58 research outputs found
GP access for inclusion health groups: perspectives and recommendations.
Get PDFBACKGROUND: General practice has seen the widespread adoption of remote consulting and triage systems. There is a lack of evidence exploring how inclusion health populations have been impacted by this transformation. AIM: This study aimed to explore the post-pandemic GP access for inclusion health populations, through the lens of those with lived experience, and identify practical recommendations for improving access for this population. DESIGN & SETTING: A mixed methods study exploring the direct experience of people from inclusion health groups trying to access GP care in 13 practices in east London. METHOD: A mystery shopper exercise involving 39 in-person practice visits and 13 phone-calls were undertaken. The findings were reflected upon by a multidisciplinary stakeholder group which identified recommendations for improvements. RESULTS: Only 31% of the mystery shopper visits (n=8) resulted in registration and the offer of an appointment to see a GP for an urgent problem. None of the mystery shoppers was able to book an appointment over the phone but 10/13 felt that they would be able to register and make an appointment if they followed the receptionist's instructions. Most mystery shoppers felt respected, listened to and understood the information provided to them. Just under half of the practices (46%, n=6) received positive comments on how accessible and supportive their spaces felt.Practice and system-level recommendations were identified by the stakeholder group. CONCLUSION: Ongoing GP access issues persist for inclusion health populations. We identified practice and system level recommendations for improving access for this vulnerable population
Inclusion health patient perspectives on remote access to general practice: a qualitative study.
Get PDFBACKGROUND: The COVID-19 pandemic has led to rapid and widespread adoption of remote consultations and triage-first pathways in general practice. However, there is a lack of evidence on how these changes have been perceived by patients from inclusion health groups. AIM: To explore the perspectives of individuals from inclusion health groups on the provision and accessibility of remote general practice services. DESIGN & SETTING: A qualitative study with individuals from Gypsy, Roma and Traveller communities, sex workers, vulnerable migrants, and those experiencing homelessness, recruited by Healthwatch in east London. METHOD: The study materials were co-produced with people with lived experience of social exclusion. Semi-structured interviews with 21 participants were audiorecorded, transcribed, and analysed using the framework method. RESULTS: Analysis identified barriers to access owing to lack of translation availability, digital exclusion, and a complex healthcare system, which is difficult to navigate. The role of triage and general practice in emergencies often seemed unclear to participants. Other themes identified included the importance of trust, face-to-face consultation options for ensuring safety, and the benefits of remote access, particularly in terms of convenience and saving time. Themes on reducing barriers included improving staff capacity and communication, offering tailored options and continuity of care, and simplifying care processes. CONCLUSION: The study highlighted the importance of a tailored approach for addressing the multiple barriers to care for inclusion health groups and the need for clearer and inclusive communication on the available triage and care pathways
Implementation of Sexual and Reproductive Health Education Policy in Schools in Asia and Africa: A Scoping Review
Get PDFObjectives: This review aimed to map and synthesize existing literature on sex and reproductive education policy implementation in primary and secondary schools in Asia and Africa. Methods: Database searches yielded 24 relevant articles, which underwent thematic analysis. Results: Most studies were conducted in Africa and looked at barriers to implementation. Studies assessing implementation showed it was incomprehensive. Barriers were: policy/curriculum issues, societal opinions, teaching discomfort, lack of educator training, and lack of sufficient economical support. Conclusions: Based on the limited evidence, a cultural shift to reduce stigma seems necessary, alongside teacher and student involvement in policy formulation and implementation monitoring
Dissolved organic matter cycling in eastern Mediterranean rivers experiencing multiple pressures. The case of the trans-boundary Evros River
Get PDFThe objective of our study was to provide a comprehensive evaluation on C, N, P cycling in medium sized Mediterranean rivers, such as the Evros, experiencing multiple pressures (intensive agriculture, industrial activities, population density). Our work aims also to contribute to the development of integrated management policies. Dissolved organic matter (DOM) cycling were investigated, during a one-year study. It was shown that the organic component of N and P was comparable to those of large Mediterranean rivers (Rhone, Po). In the lower parts of the river where all point and non-point inputs converge, the high inorganic N input favour elevated assimilation rates by phytoplankton and result in increased chl-a concentrations and autochthonous dissolved organic matter (DOM) production during the dry season with limited water flow. Moreover, carbohydrate distribution revealed that there is a constant background of soil derived mono-saccharides on top of which are superimposed impulses of poly-saccharides during blooms. During the dry season, inorganic nutrients and DOM are trapped in the lower parts of the river, whereas during high flow conditions DOM is flushed towards the sea and organic nitrogen forms can become an important TDN constituent (at least 40%) transported to shelf waters. The co-existence of terrigenous material with autochthonous and some anthropogenic is supported by the relatively low DOC:DON and DOC:DOP ratios, the positive correlation of DOC vs chl-a and the decoupling between DOC and DON. Overall, this study showed that in medium size Mediterranean rivers, such as the Evros, intensive agriculture and pollution sources in combination with water management practices and climatic variability are important factors determining C, N, P dynamics and export to coastal seas. Also, it highlights the importance of the organic fraction of N and P when considering management practices
