BJGP Open最新文献

Background: UK general practice training requires trainees to evidence clinical competencies through reflective writing entries in online portfolios. Trainees who complete their medical degree in the UK experience reflection as an undergraduate, whereas 80% of international medical graduates (IMGs) have no previous experience of reflection.

Aim: To explore IMGs' perspectives on the positive and negative aspects of reflection in the context of postgraduate GP training.

Design & setting: A mixed-methods qualitative study undertaken in the UK. Qualitative 'free-text' survey data obtained in 2021 were analysed. The themes were further explored by semi-structured interviews conducted in 2022-2023.

Method: Participants were IMGs with experience of the UK GP training scheme. Verbatim open-question survey data underwent content analysis. Broad themes identified were used to develop the interview topic guide. A geographically dispersed, purposive sample of participants were recruited for semi-structured interviews. Interview and survey data were then analysed thematically.

Results: In total, 433 participant datasets are included: 422 of 485 responses to a UK-wide survey, including open questions, and 11 interview transcripts. IMGs considered reflection to provide an effective approach for learning, an opportunity for self-assessment and professional development, and a means of developing self-awareness. Concerns were expressed about how time-consuming recording reflection is, how its mandated aspect makes it forced, and fears regarding the medico-legal consequences of reflective writing.

Conclusion: Despite a lack of previous experience in reflection, most IMGs showed an understanding of the benefits of reflection in GP training. However, the challenges of reflection must be addressed, to avoid devaluing reflection for clinical learning.

Background: Family medicine, vital for patient care but underfunded, prompts an evaluation of how family medicine journals endorse, require, and advocate for reporting guidelines (RGs), clinical trial, and systematic review registration.

Aim: Assess endorsement and requirement of RGs, and the stance on registration of clinical trials and systematic reviews in family medicine journals, impacting research quality and transparency.

Design & setting: A cross-sectional analysis of 43 'family practice' journals, identified through the 2021 Scopus CiteScore, was undertaken. Editors-in-chief were contacted to confirm article types. Data extracted from 'instructions to authors' pages focused on recommendations or requirements for use of RGs, and for trial registration.

Method: To ensure confidentiality and prevent bias, authors independently extracted data on the requirement or recommendation for use of RGs and clinical trial registration to provide an overview of research standards.

Results: From the 43 journals, the most recommended guidelines were CONSORT (69%), PRISMA (58%), and STROBE (60%). The most required were PRISMA (16%) and CONSORT (11%). Clinical trial registration was recommended or required by 67% of journals. Additionally, 40 out of the 43 (93%) journals cited at least one reporting guideline in their instructions to authors.

Conclusion: Family medicine journals exhibit a variety of endorsement and requirement patterns for RGs and clinical trial registration. While guidelines like CONSORT, PRISMA, and STROBE are acknowledged, caution is needed in presuming a direct link between mention of these RGs and enhanced research quality. A nuanced approach, promoting diverse RGs and rigorous study registration, is essential for elevating transparency and advancing research standards in family medicine.

Background: GPs and mental health nurse practitioners (MHNPs) often feel ill equipped to provide mental health (MH) care to people with mild intellectual disabilities (MID). This is worrying, as insufficient primary MH care may lead to more severe or chronic problems. To improve primary MH care for this patient group, account must be taken of the experiences and needs of GPs and MHNPs providing the care.

Aim: To explore GPs' and MHNPs' experiences, needs, and recommendations for improvement regarding primary MH care for adults with MID.

Design & setting: A qualitative study was undertaken using focus groups with GPs and MHNPs in the Netherlands.

Method: The focus groups were guided by topics based on an interview study with adults with MID receiving primary MH care. Transcripts were analysed by thematic analysis.

Results: Four focus groups, with 19 GPs and nine MHNPs, revealed four themes describing the needs and perceived complexity involved in providing MH care to patients with both MID and MH problems: (1) GPs' and MHNPs' struggles with adapting to challenging patient characteristics; (2) importance and difficulties of establishing a good doctor-patient relationship; (3) facilitating and hampering roles of the patient's network; and (4) GPs' and MHNPs' challenges to provide care in the healthcare chain.

Conclusion: GPs and MHNPs often experience providing care and support to this patient group as burdensome. It is important to consider the MID throughout the MH trajectory, to invest in a strong doctor-patient relationship, and to establish a stable, sustainable network and coordinated collaborative care around the patient.

Background: The true burden of acute lower respiratory tract disease (aLRTD; includes acute lower respiratory tract infection [aLRTI] and presumed non-infective exacerbations of chronic lung disease and heart failure) among adults presenting to primary care, and the proportion that are potentially vaccine preventable is unknown.

