Category: Management of disease

Improving papilloedema diagnosis and referral

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by Dr Denize Atan, Associate Professor in Neuro-opthalmology, Neuroscience and Genetics, University of Bristol

Papilloedema is nerve swelling at the back of the eyes. It is caused by increased pressure inside the head and can be the first sign of a brain tumour or other serious health problems.

As half the people with a brain tumour have no symptoms, optometrists (trained eye care professionals who work at optician practices) may be the first to notice nerve swelling in someone during a routine eye test.

The importance of detecting papilloedema has been highlighted by recent high profile cases in the media.

The ‘Improving the Diagnostic accuracy of referrals for Papilloedema’ (DIPP) Study is funded by the National Institute for Health and Care Research (NIHR) to develop a set of guidelines and educational materials for optometrists and GPs that will help them to diagnose papilloedema more accurately … Read more

Treatment decision-making in advanced kidney disease: an international collaborative workshop on future directions

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By Dr Lucy Selman, Associate Professor in Palliative and End of Life Care, Centre for Academic Primary Care, University of Bristol

On Thursday 8 June 2023, an expert meeting was held at the University of Bristol, on treatment decision-making in advanced kidney disease. The meeting brought together renal and palliative care clinicians and researchers specialising in the area from across the UK with colleagues from Harvard University and Brigham and Women’s Hospital, with two guests from Boston coming to Bristol to attend in person.

The aim of the event was to share research and clinical practice models related to treatment decision-making in advanced kidney disease – an area in which the partnering teams have complementary expertise.

The event was led by Dr Lucy Selman, Associate Professor of Palliative and End-of-Life Care at the University of Bristol in collaboration with Professor James Tulsky, Professor of Medicine at … Read more

Anyone can get long-term pain from shingles

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By Lorelei Hunt, Patient and Public Involvement Representative on the ATHENA Shingles Study, Centre for Academic Primary Care, University of Bristol

Five years ago, when I felt unwell with a pain on one side of my body, I assumed I had a virus. Only after a week, when a rash appeared in the same place, did I think that I might have shingles. I was in good health and never thought shingles was something that I was at risk of. But I now know that anyone can get it.

After getting chicken pox, the virus lurks in your nervous system and can reappear as shingles without warning at any time and the risk of this increases with age. The painful, blistering rash was bad enough, but I didn’t know that shingles can have a nasty after-effect, causing a type of nerve pain called post-herpetic neuralgia (PHN for … Read more

Championing a ‘People Era’ in heart failure research

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By Dr Alyson Huntley, Senior Research Fellow in Evidence Synthesis, Centre for Academic Primary Care, University of Bristol

World Heart Day on 29 September 2022 aims to inform people that cardiovascular disease, including heart failure and stroke, is the world’s leading cause of death, claiming 18.6 million lives each year. It also aims to highlight the actions that individuals can take to prevent and control heart disease. Alyson Huntley describes how researchers at the Centre for Academic Primary Care are refocusing priorities to ensure that the needs of people living with heart failure are at the centre of their work.

We aim to put people with heart failure at the centre of our research. A recent collaborative project with other universities highlighted the unmet needs of people living with heart failure. The priority setting process brought clinicians, patients and families/carers together on an equal footing to … Read more

Wakey! Evaluating the feasibility of a mental wellbeing app

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Dr Sophie Turnbull

 

 

By Sophie Turnbull, Senior Research Associate, Centre for Academic Primary Care, University of Bristol

I have an ongoing interest in how industry and academia can work together to produce really good evidence-led products that can be accessible for the target users, and have more longevity than those produced in purely academic settings.

From experience, when we produce digital interventions in our academic bubble, they are brilliantly researched, but often not maintained in the long-term, meaning they disappear soon after the research funding stops. Or we do not have enough budget to develop something that people are going to want to use.

While exploring how academia and industry can come together to reduce inequalities in access to good quality healthcare, I discovered ZINC. ZINC runs mission-led programmes with people from across disciplines to build commercial solutions to solve some of the most pressing societal issues. I … Read more

Point-of-care tests to inform antibiotic prescribing

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by Alastair Hay, Professor of Primary Care, Centre for Academic Primary Care, University of Bristol

This article was first published in the BMJ.