Dissolved organic matter cycling in eastern Mediterranean rivers experiencing multiple pressures. The case of the trans-boundary Evros River
Get PDFThe objective of our study was to provide a comprehensive evaluation on C, N, P cycling in medium sized Mediterranean rivers, such as the Evros, experiencing multiple pressures (intensive agriculture, industrial activities, population density). Our work aims also to contribute to the development of integrated management policies. Dissolved organic matter (DOM) cycling were investigated, during a one-year study. It was shown that the organic component of N and P was comparable to those of large Mediterranean rivers (Rhone, Po). In the lower parts of the river where all point and non-point inputs converge, the high inorganic N input favour elevated assimilation rates by phytoplankton and result in increased chl-a concentrations and autochthonous dissolved organic matter (DOM) production during the dry season with limited water flow. Moreover, carbohydrate distribution revealed that there is a constant background of soil derived mono-saccharides on top of which are superimposed impulses of poly-saccharides during blooms. During the dry season, inorganic nutrients and DOM are trapped in the lower parts of the river, whereas during high flow conditions DOM is flushed towards the sea and organic nitrogen forms can become an important TDN constituent (at least 40%) transported to shelf waters. The co-existence of terrigenous material with autochthonous and some anthropogenic is supported by the relatively low DOC:DON and DOC:DOP ratios, the positive correlation of DOC vs chl-a and the decoupling between DOC and DON. Overall, this study showed that in medium size Mediterranean rivers, such as the Evros, intensive agriculture and pollution sources in combination with water management practices and climatic variability are important factors determining C, N, P dynamics and export to coastal seas. Also, it highlights the importance of the organic fraction of N and P when considering management practices
Language of primary medical qualification and differential MRCGP exam attainment: an observational study
Get PDFBackground International Medical Graduates (IMGs) are more likely to fail postgraduate assessments and comprise over half of GP trainees. Aim This study assessed whether there is an association between language of primary medical qualification (PMQ) and Membership of the Royal College of General Practitioners (MRCGP) results and whether performance in previous pre-qualification assessments is correlated. Design and Setting We used the World Directory of Medical Schools Search and the UK Medical Education databases. Data were obtained for all candidates who sat the MRCGP exams between October 2013 and July 2021 (N=28,005). Method Cohort 1 included UK graduates, cohort 2 included IMGs with PMQ English who trained in countries with English (2a) or non-English (2b) as a first language, and cohort 3 included IMGs with PMQ non-English. Logistic and linear regression analyses were used to compare the odds of exam passing and the scores relative to pass. Associations with past MSRA scores, IELTS scores and PLAB scores were examined. Results IMGs who trained in countries with non-English as first language had statistically significantly lower odds of passing the exams and lower exam scores across all exam components. There were significant positive correlations between MSRA, IELTs and PLAB scores and MRCGP exam scores. Conclusion English PMQ language and undertaking medical training in a country with English as the native language seem to result in significantly better chances of passing the exams and better exam scores. Performance in pre-qualification assessments can help identify IMG trainees who may benefit from tailored support.</jats:p
Are patients satisfied? A systematic review and meta-analysis of patient ratings in exercise therapy for the management of tendinopathy.
Get PDFOutcomes measuring patient rating of overall condition, including patient satisfaction, are associated with improved general health and higher quality of life. However, this outcome domain is under-explored in the management of tendinopathy. The purpose of this systematic review and meta-analysis was to synthesise intervention data investigating patient satisfaction and perceived improvement or deterioration following engagement in exercise therapy for the management of tendinopathy. A search of randomised controlled trials investigating exercise therapy interventions across all tendinopathies was conducted, extracting data assessing patient rating of overall condition. Outcomes were split into those measuring satisfaction (binary) and those measuring global rating of change (GROC). Bayesian hierarchical models were used to meta-analyse proportions and mean effect size (percentage of maximum) for the two outcome categories. From a total of 124 exercise therapy studies, 34 (Achilles: 41%, rotator cuff: 32%, patellar: 15%, elbow: 9% and gluteal: 3%) provided sufficient information to be meta-analysed. The data were obtained across 48 treatment arms and 1246 participants. The pooled estimate for proportion of satisfaction was 0.63 [95% CrI: 0.53 to 0.73], and the pooled estimate for percentage of maximum GROC was 53 [95% CrI: 38 to 69%]. Evidence was also obtained that the proportion of patients reporting positive satisfaction and perception of change increased with longer durations relative to treatment onset. The study concluded that patient satisfaction is not commonly reported in tendinopathy research and, in those studies where it is reported, satisfaction and GROC appear similar and are ranked moderately high, demonstrating that patients generally perceive exercise therapy for tendinopathy management positively. Further research including greater consistency in measurement tools is required to explore, and where possible identify patient and exercise moderating factors that can be used to improve person-centred care
Which treatment classes and combinations are more effective for the management of common tendinopathies? A systematic review and network meta-analysis.
