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This document discusses a study on the use of erythropoiesis stimulating agents (ESAs) as a treatment for anemia in low-risk myelodysplastic neoplasms (LR-MDS). The study used flow cytometry to analyze erythroid subpopulations in LR-MDS patients treated with ESAs and found that the response to ESAs was associated with an increase in certain bone marrow cells. However, this correlation was not seen in cases with a specific gene mutation. The study suggests that a combination of scoring and cell fraction analysis could predict ESA response in certain MDS cases. [Extracted from the article]

Background: Social determinants of health (SDOH) are the non-medical factors that impact health. Although geographical measures of deprivation are used, individual measures of social risk could identify those most at risk and generate more personalised care and targeted referrals to community resources. We know SDOH are important to health care, but it is not yet known whether their collection via the electronic health record (EHR) is acceptable and useful from the patient perspective. Aim: To synthesise relevant literature to explore patient perspectives on integrating information about SDOH into primary care EHRs, and the opportunities and challenges of its implementation in a general practice setting. Design & setting: Systematic review of primary care-based qualitative and mixed-method studies using thematic framework analysis. Method: Key databases were searched for articles reporting patient perspectives of SDOH collection within the primary care EHR. Qualitative and mixed-methods studies written in English were included. A framework analysis was conducted to identify themes. Results: From 14 included studies, the following five main themes were identified: rationale for SDOH screening and the anticipated outcomes; impact of the provider-patient relationship on patient perceptions; data, which included privacy concerns; screening process and referral; and recommendations for future research. Conclusion: Integration of information on SDOH into the EHR appears acceptable to patients. This review has added to the discussion of whether and how to implement SDOH screening and referral programmes into UK primary care systems. [ABSTRACT FROM AUTHOR]

The challenge faced by newly graduated nurses from undergraduate study to practice is a persistent theme in nursing practice literatures. However, there is a lack of understanding about how this transition happens. This focused ethnographic study explored how newly graduated nurses (novices) interacted with experienced nurses and learnt in a hospital ward in Singapore. Using the 'Trajectory of identification framework' developed from Wenger's Community of Practice theory, data was collected through observation and focused group discussions. This research revealed the participating rules as the sociocultural characteristics of the nursing community, and how these characteristics are ongoingly negotiated among the nurses. The nurses' changing performative competence and identity in different situations are conceptualised as the 'Participation Space'. This study also showed how concepts of Community of Practice theory can be analytically applied and further developed in empirical study. Specifically, a conceptual 'Participation Matrix' is theorised which adds an additional tool to understand the nurses' dynamic participation and negotiation of membership in a Community of Practice. Novices' transition should be viewed as an ongoing dynamic workplace learning, through which negotiation of performative competence and identity among members take place. The soon to be novices and workplaces should be prepared with this understanding. [ABSTRACT FROM AUTHOR]

Background: Research activity usually improves outcomes by being translated into practice. However, there is developing evidence that research activity itself may improve the overall performance of health care organisations. However, evidence that these relationships represent a causal impact of research activity is less clear. Additionally, the bulk of the existing evidence relates to hospital settings, and it is not known if those relationships would also be found in general practice, where most patient contacts occur., Aim: We sought to (a) test whether there were significant relationships between research activity in general practice and organisational performance (b) test whether those relationships were plausibly causal., Design and Setting: We analysed national data between 2008 and 2019 using cross sectional and longitudinal analyses, on general practices in England., Methods: We used cross-sectional, panel and instrumental variable analyses to explore relationships between research activity (including measures from the NIHR Clinical Research Network and the Royal College of General Practitioners) and practice performance (including clinical quality of care, patient reported experience of care, prescribing quality and hospital admissions) Results: In cross-sectional analyses, research activity was positively associated with several measures of practice performance, including clinical quality of care, patient reported experience of care, and reduced hospital admissions. The associations were generally modest in magnitude. However, longitudinal analyses did not support a reliable causal relationship., Conclusion: Similar to findings from hospital settings, research activity in general practice is associated with practice performance. There is less evidence that research is causing those improvements, although this may reflect the limited level of research activity in most practices. We identified no negative impacts, suggesting that research activity is a potential marker of quality and something that high quality practices can deliver alongside their core responsibilities., (Copyright © 2024, The Authors.)

