1,721,141 research outputs found
Capturing and reporting topical treatment use in childhood eczema: lessons for data collection in eczema trials
Full text linkBackground Emollients and topical corticosteroids (TCS) prevent and treat flares in eczema. However, topical treatment use is poorly recorded and reported in clinical trials. There is no clear consensus of how best to capture and summarize topical treatment use. Objectives To explore different ways of capturing and reporting topical treatment use in childhood eczema. Methods This was a secondary data analysis using 450 participants from the Best Emollients for Eczema (BEE) trial. Participants were allocated to use one type of emollient (lotion, cream, gel or ointment) ‘twice daily and when required’ for 16 weeks. Otherwise, clinical management remained unchanged. Parents completed weekly questions about topical therapy use and eczema symptoms. Two versions of topical treatment use questionnaires were used. The first (n=202, 44.9%) asked parents to report treatment use on days 1–7, starting completion on the day they were randomized. The second (n=248, 55.1%) reported use by day of the week (Monday to Sunday), starting completion the first Monday after randomization. Both underwent patient and public involvement review but the second version was tested more thoroughly using cognitive interviewing techniques, following parent feedback that questions on the first version were confusing. Descriptive statistics compared questionnaire completion and differences in emollient and TCS use. Results Overall, questionnaire completion for both emollient and TCS use decreased with time, but at weeks 1 and 16, it was 84.7% (381/450) and 58.9% (265/450) for emollient use, and 94.2% (424/450) and 80.4% (362/450) for TCS use, respectively. Fewer emollient use questionnaires were completed with the first (33.5%, 1082/3232 patient-weeks) than the second (87.9%, 3489/3968 patient-weeks) version (P<0.001). TCS use questionnaire completion were similar for both (84.9%, 2744/3232 patient-weeks and 87.4%, 3468/3968 patient-weeks, P=0.002). We present different ways of summarizing topical treatment use. Conclusions Although questionnaire completion was similar for TCS use, emollient-use data completeness was higher in the second version. When designing questionnaires, balancing the detail and complexity of questions is important, especially if being collected as a secondary outcome measure. Numerous ways of summarizing the same data can provide different information. Future collection and reporting of treatment use should reflect specific trial aims
Rapid microbiological respiratory point-of-care-testing:a qualitative study with primary care clinicians
No full textBackground:Rapid microbiological point-of-care tests (POCTRM) present an opportunity to reduce antibiotic exposure and antimicrobial resistance. So far, there is limited understanding of how POCTRM may support clinicians in primary care in the UK and how POCTs might be integrated into practice.Aim: To investigate clinicians’ views on how POCTRM could influence clinical decisions and routine practice, and perspectives on how POCTRM may impact the clinician-patient relationship. Design and setting: Qualitative study embedded in a multi-centre, individually randomised controlled efficacy trial evaluating the use of a multiplex POCTRM for suspected respiratory tract infections in primary care.Method:Individual interviews were conducted with 18 clinicians (n= 9 General Practitioners, 4 Advanced Nurse Practitioners, 1 trainee Advanced Nurse Practitioner, 1 Clinical Pharmacist, 2 Paramedics, 1 Emergency Care Practitioner). Interviews were audio-recorded, transcribed verbatim and analysed thematically informed a realist approach.Results:POCTRM can guide prescribing decisions when clinicians experience diagnostic uncertainty and support communication with patients to reinforce prescribing decisions. Consequently, the perceived value, and use of, POCTRM varied according to clinicians’ confidence in making prescribing decisions and managing patient expectations and their clinical roles. The costly and time-consuming nature of POCTRM meant that integration of POCTRM into routine practice was considered unlikely at present.Conclusion:Clinicians in this study had generally favourable views towards POCTRM, but further POCTRM training, complementary strategies such as communication skills training and patient education, and clear guidance on implementation should be explored to optimise POCTRM feasibility and outcomes across different primary care settings
Perspectives of community pharmacy staff on commonly encountered skin conditions and the key challenges towards enhancing their role in dermatology
Full text linkThis research letter discusses the perspectives of community pharmacy staff on commonly encountered skin conditions and the key challenges towards enhancing their role in this area. A mixed methods online survey was created, and a total of 174 community pharmacy staff completed the survey. The results highlight the range of conditions currently encountered in community pharmacy and the breadth of challenges facing community pharmacy staff, in particular challenges surrounding providing a differential diagnosis. Community pharmacies are an integral part of the NHS and have a key role in managing skin conditions; however, in order to optimise this role, the perspectives of staff discussed in this letter need to be further explored and addressed
