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

 

 

 

 

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

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

 

 

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

Involving people with advanced heart failure in setting the research agenda

Rachel Johnson

 

 

by Dr Rachel Johnson, GP and NIHR Clinical Researcher in Primary Health Care, Centre for Academic Primary Care, University of Bristol

Together with colleagues at the Universities of Bristol, Oxford, Birmingham, Cambridge and Lancaster, I recently completed a James Lind Alliance Priority Setting Partnership for advanced heart failure, funded by the NIHR School for Primary Care Research.

Priority setting partnerships (PSPs) are an established method for involving patients and the public in the first, crucial stage of research – deciding which research questions should be tackled by research studies. The results have just been published in BMJ Open Heart and include a list of the final top 10 priority research questions.

Briefly the process involved:

  • conducting a survey to elicit priority questions from a wide range of stakeholders, including patients, carers and clinicians
  • excluding questions that had already been addressed in the literature
  • ranking the
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Finding the best moisturiser for eczema – the impact research can have on everyday lives

Zoe Wilkins

 

 

by Zoe Wilkins, Trial Administrator, Centre for Academic Primary Care, University of Bristol

It’s safe to say that I knew little about eczema before working as an administrator on the Best Emollients for Eczema (BEE) trial and even less so about emollients, the different types of moisturiser used to treat the condition.

My own children occasionally suffered with very mild eczema; tiny patches here and there that would clear up with a couple of days of moisturisation. So, it was only after starting work on the trial that I began to understand the complexity of this condition. Some suffer seasonal ‘flare-ups’, for others year-round torment, which can be triggered by many different factors.

Although I knew that if you had eczema it was important to keep skin moisturised, I had not heard of the word ‘emollient’ before. Emollient is the medical word for moisturiser and comes in … Read more

What we know about ACE inhibitors, high blood pressure and COVID-19

 

 

by Dr Rupert Payne, Consultant Senior Lecturer in Primary Health Care, Centre for Academic Primary Care, University of Bristol

The COVID-19 pandemic has unsurprisingly been associated with a similar epidemic of social media misinformation. But there are also some genuine clinical issues of relevance to people with existing health conditions, who are known to be more vulnerable to the disease. One particular topic that has left patients and health professionals alike confused and alarmed is the suggestion that ACE inhibitor drugs may increase the dangers of COVID-19.

First introduced in the early 1980s, ACE (angiotensin-converting enzyme) inhibitors were initially used for the treatment of high blood pressure, but their role has grown over the years to include the management of heart failure, heart attacks, diabetes and kidney disease. Given that roughly one-fifth of the adult population in the UK has diagnosed hypertension, and other … Read more

Vaccinating children – why peace of mind should not be forgotten when it comes to funding

Gemma Lasseter

 

by Gemma Lasseter, Research Fellow, Centre for Academic Primary Care and NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol

In the UK, government policy on whether to fund new vaccines, or modify their availability, is based on advice from an independent scientific advisory group. This involves weighing up the benefits and costs, and then deciding whether a vaccine is value for money.

The idea is to find a balance between the cost of doing something (such as routinely vaccinating all children against a particular disease) and how much benefit you get from doing it (such as health gains by preventing disease and the associated economic savings).

Yet the current approach does not take into account many of the benefits that vaccinations offer and which set them apart from other health interventions. The fact that vaccinations are preventative rather than curative, for … Read more

What are the causes of unnecessary antibiotic prescribing?

 

 

By Christie Cabral, Research Fellow, Centre for Academic Primary Care, University of Bristol

Why do parents seeking evaluation, reassurance and information about their child’s cough end up with antibiotics from their GP? Research fellow Christie Cabral looks at the evidence.

GPs see a lot of children with respiratory tract infections (RTIs), usually presenting with a cough, high temperature or both. RTIs can be distressing and disruptive for children and parents but are mostly viral illnesses that will get better on their own: there is little that a GP can do to treat them.

However, many are prescribed unnecessary antibiotics that can lead to resistant bacteria. From our previous research, we know that parents often feel uncertain about the severity of an RTI and feel that it’s safer to consult a doctor.

They are usually seeking a medical evaluation, reassurance and information to help them understand and … Read more

SafeTea: An online intervention to prevent hot drink scalds in small children and improve burn first aid

Professor Alan Emond

 

 

Guest blog by Professor Alan Emond, Emeritus Professor of Child Health, Bristol Medical School, University of Bristol

SafeTea is a national campaign which aims to reduce hot drink scalds to young children and promote burns first aid. The launch of the intervention will be on 16 October 2019, National Burn Awareness Day. The target audience is parents, grandparents and carers of children under 5 across the UK.

Primary care centres can participate in the campaign by:

  • displaying posters, flyers or videos that are freely available on the SafeTea website. 
  • by following us on social media @SafeTeaCampaign on Twitter, Facebook, Instagram and YouTube
  • by taking the SafeTea pledge.

The key messages of the campaign are to:

  • Keep hot drinks away from young children
  • Never carry a hot drink whilst carrying a baby
  • Never pass a hot drink over the heads of young children
  • Make a
Read more

Children with eczema: the link to food allergies is not clear cut

By Dr Matthew Ridd, GP and Senior Lecturer in Primary Healthcare, Centre for Academic Primary Care, University of Bristol
and Dr Robert Boyle, Consultant Paediatric Allergist, Imperial College London

Around one in five children have eczema – and even mild cases can have a big impact on both the child and their family. For many, symptoms will come and go before they start primary school, but for others it can indicate the beginning of a genetic tendency to develop allergic conditions such as hay fever or asthma (or both).

We also know that children with eczema are more likely to develop food allergies, especially if the condition starts in the first few months of life and is severe. Often parents will make the allergy diagnosis themselves – at the sudden onset of vomiting, diarrhoea or rash after eating scrambled egg, for example.

This can be frightening, but … Read more