Background: UK general practice has been described as being in crisis. A shortage and exodus of GPs is an urgent and challenging problem, attracting significant media attention, widespread public debate, and policy action., Aim: Our review aims to examine which aspects of the healthcare system affect GP workforce sustainability, how, why, and for whom., Method: A realist review is an interpretive, theory-driven approach to evidence synthesis, that brings together data from quantitative, qualitative, mixed methods research, and the wider grey literature (e.g., policy documentation). Using this data allows us to examine a diverse range of evidence with a clear focus on understanding factors which support (or hinder) GP workforce sustainability, how these are shaped by contexts, and the mechanisms that underpin them. We identify important individual and system-level contexts that may be amenable to change., Results: We present our emerging findings in the form of a programme theory which explores human connection with patients, colleagues, and across organisations, gaining intellectual enrichment and learning systems comprising socially-situated knowledge. Relational continuity is key across these, supporting GP workforce sustainability. Challenges include standardisation, alienation and professional loneliness, inflexible organisation, and restrictive technologies., Conclusion: Our research generates new knowledge about the interdependencies between contexts, mechanisms, and outcomes. The findings can inform strategies and interventions intended to support, facilitate, and assist the GP workforce in delivering equitable and effective patient care. We identify critical gaps in knowledge and prioritise the expectations for scope and nature of future GP work and retention strategies., (© British Journal of General Practice 2024.)

Background: Total triage (TT) has the potential to achieve more equitable access to primary care, to improve the overall quality of care, and enhance health outcomes. TT has gained increasing attention from the public, policymakers, and academics., Aim: To examine relevant scientific literature regarding the implementation of TT, the reported opportunities and challenges for patients and staff, and implications for practice., Method: Medline, Embase, CINAHL, and Scopus were searched for articles and grey literature between 2013 and February 2023. Included documents described the implementation of TT during in-hours general practice and provided perspectives from patients/staff. Patients and stakeholders were involved throughout each stage of the review process. Findings were synthesised using a framework approach., Results: In total, 23 documents were included at full-text screening. Analysis highlights a range of TT approaches, sometimes conflating remote and TT systems. TT was seen to both increase and reduce workload. Consistently, patient and staff views worsened with TT use. TT can increase barriers to care access with potential to exacerbate inverse care laws across the UK. Critical knowledge gaps included patient co-production in TT systems and the role of reception teams to adapt systems to meet patients' needs., Conclusion: TT can influence patient access, safety, and equity. The approach may also generate profoundly different working styles for general practice. This review adds to current debates surrounding patient access and TT, and consequences for staff/patients. The findings can be used to aid practices when navigating the new GP contract and the implementation of new TT approaches., (© British Journal of General Practice 2024.)

