General practice in an integrated NHS: reasons to be hopeful.

Moving from leadership of general practice to leadership involving all medical disciplines throughout the Coronavirus 2019 (COVID-19) pandemic provided a fascinating overview of the health and care landscape. There are many erroneous assumptions in secondary care about general practice, and vice versa, with professional tribalism a cause for concern. However, there are many examples of effective and straightforward integration, and the establishment of integrated care systems in England has provided a unique opportunity to address the commissioning challenges that had previously been barriers.

Assessing whether COVID-19 patients will benefit from critical care, and an objective approach to capacity challenges during a pandemic: An Intensive Care Society clinical guideline.

This national professional society guidance lays out operational and ethical principles for decision-making during a pandemic, in the immediate context of COVID-19 in the early 2020 surge iteration but with potential ongoing relevance. It identifies the different phases of a pandemic and the implications for capacity and mutual aid within a national healthcare system, and introduces a revised CRITCON-PANDEMIC framework for shared operational responsibilities and clinical decision-making. Usual legal and ethical frameworks should continue to apply while capacity and mutual aid are available (CRITCON-PANDEMIC levels 0-3); clinicians should focus on current clinical needs and should not treat patients differently because of anticipated future pressures.

Rising to the challenge of multimorbidity.

We need to combine generalist and specialist skills

Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial.

Objective: To compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms.

Design: Economic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective.

Setting: Primary care.

An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial.

Background: Handwashing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic. However, the role of handwashing is debated, and no good randomised evidence exists among adults in non-deprived settings. We aimed to assess whether an internet-delivered intervention to modify handwashing would reduce the number of RTIs among adults and their household members.

The effectiveness of exercise as treatment for vasomotor menopausal symptoms: randomised controlled trial.

Objective: To investigate the effectiveness of exercise as treatment for vasomotor menopausal symptoms.

Design: Three-group randomised controlled trial, two exercise interventions and a control group.

Setting: Primary Care, West Midlands UK.

Exercise for vasomotor menopausal symptoms.

Background: Evidence suggests that many perimenopausal and early postmenopausal women will experience menopausal symptoms; hot flushes are the most common. Symptoms caused by fluctuating levels of oestrogen may be alleviated by hormone therapy (HT), but a marked global decline in its use has resulted from concerns about the risks and benefits of HT. Consequently, many women are seeking alternatives.

Aerobic exercise as a treatment for vasomotor menopausal symptoms: randomised controlled trial protocol.

Background: Evidence suggests that a high proportion of perimenopausal and postmenopausal women experience vasomotor symptoms (hot flushes/night sweats) that can be severe and disruptive and which are the principal reason for seeking medical intervention. Hormone therapy (HT) is known to be an effective treatment for troublesome hot flushes/night sweats but research has raised questions about the safety of HT and there have been negative high profile media reports about its use. Consequently many women are seeking alternatives and exercise might be one such option but there is a lack of high quality evidence on its effectiveness.

Assessing the predictive value of HIV indicator conditions in general practice: a case-control study using the THIN database.

Background: UK HIV guidelines identify 37 clinical indicator conditions for adult HIV infection that should prompt an HIV test. However, few data currently exist to show their predictive value in identifying undiagnosed HIV.

Aim: To identify symptoms and clinical diagnoses associated with HIV infection and assess their relative importance in identifying HIV cases, using data from The Health Improvement Network (THIN) general practice database.