The British journal of general practice : the journal of the Royal College of General Practitioners
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Randomized Controlled Trial Observational Study
Antibiotic effectiveness for children with lower respiratory infections: prospective cohort and trial in primary care.
Antibiotics are commonly prescribed for children with chest infections but there is little randomised evidence and trials commonly recruit selected populations, which undermines their applicability. ⋯ Antibiotics for uncomplicated chest infections, even in a sample of more unwell children, are unlikely to be clinically very effective.
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Randomized Controlled Trial
Comparing GPs' antibiotic prescribing decisions to a clinical prediction rule: an online vignette study.
The 'STARWAVe' clinical prediction rule (CPR) uses seven factors to guide risk assessment and antibiotic prescribing in children with cough (Short illness duration, Temperature, Age, Recession, Wheeze, Asthma, Vomiting). ⋯ GPs use some, but not all, STARWAVe factors when making unaided risk assessments and prescribing decisions. Such discrepancies must be considered when introducing CPRs to clinical practice.
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Health emergencies disproportionally affect vulnerable populations. Digital tools can help primary care providers find, and reach, the right patients. ⋯ Data-driven digital solutions can promote care coordination at scale during national emergencies, opening up new perspectives for precision public-health initiatives.
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Primary care transformation in Scotland aims to improve population health, reduce health inequalities, and reduce GP workload. Two key strategies (formalised in April 2018 in the new Scottish GP contract [Scottish General Medical Services contract], although started in early 2016) are the expansion of the multidisciplinary team (MDT) and GP cluster working. ⋯ Key PCSs and CQLs in different areas of Scotland report limited progress in primary care transformation, only partly related to the pandemic. There is a need for better workforce planning and support if the new GP contract is to succeed in transforming primary care in Scotland.
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To date, research on adverse drug reactions (ADRs) has focused on secondary care, and there is a paucity of studies that have prospectively examined ADRs affecting older adults in general practice. ⋯ This prospective cohort study of ADRs in general practice shows that over one-quarter of older adults experienced an ADR over a 6-year period. Polypharmacy is independently associated with ADR risk in general practice and older adults on ≥10 drug classes should be prioritised for regular medication review.