The tests have potential but more evidence is needed. 

Given the global concerns(1) about antibiotic resistance, antimicrobial stewardship is essential to preserve the future effectiveness(2) of antibiotics. Healthcare practitioners must balance public and patient health, ensuring that only patients who need antibiotics receive them, and that they receive an antibiotic to which their infection is susceptible, at the optimum time, dose, and duration. Whether to prescribe an antibiotic is a key issue for clinicians treating respiratory infections in the community.

Point-of-care tests provide results in time to inform treatment. For respiratory infections, the tests can identify the presence of a microbe(3-5) or measure markers of a host’s response to a microbe, such as C reactive protein or procalcitonin, in finger prick quantities … Read more

Is there value in GPs diagnosing an anxiety disorder?

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by Charlotte Archer, Senior Research Associate in Primary Care Mental Health, and Katrina Turner, Professor of Primary Care Research, Centre for Academic Primary Care, University of Bristol

Research has shown that fewer people in primary care are now being diagnosed with anxiety than in the past, despite reports that rates of anxiety have increased in the general population. Individuals with anxiety may be reluctant to seek help for their symptoms. They may also find it difficult to talk to their GP about their mental health or may normalise their symptoms.

Although most anxiety is managed in primary care by GPs, we know very little about whether GPs and patients think it is important to diagnose and manage anxiety disorders. Knowing this might help us identify possible reasons for the decline in their recording, and the potential impact of this on patient care and … Read more

Primary care and the maintenance of abstinence in alcohol dependence: what might work?

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by Dr Vincent Cheng, Senior Research Associate in Research Synthesis, Bristol Medical School and Professor David Kessler, Professor of Primary Care, Centre for Academic Primary Care and Centre for Academic Mental Health,  University of Bristol

The problem

Specialist alcohol treatment services cannot cope with the growing problem of alcohol use disorder. Even before the recent COVID-19 lockdown, it was estimated that more than 80% of those in need of treatment were not receiving it. The predicted economic downturn is not likely to improve this figure. Given that primary care is universally accessible in the UK, we were interested in bringing together the evidence on what interventions could be delivered in primary care.

We conducted a systematic review and network meta-analysis of treatments (psychological, pharmacological, or both) for maintaining abstinence in recently detoxified, alcohol dependent adults that could be delivered in a community setting. … Read more

‘Not just on the surface’: Improving support for patients with skin problems

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by Emma Le Roux, GP with a dermatology special interest. Formerly Senior Clinical Research Fellow (NIHR-in-Practice) at the Centre for Academic Primary Care, University of Bristol

Skin problems are among the most common reasons patients to go to the doctor. As a GP, I often reflect on the patients I see, such as the 35-year-old man who suffers with psoriasis. Over 15 years he has struggled with managing his itchy skin symptoms but of more concern to him is his related low self-esteem. Because of the appearance of his skin he felt unable to take part in leisure activities, such as taking his son swimming. He lacked understanding of treatment options and was unaware of the condition’s associations with arthritis and cardiovascular disease. His experience reflects the evidence that skin problems are known to have a heavy physical and psychosocial burden.

Most patients with skin problems … Read more

Why does the type of moisturiser matter to a child with eczema? A research nurse’s perspective

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By Sue Davies-Jones, Research Nurse, Faculty of Medicine and Health Sciences, Nottingham University

I have worked as a research nurse at the Centre of Evidence Based Dermatology for 13 years, working on various dermatology research projects. The Best Emollients for Eczema (BEE) study aims to answer the important question of whether some types of emollient (moisturisers) are better than others in the treatment of childhood eczema.

In an ideal world, patients would be able to sample different emollients before deciding which one they preferred, but this is not usually practical. The BEE Trial has been designed to help doctors and patients to decide which types of emollient are best to try first.

GPs are under pressure to prescribe on cost, but we don’t know whether a more watery or cheaper moisturiser is as good as a thicker or more expensive one. Helping families find the “right” moisturiser … Read more