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  1. Artikel ; Online: Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study.

    Goldsmith, Robert / Williams, Nefyn Howard / Wood, Fiona

    BJGP open

    2019  Band 3, Heft 3

    Abstract: Background: Several pathological processes contribute to lumbar radicular pain (LRP), commonly known as sciatica. It is not known how patients rationalise the experience of sciatica or understand the diagnosis. Providing clinicians with a better ... ...

    Abstract Background: Several pathological processes contribute to lumbar radicular pain (LRP), commonly known as sciatica. It is not known how patients rationalise the experience of sciatica or understand the diagnosis. Providing clinicians with a better understanding of how patients conceptualise sciatica will help them to tailor information for patients on the management and treatment of the condition.
    Aim: To understand patients' beliefs regarding their illness following a diagnosis of LRP, how these beliefs were developed, and the impact of illness beliefs on treatment beliefs.
    Design & setting: Qualitative interview study from a single NHS musculoskeletal interface service (in Wales, UK).
    Method: Thirteen patients recently diagnosed with LRP were consecutively recruited. Individual semi-structured interviews were recorded and transcribed. Data were analysed using a thematic approach.
    Results: Four main themes were generated: (1) the illness experience (2) the concept of sciatica, (3) treatment beliefs, and (4) the desire for credible information.
    Conclusion: The diagnosis of LRP is often communicated and understood within a compressive conceptual illness identity. Explaining symptoms with a compressive pathological model is easily understood by patients but may not accurately reflect the spectrum of pathological processes known to contribute to radicular pain. This model appears to inform patient beliefs about treatments. Clinicians should take care to fully explain the pathology prior to shared decision-making with patients.
    Sprache Englisch
    Erscheinungsdatum 2019-10-29
    Erscheinungsland England
    Dokumenttyp Journal Article
    ISSN 2398-3795
    ISSN (online) 2398-3795
    DOI 10.3399/bjgpopen19X101654
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Tensions in primary care cancer detection: An embedded qualitative intervention development study.

    Hiscock, Julia / Law, Rebecca-Jane / Brain, Katherine / Smits, Stephanie / Nafees, Sadia / Williams, Nefyn Howard / Rose, Jan / Lewis, Ruth / Roberts, Jessica / Hendry, Annie / Neal, Richard / Wilkinson, Clare E

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2024  

    Abstract: Background: UK cancer mortality is worse than many other high-income countries, partly due to diagnostic delays in primary care.: Aim: To understand beliefs and behaviour of GPs, and systems of general practice teams, to inform the Think Cancer! ... ...

    Abstract Background: UK cancer mortality is worse than many other high-income countries, partly due to diagnostic delays in primary care.
    Aim: To understand beliefs and behaviour of GPs, and systems of general practice teams, to inform the Think Cancer! intervention development.
    Design and setting: An embedded qualitative study guided by behaviour change models (COM-B and TDF) in primary care in Wales, UK.
    Method: Twenty qualitative, semi-structured telephone interviews with GPs and four face-to-face focus groups with practice teams. Analysis used Framework, results were mapped to multiple, overlapping components of COM-B and TDF.
    Results: Three themes illustrate (1) complex, multi-level referral considerations facing GPs and practice teams, (2) external influences and constraints, (3) the role of practice systems and culture. Tensions emerged between individual considerations of GPs (Capability, Motivation) and context-dependent external pressures (Opportunity). Detecting cancer was guided not only by external requirements, but also by motivational factors GPs described as part of their cancer diagnostics process. External influences on the diagnosis process often resulted from the primary-secondary care interface and social pressures. GPs adapted their behaviour to deal with this disconnect. Positive practice culture and supportive practice-based systems ameliorated these tensions and complexity.
    Conclusion: By exploring individual GP behaviours together with practice systems and culture we contribute new understandings on how cancer diagnosis operates in primary care and how delays can be improved. We highlight commonly overlooked dynamics and tensions, experienced by GPs as a tension between individual decision-making (Capability, Motivation) and external considerations such as pressures in secondary care (Opportunity).
    Sprache Englisch
    Erscheinungsdatum 2024-05-28
    Erscheinungsland England
    Dokumenttyp Journal Article
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/BJGP.2023.0339
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  3. Artikel ; Online: Earlier cancer diagnosis in primary care: a feasibility economic analysis of ThinkCancer!

