1,721,105 research outputs found
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
How parents and children evaluate emollients for childhood eczema: a qualitative study
No full textBackground: eczema affects one in five children in the UK. Regular application of emollients is routinely recommended for children with eczema. There are four main emollient types, but no clear evidence of which is best. The current ‘trial and error’ approach to find suitable emollients can be frustrating for parents, children, and clinicians.Aim: to identify how parents and children experience and evaluate emollients.Design and setting: qualitative interview study, nested within a primary care trial of emollients (Best Emollients for Eczema [BEE] trial).Method: semi-structured interviews with children with eczema and their parents were conducted. Participants were purposively sampled on emollient type (lotion, cream, gel, or ointment), age, and eczema severity.Results: forty-four parents were interviewed, with children participating in 24 of those interviews. There was no clear preference for any one emollient type. The strongest theme was the variation of experience in each of the four types. Participants focused on thickness and absorbency, both positively and negatively, to frame their evaluations. Effectiveness and acceptability were both considered when evaluating an emollient but effectiveness was the primary driver for continued use. For some, participating in the trial had changed their knowledge and behaviour of emollients, resulting in use that was more regular and for a longer duration.Conclusion: there is no one emollient that is suitable for everyone, and parents/children prioritise different aspects of emollients. Future research could evaluate decision aids and/or tester pots of different types, which could enable clinicians and parents/children to work collaboratively to identify the best emollient for them
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
Impact of a deferred recruitment model in a randomised controlled trial in primary care (CREAM study)
Full text linkBackground: Recruitment of participants is particularly challenging in primary care, with less than a third of randomised controlled trials (RCT) achieving their target within the original time frame. Participant identification, consent, randomisation and data collection can all be time-consuming. Trials recruiting an incident, as opposed to a prevalent, population may be particularly affected. This paper describes the impact of a deferred recruitment model in a RCT of antibiotics for children with infected eczema in primary care, which required the recruitment of cases presenting acutely. Methods: Eligible children were identified by participating general practitioners (GPs) and referred to a study research nurse, who then visited them at home. This allowed the consent and recruitment processes to take place outside the general practice setting. Information was recorded about patients who were referred and recruited, or if not, the reasons for non-recruitment. Data on recruitment challenges were collected through semi-structured interviews and questionnaires with a sample of participating GPs. Data were thematically analysed to identify key themes. Results: Of the children referred to the study 34% (58/171) were not recruited - 48% (28/58) because of difficulties arranging a baseline visit within the defined time frame, 31% (18/58) did not meet the study inclusion criteria at the time of nurse assessment, and 21% (12/58) declined participation. GPs had positive views about the recruitment process, reporting that parents valued and benefitted from additional contact with a nurse. GPs felt that the deferred recruitment model did not negatively impact on the study. Conclusions: GPs and parents recognised the benefits of deferred recruitment, but these did not translate into enhanced recruitment of participants. The model resulted in the loss of a third of children who were identified by the GP as eligible, but not subsequently recruited to the study. If the potential for improving outcomes in primary care through complex studies is to be realised, new approaches to recruitment into primary care trials need to be developed and evaluated. Trial registration: International Standard Randomised Controlled Trials, ISRCTN96705420. Registered on 27 June 2012.</p
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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