Search

Introduction: There have been some concerns about the impact of temporary doctors, otherwise known as locums, on patient safety and the quality of care. Despite these concerns, research has paid little attention to the implications of locum working on patient experience. Methods: A qualitative semi‐structured interview study was conducted with 130 participants including locums, people working with locums and patients with experience of being seen or treated by locums. Analysis was conducted using a reflexive thematic approach and abductive analysis to position themes against wider knowledge. Results: Three main themes were constructed through analysis: (1) Awareness and disclosure; patients were not always aware if their doctor was a locum, and there was some debate about whether patients had a right to know, particularly if locum working presented quality and safety risks. (2) Continuity and accessibility of care; access was regarded as priority for acute conditions, but for long‐term or serious conditions, patients preferred to see a permanent doctor who knew their history, although it was acknowledged that locums could provide fresh perspectives. (3) Communication and practice; locums and patients described how consultations were approached differently when doctors worked as locums. Patients evaluated their interactions based on how safe they felt with practitioners. Conclusion: Patients reported that they were unlikely to have continuity of care with any doctors delivering care, regardless of their contractual status. Locums sometimes provided new perspectives on care which could be beneficial for patient outcomes, but for patients with long‐term, complex or serious conditions continuity of care was important, and these patients may avoid or delay seeking care when locums are the only available option. Patient or Public Contribution: Patients and carers were involved in our study from inception to dissemination. Our Patient and Public Involvement (PPI) forum was involved throughout project design and planning and gave us feedback and guidance on research materials and outputs (e.g., study protocol, participant information sheets, survey tools, interview schedules, emerging findings). Our PPI forum co‐produced our patient interview schedule, two members of our PPI forum led the patient focus groups and all were involved in analysis of patient interviews. Our PPI Chair was involved in the preparation of this manuscript. [ABSTRACT FROM AUTHOR]

A study conducted at a hospital in Kabul, Afghanistan examined the prevalence of anxiety and depression symptoms among patients with psoriasis. The study included 340 individuals, with 57.1% being women and 42.9% being men, and the average age was 35.2 years. The study found that 25.9% of patients had moderate to severe anxiety symptoms, with factors such as being female, older age, low education, and multiple psoriasis symptoms being associated with these symptoms. The study also found that 31.8% of patients had moderate to severe depression symptoms, with similar factors being associated with these symptoms. The study highlights the psychological impact of psoriasis in Afghanistan and suggests the need for screening and integrated management of both dermatological and psychological factors. However, the study's limitations include its single-center, hospital-based nature. [Extracted from the article]

Context: We previously reported the effectiveness and cost-effectiveness of a pharmacist-led information technology intervention (PINCER) at reducing hazardous prescribing. The PINCER intervention searches GP clinical systems to identify patients at risk of hazardous prescribing, identified by 11 prescribing safety indicators, and with pharmacist support the practice acts to correct the prescribing to minimise future risk. Objective: To evaluate the effectiveness of PINCER when widely implemented in general practices on the prevalence of patient exposure to hazardous prescribing and also on the incidence of serious harm in patients at risk of hazardous prescribing. Study Design and Analysis: The PINCER intervention was rolled out in 370 general practices using a non-randomised multicentre incomplete stepped-wedge study design whereby the intervention was introduced to successive groups of general practices between Sept 2015 and Apr 2017. Data was extracted from 115 of these practices between Feb 2013 and Aug 2019. We used the indicators to identify potentially hazardous prescribing and collected data over a maximum of 16 quarterly time periods around the times of implementation. Modelling of each hazardous prescribing indicator and serious harm outcome, and composite indicators utilised a mixed model approach, with logistic mixed models for the quarterly event numbers with the appropriate denominator. Setting or Dataset: Data extracted directly from GP systems. Population Studied: Practices who had implemented PINCER in the East Midlands, England. Intervention/Instrument: PINCER. Outcome Measures: The proportion of patients in each practice and quarter exposed to at least one type of hazardous prescribing, identified using the prescribing safety indicators, and the proportion of patients with serious harm. Results: The PINCER intervention was associated with a decrease in the rate of hazardous prescribing at 6 months, 12 months and 24 months post-intervention. A reduction in deaths and all cause hospitalisation were observed post intervention. However, a less clear association between the PINCER intervention and serious harm outcomes (identified within primary care data) were observed. Detailed results will be presented. Conclusions: We demonstrate the real-world effectiveness of the PINCER intervention in reducing exposure to potentially hazardous medication when rolled out at scale in UK general practices, where the reductions were sustained for up to 24 months., Presenters Amelia Taylor, PhD, BSc, Anthony Avery, MD, FRCGP, FRCPC, MBChB, DM, Steve Roberts, PhD, Darren Ashcroft, Sarah Rodgers, PhD, BSc, Rachel Elliott, PhD, BPharm, FRPharmS, Thomas Allen, PhD, BSc, [...]

