Midlands Evidence Repository
Not a member yet
9653 research outputs found
Sort by
Quality metrics for same day emergency care-Consensus of a multi-professional panel of experts using a modified Delphi process
No full textSame Day Emergency Care (SDEC) services are at the heart of recovery plans for Emergency Care in the National Health Service. There are no validated metrics for the quality of care in SDEC. The Society for Acute Medicine's Quality Improvement Committee invited to a three-stage modified Delphi process to gather metrics used by clinicians. Proposed metrics were ranked and further explored by 33 participating experts from a broad range of backgrounds including clinicians, data scientists and operational managers. Experts ranked five system-based metrics highest. These focus on optimisation of the proportion of patients receiving same day care in and out of SDEC units. Patient and staff experience metrics were ranked low, possibly due to present lack of viable examples. The paper adds a glossary with the rationale for ranking of metrics and their use for the improvement of quality and safety of clinical care.https://www.sciencedirect.com/science/article/pii/S1470211824053971?via%3Dihu
Designing a primary care pharmacist-led review for people treated with opioids for persistent pain: a multi-method qualitative study
Get PDFThis article relates to a research study that included patients or members of the workforce as study participants from GP practices in Nottingham and Nottinghamshire.Background: Opioids are frequently prescribed for persistent non-cancer pain despite limited evidence of long-term effectiveness and risk of harm. Evidence-based interventions to address inappropriate opioid prescribing are lacking. Aim: To explore perspectives of people living with persistent pain to understand barriers and facilitators in reducing opioids in the context of a pharmacist-led primary care review, and identify review components and features for optimal delivery. Design & setting: Primary care multi-method qualitative study. Method: Adults with experience of persistent pain and taking opioids participated in semi-structured interviews (n=15, 73% female) and an online discussion forum (n=31). The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis, involving deductive analysis to TDF domains, inductive analysis within-domains to generate subthemes, and subtheme comparison to form across-domain overarching themes. The behaviour change technique taxonomy v.1 and motivational behaviour change technique classification system were used to systematically map themes to behaviour change techniques to identify potential review components and delivery features. Results: 32 facilitator and barrier subthemes for patients reducing opioids were identified across 13 TDF domains. These combined into six overarching themes: learning to live with pain, opioid reduction expectations, assuming a medical model, pharmacist-delivered reviews, pharmacist-patient relationship and patient engagement. Subthemes mapped to 21 unique behaviour change techniques, yielding 17 components and five delivery features for the proposed PROMPPT review. Conclusion: This study generated theoretically-informed evidence for design of a practice pharmacist-led PROMPPT review. Future research will test the feasibility and acceptability of the PROMPPT review and pharmacist training
Long-term trends in GP practice consultation rates
Get PDFGP practice consultations are, by some distance, the most common interaction between the NHS and the population it serves. During these consultations, patient’s acute conditions are diagnosed and treated, their long-term conditions are managed, preventative interventions are delivered, and referrals to secondary care are made. Patient satisfaction with access to GP practice consultations is a long-standing problem, but this issue has become more acute since the COVID-19 pandemic. Most consultation appointments are booked by telephone, but in a recent survey, 50% of patients reported difficulties getting through to their GP practice by telephone, up from 30% in 2018. One might expect that the NHS would have a detailed and comprehensive understanding of the levels, types, and distribution of this important service. Whilst there have been many advances in recent years, there remain important gaps in our knowledge. In this paper we explore the long-term trends in GP practice consultation rates. We use two research databases, Clinical Practice Research Datalink (CPRD) Gold and Aurum, to estimate consultation rates between 1995 and 2022. We consider all interactions between a patient and a healthcare professional: face-to-face consultations in the GP practice, consultations conducted by telephone, or using digital technologies, and visits made to the patient. We set our results alongside (1) estimates from other studies, (2) new data on GP appointment rates, (3) GP patient survey results, (4) information about the GP practice workforce and its workload, and (5) data on other important forms of GP Practice activity. Key findings Practice consultation rates, the average number of consultations per patient per year, increased steadily and for many years until 2012, corroborating results from earlier studies. Between 2012 and 2019, consultation rates fell, reversing the gains seen since 2008. As far as we are aware, this is the first study that highlights a fall in GP practice service levels over this period. From 2020, the two sources of data that we used to estimate consultation rates, produce substantially different results, with one showing continued reductions and the other showing rapid increases in consultation rates. Analysis of other sources of information fails to resolve the matter. Experimental data from NHS Digital suggests GP practice appointments have increased, but responses to the GP Patient Survey, and data on prescription and referral rates imply that consultation rates have decreased. That no clear consensus emerges from these analyses of post-pandemic trends, may indicate an issue with the primary unit of activity of GP practices, a patient consultation. For many years, this unit of activity had a clear and consistent meaning. Between 2008 and 2019, counts of consultations from different systems and sources provide similar results and similar trends. But the widespread adoption of remote consultations and digital technologies, the emergence of Primary Care Networks, and the rapid expansion of the allied healthcare professional workforce, have led to radical changes in service models. Future analyses of activity trends and equity of access may require the development of new activity units that better reflect the operations of modern general practice. This analysis, the first in a series of three, considers changes in the rate of consultations per patient per year. The remaining papers in the series will explore how rates of consultations have changed relative to patient need, the consequences of these changes on hospital activity, and changes in the productivity and continuity of GP practice service provision.https://www.midlandsdecisionsupport.nhs.uk/knowledge-library/long-term-trends-in-gp-practice-consultation-rates
Can compassionate leadership of senior hospital leaders help retain trainee doctors?
