British Journal of General Practice最新文献

{"title":"Pilot postal birth cohort hepatitis C virus screening in UK primary care: HepCAPP study.","authors":"Ruth Simmons, Annabel A Powell, Samreen Ijaz, Sema Mandal, Justin Shute, Yasmin Mohammadi, Michael Lattimore, Kelsey McOwat, Hannah L Moore, Aisling O'Rourke, Monica Desai, John Macleod, Asra Asgharzadeh, Zoe Ward, Peter Vickerman, Ross J Harris, Graham R Foster, Kirsty Roberts, Matthew Hickman","doi":"10.3399/BJGP.2024.0219","DOIUrl":"10.3399/BJGP.2024.0219","url":null,"abstract":"<p><strong>Background: </strong>Birth cohort screening has been implemented in some countries to identify the potentially 'missed population' of people with undiagnosed chronic hepatitis C virus (HCV) who may not be found through targeted approaches.</p><p><strong>Aim: </strong>To determine uptake of HCV antibody testing using an oral swab screening method, the overall yield, whether those testing positive had risk markers in their primary care record, and the cost per case detected.</p><p><strong>Design and setting: </strong>This was a pilot screening study set in general practices in the Southwest of England, Yorkshire and Humber, and South London.</p><p><strong>Method: </strong>Participants consenting were sent an oral swab kit in the post and saliva samples were tested for antibodies to HCV.</p><p><strong>Results: </strong>In total, 16 436/98 396 (16.7%) patients consented and were sent an oral swab kit. Of these, 12 216 (12.4%) returned a kit, with 31 participants (yield 0.03%) testing positive for HCV antibodies. Of those positive, 14/35 (45%) had a risk marker for HCV on their primary care record. Two (yield 0.002%) were confirmed RNA positive and referred for treatment, both had HCV risk markers. The cost per case was £16 000 per HCV antibody detected and £247 997 per chronic HCV detected.</p><p><strong>Conclusion: </strong>Wide-scale screening could be delivered and identify people infected with HCV, however, most of these individuals could have been detected through lower-cost targeted screening. The yield and cost per case found in patients were substantially worse than model estimates and targeted screening studies. Birth cohort screening should not be rolled out in primary care in England.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e122-e128"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538976","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":"Better health for all: public health and general practice working together.","authors":"Kevin Fenton","doi":"10.3399/bjgp25X740541","DOIUrl":"10.3399/bjgp25X740541","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 751","pages":"55-56"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076619","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>Shattered: a Memoir</i>: The spark of life.","authors":"Maryam Naeem","doi":"10.3399/bjgp25X740685","DOIUrl":"https://doi.org/10.3399/bjgp25X740685","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 751","pages":"82-83"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076621","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":"Overcoming the monster.","authors":"Ben Hoban","doi":"10.3399/bjgp25X740625","DOIUrl":"10.3399/bjgp25X740625","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 751","pages":"75"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076627","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":"Assessing children who are acutely ill in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort study.","authors":"Amy Clark, Rebecca Cannings-John, Enitan D Carrol, Emma Thomas-Jones, Gerri Sefton, Alastair D Hay, Christopher C Butler, Kathryn Hughes","doi":"10.3399/BJGP.2023.0638","DOIUrl":"10.3399/BJGP.2023.0638","url":null,"abstract":"<p><strong>Background: </strong>Clinical tools are needed in general practice to help identify children who are seriously ill. The Liverpool quick Sequential Organ Failure Assessment (LqSOFA) was validated in an emergency department and performed well. The National Paediatric Early Warning System (PEWS) has been introduced in hospitals throughout England with hopes for implementation in general practice.</p><p><strong>Aim: </strong>To validate the LqSOFA and National PEWS in general practice.</p><p><strong>Design and setting: </strong>Secondary analysis of 6703 children aged <5 years presenting to 225 general practices in England and Wales with acute illnesses, linked to hospital data.</p><p><strong>Method: </strong>Variables from the LqSOFA and National PEWS were mapped onto study data to calculate score totals. A primary outcome of admission within 2 days of GP consultation was used to calculate sensitivity, specificity, negative predictive values (NPVs), positive predictive values (PPVs), and area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>A total of 104/6703 children were admitted to hospital within 2 days (pre-test probability 1.6%) of GP consultation. The sensitivity of the LqSOFA was 30.6% (95% confidence interval [CI] = 21.8% to 41.0%), with a specificity of 84.7% (95% CI = 83.7% to 85.6%), PPV of 3.0% (95% CI = 2.1% to 4.4%), NPV of 98.7% (95% CI = 98.4% to 99.0%), and AUC of 0.58 (95% CI = 0.53 to 0.63). The sensitivity of the National PEWS was 81.0% (95% CI = 71.0% to 88.1%), with a specificity of 32.5% (95% CI = 31.2% to 33.8%), PPV of 1.9% (95% CI = 1.5% to 2.5%), NPV of 99.1% (95% CI = 98.4% to 99.4%), and AUC of 0.66 (95% CI = 0.59 to 0.72).</p><p><strong>Conclusion: </strong>Although the NPVs appear useful, owing to low pre-test probabilities rather than discriminative ability, neither tool accurately identified admissions to hospital. Unconsidered use by GPs could result in unsustainable referrals.