New combined hormonal contraception guideline and its impact on prescribing practice

2019 ◽  
Vol 1 (7) ◽  
pp. 332-337
Author(s):  
Claire Nicol
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Sexual And Reproductive Health ◽  
Hormonal Contraception ◽  
Clinical Effectiveness ◽  
Prescribing Practice ◽  
Combined Hormonal Contraception ◽  
Reproductive Healthcare ◽  
The Impact ◽  
New Evidence

The Clinical Effectiveness Unit of the Faculty of Sexual and Reproductive Healthcare (FSRH) regularly develops and updates national clinical guidelines. The most recent updated guideline on combined hormonal contraception details the new evidence and suggests recommendations for clinical practice based on this evidence. This guideline will influence clinical and prescribing practice within the speciality of sexual and reproductive health and primary care. This article will critically analyse the impact this updated guideline will have on prescribing practice and will evaluate how the implementation of the recommendations will be influenced by the multidisciplinary team.

scholarly journals Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0056
Author(s):  
Stephanie Archer ◽  
Natalia Calanzani ◽  
Stephanie Honey ◽  
Margaret Johnson ◽  
Richard Neal ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Thematic Analysis ◽  
Help Seeking ◽  
Structured Interview ◽  
Cancer Symptoms ◽  
The Impact ◽  
New Evidence ◽  
Remote Consultations ◽  
Urgent Action

BackgroundEarly diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic.AimTo understand GPs’ views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer.Design & settingGPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis.MethodA qualitative semi-structured interview study with GPs from the East of England.ResultsThree themes were identified across 23 interviews on GP views on the impact of: (1) patient help-seeking on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how to manage backlog in referrals.ConclusionThis study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.

WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697085
Author(s):  
Trudy Bekkering ◽  
Bert Aertgeerts ◽  
Ton Kuijpers ◽  
Mieke Vermandere ◽  
Jako Burgers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Physicians ◽  
Urinary Stones ◽  
Care Practice ◽  
Supporting Evidence ◽  
Supervised Exercise ◽  
Review Team ◽  
New Evidence

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.

An observational study of the impact of the 2014 XX Commonwealth Games on the sexual and reproductive health services in Glasgow, Scotland

Sexual Health ◽  
2016 ◽  
Vol 13 (5) ◽  
pp. 480
Author(s):  
Rebecca Metcalfe ◽  
Rebecca R. Acquah ◽  
Janine Simpson ◽  
Gwendolyn Allardice ◽  
Andrew Winter
Keyword(s):  
Reproductive Health ◽  
Sexual And Reproductive Health ◽  
Hormonal Contraception ◽  
Service Planning ◽  
Post Exposure Prophylaxis ◽  
Sporting Events ◽  
Sexual Assaults ◽  
Sexually Transmissible Infections ◽  
Commonwealth Games ◽  
The Impact

Background: Large sporting events have raised concerns about the effect on the sexual and reproductive health (SRH) of visiting and resident populations to the host city and increased demand on SRH services. However, there is little evidence to support these concerns. The aim of this study is to investigate if the 2014 XX Commonwealth Games had an effect on the service demands of a Glasgow city-wide integrated SRH service. Methods: Electronic patient records, city-wide pharmacy data and case note review was used to assess aspects of SRH; this included overall attendance at integrated services, clinic and community emergency contraception prescriptions, victims of sexual assault, acute sexually transmissible infections (STIs), post exposure prophylaxis after sexual exposure (PEPSE) prescriptions, condom distribution and termination of pregnancy. Results: There was a significant decrease in core sexual health attendances, total acute STIs and emergency hormonal contraception prescriptions. There was no change in PEPSE prescriptions or the number of reported sexual assaults throughout the city. Conclusions: This study found no evidence that the 2014 XX Commonwealth Games placed any increased demand on the local SRH services, and showed no increase in STIs, emergency hormonal contraception prescriptions or sexual assaults. These findings will help service planning in host cities hosting future large sporting events.

scholarly journals Clinical prediction tools to identify patients at highest risk of myeloma in primary care: a retrospective open cohort study

2021 ◽  
Vol 71 (706) ◽  
pp. e347-e355
Author(s):  
Constantinos Koshiaris ◽  
Ann Van den Bruel ◽  
Brian D Nicholson ◽  
Sarah Lay-Flurrie ◽  
FD Richard Hobbs ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Clinical Practice ◽  
External Validation ◽  
Area Under The Curve ◽  
Full Blood Count ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Clinical Prediction ◽  
The Impact

BackgroundPatients with myeloma experience substantial delays in their diagnosis, which can adversely affect their prognosis.AimTo generate a clinical prediction rule to identify primary care patients who are at highest risk of myeloma.Design and settingRetrospective open cohort study using electronic health records data from the UK’s Clinical Practice Research Datalink (CPRD) between 1 January 2000 and 1 January 2014.MethodPatients from the CPRD were included in the study if they were aged ≥40 years, had two full blood counts within a year, and had no previous diagnosis of myeloma. Cases of myeloma were identified in the following 2 years. Derivation and external validation datasets were created based on geographical region. Prediction equations were estimated using Cox proportional hazards models including patient characteristics, symptoms, and blood test results. Calibration, discrimination, and clinical utility were evaluated in the validation set.ResultsOf 1 281 926 eligible patients, 737 (0.06%) were diagnosed with myeloma within 2 years. Independent predictors of myeloma included: older age; male sex; back, chest and rib pain; nosebleeds; low haemoglobin, platelets, and white cell count; and raised mean corpuscular volume, calcium, and erythrocyte sedimentation rate. A model including symptoms and full blood count had an area under the curve of 0.84 (95% CI = 0.81 to 0.87) and sensitivity of 62% (95% CI = 55% to 68%) at the highest risk decile. The corresponding statistics for a second model, which also included calcium and inflammatory markers, were an area under the curve of 0.87 (95% CI = 0.84 to 0.90) and sensitivity of 72% (95% CI = 66% to 78%).ConclusionThe implementation of these prediction rules would highlight the possibility of myeloma in patients where GPs do not suspect myeloma. Future research should focus on the prospective evaluation of further external validity and the impact on clinical practice.

Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

2008 ◽  
Vol 18 (1) ◽  
pp. 31-40 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Clinical Practice ◽  
Speech Intelligibility ◽  
Current Practice ◽  
Computer Assisted ◽  
Behavioral Management ◽  
Single Word ◽  
Future Directions ◽  
Speech Science ◽  
The Impact ◽  
Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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