The Implications of living with Heart Failure; the impact on everyday life, family support, co-morbidities and access to healthcare: A secondary qualitative analysis

Background: The aim of this study was to use secondary analysis to interrogate a qualitative data set to explore the experiences of patients living with heart failure. Methods: The data-set comprised interviews with 11 patients who had participated in an ethnographic study of heart failure focusing on unplanned hospital admissions. Following an initial review of the literature, a framework was developed with which to interrogate the data-set. This was modified in light of analysis of the first two interviews, to focus on the rich data around patients’ perceptions of living with heart failure, managing co-morbidities, accessing healthcare and the role of their family and friends, during their illness journey. Results: Respondents described how the symptoms of heart failure impacted on their daily lives and how disruption of routine activity due to their symptoms caused them to seek medical care. Respondents disclosed the difficulties of living with other illnesses, in addition to their heart failure, particularly managing multiple and complex medication regimes and negotiating multiple appointments; all expressed a desire to return to their pre-morbid, more independent lives. Many respondents described uncertainty around diagnosis and delays in communication from their healthcare providers. The importance of family support was emphasised, but respondents worried about burdening relatives with their illness. Conclusion: Living with heart failure causes disruption to the lives of sufferers. Facilitation of access to healthcare, through good communication between services and having a strong support network of both family and clinicians can reduce the impact of heart failure on the lives of the patient and those around them

Non-pharmacological interventions for the management of perinatal anxiety in primary care: a meta-review of systematic reviews

Background Perinatal anxiety (PNA), anxiety that occurs during pregnancy and/or up to 12 months postpartum, is estimated to affect up to 21% of women, and may impact negatively on mothers, children, and their families. The National Institute for Health and Care Excellence (NICE) has called for further research around non-pharmacological interventions in primary care for PNA. Aim To summarise the available international evidence on non-pharmacological interventions for women with PNA in a primary care population. Design & setting A meta-review of systematic reviews (SRs) with narrative synthesis was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Method Systematic literature searches were conducted in 11 health-related databases up to June 2022. Titles, abstracts, and full-text articles were dual-screened against pre-defined eligibility criteria. A variety of study designs were included. Data were extracted about study participants, intervention design, and context. Quality appraisal was performed using the AMSTAR 2 tool (A MeaSurement Tool to Assess systematic Reviews). A patient and public involvement group informed and contributed towards this meta-review. Results Twenty-four SRs were included in the meta-review. Interventions were grouped into the following six categories for analysis purposes: psychological therapies; mind–body activities; emotional support from healthcare professionals (HCPs); peer support; educational activities; and alternative or complementary therapies. Conclusion In addition to pharmacological and psychological therapies, this meta-review has demonstrated that there are many more options available for women to choose from that might be effective to manage their PNA. Evidence gaps are present in several intervention categories. Primary care clinicians and commissioners should endeavour to provide patients with a choice of these management options, promoting individual choice and patient-centred care

The experiences and needs of supporting individuals of young people who self-harm: A systematic review and thematic synthesis

Self-harm in young people is a serious international health concern that impacts on those providing informal support: the supporting individuals of young people. We aimed to highlight the experiences, views, and needs of these supporting individuals of young people. We conducted a systematic review and thematic synthesis: PROSPERO CRD42020168527. MEDLINE, PsycINFO, EMBASE, AMED, CINAHL, ASSIA, and Web of Science were searched from inception to 6 May 2020 with citation tracking of eligible studies done on 1 Oct 2021. Primary outcomes were experiences, perspectives, and needs of parents, carers, or other family members of young people aged 12-25. Searches found 6167 citations, of which 22 papers were included in synthesis. Supporting individuals seek an explanation for and were personally affected by self-harm in young people. It is important that these individuals are themselves supported, especially as they negotiate new identities when handling self-harm in young people, as they attempt to offer support. The GRADE-CERQual confidence in findings is moderate. Recommendations informed by the synthesis findings are made for the future development of interventions. Clinicians and health service providers who manage self-harm in young people should incorporate these identified unmet needs of supporting individuals in a holistic approach to self-harm care. Future research must co-produce and evaluate interventions for supporting individuals

Working conditions, psychological distress and suicidal ideation: cross-sectional survey study of UK junior doctors

