The British journal of general practice : the journal of the Royal College of General Practitioners
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Type 2 diabetes causes poor health outcomes if management is ineffective. Day-to-day self-management of type 2 diabetes is associated with diabetes distress, anxiety, and depression. This is also true for family members and informal (unpaid) carers, albeit the knowledge base about their lived experience is under-developed. ⋯ The research gave voice to this group of carers, many of whom experienced stress in their roles. They reduced stress about lifestyle change through a variety of strategies that have implications for effective management of diabetes within dyads and future health outcomes.
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The NHS has limited human and financial resources, with particular pressures in primary care. The National Institute for Health and Care Excellence (NICE) makes decisions on which services can be commissioned within the NHS. Many women experiencing antenatal depression are not identified as such in routine care and so may not access support. Current NICE guidance does not recommend universal case-finding for antenatal depression; however, a programme targeted towards pregnant women with risk factors (for example, previous mental illness, traumatic life events) has not been considered. ⋯ Universal case-finding for antenatal depression is cost-saving and improves health compared with no case-finding. It should be considered by policymakers to improve the identification and support of women experiencing antenatal depression in primary and maternity care.
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Diagnosing cancer early is crucial in improving patient outcomes. Primary care networks are encouraged to audit routes to cancer diagnosis, as suggested by the Network Contract Directed Enhanced Service Early Cancer Diagnosis Guidance. ⋯ It is promising that the majority of cancers are diagnosed through 2WW and screening; however, improving patient engagement, streamlining referrals, and thorough clinical examination and documentation will reduce delayed or missed diagnoses.
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Almost every patient and every healthcare condition are seen within primary care, but research is not yet embedded in general practice in the same way it is in secondary care. There is no well-defined pathway for a career combining research delivery and active clinical general practice. ⋯ National recognition for education on research has been achieved and a career pathway for GPs to train in and then work in research has been established. This will help embed research expertise and interest within primary care. This should increase research delivery and hence a cycle of increased research funding for further similar posts.
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Haematological malignancies are the fifth most common cancer in the UK. Aggressive subtypes are potentially curable; chronic variants (the most frequent diagnoses) are incurable, although can be successfully managed for many years with observation, interspersed with treatment if required, or with long-term oral therapy. Chronic subtypes involve uncertain pathways, long-term symptoms and psychological distress, which may emerge in primary care. ⋯ Given the rising prevalence of haematological malignancies, pressure on acute services and UK survivorship policy, care may be increasingly shared between secondary and primary care-settings. Challenges include complex shared-care models that lack guidance, workforce issues, and knowledge of haematological malignancies. However, the value patients placed on primary care, coupled with difficulties experienced in hospital clinics, indicate shared care could succeed.