British Journal of General Practice最新文献

{"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":5.2,"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":5.2,"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}

{"title":"GP records and asylum claims.","authors":"Jo Miller","doi":"10.3399/bjgp25X741393","DOIUrl":"10.3399/bjgp25X741393","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"204"},"PeriodicalIF":5.1,"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":"Digital maturity: towards a strategic approach.","authors":"Trisha Greenhalgh, Rebecca Payne","doi":"10.3399/bjgp25X741357","DOIUrl":"10.3399/bjgp25X741357","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"200-202"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063303","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":"Diagnosis and management of cancer recurrence: a clinical update for GPs.","authors":"Rosie Mew, Richard D Neal","doi":"10.3399/bjgp25X741549","DOIUrl":"10.3399/bjgp25X741549","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"231-233"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042916","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":"For the attention of Doctor Nemo.","authors":"Andrew Papanikitas","doi":"10.3399/bjgp25X741441","DOIUrl":"10.3399/bjgp25X741441","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"218"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028282","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":"General practice chest X-ray rate is associated with earlier lung cancer diagnosis and reduced all-cause mortality: a retrospective observational study.","authors":"Stephen H Bradley, Richard D Neal, Matthew Ej Callister, Benjamin Cornwell, William T Hamilton, Gary A Abel, Bethany Shinkins, Richard B Hubbard, Matthew E Barclay","doi":"10.3399/BJGP.2024.0466","DOIUrl":"10.3399/BJGP.2024.0466","url":null,"abstract":"<p><strong>Background: </strong>Evidence is equivocal on whether general practice rates of investigation in symptomatic patients using chest X-ray (CXR) affect outcomes.</p><p><strong>Aim: </strong>To determine whether there is an association between rates of CXR requested in general practice and lung cancer outcomes.</p><p><strong>Design and setting: </strong>Observational study using data on English general practices.</p><p><strong>Method: </strong>Cancer registry data for patients diagnosed with lung cancer in 2014-2018 were linked to data on general practice CXRs from 2013 until 2017. Cancer stage at diagnosis (I/II versus III/IV) and 1-year and 5-year survival rates (conditional on survival to 1 year) post-diagnosis were reported by general practice quintile of CXR rate, with adjustment for population differences (age, smoking, prevalence of chronic obstructive pulmonary disease and heart failure, ethnicity, and deprivation) and by unadjusted category (low, medium, and high).</p><p><strong>Results: </strong>In total, 192 631 patient records and CXR rates for 7409 practices were obtained. Practices in the highest quintile of CXR rate had fewer cancers diagnosed at stage III/IV compared with those in the lowest quintile (odds ratio [OR] 0.87, 95% confidence interval [CI] = 0.83 to 0.92, <i>P</i><0.001). The association was weaker for the high unadjusted CXR category (OR 0.94, 95% CI = 0.91 to 0.97). For the highest adjusted quintile, hazard ratios (HRs) for death within 1 year and 5 years were 0.92 (95% CI = 0.90 to 0.95, <i>P</i><0.001) and 0.95 (95% CI = 0.91 to 0.99, <i>P</i> = 0.023), respectively. For the high unadjusted CXR category, the HR for 1-year survival was 0.98 (95% CI = 0.96 to 0.99, <i>P</i> = 0.004), with no association demonstrated for 5-year survival.</p><p><strong>Conclusion: </strong>Patients registered at general practices with higher CXR use have a favourable stage distribution and slightly better survival. This supports the use of CXR in promoting earlier diagnosis of symptomatic lung cancer in general practice.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e323-e332"},"PeriodicalIF":5.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911214","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":"Association between cancer risk assessment tool use and GP consultation duration: an observational study.","authors":"Emily Fletcher, John L Campbell, Emma Pitchforth, Luke Mounce, Willie Hamilton, Gary Abel","doi":"10.3399/BJGP.2024.0135","DOIUrl":"10.3399/BJGP.2024.0135","url":null,"abstract":"<p><strong>Background: </strong>England is short of GPs, and GP consultation rates, consultation duration, and workload are increasing. Electronic clinical decision support tools assist decision making for screening, diagnosis, and risk management. Cancer detection is one area in which tools are designed to support GPs, with some electronic risk assessment tools (eRATs) estimating the risk of current cancer based on symptoms.</p><p><strong>Aim: </strong>To explore any association between the impact of eRATs and GP workload and workflow during consultations.</p><p><strong>Design and setting: </strong>Observational sub-study.</p><p><strong>Method: </strong>Thirteen practices in England participating in a cluster randomised controlled trial of eRATs were recruited to the study. Using mixed-effects regression models, the average duration of consulting sessions and individual consultations in which eRATs were, or were not, activated were compared.</p><p><strong>Results: </strong>There was no evidence that consulting sessions in which an eRAT was activated were, on average, longer than sessions in which an eRAT had not been activated. However, after adjusting for a range of session and consultation characteristics, individual consultations involving an eRAT were longer, on average, by 3.96 minutes (95% confidence interval = 3.45 to 4.47; <i>P</i><0.001) when compared with consultations with no eRAT.</p><p><strong>Conclusion: </strong>There was no evidence to suggest that eRATs should not be used to support GPs in early cancer diagnosis from a workload perspective. Activation of eRATs was not associated with increased workload across a consulting session, despite a small increase in time observed in individual consultations involving eRATs. Ultimately, therefore, it should be definitive findings regarding the clinical effectiveness of eRATs, not the related workload/workflow implications, that determine whether the use of eRATs should be rolled out more widely.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e349-e356"},"PeriodicalIF":5.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717196","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":"Narrative failure.","authors":"Ben Hoban","doi":"10.3399/bjgp25X741501","DOIUrl":"10.3399/bjgp25X741501","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"225"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054624","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":"Yonder: Extended access, GP retention, registrar wellbeing interventions, and contacts post-paediatric admission.","authors":"Alex Burrell","doi":"10.3399/bjgp25X741489","DOIUrl":"10.3399/bjgp25X741489","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"224"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053126","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}