Introduction: Many patients referred for suspicion of myelodysplastic neoplasm (MDS) are subjected to unnecessary discomfort from bone marrow aspiration, due to the low disease prevalence in this population. Flow cytometric analysis of peripheral blood neutrophil myeloperoxidase expression could rule out MDS with sensitivity and negative predictive value estimates close to 100%, ultimately obviating the need for bone marrow aspiration in up to 35% of patients. However, the generalisability of these findings is uncertain due to the limited sample size, the enrolment of patients at a single study site, and the reliability issues associated with laboratory-developed tests and varying levels of operator experience. This study aims to validate the accuracy attributes of peripheral blood neutrophil myeloperoxidase expression quantified by flow cytometric analysis in an independent multicentre sample., Methods and Analysis: The MPO-MDS-Valid project is a cross-sectional diagnostic accuracy study comparing an index test to a reference standard. Consecutive adult patients referred for suspicion of MDS are being recruited at seven university hospitals and one cancer centre in France. At each site, flow cytometric analysis of peripheral blood samples is performed by operators who are blinded to the reference diagnosis. A central adjudication committee whose members are unaware of the index test results will determine the reference diagnosis of MDS, based on cytomorphological evaluation of bone marrow performed in duplicate by experienced hematopathologists. The target sample size is 400 patients and the anticipated study recruitment completion date is 31 December 2025., Ethics and Dissemination: An institutional review board (Comité de Protection des Personnes Nord-Ouest III, Caen, France) approved the protocol, prior to the start of the study. Participants are recruited using an opt-out approach. Efforts will be made to publish the primary results within 6 months after study completion., Trial Registration Number: NCT05175469., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Social determinants of health (SDOH) are the non-medical factors that impact health. Although geographical measures of deprivation are used, individual measures of social risk could identify those most at risk and generate more personalised care and targeted referrals to community resources. We know SDOH are important to health care, but it is not yet known whether their collection via the electronic health record (EHR) is acceptable and useful from the patient perspective., Aim: To synthesise relevant literature to explore patient perspectives on integrating information about SDOH into primary care EHRs, and the opportunities and challenges of its implementation in a general practice setting., Design & Setting: Systematic review of primary care-based qualitative and mixed-method studies using thematic framework analysis., Method: Key databases were searched for articles reporting patient perspectives of SDOH collection within the primary care EHR. Qualitative and mixed-methods studies written in English were included. A framework analysis was conducted to identify themes., Results: From 14 included studies, the following five main themes were identified: rationale for SDOH screening and the anticipated outcomes; impact of the provider-patient relationship on patient perceptions; data, which included privacy concerns; screening process and referral; and recommendations for future research., Conclusion: Integration of information on SDOH into the EHR appears acceptable to patients. This review has added to the discussion of whether and how to implement SDOH screening and referral programmes into UK primary care systems., (Copyright © 2024, The Authors.)

Background: There is evidence that engaging in research is directly associated with better performance. If this relationship is to be strengthened, it is necessary to understand the mechanisms which might underlie that relationship., Aim: To explore the perspectives of staff and wider stakeholders about mechanisms by which research activity might impact on the performance of general practices., Design & Setting: Qualitative study using semi-structured interviews with general practice professionals and wider stakeholders in England., Method: Individual interviews with 41 purposively sampled staff in 'research ready' or 'research active' general practices and 21 other stakeholders. Interviews were independently coded by three researchers using a Framework approach., Results: Participants described potential 'direct' and 'indirect' impacts on their work. 'Direct' impacts included research changing practice work (eg, additional records searches for particular conditions), bringing in additional resources (eg, access to investigations or staff) and improving relationships with patients. 'Indirect' impacts included job satisfaction (eg, perception of practice as a centre of excellence and innovation, and the variety afforded by research activity reducing burnout) and staff recruitment (increasing the attractiveness of the practice as a place to work). Respondents identified few negative impacts., Conclusions: Staff and stakeholders identified a range of potential impacts of research activity on practice performance, with impacts on their working lives most salient. Negative impacts were not generally raised. Nevertheless, respondents generally discussed potential impacts rather than providing specific examples of those impacts. This may reflect the type of research activity conducted in general practice, often led by external collaborators., (Copyright © 2024, The Authors.)

Myelodysplastic syndromes (MDS) with mutated SF3B1 gene present features including a favourable outcome distinct from MDS with mutations in other splicing factor genes SRSF2 or U2AF1. Molecular bases of these divergences are poorly understood. Here we find that SF3B1-mutated MDS show reduced R-loop formation predominating in gene bodies associated with intron retention reduction, not found in U2AF1- or SRSF2-mutated MDS. Compared to erythroblasts from SRSF2- or U2AF1-mutated patients, SF3B1-mutated erythroblasts exhibit augmented DNA synthesis, accelerated replication forks, and single-stranded DNA exposure upon differentiation. Importantly, histone deacetylase inhibition using vorinostat restores R-loop formation, slows down DNA replication forks and improves SF3B1-mutated erythroblast differentiation. In conclusion, loss of R-loops with associated DNA replication stress represents a hallmark of SF3B1-mutated MDS ineffective erythropoiesis, which could be used as a therapeutic target., (© 2024. The Author(s).)