The British journal of general practice : the journal of the Royal College of General Practitioners
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The diagnosis and management of psychogenic non-epileptic seizures (PNES) is often challenging. This literature review was done to investigate available data on PNES to make recommendations for its management. ⋯ The unmasking of the masquerade of PNES is challenging for clinicians in primary and tertiary care. Raising awareness of the condition reduces the burden on health care. Definitive guidelines and more control trials are required. Provocative measures to establish the diagnosis are limited. The feasibility of using the tilt table as a provocative measure is discussed.
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Children with pre-symptomatic type 1 diabetes can be identified through testing for circulating islet autoantibodies. Identifying children at risk reduces the rates of diabetic ketoacidosis at presentation and allows participation in clinical trials for type 1 diabetes prevention. ⋯ Social media has been an effective route to recruitment. Community outreach to schools and general practices will be implemented as this study evolves, to explore optimal recruitment modalities and acceptability.
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Chronic kidney disease (CKD) is prevalent in the UK, associated with significant mortality and morbidity, and disproportionately affects minority ethnic groups. The most common causes for CKD are diabetes and hypertension. An estimated glomerular function (eGFR) blood test and an albumin creatinine ratio (uACR) urine test can be used to assess the level of CKD and predict the risk of adverse outcomes such as cardiovascular disease, end stage renal failure, and death. However, UK National CKD audit data suggest that only 30% of those with hypertension have a recorded uACR. Our quality improvement project working with community stakeholders and Healthy.io digital enterprise will evaluate the feasibility of uACR self-testing in the community. ⋯ Improving equity in uACR testing through quality improvement tools can deliver a sustainable project for improving patient renal care. Leveraging innovative methods provides the potential for effective, equitable, and efficient services.
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Restrictions due to the COVID-19 pandemic resulted in a sudden shift to a predominantly remote consulting model in primary care from March 2020. Little evidence exists examining the experience of remote consulting for people living with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) or fibromyalgia, with the current literature focusing on the challenges faced by clinicians and people living with these conditions. Clinical guidance highlights the importance of building therapeutic relationships and personalising care, but it is unclear how this translates into a remote or virtual consulting space. ⋯ Remote consulting has presented new challenges for primary care, and it is important to identify which groups of patients are most suited. This study explores the views from a group of patients that are associated with some complexity, and complements the literature that explores the ability to deliver relationship-based care when consulting digitally/remotely. Recommendations from the findings will be created for use by patients and clinicians alike.
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Mesothelioma is a terminal disease linked to asbestos exposure, often with a poor prognosis. Palliative care can be valuable at all stages of the disease trajectory. GPs have a key role in supporting such patients. Continuity is difficult to provide within the current NHS primary care system but is highly valued by patients with mesothelioma. ⋯ More research is needed to understand the experiences of continuity in primary care among people with mesothelioma. Specifically, there is an evidence gap regarding understanding their ability to achieve their desired level of continuity within primary care.