Background Evidence attests a link between junior doctors’ working conditions and psychological distress. Despite increasing concerns around suicidality among junior doctors, little is known about its relationship to their working conditions. Aims To (a) establish the prevalence of suicidal ideation among junior doctors in the National Health Service; (b) examine the relationships between perceived working conditions and suicidal ideation; and (c) explore whether psychological distress (e.g. symptoms of depression and anxiety) mediates these relationships. Method Junior doctors were recruited between March 2020 and January 2021, for a cross-sectional online survey. We used the Health and Safety Executive's Management Standards Tool; Depression, Anxiety and Stress Scale 21; and Paykel Suicidality Scale to assess working conditions, psychological distress and suicidality, respectively. Results Of the 424 participants, 50.2% reported suicidal ideation, including 6.1% who had made an attempt on their own life. Participants who identified as LGBTQ+ (odds ratio 2.18, 95% CI 1.15–4.12) or reported depression symptoms (odds ratio 1.10, 95% CI 1.07–1.14) were more likely to report suicidal ideation. No direct relationships were reported between working conditions (i.e. control, support, role clarity, strained relationships, demand and change) and suicidal ideation. However, depression symptoms mediated all six relationships. Conclusions This sample of junior doctors reported alarming levels of suicidal ideation. There may be an indirect relationship between working conditions and suicidal ideation via depressive symptoms. Clearer research exploring the experience of suicidality in junior doctors is needed, including those who identify as LGBTQ+. Systematic interventions addressing working environment are needed to support junior doctors’ mental health

Markers of dementia-related health in primary care electronic health records

Objectives: Identifying routinely recorded markers of poor health in patients with dementia may help treatment decisions and evaluation of earlier outcomes in research. Our objective was to determine whether a set of credible markers of dementia-related health could be identified from primary care electronic health records (EHR). Methods: The study consisted of (i) rapid review of potential measures of dementia-related health used in EHR studies; (ii) consensus exercise to assess feasibility of identifying these markers in UK primary care EHR; (iii) development of UK EHR code lists for markers; (iv) analysis of a regional primary care EHR database to determine further potential markers; (v) consensus exercise to finalise markers and pool into higher domains; (vi) determination of 12-month prevalence of domains in EHR of 2328 patients with dementia compared to matched patients without dementia. Results: Sixty-three markers were identified and mapped to 13 domains: Care; Home Pressures; Severe Neuropsychiatric; Neuropsychiatric; Cognitive Function; Daily Functioning; Safety; Comorbidity; Symptoms; Diet/Nutrition; Imaging; Increased Multimorbidity; Change in Dementia Drug. Comorbidity was the most prevalent recorded domain in dementia (69%). Home Pressures were the least prevalent domain (1%). Ten domains had a statistically significant higher prevalence in dementia patients, one (Comorbidity) was higher in non-dementia patients, and two (Home Pressures, Diet/Nutrition) showed no association with dementia. Conclusions: EHR captures important markers of dementia-related health. Further research should assess if they indicate dementia progression. These markers could provide the basis for identifying individuals at risk of faster progression and outcome measures for use in research

The burden of depression in primary care: a qualitative investigation of general practitioners' constructs of depressed people in the inner city

Depression is a common problem, often being recurrent or becoming chronic. It has been stated that people with depression should continue to be predominantly managed in primary care. There is much evidence to suggest that the detection and management of depression by general practitioners (GPs) could be improved, but little work has focused on GPs' views on their work with depressed patients. This was a qualitative study exploring GPs' attitudes to the management of patients with depression. Semi-structured interviews were conducted with 22 GPs in north-west England. These GPs were practising in urban or inner-city areas and were all based in practices that participated in undergraduate teaching. The interviews were audiotaped and subsequently transcribed. Analysis was by constant comparison until category saturation was achieved. The subjects conceptualized depression as an everyday problem of practice rather than as an objective diagnostic category. Thematic coding of their accounts suggested a tension between three kinds of views of depressed people, namely (1) that depression is a common and normal response to socioeconomic disadvantage and that it reflects the medicalization of these conditions, (2) that the diagnosis of depression offers a degree of secondary gain to both patients and doctors and (3) that GPs experienced depressed people as an intractable interactional problem. It was concluded that depression is commonly presented to GPs who feel that its diagnosis often involves the separation of a normal reaction to a harsh environment and true illness. In addition, they felt ill-equipped to deal with the long-term management of such patients. They doubted that anything therapeutic occurs in review consultations with such patients. This has an important implication for the construction of educational interventions around improving the recognition and treatment of depression in primary care: doctors may be reluctant to recognize and respond to such patients in depth because of the much wider structural and social factors that we have suggested in this paper