Previous studies have demonstrated the association between antibiotic use and severe COVID-19 outcomes. This study aimed to explore detailed antibiotic exposure characteristics among COVID-19 patients. Using the OpenSAFELY platform, which integrates extensive health data and covers 40% of the population in England, the study analysed 3.16 million COVID-19 patients with at least two prior antibiotic prescriptions. These patients were compared to up to six matched controls without hospitalisation records. A machine learning model categorised patients into ten groups based on their antibiotic exposure history over the three years before their COVID-19 diagnosis. The study found that for COVID-19 patients, the total number of prior antibiotic prescriptions, diversity of antibiotic types, broad-spectrum antibiotic prescriptions, time between first and last antibiotics, and recent antibiotic use were associated with an increased risk of severe COVID-19 outcomes. Patients in the highest decile of antibiotic exposure had an adjusted odds ratio of 4.8 for severe outcomes compared to those in the lowest decile. These findings suggest a potential link between extensive antibiotic use and the risk of severe COVID-19. This highlights the need for more judicious antibiotic prescribing in primary care, primarily for patients with higher risks of infection-related complications, which may better offset the potential adverse effects of repeated antibiotic use. [ABSTRACT FROM AUTHOR]

Objectives: Develop an endometrial cancer risk prediction model and externally validate it for UK primary care use. Design: Cohort study. Setting: The UK Biobank was used for model development and a linked primary (Clinical Practice Research Datalink, CPRD) and secondary care (HES), mortality (ONS) and cancer register (NRCAS) dataset was used for external validation. Population: Women aged 45–60 years with no history of endometrial cancer or hysterectomy. Methods: Model development was performed using a flexible parametric survival model and stepwise backward selection aiming to minimise the Akaike information criterion. Model performance on external validation was assessed through flexible calibration plots, calculation of the expected to observed ratio and C‐statistic and decision curve analysis. Main outcome measures: Endometrial cancer diagnosis within 1–10 years of the index date. Results: Model development included 222 031 women (902 incident endometrial cancer cases) and external validation 3 094 371 women (8585 endometrial cancer cases). The final model (with equation provided) incorporated age, body mass index, waist circumference, age at menarche, menopause and last birth, hormone replacement, tamoxifen and oral contraceptive pill use, type 2 diabetes, smoking and family history of bowel cancer. It was well calibrated on external validation (calibration slope 1.14, 95% confidence interval [CI] 1.11–1.17, E/O 1.03, 95% CI 1.01–1.05), with moderate/good discrimination (C‐statistic 0.70, 95% CI 0.69–0.70) and had improved net benefit compared with previously developed models. Conclusions: The Predicting risk of endometrial cancer in asymptomatic women model (PRECISION), using easily measurable anthropometric, reproductive, personal and family history, accurately quantifies a woman's 10‐year risk of endometrial cancer. Its use could determine eligibility for primary endometrial cancer prevention trials and for targeted resource allocation in UK general practices. [ABSTRACT FROM AUTHOR]