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e98-e104"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302184","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":"'Everyone has heard of it, but no one knows what it is': a qualitative study of patient understandings and experiences of herpes zoster.","authors":"Sophie Rees, Matthew Ridd, Lorelei Hunt, Hazel Everitt, Anna Gilbertson, Robert Johnson, Anthony E Pickering, Oliver van Hecke, Vikki Wylde, Sian Wells, Jonathan P Banks","doi":"10.3399/BJGP.2024.0025","DOIUrl":"10.3399/BJGP.2024.0025","url":null,"abstract":"<p><strong>Background: </strong>Shingles (herpes zoster), caused by reactivation of the varicella-zoster virus, is usually diagnosed and managed in primary care. The lifetime risk of shingles in the general population is approximately 30%, and it can have a detrimental effect on quality of life. There has been little qualitative research about patient experience and understanding of shingles.</p><p><strong>Aim: </strong>To explore patient experiences and understanding of shingles.</p><p><strong>Design and setting: </strong>Qualitative interviews with people with shingles recruited from primary care in England.</p><p><strong>Method: </strong>Qualitative semi-structured remote interviews were undertaken with 29 participants in a randomised controlled trial in primary care in England (ATHENA, ISRCTN14490832). Participants were aged >49 years and were diagnosed within 6 days of shingles rash onset. Interviewees were sampled for diversity in terms of pain, intervention adherence, age, gender, and ethnicity. Data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Interviews took place in November 2022 to April 2023. Participants' understanding of shingles was limited, particularly pre-diagnosis. A common theme was that 'everyone has heard of it, but no one knows what it is'. Television campaigns about the shingles vaccination programme helped some to recognise the rash. Shingles was understood as a disease with a variable prognosis, resulting in a sense of uncertainty about the significance when diagnosed. Participants reported a range of symptoms, which impacted on everyday life. Some people thought their diagnosis was caused by poor mental health or challenging life circumstances, a perception sometimes reinforced by healthcare professionals. Many participants sought meaning in their diagnosis, reflecting on, and sometimes changing, their life and circumstances.</p><p><strong>Conclusion: </strong>Primary care practitioners should be aware of the broad spectrum of patient knowledge, and the potential for better understanding to promote early attendance and treatment to reduce the impact of shingles.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e137-e142"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861741","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":"Poem: For Whom Do You Serve?","authors":"Callum Leese","doi":"10.3399/bjgp25X740661","DOIUrl":"https://doi.org/10.3399/bjgp25X740661","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 751","pages":"79"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076629","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":"Preconception indicators and associations with health outcomes reported in UK routine primary care data: a systematic review.","authors":"Danielle Schoenaker, Elizabeth M Lovegrove, Emma H Cassinelli, Jennifer Hall, Majel McGranahan, Laura McGowan, Helen Carr, Nisreen A Alwan, Judith Stephenson, Keith M Godfrey","doi":"10.3399/BJGP.2024.0082","DOIUrl":"10.3399/BJGP.2024.0082","url":null,"abstract":"<p><strong>Background: </strong>Routine primary care data may be a valuable resource for preconception health research and to inform the provision of preconception care.</p><p><strong>Aim: </strong>To review how primary care data could provide information on the prevalence of preconception indicators and examine associations with maternal and offspring health outcomes.</p><p><strong>Design and setting: </strong>Systematic review of observational studies using UK routine primary care data.</p><p><strong>Method: </strong>Literature searches were conducted in March 2023 using five databases to identify observational studies that used national primary care data from individuals aged 15-49 years. Preconception indicators were defined as medical, behavioural, and social factors that may impact future pregnancies; health outcomes included those that may occur during and after pregnancy.</p><p><strong>Results: </strong>From 5259 screened records, 42 articles were included. The prevalence of 37 preconception indicator measures was described for female patients, ranging from 0.01% for sickle cell disease to >20% for each of advanced maternal age, previous caesarean section (among those with a recorded pregnancy), overweight, obesity, smoking, depression, and anxiety (irrespective of pregnancy). Few studies reported indicators for male patients (<i>n</i> = 3) or associations with outcomes (<i>n</i> = 5). Most studies had a low risk of bias, but missing data may limit generalisability of the findings.</p><p><strong>Conclusion: </strong>The findings demonstrated that routinely collected UK primary care data could be used to identify patients' preconception care needs. Linking primary care data with health outcomes collected in other datasets is underutilised, but could help to quantify how optimising preconception health and care could reduce adverse outcomes for mothers and children.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e129-e136"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478037","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":"An empathy definition at last: exposing the narcissism of small differences.","authors":"Jeremy Howick, Amber Bennett-Weston","doi":"10.3399/bjgp25X740613","DOIUrl":"10.3399/bjgp25X740613","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 751","pages":"74"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076618","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":"Five questions about food allergy: management in primary care.","authors":"Saud Jukaku, Siraj A Misbah, Vincent St Aubyn Crump","doi":"10.3399/bjgp25X740769","DOIUrl":"10.3399/bjgp25X740769","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 751","pages":"90-91"},"PeriodicalIF":5.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076624","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}