Get PDFThe aim of this research was to quantify the comparative effectiveness of treatment classes used for the management of the most common tendinopathies. The project studied network meta-analyses comparing combinations of exercise, non-exercise, and non-active treatments across a range of tendinopathy locations and outcome domains. The review covered randomised and quasi-randomised controlled trials including an exercise arm and persons with a tendinopathy diagnosis at any location, and of any severity or duration. Outcome measures included outcomes assessing disability, function, pain, shoulder range of motion, physical function capacity, or quality of life. Through network meta-analyses, broad (exercise/non-exercise/combined/non-active) and more specific (exercise/biomechanics/injection/electrotherapy/manual-therapy/non-active/surgery) treatment class models were fitted with hierarchical Bayesian models. Results were interpreted using pooled standardised mean difference effect sizes and ranking through Surface Under the Cumulative Ranking curves (SUCRA). Treatment hierarchies were assessed using the GRADE minimally contextualised framework. Two-hundred studies comprising 458 treatments arms were identified. Many comparisons were within the same class reducing data available to assess comparative effectiveness. Data from 85 studies generating 140 pairwise comparisons consistently identified the superiority of combining exercise and non-exercise treatment classes (SUCRA: 0.70 to 0.88). Central estimates indicated that combining exercise and non-exercise treatments increased effect sizes by ~0.1 to 0.3 compared with exercise alone. Analysis of more specific treatment classes identified with low/very low certainty the superiority of combining exercise with either biomechanical (e.g. taping, bracing or splinting; SUCRA: 0.73) or injection therapies (SUCRA: 0.72). The study concluded that clinicians should consider combining exercise and non-exercise therapies as a starting point for tendinopathy management. The most effective treatment combinations include exercise with the use of biomechanical or injection therapies
What are small, medium and large effect sizes for exercise treatments of tendinopathy? A systematic review and meta-analysis.
Get PDFThe objective of this study was to quantify and describe effect size distributions from exercise therapies across a range of tendinopathies and outcome domains, to inform future research and clinical practice through conducting a systematic review with meta-analysis. The review and meta-analysis explored moderating effects and context specific small, medium, and large thresholds. The study looked specifically at randomised and quasi-randomised controlled trials involving any persons with a diagnosis of rotator cuff, lateral elbow, patellar, Achilles or gluteal tendinopathy of any severity or duration. The study was conducted using common databases, six trial registries and six grey literature databases, which were searched on 18/01/21 (PROSPERO: CRD42020168187). Standardised mean difference (SMDpre) effect sizes were used with Bayesian hierarchical meta-analysis models to calculate the 0.25- (small), 0.5- (medium) and 0.75-quantiles (large), and to compare pooled means across potential moderators. Risk of bias was assessed with Cochrane's Risk of Bias tool. Data were obtained from 114 studies comprising 171 treatments and 4104 participants. SMDpre effect sizes were similar across tendinopathies but varied across outcome domains. Greater threshold values were obtained for self-reported measures of pain (small = 0.5; medium = 0.9; large = 1.4), disability (small = 0.6; medium = 1.0; large = 1.5) and function (small = 0.6; medium = 1.1; large = 1.8); and lower threshold values obtained for quality of life (small = -0.2; medium = 0.3; large = 0.7), and objective measures of physical function (small = 0.2; medium = 0.4; large = 0.7). Potential moderating effects of assessment duration, exercise supervision and symptom duration were also identified, with greater pooled mean effect sizes estimated for longer assessment durations, supervised therapies and studies comprising patients with shorter symptom durations. The study found that the effect size of exercise on tendinopathy is dependent on the type of outcome measure assessed. Threshold values presented here can be used to guide interpretation and assist with further research better establishing minimal important change
Evaluating case studies of community-oriented integrated care.
Get PDFThis paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub - both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into 'wicked problems', and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention
- …
