DOIUrl":"https://doi.org/10.3399/bjgp25X741453","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"219"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Globus: a practical guide for general practice.","authors":"Alex Watson, Rakesh Chopra, Anand Muddaiah","doi":"10.3399/bjgp25X741573","DOIUrl":"https://doi.org/10.3399/bjgp25X741573","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"237-238"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Books: <i>GPs, Politics and Medical Professional Protest in Britain, 1880-1948</i>: A history of GPs' concerns about workload, funding, and threats to independence.","authors":"Richard Vautrey","doi":"10.3399/bjgp25X741513","DOIUrl":"https://doi.org/10.3399/bjgp25X741513","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"226-227"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary care: the 'linchpin' in Lynch syndrome.","authors":"Kelly E Lloyd, Sarah Alderson","doi":"10.3399/bjgp25X741345","DOIUrl":"https://doi.org/10.3399/bjgp25X741345","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"198-199"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's the value of annual medical conferences?","authors":"Terry Kemple","doi":"10.3399/bjgp25X741477","DOIUrl":"https://doi.org/10.3399/bjgp25X741477","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"222-223"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GP records and asylum claims.","authors":"Jo Miller","doi":"10.3399/bjgp25X741393","DOIUrl":"https://doi.org/10.3399/bjgp25X741393","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"204"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future Health Today and patients at risk of undiagnosed cancer: a pragmatic cluster randomised trial of quality- improvement activities in general practice.","authors":"Sophie Chima, Javiera Martinez-Gutierrez, Barbara Hunter, Adrian Laughlin, Patty Chondros, Natalie Lumsden, Douglas Boyle, Craig Nelson, Paul Amores, An Tran-Duy, Jo-Anne Manski-Nankervis, Jon Emery","doi":"10.3399/BJGP.2024.0491","DOIUrl":"10.3399/BJGP.2024.0491","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing cancer in general practice is complex, given the non-specific nature of many presenting symptoms and the overlap of potential diagnoses.</p><p><strong>Aim: </strong>This trial aimed to evaluate the effectiveness of Future Health Today (FHT) - a technology that provides clinical decision support, auditing, and quality-improvement monitoring - on the appropriate follow-up of patients at risk of undiagnosed cancer.</p><p><strong>Design and setting: </strong>Pragmatic, cluster randomised trial undertaken in general practices in Victoria and Tasmania, Australia.</p><p><strong>Method: </strong>Practices were randomly assigned to receive recommendations for follow-up investigations for cancer (FHT cancer module) or the active control. Algorithms were applied to the electronic medical record, and used demographic information and abnormal test results that are associated with a risk of undiagnosed cancer (that is, anaemia/iron deficiency, thrombocytosis, and raised prostate-specific antigen) to identify patients requiring further investigation and provide recommendations for care. The intervention consisted of the FHT cancer module, a case-based learning series, and ongoing practice support. Using the intention-to-treat approach, the between-arm difference in the proportion of patients with abnormal test results who were followed up according to guidelines was determined at 12 months.</p><p><strong>Results: </strong>In total, 7555 patients were identified as at risk of undiagnosed cancer. At 12 months post-randomisation, 76.0% of patients in the intervention arm had received recommended follow-up (21 practices, <i>n</i> = 2820/3709), compared with 70.0% in the control arm (19 practices, <i>n</i> = 2693/3846; estimated between-arm difference = 2.6% [95% confidence interval (CI)] = -2.8% to 7.9%; odds ratio = 1.15 [95% CI = 0.87 to 1.53]; <i>P</i> = 0.332).</p><p><strong>Conclusion: </strong>The FHT cancer module intervention did not increase the proportion of patients receiving guideline-concordant care. The proportion of patients receiving recommended follow-up was high, suggesting a possible ceiling effect for the intervention.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e306-e315"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence for early detection of lung cancer in GPs' clinical notes: a retrospective observational cohort study.","authors":"Martijn C Schut, Torec T Luik, Iacopo Vagliano, Miguel Rios, Charles W Helsper, Kristel M van Asselt, Niek de Wit, Ameen Abu-Hanna, Henk Cpm van Weert","doi":"10.3399/BJGP.2023.0489","DOIUrl":"10.3399/BJGP.2023.0489","url":null,"abstract":"<p><strong>Background: </strong>The journey of >80% of patients diagnosed with lung cancer starts in general practice. About 75% of patients are diagnosed when it is at an advanced stage (3 or 4), leading to >80% mortality within 1 year at present. The long-term data in GP records might contain hidden information that could be used for earlier case finding of patients with cancer.</p><p><strong>Aim: </strong>To develop new prediction tools that improve the risk assessment for lung cancer.</p><p><strong>Design and setting: </strong>Text analysis of electronic patient data using natural language processing and machine learning in the general practice files of four networks in the Netherlands.</p><p><strong>Method: </strong>Files of 525 526 patients were analysed, of whom 2386 were diagnosed with lung cancer. Diagnoses were validated by using the Dutch cancer registry, and both structured and free-text data were used to predict the diagnosis of lung cancer 5 months before diagnosis (4 months before referral).</p><p><strong>Results: </strong>The algorithm could facilitate earlier detection of lung cancer using routine general practice data. Discrimination, calibration, sensitivity, and specificity were established under various cut-off points of the prediction 5 months before diagnosis. Internal validation of the best model demonstrated an area under the curve of 0.88 (95% confidence interval [CI] = 0.86 to 0.89), which shrunk to 0.79 (95% CI = 0.78 to 0.80) during external validation. The desired sensitivity determines the number of patients to be referred to detect one patient with lung cancer.</p><p><strong>Conclusion: </strong>Artificial intelligence-based support enables earlier detection of lung cancer in general practice using readily available text in the patient files of GPs, but needs additional prospective clinical evaluation.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e316-e322"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}