Aim: To describe aLRTD incidence in adults presenting to primary care; estimate proportions caused by respiratory syncytial virus (RSV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and Streptococcus pneumoniae (SP); and investigate disease burden from patient and NHS perspectives.

Design & setting: Primary care prospective cohort study conducted in six representative general practices (total ∼86 000 registered adults) in Bristol, UK.

Method: Adults (aged ≥18 years) registered at participating general practices and presenting to primary care (in-hours or out-of-hours) or emergency department (if not admitted) with aLRTD will be eligible. They will be identified by real-time primary care record searches. Researchers will screen electronic GP records, including free text, contact patients to assess eligibility, and offer enrolment in a surveillance study and an enhanced diagnostic study (urine, saliva, and respiratory samples; physical examination; and symptom diaries). Data will be collected for all aLRTD episodes, with patients assigned to one of three arms: surveillance; embedded diagnostic; and descriptive dataset. Outcome measures will include clinical and pathogen-defined aLRTD incidence rates, symptom severity and duration, NHS contacts and costs, health-related quality-of-life changes, and mortality (≤30 days post-identification).

Conclusion: This comprehensive surveillance study of adults presenting to primary care with aLRTD, with embedded detailed data and sample collection, will provide an accurate assessment of aLRTD burden due to vaccine-preventable infections.

Background: People's involvement and participation in their own care are the essential basis of nursing care. This phenomenon can be characterised as an approach based on the integration of the person's values, beliefs, and preferences during nursing care. This process contributes to improve quality of care, improve satisfaction levels, and result in a better experience for people receiving care. To promote the person's participation in nursing care, it is necessary to better understand their experiences about this topic.

Aim: To synthesise the available evidence on people's experiences of their involvement and participation in nursing care in a hospital setting.

Design & setting: A systematic review that will be conducted according to the JBI methodology for systematic reviews of qualitative evidence.

Method: The study selection, critical appraisal, and data extraction will be conducted by two independent reviewers. This review will consider studies with a qualitative approach, published and unpublished, in Portuguese, English, or Spanish, with no temporal limit, which include adults, aged 18 years or older, who have experienced an admission to a hospital, that explored people's experiences of their involvement and participation in nursing care in hospital ward settings. Findings will be presented using a meta-aggregation approach and narrative format, and the final synthesised findings will be graded according to the ConQual approach.

Conclusion: It is expected that this qualitative synthesis will inform people, health professionals, and policymakers, allowing them to develop recommendations to promote the person's participation in nursing care.

Background: Role models encountered during undergraduate training play an important part in shaping future doctors. They can act as powerful attractants towards, and deterrents away from, a career in general practice. Many GP educators, who act as role models, are burnt-out and wish to leave the profession, which may limit their ability to influence students positively, with consequent detrimental impact on recruitment to the specialty.

Aim: A realist review will be undertaken, aiming to explore how, why, and for whom role modelling in undergraduate medical education can support medical students towards careers in general practice.

Design & setting: The realist review will follow Pawson's five steps, including: locating existing theories; searching for evidence; article selection; data extraction; and synthesising evidence and drawing conclusions. It will explore literature published in the English language between 2013 and 2024.

Method: An initial explanatory framework (initial programme theory; IPT) will be developed, guided by a stakeholder panel including medical undergraduates, GPs, and patient and public representatives. Searches will be developed and conducted in electronic databases and grey literature. Studies will be included if they explore the relationship between GP role modelling and undergraduate career choice, and relevant data will be extracted.

Conclusion: Findings will refine the IPT, unveiling key contexts, mechanisms, and outcomes that influence role modelling in undergraduate GP medical education and support or deter students from careers in general practice. These findings will support recommendations and interventions to facilitate positive outcomes, including improved recruitment to general practice.

Background: General practice is an essential part of healthcare systems in the UK and internationally but continues to struggle with recruitment. Despite this, few studies have explored factors that influence medical students' career choices around primary care.

Aim: We aimed to revisit factors that had previously been proposed following new ways of working adopted since the COVID-19 pandemic, including the impact of these changes on learning experiences in primary care.

Design & setting: A qualitative study using focus groups across three English medical schools.

Method: Eight focus groups were held involving 33 final and penultimate year medical students. Qualitative data were analysed using a framework approach. Transcripts were coded independently by two researchers from a different institution before themes were identified.

Results: Six themes were identified: students' prior career aspirations, their experience of the medical school curriculum, conceptualisation of general practice, future career predictions, views on the school's curriculum philosophy, and the influence of the COVID-19 pandemic. The curriculum philosophy of each school appeared to be important in this journey and changes since the COVID-19 pandemic had an impact on all themes.