    Anthony, Bethany Fern / Disbeschl, Stefanie / Goulden, Nia / Hendry, Annie / Hiscock, Julia / Hoare, Zoe / Roberts, Jessica / Rose, Jan / Surgey, Alun / Williams, Nefyn Howard / Walker, Daniel / Neal, Richard / Wilkinson, Clare / Edwards, Rhiannon Tudor

    BJGP open

    2023  Band 7, Heft 1

    Abstract: Background: UK cancer survival rates are much lower compared with other high-income countries. In primary care, there are opportunities for GPs and other healthcare professionals to act more quickly in response to presented symptoms that might represent ...

    Abstract Background: UK cancer survival rates are much lower compared with other high-income countries. In primary care, there are opportunities for GPs and other healthcare professionals to act more quickly in response to presented symptoms that might represent cancer. ThinkCancer! is a complex behaviour change intervention aimed at primary care practice teams to improve the timely diagnosis of cancer.
    Aim: To explore the costs of delivering the ThinkCancer! intervention to expedite cancer diagnosis in primary care.
    Design & setting: Feasibility economic analysis using a micro-costing approach, which was undertaken in 19 general practices in Wales, UK.
    Method: From an NHS perspective, micro-costing methodology was used to determine whether it was feasible to gather sufficient economic data to cost the ThinkCancer!
    Intervention: Owing to the COVID-19 pandemic, ThinkCancer! was mainly delivered remotely online in a digital format. Budget impact analysis (BIA) and sensitivity analysis were conducted to explore the costs of face-to-face delivery of the ThinkCancer! intervention as intended pre-COVID-19.
    Results: The total costs of delivering the ThinkCancer! intervention across 19 general practices in Wales was £25 030, with an average cost per practice of £1317 (standard deviation [SD]: 578.2). Findings from the BIA indicated a total cost of £34 630 for face-to-face delivery.
    Conclusion: Data collection methods were successful in gathering sufficient health economics data to cost the ThinkCancer!
    Intervention: Results of this feasibility study will be used to inform a future definitive economic evaluation alongside a pragmatic randomised controlled trial (RCT).
    Sprache Englisch
    Erscheinungsdatum 2023-03-21
    Erscheinungsland England
    Dokumenttyp Journal Article
    ISSN 2398-3795
    ISSN (online) 2398-3795
    DOI 10.3399/BJGPO.2022.0130
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  4. Artikel ; Online: A lifestyle management programme focused on exercise, diet and physiotherapy support for patients with hip or knee osteoarthritis and a body mass index over 35: A qualitative study.

    Law, Rebecca-Jane / Nafees, Sadia / Hiscock, Julia / Wynne, Cathy / Williams, Nefyn Howard

    Musculoskeletal care

    2019  Band 17, Heft 1, Seite(n) 145–151

    Abstract: The Lifestyle Management Programme (LMP) is an exercise and weight management programme with physiotherapy support for people with hip or knee osteoarthritis (OA) and a body mass index (BMI) over 35. This qualitative study explored views and experiences ... ...

