Family practice
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Glycaemic control is fundamental to the management of and risk reduction in microvascular complications of diabetes. ⋯ This study demonstrated that both poor sleep quality and less-efficient sleep are significantly correlated with worse glycaemic control in patients with type 2 diabetes. These findings are expected to contribute to the prevention and risk reduction of microvascular complications in type 2 diabetes.
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In the UK, explicit quality standards for chronic disease management, including for diabetes and chronic kidney disease (CKD), are set out National Service Frameworks and pay-for-performance indicators. These conditions are common with a prevalence of 4% and 5.4%, respectively. CKD is largely asymptomatic, detected following renal function testing and important because associated with increased mortality and morbidity, especially in people with diabetes and proteinuria. ⋯ Quality improvement initiatives and equity audits, which include CKD should take account of disparities in renal function testing.
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Comparative Study
Validity of self-reported colorectal cancer test use in different racial/ethnic groups.
Prevalence of colorectal cancer (CRC) screening is ascertained by self-reported screening, yet little is known about the accuracy of this method across different racial/ethnic groups, particularly Hispanics. The purpose of this study was to compare the accuracy of CRC self-report measures across three racial/ethnic groups. ⋯ Self-report prevalence data are overestimating CRC test use in all groups; current measures are less sensitive in Hispanics.
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Centralization of urgent care services may reduce access for patients living further away from primary care centres (PCCs). Telephone-based access is often proposed to remedy this. ⋯ Patients experience differences in how their call to out-of-hours services is managed depending on where they live. Telephone access and consultation can be used to overcome geographical barriers but do not necessarily make access geographically equitable. Those who live furthest away are more likely to receive telephone advice rather than being seen face-to-face, but paradoxically, those who do get a home visit are more likely to live at a greater distance from the PCC. These findings present important challenges to proposals to integrate urgent care services and increase telephone-based provision and suggest that attention should be given to configuring services to ensure geographical equity of access, regardless of how far away people live from health services.
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Point of care tests (POCTs) are being promoted to better target antibiotic prescribing with the aim of improving outcomes and containing antibiotic resistance. ⋯ Acceptability of POCTs to clinicians is likely to be improved if tests perform well on accuracy, time to result, simplicity and cost. Including POCTs in the routine management of acute cough/LRTI is likely to be acceptable to most patients.