Implications of evidence-based understanding of benefits and risks for cancer prevention strategy

No abstract available

Taking a multidisciplinary team approach to better healthcare outcomes for society

No abstract available

Medication adherence among the older adults: challenges and recommendations

No abstract available

A mixed-methods evaluation of patients’ views on primary care multi-disciplinary teams in Scotland

BackgroundExpanding primary care multi-disciplinary teams (MDTs) was a key component of the 2018 Scottish GP contract, with over 4,700 MDT staff appointed since then.AimTo explore patients’ views on primary care MDT expansion in Scotland.Design and methods(1) Survey of patients recently consulting a GP in deprived-urban, affluent-urban and remote/rural areas, assessing awareness of five MDT roles and attitudes towards receptionist signposting; (2) 30 individual interviews exploring MDT-care experiences.ResultsOf 1,053 survey respondents, most were unaware of the option of MDT rather than GP consultations for three out of five roles (69% unaware of link worker appointments; 68% mental health nurse; 58% pharmacist). Reception signposting was less popular in deprived-urban areas (34% unhappy vs 29% in remote/rural vs 21% affluent-urban; p&lt;0.001), and in patients with multimorbidity (31% unhappy vs 24% in non-multimorbid; p&lt;0.05).Two-thirds of interviewees had multimorbidity and almost all reported positive MDT-care experiences. However, MDT-care was generally seen as a supplement rather than a substitute for GP care. Around half of patients expressed concerns about reception signposting. These patients were more likely to also express concerns about GP access in general. Both of these concerns were more common in deprived-urban areas than in remote/rural or affluent-urban areas.ConclusionMDT-care has expanded in Scotland with limited patient awareness. Although patients understand its potential value, many are unhappy with reception signposting to first-contact MDT care, especially those in deprived-urban areas living with multimorbidity. This represents a barrier to the aims of the new GP contract.<br/

Contributions of physicians to government-subsidised disease prevention programmes: an appeal for active participation

No abstract available

The association between distal findings and proximal colorectal neoplasia: a systematic review and meta-analysis

Objectives: Whether screening participants with distal hyperplastic polyps (HPs) detected by flexible sigmoidoscopy (FS) should be followed by subsequent colonoscopy is controversial. We evaluated the association between distal HPs and proximal neoplasia (PN)/advanced proximal neoplasia (APN) in asymptomatic, average-risk patients. Methods: We searched Ovid Medline, EMBASE, and the Cochrane Library from inception to 30 June 2016 and included all screening studies that examined the relationship between different distal findings and PN/APN. Data were independently extracted by two reviewers with disagreements resolved by a third reviewer. We pooled absolute risks and odds ratios (ORs) with a random effects meta-analysis. Seven subgroup analyses were performed according to study characteristics. Heterogeneity was characterized with theI2 statistics. Results: We analyzed 28 studies (104,961 subjects). When compared with normal distal findings, distal HP was not associated with PN (OR=1.16, 95% confidence interval (CI)=0.89–1.51,P=0.14,I2=40%) or APN (OR=1.09, 95% CI=0.87–1.36,P=0.39,I2=5%), while subjects with distal non-advanced or advanced adenoma had higher odds of PN/APN. Higher odds of PN/APN were observed for more severe distal lesions. Weaker association between distal and proximal findings was noticed in studies with higher quality, larger sample size, population-based design, and more stringent endoscopy quality-control measures. The Egger’s regression tests showed allP&gt;0.05. Conclusions: Distal HP is not associated with PN/APN in asymptomatic screening population when compared with normal distal findings. Hence, the presence of distal HP alone detected by FS does not automatically indicate colonoscopy referral for all screening participants, as other risk factors of PN/APN should be considered

Transforming primary care in Scotland : a critical policy analysis

Strong primary care is central to effective health systems, but both in the United Kingdom (UK) and internationally, primary care has proved one of the most challenging areas for health policy reform (1,2). Across the UK's four health systems, there are currently some strong resonances in policy ambitions, including broadening the multidisciplinary team to support general practitioners, encouraging place-based collaboration between practices, and innovating for quality improvement. However, especially when comparing England and Scotland, contrasting policy approaches to pursuing these goals reflect different governmental "styles of intervention" (3). In Scotland, where health policy was devolved to the Scottish Parliament in 1999, primary care has undergone continual evolution as policymakers have sought to improve the quality of care delivered, and to address underlying - and still stubborn - population health inequalities. The seismic, top-down reorganisations that have characterised recent English health policy (4) have been absent in Scotland. There have, though, been significant developments. The wider health system was reconfigured by Scotland's 2014 Public Bodies (Joint Working) (Scotland) Act which mandated the statutory integration of health and social care, creating new integration authorities on a legal basis(5). Then in 2018, a Scotland-specific GP contract was introduced for the first time, removing the Quality and Outcomes Framework (QOF) from Scottish primary care

The incidence of all-cause, cardiovascular and respiratory disease admission among 20,252 users of lisinopril vs. perindopril: a cohort study

Background: Major international guidelines do not offer explicit recommendations on any specific angiotensin-converting enzyme inhibitor (ACEI) agent over another within the same drug group. This study compared the effectiveness of lisinopril vs. perindopril in reducing the incidence of hospital admission due to all-cause, cardiovascular disease and respiratory disease. Methods: Adult patients who received new prescriptions of lisinopril or perindopril from 2001 to 2005 in all public hospitals and clinics in Hong Kong were included, and followed up for ≥2 years. The incidence of admissions due to all-cause, cardiovascular disease and respiratory disease were evaluated, respectively, by using Cox proportional hazard regression models. The regression models were constructed with propensity score matching to minimize indication biases. Results: A total of 20,252 eligible patients with an average age of 64.5 years (standard deviation 15.0) were included. The admission rate at 24 months within the date of index prescription due to any cause, cardiovascular disease and respiratory disease among lisinopril vs. perindopril users was 24.8% vs. 24.8%, 13.7% vs. 14.0% and 6.9% vs. 6.3%, respectively. Lisinopril users were significantly more likely to be admitted due to respiratory diseases (adjusted hazard ratios [AHR] = 1.25, 95% CI 1.08 to 1.43, p = 0.002 at 12 months; AHR = 1.17, 95% CI 1.04 to 1.31, p = 0.009 at 24 months) and all causes (AHR = 1.12, 95% CI 1.05 to 1.19, p &lt; 0.001 at 24 months) than perindopril users. Conclusions: These findings support intra-class differences in the effectiveness of ACEIs, which could be considered by clinical guidelines when the preferred first-line antihypertensive drugs are recommended