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Search results

Found 10308 matches for

World-class teaching and research that helps general practitioners and other health professionals deliver better care in the community.

  • Determinants of initiation, implementation, and discontinuation of amoxicillin by adults with acute cough in primary care

    10 July 2017

  • Short-course versus long-course oral antibiotic treatment for infections treated in outpatient settings: a review of systematic reviews.

    1 June 2017

    Purpose.: To summarize the evidence comparing the effectiveness of short and long courses of oral antibiotics for infections treated in outpatient settings. Methods.: We identified systematic reviews of randomized controlled trials for children and adults with bacterial infections treated in outpatient settings from Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews and The Database of Review of Effects. Data were extracted on the primary outcome of clinical resolution and secondary outcomes. Results.: We identified 30 potential reviews, and included 9. There was no difference in the clinical cure for children treated with short or long course antibiotics for Group A streptococcal tonsillopharyngitis (OR 1.03, 95% CI:0.97, 1.11); community acquired pneumonia (RR 0.99, 95% CI:0.97, 1.01); acute otitis media [<2 years old OR: 1.09 (95% CI:0.76, 1.57); ≥2 years old OR: 0.85 (95% CI:0.60, 1.21)]; or urinary tract infection (RR 1.06, 95% CI:0.64, 1.76). There was no difference in the clinical cure for adults treated with short or long course antibiotics for acute bacterial sinusitis (RR 0.95, 95% CI:0.81, 1.21); uncomplicated cystitis in non-pregnant women (RR 1.10, 95% CI:0.96, 1.25), or elderly women (RR: 0.98, 95% CI:0.62, 1.54); acute pyelonephritis (RR 1.03, 95% CI:0.80, 1.32); or community acquired pneumonia (RR: 0.96, 95% CI:0.74, 1.26). We found inadequate evidence about the effect on antibiotic resistance. Conclusions.: This overview of systematic reviews has identified good quality evidence that short course antibiotics are as effective as longer courses for most common infections managed in ambulatory care. The impact on antibiotic resistance and associated treatment failure requires further study.

  • Comment on Rishu et al. Time required to initiate outbreak and pandemic observational research

    7 July 2017

  • Patient use of blood pressure self-screening facilities in general practice waiting rooms: a qualitative study in the UK.

    7 July 2017

    BACKGROUND: Blood pressure (BP) self-screening, whereby members of the public have access to BP monitoring equipment outside of healthcare consultations, may increase the detection and treatment of hypertension. Currently in the UK such opportunities are largely confined to GP waiting rooms. AIM: To investigate the reasons why people do or do not use BP self-screening facilities. DESIGN AND SETTING: A cross-sectional, qualitative study in Oxfordshire, UK. METHOD: Semi-structured interviews with members of the general public recruited using posters in GP surgeries and community locations were recorded, transcribed, and coded thematically. RESULTS: Of the 30 interviewees, 20% were hypertensive and almost half had self-screened. Those with no history of elevated readings had limited concern over their BP: self-screening filled the time waiting for their appointment or was done to help their doctor. Patients with hypertension self-screened to avoid the feelings they associated with 'white coat syndrome' and to introduce more control into the measurement process. Barriers to self-screening included a lack of awareness, uncertainty about technique, and worries over measuring BP in a public place. An unanticipated finding was that several interviewees preferred monitoring their BP in the waiting room than at home. CONCLUSION: BP self-screening appeared acceptable to service users. Further promotion and education could increase awareness among non-users of the need for BP screening, the existence of self-screening facilities, and its ease of use. Waiting room monitors could provide an alternative for patients with hypertension who are unwilling or unable to monitor at home.

  • Effectiveness of curcuminoids in the treatment of knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials

    6 July 2017

  • A real-world approach to Evidence-Based Medicine in general practice: A competency framework derived from a systematic review and Delphi process

    6 July 2017

  • Care, Control and the Electroconvulsive Therapy (ECT) Ritual: Making sense of polarised patient narratives

    24 May 2017

  • Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach

    24 May 2017

    Objective: To identify patient and family practice characteristics associated with patient-reported experiences of safety problems and harm. Design: Cross-sectional study combining data from the individual postal administration of the validated Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire to a random sample of patients in family practices (response rate =18.4%) and practice level data for those practices obtained from NHS Digital. We built linear multilevel multivariate regression models to model the association between patient (clinical and sociodemographic) and practice level (size and case-mix, human resources, indicators of quality and safety of care, and practice safety activation) characteristics, and outcome measures. Setting: General practices distributed across five regions in the North, Centre and South of England. Participants: 1,190 patients registered in 45 practices purposefully sampled (maximal variation in practice size and levels of deprivation). Main outcome measures: Self-reported safety problems, harm, and overall perception of safety. Results: Higher self-reported levels of safety problems were associated with younger age of patients (beta coefficient 0.15) and lower levels of practice safety activation (0.44). Higher self-reported levels of harm were associated with younger age (0.13) and worse self-reported health status (0.23). Lower self-reported healthcare safety was associated with lower levels of practice safety activation (0.40). The fully adjusted models explained 4.5% of the variance in experiences of safety problems, 8.6% of the variance in harm, and 4.4% of the variance in perceptions of patient safety. Conclusions: Practices’ safety activation levels and patients’ age and health status are associated with patient-reported safety outcomes in English family practices. The development of interventions aimed at improving patient safety outcomes would benefit from focusing on the identified groups.

  • The Influence of Maternally Derived Antibody and Infant Age at Vaccination on Infant Vaccine Responses : An Individual Participant Meta-analysis.

    1 June 2017

    Importance: The design of infant immunization schedules requires an understanding of the factors that determine the immune response to each vaccine antigen. Data Sources: Deidentified individual participant data from GlaxoSmithKline clinical trials were obtained through Clinical Study Data Request. The data were requested on January 2, 2015, and final data were received on April 11, 2016. Study Selection: Immunogenicity trials of licensed or unlicensed vaccines administered to infants were included if antibody concentrations in infants were measured prior to the first dose of vaccine. Data Extraction and Synthesis: The database was examined; studies that appeared to have appropriate data were reviewed. Main Outcomes and Measures: Antigen-specific antibody concentration measured 1 month after priming vaccine doses, before booster vaccination, and 1 month after booster vaccine doses. Results: A total of 7630 infants from 32 studies in 17 countries were included. Mean (SD) age at baseline was 9.0 (2.3) weeks; 3906 (51.2%) were boys. Preexisting maternal antibody inhibited infant antibody responses to priming doses for 20 of 21 antigens. The largest effects were observed for inactivated polio vaccine, where 2-fold higher maternal antibody concentrations resulted in 20% to 28% lower postvaccination antibody concentration (geometric mean ratios [GMRs], type 1: 0.80; 95% CI, 0.78-0.83; type 2: 0.72; 95% CI, 0.69-0.74; type 3: 0.78; 95% CI, 0.75-0.82). For acellular pertussis antigens, 2-fold higher maternal antibody was associated with 11% lower postvaccination antibody for pertussis toxoid (GMR, 0.89; 95% CI, 0.87-0.90) and filamentous hemagglutinin (GMR, 0.89; 95% CI, 0.88-0.90) and 22% lower pertactin antibody (GMR, 0.78; 95% CI, 0.77-0.80). For tetanus and diphtheria, these estimates were 13% (GMR, 0.87; 95% CI, 0.86-0.88) and 24% (GMR, 0.76; 95% CI, 0.74-0.77), respectively. The influence of maternal antibody was still evident in reduced responses to booster doses of acellular pertussis, inactivated polio, and diphtheria vaccines at 12 to 24 months of age. Children who were older when first immunized had higher antibody responses to priming doses for 18 of 21 antigens, after adjusting for the effect of maternal antibody concentrations. The largest effect was seen for polyribosylribitol phosphate antibody, where responses were 71% higher per month (GMR, 1.71; 95% CI, 1.52-1.92). Conclusions and Relevance: Maternal antibody concentrations and infant age at first vaccination both influence infant vaccine responses. These effects are seen for almost all vaccines contained in global immunization programs and influence immune response for some vaccines even at the age of 24 months. These data highlight the potential for maternal immunization strategies to influence established infant programs.

  • Corrigendum to “Persistence of bactericidal antibodies following booster vaccination with 4CMenB at 12, 18 or 24 months and immunogenicity of a fifth dose administered at 4 years of age-a phase 3 extension to a randomised controlled trial” (Vaccine (2017) 35(2) (395–402) (S0264410X16310404) (10.1016/j.vaccine.2016.11.009))

    4 July 2017

  • EBM DataLab

    25 April 2017

  • Heart Failure Research

    26 June 2012

    Research into the main causes and impact of heart failure, with a linked programme on its better diagnosis.

  • Stroke Prevention and Atrial Fibrillation

    26 June 2012

    Reducing the risk of stroke is vital to improving the health of older people. We research ‘funny turns’ that are a warning sign of stroke (termed ‘transient ischaemic attacks’) and the detection and treatment of major risk factors for stroke - high blood pressure and atrial fibrillation.

  • Primary Care for the Developing World

    26 June 2012

    Our aim is to support the provision of high quality primary health care in countries with limited economic resources, undertaking research and policy development in collaboration with academic institutions, NGOs and government agencies.

  • Cancer Research

    26 June 2012

  • Cochrane Tobacco Addiction Group

    26 June 2012

    We produce and help others to produce systematic reviews and meta-analyses of interventions to prevent and treat tobacco addiction. Cochrane is dedicated to making high quality, accurate information about the effects of healthcare readily available worldwide.

  • Diabetes and long-term conditions

    26 June 2012

    We work to develop and evaluate new ways to help people with single and multiple long-term conditions improve their health through better self-management. We aim to do this through development and evaluation of tests, interventions, and technologies, appropriately targeted and used for prevention, treatment and monitoring.

  • Monitoring and Diagnosis (MaDOx)

    26 June 2012

    Our aim is to improve monitoring and diagnostics used in primary care and community settings.

  • Infectious Diseases Research Group

    26 June 2012

    We investigate infectious diseases in primary care to find out how we can identify patients with serious infection in primary care, and more effective ways of diagnosing and treating patients with common infections.

  • Medical Statistics Group

    26 June 2012

    Our aim is to support clinical research in primary care and to advance the way we answer clinical questions using statistics to improve healthcare worldwide.