The British journal of general practice : the journal of the Royal College of General Practitioners
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The 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5-7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes. ⋯ Failure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.
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Multicenter Study
The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice.
Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse. ⋯ In this sample of patients in familiar doctor-patient relationships, the GP's clinical judgement holds additional value for predicting dementia, complementing test performance and patients' self-reports. Existing and emerging primary care-based dementia risk models should consider the GP's judgement as one predictor. Results underline the importance of the GP-patient relationship.
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Plantar heel pain (PHP) is a common cause of foot complaints in general practice. However, information on the occurrence and practical management is scarce. ⋯ There was large variation in treatment strategies of GPs for patients with PHP. GPs should be aware of conflicting evidence for interventions, such as insoles, and focus more on exercises for which there is evidence for effectiveness.
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Self-harm and suicide are major public health concerns. Self-harm is the strongest risk factor for suicide, with the highest suicide rates reported in older populations. Little is known about how older adults access care following self-harm, but they are in frequent contact with primary care. ⋯ Despite older adults' frequent contact with GPs, barriers to primary care existed, which included stigma, previous negative experiences, and practical barriers such as mobility restrictions. Older adults' help-seeking behaviour was facilitated by previous positive experiences. Primary care is a potential avenue for delivering effective self-harm support, management, and suicide prevention in older adults. Given the complex nature of self-harm, there is a need for primary care to work with other sectors to provide comprehensive support to older adults who self-harm.