Atopic eczema in primary care: evidence update and implications for practice
Full text linkMost people with eczema have mild or moderate disease, and most are treated in primary care.1 This article aims to support health professionals in helping patients get control of eczema in time-limited consultations. Recent updated National Institute for Health and Care Excellence (NICE) guidance on atopic eczema highlighted changes to advice regarding bath emollients and advice on how to wash.2 While a fuller update is awaited, the evidence behind this is presented here, along with a summary of other recent research on eczema
Education to improve timeliness of shingles diagnosis in primary care: a cluster randomised study within a trial with nested qualitative study
No full textBackground Herpes zoster (shingles) is normally diagnosed clinically. Timely diagnosis is important so that antiviral treatment can be started soon after rash onset. Aim To assess whether a practice-level educational intervention, aimed at non-clinical patient-facing staff, improves the timely assessment of patients with shingles. Design and setting This was a cluster randomised study within a trial (SWAT) with nested qualitative study in general practices in England. Method Practices were cluster randomised 1:1, stratified by centre and minimised by practice list size and Index of Multiple Deprivation score. Intervention practices were sent educational materials, highlighting the common presenting features of shingles and what action to take if suspected. The primary and secondary outcomes were the mean proportion of patients per practice seen within 72 and 144 h of rash onset, respectively. Comparison between groups was conducted using linear regression, adjusting for randomisation variables. Semi-structured interviews with practice staff in intervention practices explored views and opinions about the intervention. Results In total, 67 practices were enrolled; 34 randomised to the intervention and 33 to the control. The mean difference in proportion of patients seen within 72 and 144 h was –0.132 (95% confidence interval [CI] = –0.308 to 0.043) and –0.039 (95% CI = –0.158 to 0.080), respectively. In intervention practices, 90.9% reported distributing the educational materials; however, engagement with these was suboptimal. Twelve participants were interviewed, and the poster component of the intervention was said to be easiest to implement. Conclusion Our educational intervention did not improve the timely assessment of patients with shingles. This may be the result of poor intervention engagement.</p
Patient perceptions of primary care rapid respiratory microbiological point-of-care-testing:a qualitative study
No full textObjectives Rapid microbiological point-of-care tests (RM-POCTs) have the potential to reduce antimicrobial overuse for respiratory tract infections (RTIs). However, patient perspectives regarding RM-POCTs remain unclear. Therefore, this study aimed to explore patients’ and parents’ experiences using RM-POCTs for RTIs and their views on how RM-POCTs influence treatment decisions, symptom management and future consulting.Design A qualitative study using in-depth, semistructured interviews. Data were analysed thematically, informed by a realist approach.Setting Interviewees were recruited from a multicentre, individually randomised controlled efficacy trial evaluating the use of a multiplex RM-POCT for suspected RTIs in primary care.Participants Purposive sample of primary care patients (n=21 adults, 9 parents) participating in the trial.Results In general, participants viewed RM-POCTs favourably. Patients believed RM-POCTs reduced diagnostic uncertainty but emphasised that RM-POCTs should be used alongside clinical judgement. For some, additional information from RM-POCTs created positive outcome expectancies and reduced the perception that antibiotics were necessary. Others felt invalidated by RM-POCTs’ results or believed further support was necessary to understand when antibiotics were needed and how they could manage symptoms. While RM-POCTs may reduce reconsulting for the same illness, participants indicated future consulting behaviours would persist for self-limiting symptoms or health anxiety. Increased consulting may occur if patients perceive RM-POCTs to reduce pressure on primary care.Conclusion RM-POCT offers the potential to improve self-efficacy beliefs and reduce reconsulting for the same illness. Effective clinician communication and patient education may be beneficial alongside RM-POCTs to minimise unintended outcomes and enhance patients’ ability to determine when primary care attendance is necessary in the future.Trial registration number ISRCTN1603919
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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