Primary medical care continuity and patient mortality: a systematic review.

Background: A 2018 review into continuity of care with doctors in primary and secondary care concluded that mortality rates are lower with higher continuity of care.

Aim: This association was studied further to elucidate its strength and how causative mechanisms may work, specifically in the field of primary medical care.

Design And Setting: Systematic review of studies published in English or French from database and source inception to July 2019.

How should complete lung collapse secondary to primary spontaneous pneumothorax be managed? .

Management of primary spontaneous pneumothorax (PSP) depends on the symptoms and size of lung collapse. The British Thoracic Society recommends needle aspiration (NA) for all PSP requiring intervention, followed by intercostal drain (ICD) if NA fails. We compared the role of NA versus ICD as the first step in PSP with 'complete lung collapse'.

The potential clinical benefits of medicines optimisation through comprehensive geriatric assessment, carried out by secondary care geriatricians, in a general practice care setting in North Staffordshire, UK: a feasibility study.

Objectives: To evaluate the feasibility and potential clinical benefits of medicines optimisation through comprehensive geriatric assessment (CGA) of frail patients with multiple conditions, by secondary care geriatricians in a general practice care setting.

Methods: Seven general practitioner (GP) practices in one region of Stoke-on-Trent volunteered to take part. GPs selected patients (n=186) who were local permanent residents, at least 65 years old and on eight or more medications per day.

Variations in coronary mortality rates between English primary care trusts: observational study 1993-2010.

Background: In England, coronary heart disease (CHD) mortality has declined, but variations remain.

Methods: This study aimed to describe under 75-year CHD mortality variations across geographically defined populations. Regression slopes for mortality data as a function of time were calculated for all 151 English primary care trusts (PCTs), giving the change in the expected age adjusted rate for each extra year.

Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013-2014 and 2014-2015.

Background: NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups.

Aim: To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England.

Design And Setting: Cross-sectional study of all practices in England, in financial years 2013-2014 and 2014-2015.

Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study.

Objectives: Health systems with strong primary care tend to have better population outcomes, but in many countries demand for care is growing. We sought to identify mechanisms of primary care that influence premature mortality.

Design: We developed a conceptual model of the mechanisms by which primary care influences premature mortality, and undertook a cross-sectional study in which population and primary care variables reflecting the model were used to explain variations in mortality of those aged under 75 years.

Estimating smoking prevalence in general practice using data from the Quality and Outcomes Framework (QOF).

Objectives: To determine to what extent underlying data published as part of Quality and Outcomes Framework (QOF) can be used to estimate smoking prevalence within practice populations and local areas and to explore the usefulness of these estimates.

Design: Cross-sectional, observational study of QOF smoking data. Smoking prevalence in general practice populations and among patients with chronic conditions was estimated by simple manipulation of QOF indicator data.

An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial.

Objective: To investigate whether an early rehabilitation intervention initiated during acute admission for exacerbations of chronic respiratory disease reduces the risk of readmission over 12 months and ameliorates the negative effects of the episode on physical performance and health status.

Design: Prospective, randomised controlled trial.

Setting: An acute cardiorespiratory unit in a teaching hospital and an acute medical unit in an affiliated teaching district general hospital, United Kingdom.

Changing cluster composition in cluster randomised controlled trials: design and analysis considerations.

Background: There are many methodological challenges in the conduct and analysis of cluster randomised controlled trials, but one that has received little attention is that of post-randomisation changes to cluster composition. To illustrate this, we focus on the issue of cluster merging, considering the impact on the design, analysis and interpretation of trial outcomes.

Methods: We explored the effects of merging clusters on study power using standard methods of power calculation.

Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality.

Objectives: To identify features of primary care quality improvement associated with improved health outcomes using premature coronary heart disease (CHD) mortality as an example, and to determine impacts of different modelling approaches.

Design: Cross-sectional study of mortality rates in 229 general practices.

Setting: General practices from three East Midlands primary care trusts.

Are there enough GPs in England to detect hypertension and maintain access? A cross-sectional study.

Background: Fewer patients are recorded by practices as having hypertension than are identified in systematic population surveys. However, as more patients are recorded on practice hypertension registers, mortality from coronary heart disease and stroke declines.

Aim: To determine whether the number of GPs per 1000 practice population is associated with the number of patients recorded by practices as having hypertension, and whether patients' reports of being able to get an appointment with a GP are associated with the number of GPs and the number of patients recorded as having hypertension.

Ciliary dyskinesia is an early feature of respiratory syncytial virus infection.

Respiratory syncytial virus is a major cause of respiratory disease. There are conflicting accounts of the response of human epithelial cells to respiratory syncytial virus and a lack of data on its effect on ciliary function. Our aim was to study the early stages of respiratory syncytial virus infection of primary human basal and ciliated cultures.

