Exeter Primary Care

Patients with symptoms of suspected cancer usually present to general practice; however, they may present to other healthcare providers, such as community pharmacies. The clinical role of pharmacy staff has significantly increased in England in recent years. To describe the range of interventions targeting early cancer detection in community pharmacies globally; to summarise the outcomes of these interventions; to report on barriers and facilitators to delivering the interventions and on service users' and stakeholders' experiences with such interventions. Systematic review with narrative synthesis, of international literature, on community pharmacy-based early cancer detection. Online searches of Medline, CINAHL, Cochrane CENTRAL, PsycINFO, and Embase and UK-based relevant grey literature were performed. Interventions were defined as any intervention, initiative, or programme that focused on community pharmacy-based early cancer detection programmes. In total, 14 134 titles and abstracts were screened, and 330 full-text publications were reviewed by two independent reviewers. Of these, 52 publications were included in the review. They reported on interventions focusing on early diagnosis of colorectal (n = 19), skin (n = 8), lung (n = 4), cervical (n = 3), breast (n = 2), head and neck (n = 2), and mixed (n = 14) cancers. The feasibility and acceptability of such interventions by community pharmacy staff and customers/patients have been demonstrated in the included studies. Studies involving opportunistic identification of customers with suspected cancer symptoms in pharmacies recruited only a few participants. Robust, large-scale clinical trials are needed to demonstrate cost-effectiveness, delineate and inform the use of relevant clinical outcomes, and to explore arrangements for information sharing between community pharmacy and other healthcare settings.

The use of health-related online peer support groups to support self-management of health issues has become increasingly popular. The quality of information and advice may have important implications for public health and for the utility of such groups. There is some evidence of variable quality of web-based health information, but the extent to which misinformation is a problem in online peer support groups is unclear. We aimed to gain insight into the quality of information and advice about health conditions in online peer support groups and to review the tools available for assessing the quality of such information. A scoping review was undertaken following the Joanna Briggs Institute scoping review methodology. We searched electronic databases (MEDLINE [Ovid], CINAHL, Web of Science, ASSIA, ProQuest Dissertation and Theses, and Google Scholar) for literature published before November 2023, as well as citations of included articles. Primary research studies, reviews, and gray literature that explored the quality of information and advice in online peer support groups were included. Title and abstracts were independently screened by 2 reviewers. Data were extracted and tabulated, and key findings were summarized narratively. A total of 14 (0.45%) relevant articles, from 3136 articles identified, were included. Of these, 10 (71%) were primary research articles comprising diverse quality appraisal methodologies, and 4 (29%) were review articles. All articles had been published between 2014 and 2023. Across the literature, there was more evidence of poor quality information and misinformation than of good quality information and advice, particularly around long-term and life-threatening conditions. There were varying degrees of misinformation about non-life-threatening conditions and about mental health conditions. Misinformation about noncommunicable diseases was reported as particularly prevalent on Facebook. Fellow online peer support group users often played an active role in correcting misinformation by replying to false claims or providing correct information in subsequent posts. Quality appraisal tools were reported as being used by researchers and health care professionals in appraising the quality of information and advice, including established tools for the appraisal of health-related information (eg, DISCERN, HONcode criteria, and Journal of the American Medical Association benchmark criteria). No tools reported were specifically designed to appraise online peer support group content. While there is good quality information and advice exchanged between users in online peer support groups, our findings show that misinformation is a problem, which is a matter of public health concern. Confidence in the quality of information shared may determine the utility of online peer support groups for patients and health care professionals. Our review suggests that clinical and academic experts in health conditions could play a valuable role in ensuring the quality of content. Several quality appraisal tools are available to support such an initiative.

Roma, travellers and the homeless suffer from a higher risk of both COVID-19 infection and severe disease relative to the general population. The purpose of this project was to ensure as many members as possible from vulnerable groups in the Midlands availed of COVID-19 vaccines. Following on from successful testing of vulnerable populations in the Midlands of Ireland in March/April 2021, a collaboration of HSE Midland's Department of Public Health, Safetynet Primary Care and the HSE Midlands Traveller Health Unit (MTHU) operated pop-up vaccination clinics in June/July 2021, targeting the same populations. Clinics delivered the first dose of the Pfizer/BioNTech COVID-19 vaccine, registering clients for second doses in Community Vaccination Centres (CVCs). Thirteen clinics were hosted between 8 June 2021 and 20 July 2021, resulting in 890 first-dose Pfizer vaccinations delivered to vulnerable populations. Trust established months prior with our grassroots testing service resulted in strong vaccine uptake, with the quality service provided seeding further demand over time. This service integrated into the national system and allowed individuals to receive their second doses within the community.

L’article propose une incursion dans la poésie roumaine de la Grande Guerre, à travers les écrits de certains poètes « civils » comme Nicolae Iorga, Alexandru Vlahuță ou George Ranetti, afin de surprendre le profil éthique et les constantes esthétiques d’une création qui thématise à distance le conflit armé. On interroge ainsi la nature de l’engagement des intellectuels qui affirment que, pour eux, le stylo est une baïonnette, tout en reconnaissant leur appartenance à un contingent vieilli, inefficace sur le plan événementiel, mais efficace sur le plan discursif en temps de guerre.

BackgroundThe Nuffield Trust’s report on NHS winter pressures highlights a lack of data for primary care, with a consequential focus on secondary care. An increase in data is required on the scale of the winter demand on primary care, so the need for investment in this area can be clearly seen.AimTo quantify seasonal variation in workload in primary and secondary care.Design & settingAnalysis of data for nine GP practices in Greater Manchester with a patient population of 75 421.MethodDescriptive and comparative analyses were performed for winter and summer periods in 2018–2019. Data were obtained from the North of England Clinical Support Unit (NECSU) via the Rapid Actionable Insight Driving Reform (RAIDR) toolkit, and EMIS Enterprise clinical audit tools.ResultsAccident and emergency (A&E) attendances increased by 4% (P = 0.035) during winter with no difference in the number of hospital admissions (P = 0.668). The number of problems (defined as separate diagnoses or causes for a GP consultation, for example, chest infection or medication request) seen in general practice increased by 61% (P<0.001) in winter compared to summer, as did the number of GP consultations, which was also 61% (P<0.001). Respiratory diagnoses saw the greatest seasonal variation accounting for 10% in winter compared with 4% in summer (P<0.001). Self-referral accounted for 66% of all A&E attendance and increased by 16% in winter. GP referral accounted for 7% in winter and 6% in summer (P = 0.002).ConclusionGeneral practice observed a greater seasonal increase in presenting patients compared with secondary care. Any winter pressures strategy should target both respiratory illness and patients who self-refer to A&E. Transferring 50% of self-referrals in Manchester to GP appointments would achieve a £2.3 million cost saving. Increasing provision in primary care requires funding and increased appointments, but more importantly improved patient opportunities to easily access timely advice and assistance.

Objective:The Inter-arm blood Pressure difference Individual Patient Data (INTERPRESS-IPD) Collaboration recently demonstrated, based on data from over 57,000 records, that an inter-arm difference in systolic blood pressure (IAD) is an independent risk marker for cardiovascular events after adjustme