Conclusion: Our study has confirmed previous findings that clinical experiences, the perceived narrative of the school, work-life balance, and working environment remain important to students in making career plans. However, in addition, we have found the changing landscape in general practice since the COVID-19 pandemic, including remote consulting, workload, continuity of care, and team-working, are additional factors that concern students.

Background: This study evaluates the feasibility of remote deep venous thrombosis (DVT) diagnosis via ultrasound sequences facilitated by ThinkSono Guidance, an artificial intelligence (AI) app for point-of-care ultrasound (POCUS).

Aim: To assess the effectiveness of AI-guided POCUS conducted by non-specialists in capturing valid ultrasound images for remote diagnosis of DVT.

Design & setting: Over a 3.5-month period, patients with suspected DVT underwent AI-guided POCUS conducted by non-specialists using a handheld ultrasound probe connected to the app. These ultrasound sequences were uploaded to a cloud dashboard for remote specialist review. Additionally, participants received formal DVT scans.

Method: Patients underwent AI-guided POCUS using handheld probes connected to the AI app, followed by formal DVT scans. Ultrasound sequences acquired during the AI-guided scan were uploaded to a cloud dashboard for remote specialist review, where image quality was assessed, and diagnoses were provided.

Results: Among 91 predominantly older female participants, 18% of scans were incomplete. Of the rest, 91% had sufficient quality, with 64% categorised by remote clinicians as 'compressible' or 'incompressible'. Sensitivity and specificity for adequately imaged scans were 100% and 91%, respectively. Notably, 53% were low risk, potentially obviating formal scans.

Conclusion: ThinkSono Guidance effectively directed non-specialists, streamlining DVT diagnosis and treatment. It may reduce the need for formal scans, particularly with negative findings, and extend diagnostic capabilities to primary care. The study highlights AI-assisted POCUS potential in improving DVT assessment.

Background: Knowing people's pregnancy intentions would help healthcare professionals (HCPs) to take a more holistic approach to reproductive health and preconception care.

Aim: To assess the feasibility of implementation of questions about pregnancy preferences in a range of primary care settings in Great Britain, including digital implementation.

Design & setting: Qualitative study using online semi-structured interviews with primary healthcare professionals across Great Britain between February and July 2022.

Method: Twelve online interviews were conducted with GPs (n = 3), practice nurses (n = 3), sexual and reproductive health professionals (n = 4), and health visitors (n = 2). Framework analysis was conducted in NVivo, adapting a coding frame from complementary interviews with women.

Results: HCPs perceived asking about pregnancy preferences as valuable in meeting patients' reproductive health needs and most suited to women's health consultations, medication and disease reviews, baby checks, or as an addition to lifestyle questions leading to health promotion advice. An introductory, non-discriminatory signposting sentence was well-liked, and the preferred question in a face-to-face clinical encounter was asking how the person would feel about a pregnancy in the next year, in line with women's preference. Guidance and training would give clinicians confidence in knowing how to ask about pregnancy preferences and advise their patients accordingly.

Conclusion: Asking about pregnancy intentions is acceptable to women and HCPs and feasible in primary care, but implementation needs to be adapted to the patient and context. Digital options that enable patients to self-manage can reduce the need for HCP input and avoid medicalising a normal process.

Background: Chronic primary pain (CPP) as a diagnosis has been introduced in the recent International Classification of Diseases, 11^th Revision (ICD-11). CPP captures the experience of pain as the primary problem, without an underlying attributable cause. Dissemination of UK guidance regarding CPP represents the first time it has been recognised as a condition in its own right. Little is known about GP views concerning caring for patients with CPP, and how related guidance is viewed and applied in practice.

Aim: To explore GP perspectives in relation to caring for people with CPP, including challenges encountered and use of related guidelines in practice.

Design & setting: A UK-wide qualitative interview study in primary care.

Method: Purposive and snowball sampling were used to recruit 15 GP participants from England, Northern Ireland, Wales, and Scotland. Semi-structured interviews were undertaken and analysed using reflexive thematic analysis.

Results: The following three main themes were generated: (1) 'How to start? Problematic beginnings', which referred to difficulties regarding diagnosis; (2) 'Where to go? Mapping the management challenge'; and (3) 'How to get there? Navigating strategies and response', which explored GP awareness and acceptability of UK guidelines for chronic pain. Areas identified for potential improvement included increased access to non-pharmacological management (NPM) and secondary care services, support with deprescribing, and an expanded multidisciplinary team input.

Conclusion: CPP is complex to both diagnose and manage. Although guidelines provide a useful framework, they pose challenges when translating into day-to-day practice.