Chronic disease detection and access: does access improve detection, or does detection make access more difficult?

Background: The recorded detection of chronic disease by practices is generally lower than the prevalence predicted by population surveys.

Aim: To determine whether patient-reported access to general practice predicts the recorded detection rates of chronic diseases in that setting.

Design And Setting: A cross-sectional study involving 146 general practices in Leicestershire and Rutland, England.

Characteristics of general practices associated with numbers of elective admissions.

Background: In England both emergency (unplanned) and non-emergency (elective) hospital admissions have been increasing. Some elective admissions are potentially avoidable.

Aim: to identify the characteristics of general practices and patients associated with elective admissions.

Bladder cancer: evaluation of staging accuracy using dynamic MRI.

Aim: To assess the accuracy of magnetic resonance imaging (MRI) in staging bladder cancer and to assess whether dynamic gadolinium-enhanced sequences have any added benefit in staging.

Materials And Methods: Over a 22 month period, the MRI findings of 100 consecutive patients with histologically proven transitional cell carcinoma (TCC) of the bladder were reviewed. The T stage was assessed independently on T2-weighted imaging alone and in combination with gadolinium-enhanced MRI.

Characteristics of general practices associated with emergency-department attendance rates: a cross-sectional study.

Background: Strategies are needed to contain emergency-department attendance. Quality of care in general practice might influence the use of emergency departments, including management of patients with chronic conditions and access to consultations.

Aim: The aim was to determine whether emergency-department attendance rates are lower for practices with higher quality and outcomes framework performance and lower for practices with better patient reported access.

Role of whole-body staging computed tomographic scans for detecting distant metastases in patients with bladder cancer.

Objective: This study aimed to establish the incidence of distant metastases on whole-body computed tomographic (CT) scans in patients with newly diagnosed bladder cancer and to determine whether there is a significant difference in the incidence of metastases in patients with superficial and muscle invasive cancers.

Materials And Methods: A total of 201 patients who had a proven histological diagnosis of transitional cell carcinoma of the bladder and a whole-body staging CT scan at diagnosis were identified from our MDT database during a 36-month period. Imaging was retrospectively reviewed with view to recording site, if any, of distant metastases.

Characteristics of general practices associated with emergency admission rates to hospital: a cross-sectional study.

Objectives: To identify characteristics of general practices associated with emergency hospital admission rates, and determine whether levels of performance and patient reports of access are associated with admission rates.

Design: A cross-sectional study.

Setting: Two primary care trusts (Leicester City and Leicestershire County and Rutland) in the East Midlands of England.

Limited impact on patient experience of access of a pay for performance scheme in England in the first year.

Background: Improvement of access to general practice is a priority in England. In 2006/07 an annual national survey of patient experience of access was introduced, with financial incentives to practices based on the findings of the survey among their own patients.

Objectives: To describe changes in patient experience of access over the first two years of the survey and incentive scheme, and identify respondent and practice characteristics associated with patient experience of access.

Cooling of cilia allows functional analysis of the beat pattern for diagnostic testing.

Background: Reports of the effect of low temperatures on ciliary beat frequency (CBF) are conflicting, and the effect on ciliary beat pattern has not been reported. We aimed to clarify this association and determine whether cooling of cilia may allow ciliary function to be assessed without the need of expensive high-speed video microscopy.

Methods: Fourteen nasal brush biopsy samples were collected, and the CBF and beat pattern of undisrupted ciliated edges were evaluated.

Multidetector CT imaging of pleura: comparison of two contrast infusion protocols.

Objectives: Imaging of the pleura by multidetector CT (MDCT) can be challenging. There is no clear evidence or guidelines on contrast infusion parameters for imaging pleura. We compared two contrast protocols for assessing pleural pathology on MDCT.

Association of features of primary health care with coronary heart disease mortality.

Context: The goal of US health care reform is to extend access. In England, with a universal access health system, coronary heart disease (CHD) mortality rates have decreased by more than two-fifths in the last decade, but variations in rates between local populations persist.

Objective: To identify which features of populations and primary health care explain variations in CHD mortality rates between the 152 primary care trust populations in England.

Early graft function defined by area under the curve serum creatinine 7 days post-transplant in a series of live donor kidney transplantation.

Background: There is a degree of variability in early graft function that is often not highlighted in live kidney donor transplantation. We used the calculation of area under the curve of serum creatinine (AUC Cr) in the first 7 d post-transplant to assess early graft function and examine the influence on longer term outcome.

Methods: A total of 188 live donor renal transplants performed between 1998 and 2007 were analyzed.