So looking at this, you look like you’ve got some issues going on with your joints: Exploring case-finding in long-term condition review consultations (the ENHANCE pilot trial)

Background: The ENHANCE pilot trial aimed to test the feasibility and acceptability of integrating case-finding for osteoarthritis, anxiety and depression within extended primary care nurse-led long-term condition (LTC) review consultations. Training was delivered to general practice nurses (PNs) to deliver ENHANCE reviews, supported by an adapted EMIS LTC computer template. This paper reports findings from a process evaluation exploring the ways in which PNs delivered ENHANCE LTC reviews, focusing on what aspects of the ENHANCE approach were delivered and how PNs integrate the ENHANCE approach within an LTC review consultation. Methods: Twenty-four patients and seven PNs from four general practices gave consent for their ENHANCE consultations to be audio-recorded and transcribed. A checklist was developed and used to assess the extent to which each intended component was included in ENHANCE consultations. Thematic analysis of transcripts enabled a rich description of the ways in which PNs conducted ENHANCE reviews. Results: Familiarity with the use and access of the ENHANCE template was high, and in more than half of the audio-recorded consultations PNs had integrated new ENHANCE components and not simply added them on at the end. In the majority of consultations PNs explained there would be additional questions about joint pain or mood, though this was often not prefixed with an explanation that many people with LTCs have low mood or joint pain. Although there were some inconsistencies in the wording used, the audio-recordings demonstrated that PNs were asking the initial case-finding questions. However, PNs did not always follow the intended consultation pathway to ask further questions as a result of positive answers to initial case-finding. In some cases, PNs used additional prompts that appeared to influence patients’ responses, and both patients and PNs attempted to normalize or dismiss responses to questions about anxiety and depression. Particular challenges for PNs included the involvement of family members in the consultation, patient understanding and interpretation of case-finding questions and delivering a person-centred approach that integrated standardized case-finding questions. Conclusion: Data demonstrate variation in the ways PNs incorporated aspects of the ENHANCE approach within LTC review consultations. PNs were asked to record patient responses on a new EMIS computer template, while maintaining a patient-centred dialogue and completing an integrated ENHANCE review within the available timeframe, so it is unsurprising that there were inconsistencies in the use of case-finding questions and following the ENHANCE consultation pathway. PNs were comfortable with using and accessing the template, and there was integration during the review, suggesting that these elements of the approach were feasible. We have identified challenges around interpreting responses to case-finding questions and explaining the approach and outcomes of case-finding to patients that will need to be addressed through PN training in a future main trial

Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue

Objective: chronic widespread pain and chronic fatigue share common associated factors but these associations may be explained by the presence of concurrent depression and anxiety.Methods: we mailed questionnaires to a randomly selected sample of people in the UK to identify participants with chronic widespread pain (ACR 1990 definition) and those with chronic fatigue. The questionnaire assessed sociodemographic factors, health status, healthcare use, childhood factors, adult attachment, and psychological stress including anxiety and depression. To identify persons with unexplained chronic widespread pain or unexplained chronic fatigue; we examined participant's medical records to exclude medical illness that might cause these symptoms.Results: of 1443 participants (58.0% response rate) medical records of 990 were examined. 9.4% (N = 93) had unexplained chronic widespread pain and 12.6% (N = 125) had unexplained chronic fatigue. Marital status, childhood psychological abuse, recent threatening experiences and other somatic symptoms were commonly associated with both widespread pain and fatigue. No common effect was found for few years of education and current medical illnesses (more strongly associated with chronic widespread pain) or recent illness in a close relative, neuroticism, depression and anxiety scores (more strongly associated with chronic fatigue). Putative associated factors with a common effect were associated with unexplained chronic widespread pain or unexplained chronic fatigue only when there was concurrent anxiety and/or depression.Discussion: this study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression