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Join me, Gavin Hubbard, as I try to navigate the intricate maze of depression and anxiety in a humerous-ish way. In this candid account, I share the good, the bad, and the absurd moments of my mental health journey. It's an invitation to look beyond the stigma, understand you're not alone, or perhaps get a better understanding of what others might be going through.
Characteristics of Optimal Cancer Referrals Made by Primary Care Clinicians: Scoping Review
Background: In England, over 2 million patients are referred each year on urgent pathways to investigate suspected cancer. The content and quality of referrals have often been audited, but there is no consensus on what should be included in a referral to optimise diagnostic outcomes. Aim: To identify and describe the characteristics of referral letters for suspected cancer from primary to secondary care that may optimise diagnostic outcomes. Method: The scoping review employed the methodology developed by Arksey and O'Malley in 2005 and further expanded by Levac and Colquhoun 2010. We searched PubMed, Embase, and PsycINFO to identify relevant studies in English Language published between 2000 and 2023. All findings were reported according to PRISMA guidelines for scoping reviews. Results: Of 3463 identified records, only thirteen met the inclusion criteria, employing qualitative and mixed methods, as well as retrospective audits of referrals. The studies noted that symptom information such as duration, appearance, and descriptive qualities was often missing. There was limited evidence suggesting that the inclusion of clinical examination findings, test information, and the motivation of the referring clinician were beneficial. Evidence relating to the benefits of guidelines and template referral forms was mixed. There was a paucity of research linking referral content to patient diagnostic outcomes. Conclusion: Despite a small number of studies retrieved, there was broad consensus about the benefit of conveying detailed information in referrals for suspected cancer, particularly with respect to comprehensive symptom description and relevant tests and clinical examinations. Further research linking referral quality to diagnostic outcomes would be beneficial to drive improvement to diagnostic outcomes.
In what context and by which mechanisms can creative arts interventions improve wellbeing in older people? A realist review protocol
Background In recent years, there has been growing interest at national and international policy level in the potential of creative arts to support individual and community wellbeing. Creative arts encompass a wide range of activities, including performing arts, visual arts, design and craft, literature, culture and digital and electronic arts. Participation in creative arts has been linked to lower mental distress, increased social connection, improved quality of life, personal growth and empowerment. Despite this, it remains unclear exactly how participation in creative arts interventions can improve wellbeing in older individuals. This realist review aims to synthesize evidence on how elements of creative arts interventions improve wellbeing amongst older people, in particular when, how, for whom and to what extent they work. Methods and analysis This review will follow the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) quality standards and Pawson’s five iterative stages to locate existing theories, search for evidence, select literature, extract data, and draw conclusions. It will be guided by stakeholder engagement with policymakers, practitioners, commissioners, and people with lived experience. A realist approach will be used to analyse data and develop causal explanations, in the form of context-mechanism-outcome-configurations (CMOCs), which explain how creative arts interventions impact wellbeing in older people. The CMOCs will be organised into one or more programme theories. Our refined programme theory will then be used to develop guidance for service providers of creative arts who want to use their services to improve wellbeing of older people. Ethics and dissemination This research will comply with the UK Policy Framework for Health and Social Care Research. Dissemination will be guided by our stakeholder group, building on links with policymakers, commissioners, providers, and the public. A final stakeholder event focused on knowledge mobilisation will aid development of recommendations. PROSPERO registration CRD42024580770.
Evidence-based problem solving: What is the efficacy of pneumococcal vaccination in people with asthma?
Aims: To determine the efficacy of pneumococcal vaccination in asthmatic patients using a pragmatic evidence-based approach to solve therapeutic problems. Methods: Use of local information, expert-opinion guidelines, evidence-based guidelines and a systematic literature search of the Medline database to identify clinical trials designed to assess vaccine efficacy among asthmatics. Results: Expert-opinion guidelines advocating the use of pneumococcal vaccine among asthmatics were found, but there was no evidence-based assessment of vaccine efficacy among asthmatics. The Medline database described no clinical trials that specifically addressed our question, although a number of studies assessing broader question of overall vaccine efficacy were identified, with conflicting results. Conclusions: Current UK expert opinion recommends that people with asthma receive pneumococcal vaccination, but there is little high-quality evidence to support this. The search strategy used may be adapted to address other therapeutic questions that may arise in primary care consultations.
Writing research protocols: An innovative approach
Aims: To develop a mechanism to write three research protocols within 10 hours while simultaneously enhancing the research protocol writing skills of participants. Method: Members of the General Practitioners In Asthma Group (GPIAG) were invited to attend a research protocol workshop with pre- and post-workshop questionnaires. The main outcome measures were the development of three detailed research protocols and improvement in participants' perceived research protocol writing skills. Results: Three detailed research protocols were completed within the time allocated. Thirty (88%) participants completed pre- and post-workshop questionnaires. Participants believed there were improvements in their ability to formulate an answerable research question (p < 0.01), choose an appropriate methodology to answer the question (p < 0.01), choose appropriate outcome measures (p = 0.03), choose appropriate statistical methods (p = 0.01), devise a research timetable (p < 0.01), and improve their overall ability to write a research protocol (p < 0.01). Conclusion: It is possible to identify a mechanism, based on a weekend workshop, to write accelerated research protocols whilst simultaneously significantly increasing the research protocol writing skills of participants. This approach has potential to promote the development of research skills within primary care.
Pneumococcal vaccination: A practice based audit
Objective: To audit the use of pneumococccal vaccine in patients at increased risk of pneumococcal infection, in a general practice setting. Design: Computer and manual search of patient records - before and one year after intervention. Setting and subjects: All patients registered at a four partner, inner-city, training practice in Wembley. Intervention: Practice based pneumococcal vaccination campaign, with implementation of practice protocol, and clinical guidelines issued to all members of the primary health care team. Outcome Measures: Proportion of patients at risk of pneumococcal infection that had been vaccinated on 16th May 1998, compared with proportion vaccinated on 1st April 1997. Results: Significant increase in the proportion of patients that had been vaccinated from 2 (0%) before the intervention to 60 (7.6%) one year later (p < 0.001, 95% CI 5.4 - 9.2%). Conclusions: A practice based campaign can deliver significant improvements in pneumococcal vaccination uptake in patients considered to be at risk of pneumococcal disease.