    Abstract The Lifestyle Management Programme (LMP) is an exercise and weight management programme with physiotherapy support for people with hip or knee osteoarthritis (OA) and a body mass index (BMI) over 35. This qualitative study explored views and experiences of the LMP among patients and professionals, and offers insight for future programmes. Five referring clinicians and six delivering professionals participated in focus groups. Three referring GPs and nine patients who attended the LMP took part in semi-structured interviews. Topics included: referral, reasons for taking up and continuing the programme or not, and experiences and outcomes. Framework method was used to analyse the qualitative data. Overall, patients and professionals valued the multidisciplinary nature of the LMP. However, professionals explained feeling guilty about delaying patients on the orthopaedic waiting list and believed that the programme should be redirected to those with less severe OA and a lower BMI. Referring clinicians differed in their interpretation of the referral criteria and expressed varying levels of autonomy when making referrals. Patients referred after a consultation with their general practitioner appeared to be more satisfied with the referral process. Patients were also encouraged by the opportunity to improve health, their likelihood of surgery and social benefits. However, patients were discouraged by inconvenience, cost, lack of readiness to change and embarrassment. In conclusion, shared decision-making about lifestyle management without delaying orthopaedic opinion is preferable, and more psychological support may increase participation. Importantly, the programme may be better focused on rehabilitation for patients with a lower BMI and less severe symptoms.
    Mesh-Begriff(e) Attitude of Health Personnel ; Attitude to Health ; Body Mass Index ; Diet ; Exercise ; Female ; Focus Groups ; General Practitioners ; Humans ; Life Style ; Male ; Osteoarthritis, Hip/rehabilitation ; Osteoarthritis, Hip/surgery ; Osteoarthritis, Knee/rehabilitation ; Osteoarthritis, Knee/surgery ; Physical Therapy Modalities ; Qualitative Research ; Referral and Consultation
    Sprache Englisch
    Erscheinungsdatum 2019-01-24
    Erscheinungsland England
    Dokumenttyp Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2171452-6
    ISSN 1557-0681 ; 1478-2189
    ISSN (online) 1557-0681
    ISSN 1478-2189
    DOI 10.1002/msc.1382
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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    Verfügbar in ZB MED Köln/Königswinter

    Zs.A 6046: Hefte anzeigen Standort:
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  5. Artikel ; Online: Barriers and facilitators to deprescribing in primary care: a systematic review.

    Doherty, Alison Jayne / Boland, Paul / Reed, Janet / Clegg, Andrew J / Stephani, Anne-Marie / Williams, Nefyn Howard / Shaw, Beth / Hedgecoe, Lynn / Hill, Ruaraidh / Walker, Lauren

    BJGP open

    2020  Band 4, Heft 3

    Abstract: Background: Managing polypharmacy is a challenge for healthcare systems globally. It is also a health inequality concern as it can expose some of the most vulnerable in society to unnecessary medications and adverse drug-related events. Care for most ... ...

    Abstract Background: Managing polypharmacy is a challenge for healthcare systems globally. It is also a health inequality concern as it can expose some of the most vulnerable in society to unnecessary medications and adverse drug-related events. Care for most patients with multimorbidity and polypharmacy occurs in primary care. Safe deprescribing interventions can reduce exposure to inappropriate polypharmacy. However, these are not fully accepted or routinely implemented.
    Aim: To identify barriers and facilitators to safe deprescribing interventions for adults with multimorbidity and polypharmacy in primary care.
    Design & setting: A systematic review of studies published from 2000, examining safe deprescribing interventions for adults with multimorbidity and polypharmacy.
    Method: A search of electronic databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature (CINHAL), Cochrane, and Health Management Information Consortium (HMIC) from inception to 26 Feb 2019, using an agreed search strategy. This was supplemented by handsearching of relevant journals, and screening of reference lists and citations of included studies.
    Results: In total, 40 studies from 14 countries were identified. Cultural and organisational barriers included: a culture of diagnosing and prescribing; evidence-based guidance focused on single diseases; a lack of evidence-based guidance for the care of older people with multimorbidities; and a lack of shared communication, decision-making systems, tools, and resources. Interpersonal and individual-level barriers included: professional etiquette; fragmented care; prescribers' and patients' uncertainties; and gaps in tailored support. Facilitators included: prudent prescribing; greater availability and acceptability of non-pharmacological alternatives; resources; improved communication, collaboration, knowledge, and understanding; patient-centred care; and shared decision-making.
    Conclusion: A whole systems, patient-centred approach to safe deprescribing interventions is required, involving key decision-makers, healthcare professionals, patients, and carers.
    Schlagwörter covid19
    Sprache Englisch
    Erscheinungsdatum 2020-08-25
    Erscheinungsland England
    Dokumenttyp Journal Article
    ISSN 2398-3795
    ISSN (online) 2398-3795
    DOI 10.3399/bjgpopen20X101096
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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