Tag: General practice

Coronavirus: how accurate are coronavirus tests?

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by Dr Jessica Watson, GP and NIHR Doctoral Senior Clinical Research Fellow, Centre for Academic Primary Care, University of Bristol and Dr Penny Whiting, Associate Professor in Clinical Epidemiology, NIHR ARC West and University of Bristol

Coronavirus testing has been the subject of huge interest, frustration and confusion. The UK has come under worldwide criticism for its lack of mass testing, despite the director general of WHO encouraging countries to “test, test, test”. Health Secretary Matt Hancock announced that the UK now aims to test 100,000 people a dayfor COVID-19 by the end of April.

There are two main types of COVID-19 tests. Swab tests, which usually take a sample from the throat or nose, to detect viral RNA. These determine if you currently have COVID-19. Blood tests, which detect antibodies, can determine if you have had COVID-19, and are therefore immune.

No test … Read more

A GP reads ‘The Plague’ during the COVID-19 pandemic

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Prof Gene Feder

 

 

by Gene Feder, GP and Professor of Primary Care, Centre for Academic Primary Care, University of Bristol

The Plague, a novel by Albert Camus, published in 1947, tells the story of Oran, a city struck by bubonic plague. It was an extended metaphor for living under fascism and the way society and individuals behave under occupation.

I found an English translation at the back of a book shelf, having first read it as a teenager over half a century ago. On the title page there is a stamp: ‘Rainbow Library Salzburg THIS BOOK IS A [sic] PROPERTY OF THE UNITED STATES’. My father – working with Holocaust* survivors in Germany and Austria – must have forgotten to return it.

In 2020, it turns out that the book – partially – exemplifies our response to the pandemic du jour: COVID-19.

Everybody knows that pestilences have

… Read more

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

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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

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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?

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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

Health Data Science: the next key development in patient-centred research will be data-led

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by Dr Yvette Pyne, Academic Clinical Fellow, Centre for Academic Primary Care, University of Bristol

The breadth of conditions doctors are expected to manage continues to grow as people and society become ever more complex and it is in GP surgeries up and down the country where this is most starkly seen. The volume of work expected of GPs is taking its toll on individual doctors and the service as a whole.

My previous career designing and developing information technology (IT) systems gives me insight into the huge potential computers and machine learning have to help us in this increasingly challenging environment. Artificial Intelligence (AI) can enable us to provide the best evidence-based medicine to our patients while also freeing us from mundane administration to spend more time connecting with the human beings in front of us.

In the UK, Primary Care is already leading … Read more

Wanted: GPs who understand that evidence alone does not create policy

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by Dr Jason Sarfo-Annin, Honorary Research Fellow, Centre for Academic Primary Care, University of Bristol

Debate surrounding the future of general practice is usually rooted in the context of the primary care workforce, the introduction of new roles and developing practitioners with a new skill-mix.
Such solutions are rooted in the medical model of health. I share the Marmotian view that health care is just one dimension of improving individual and population health.

As GPs, we often consult with patients who cannot be helped by our services. We are also often unable to effectively signpost patients or help navigate them to services that can support them. Consequently, I believe the future involves working as part of a collaboration of services – delivered optimally by co-location. Provision of these services would be based on the geographical location of patients and include amenities already provided by local authorities … Read more

Involving advanced heart failure patients in shaping research questions: A Priority Setting Partnership

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by Dr Rachel Johnson, NIHR Clinical Lecturer in Primary Health Care, Centre for Academic Primary Care, University of Bristol and Anna King, NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol

 

Our Priority Setting Partnership (PSP) began as the idea of a group of doctors who have witnessed how difficult the experience of heart failure can be for patients and their families. Heart failure is one of the commonest causes of unplanned hospital admissions, and it can place a heavy burden on carers and families.

Our aim was to put the needs of patients, carers and health professionals at the heart of the research agenda. We followed the methods of the James Lind Alliance Heart (JLA), a not for profit organisation set up to ‘open up discussion between patients and clinicians to agree on priorities for future research.

The PSP … Read more

Male victims of domestic abuse face barriers to accessing support services – new study

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by Dr Eszter Szilassy, Research Fellow, Centre for Academic Primary Care, University of Bristol

Men who experience domestic violence and abuse face significant barriers to getting help and access to specialist support services, our latest study shows.

Although the amount, severity and impact of domestic violence and abuse experienced by women is much higher than that experienced by men, men can also suffer significantly as a result of abuse from a partner, ex-partner or an adult family member.

An earlier study of 1,368 male patients in GP clinic waiting rooms in the UK found that more than one in four had experienced abusive behaviour from a partner or ex-partner. They were also between two and three times more likely to have symptoms of depression and anxiety.

The experiences of many men who are survivors of domestic violence and abuse are similar to those of women. Like … Read more

Including the views and experiences of parents and children in a clinical trial: The Best Emollient for Eczema (BEE) Study

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Dr Eileen Sutton

 

 

By Dr Eileen Sutton, Research Fellow and Trial Coordinator – BEE Study, Centre for Academic Primary Care, University of Bristol

Qualitative research in trials

Many clinical trials now include qualitative research methods – which can include interviews, focus groups, or observations – alongside clinical and survey data collection. These kinds of research methods can be used to help the design of trials or to help us understand what is going on when a treatment or service is delivered in a clinical trial. For example, we can interview research participants to find out more about how they have used or experienced a treatment, in much more detail than we could capture in a survey. Combining different research methods can help researchers to get a more complete picture.

Our research

Around 20% of children in the UK experience eczema, which is characterised by dry, itchy skin. Eczema can … Read more