No full textBackground: High burnout and low retention rates among trainee doctors threaten the future viability of the UK medical workforce. This study empirically examined factors that can sustain trainee doctors. Method: A total of 323 trainee doctors from 25 National Health Service (NHS) Trusts in England and Wales completed an online survey on their training and employment experiences. A mixed method approach was employed. Results: Structural equation modelling revealed that perceived compassionate leadership of hospital senior leaders (CLSL) (i.e., doctors in senior clinical and management positions, and senior managers) is directly and negatively associated with trainee doctors' burnout and intention to quit. We propose the associations may be indirectly strengthened through two mediating pathways: increased psychological contract fulfilment (PCF) of training/organisational support and reduced worry about the state of the NHS; however, only the former is supported. The model can explain a substantial 37% of the variance in reported burnout and 28% of intention to quit among trainee doctors. Being a Foundation Year (FY) trainee was significantly associated with poor PCF and burnout. Rich qualitative data further elaborated on their experiences in terms of senior leaders' awareness of their training/working experiences, listening to and acting on. Conclusions: Active and demonstrable CLSL plays a vital role in trainee doctors' retention. It has both direct (through support) and indirect effects through improving trainee doctors' PCF to reduce burnout and intention to quit. This seems particularly valuable among FY doctors. Implications for the development and management of the medical workforce are discussed.https://bmjleader.bmj.com/content/early/2024/07/02/leader-2024-00101
“Flow” Transcranial Direct Current Stimulation (tDCS) for depression treatment in a primary healthcare general practice — depression, functioning, and health-related quality of life outcomes.
No full textBackground: Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application that delivers wellbeing behaviour therapy training. tDCS has evidence of effectiveness in treating symptoms of depression. This post marketing study evaluated the effect of Flow on depression, functioning, and health-related quality of life for primary care general practice patients with depression symptoms. Methods: Open-label patient cohort design with no control group. Thirty-one adult patients completed six weeks of Flow treatment. Average age 45.6 years (SD = 13.72) range from 20-75 years; 24 (77.4%) females and six males (23.6%). Pre- and post-intervention assessment with participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and European Quality of Life Five Dimension (EQ-5D-5L). Results: PHQ-9 reliable improvement and remission rates were 58.1% and 32.3%. There was a significant improvement in PHQ-9 and WSAS with large effect sizes. EQ-5D-5L results showed significant improvements in three dimensions and the health index score with medium effect sizes. Conclusion: Flow tDCS can be delivered through a primary healthcare general practice service and patients use it as prescribed and complete treatment course. tDCS has evidence as an effective depression treatment, the widespread availability of tDCS in primary care general practice should be considered.https://www.scirp.org/journal/paperinformation?paperid=13310
Workplace factors impacting the wellbeing of diagnostic radiographers in clinical practice: A literature review
No full textIntroduction: The Coronavirus (COVID-19) pandemic resulted in an emphasis on external factors affecting the wellbeing of staff within the National Health Service. There is a national shortage of diagnostic radiographers in the United Kingdom, so maintaining the health and satisfaction of the current radiographic workforce is important. The aim of this literature review is to determine workplace-related factors affecting the wellbeing of diagnostic radiographers in their clinical practice. Methods: An interpretive phenomenological approach was selected to gain an insight of wellbeing from the perspective of radiographers and radiology managers. A systematic literature search was conducted, resulting in 10 core articles which were then thematically analysed. Results: Five themes were identified: Initial waves of COVID-19, Workload and Working Patterns, Mental Health, Sources of Support, and Recognition and Development. Discussion: COVID-19 has had a short and long-term impact on the working practices of radiographers, leading to a risk of burnout. Radiographers appreciated different forms of recognition from managers and support within their team but felt a lack of professional recognition outside the radiology department. Radiographers displayed resilience during the pandemic, using various strategies to cope with emotional challenges. A variety of external support was available to radiographers, but this was often self-directed, with in-person support difficult to access due to working patterns. Conclusion: This review highlights the lack of tailored support addressing radiographers' unique experiences. As imaging modalities have different workloads and varying emotional involvement with patients, further research to provide evidence-based interventions to improve radiographers' mental health is advised.https://www.jmirs.org/article/S1939-8654(24)00165-6/abstrac
ASO visual abstract: Precursor epithelial subtypes of adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN)-clinicopathological features, recurrence and response to adjuvant chemotherapy
No full texthttps://link.springer.com/article/10.1245/s10434-024-15827-
Recurrent left main stem stenosis in a young female with Behçet's aortitis: a case report
Get PDFBACKGROUND: Behçet's disease (BD) is a rare and complex vasculitis disorder renowned for its diverse clinical presentations. Cardiovascular involvement is reported to be present in 7-46% of the patients, with coronary arteries being involved in only 0.5%. The management of cardiovascular complications can be challenging due to the rarity of such cases and the absence of standardized guidelines regarding diagnosis and treatment. CASE SUMMARY: We report the case of a 27-year-old patient with BD with known aortitis and pulmonary arteritis, who presented with recurrent acute coronary syndromes related to critical left main coronary artery stenosis. She was initially managed with percutaneous coronary interventions twice. Following recurrent stent failure, she eventually underwent urgent coronary artery bypass surgery, together with aortic valve replacement and aortic root repair. She made an uneventful recovery and remains well 6 months following her operation. DISCUSSION: This case illustrates the significant challenges that can be encountered when managing coronary complications in patients with BD. Both percutaneous and surgical options have been reported in the literature with variable outcomes. Multi-disciplinary team involvement is of utmost importance in order to offer a balanced therapeutic strategy to these patients. Further research is required to shed light to the unknowns surrounding this rare cohort
Late-onset mitochondrial encephalopathy with lactic acidosis and stroke-like episodes and the role of serial imaging
No full textMitochondria are essential for human metabolic function. Over 350 genetic mutations are associated with mitochondrial diseases, which are inherited in a matrilineal fashion. In mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS), defective mitochondrial function and resultant impaired cellular energy production compromise vascular perfusion in affected tissues. Early diagnostic criteria suggested the diagnosis should be considered in those under 40. However, a broader range of phenotypes are now recognised, including those that present for the first time later in life. The primary presenting feature in MELAS is a stroke-like episode invariably resulting in patients undergoing neuroradiological imaging. We present a case of a woman with a first presentation of a stroke-like episode and seizures in her 40s who was eventually diagnosed with MELAS. We detail her clinical presentation, treatment and diagnosis, emphasising the role of serial imaging in her diagnosis.https://casereports.bmj.com/content/17/2/e259102.lon
Ibrutinib as first-line therapy for mantle cell lymphoma: a multicenter, real-world UK study
No full textDuring the COVID-19 pandemic, ibrutinib with or without rituximab was approved in England for initial treatment of mantle cell lymphoma (MCL) instead of immunochemotherapy. Because limited data are available in this setting, we conducted an observational cohort study evaluating safety and efficacy. Adults receiving ibrutinib with or without rituximab for untreated MCL were evaluated for treatment toxicity, response, and survival, including outcomes in high-risk MCL (TP53 mutation/deletion/p53 overexpression, blastoid/pleomorphic, or Ki67 ≥ 30%). A total of 149 patients from 43 participating centers were enrolled: 74.1% male, median age 75 years, 75.2% Eastern Cooperative Oncology Group status of 0 to 1, 36.2% high-risk, and 8.9% autologous transplant candidates. All patients received ≥1 cycle ibrutinib (median, 8 cycles), 39.0% with rituximab. Grade ≥3 toxicity occurred in 20.3%, and 33.8% required dose reductions/delays. At 15.6-month median follow-up, 41.6% discontinued ibrutinib, 8.1% due to toxicity. Of 104 response-assessed patients, overall (ORR) and complete response (CR) rates were 71.2% and 20.2%, respectively. ORR was 77.3% (low risk) vs 59.0% (high risk) (P = .05) and 78.7% (ibrutinib-rituximab) vs 64.9% (ibrutinib; P = .13). Median progression-free survival (PFS) was 26.0 months (all patients); 13.7 months (high risk) vs not reached (NR) (low risk; hazard ratio [HR], 2.19; P = .004). Median overall survival was NR (all); 14.8 months (high risk) vs NR (low risk; HR, 2.36; P = .005). Median post-ibrutinib survival was 1.4 months, longer in 41.9% patients receiving subsequent treatment (median, 8.6 vs 0.6 months; HR, 0.36; P = .002). Ibrutinib with or without rituximab was effective and well tolerated as first-line treatment of MCL, including older and transplant-ineligible patients. PFS and OS were significantly inferior in one-third of patients with high-risk disease and those unsuitable for post-ibrutinib treatment, highlighting the need for novel approaches in these groups.https://ashpublications.org/bloodadvances/article/8/5/1209/506677/Ibrutinib-as-first-line-therapy-for-mantle-cel