Effect of social deprivation on blood pressure monitoring and control in England: a survey of data from the quality and outcomes framework

Objective To determine levels of blood pressure monitoring and control in primary care and to determine the effect of social deprivation on these levels

Who waits longest for a kidney? : Inequalities in access to kidney transplantation among Black and Asian Minority Ethnic (BAME) groups in the UK

This version deposited with the permission of the publisher 6/15Black and Asian Minority Ethnic (BAME) groups are over-represented on active kidney transplantation waiting lists and have relatively long waiting times. This inequality arises from a particularly high need for kidney transplantation combined with a low rate of deceased donation among BAME groups which limits the availability of a well-matched graft. This paper outlines the major barriers to both registration as a potential donor and family consent to donation. It then describes initiatives to increase donation and transplantation in terms of system changes, organisational changes and community interventions, and considers requirements for effective strategies.Peer reviewedFinal Published versio

Headache: the patient's view

Introduction:- Headache is the commonest reason for neurology referrals, and the commonest neurological reason for patients attending Emergency Departments (EDs). An ethical approach to health care requires that patients be provided with informed choice about management. However researchers have not addressed patients’ concerns and choices in managing headache. This study aims to describe the views of patients, their fears, use of EDs , their perceived need for a scan and its outcome for them. Methods:- A qualitative study using semi-structured interviews with 19 adults aged 23-63, referred by Family Practitioners (FPs) to neurologists for primary headaches approximately two years previously. Audio-recorded interviews were transcribed and analysed thematically. Results:- Participants described fears about secondary organic causes for headache, like a brain tumor. They described their headaches as stressful, and leading to a vicious cycle of fear. Many believed they needed a brain scan and requested it. Participants reported relief of their fears after a scan, and in some cases relief of headache symptoms.Discussion:- UK FPs now have open access to brain scanning, which may relieve physical concerns. Interventions to address health-related anxiety may also help some consulters for headache

The ideas of people referred to neurologists about managing their headaches: A qualitative study

IntroductionHeadache is the commonest reason for General Practitioner (GP) referrals to neurologists, accounting for 25% of all referrals. Those that are referred, however, constitute only 2% of patients who consult GPs with headache. Previous research has suggested that referred patients are more fearful and anxious about their symptoms than those managed without referral. GPs described pressure to refer, often for a brain scan. We now report patients' perspectives.Aims/objectivesThe aim of this study was to explore the view of people consulting GPs with headache who were referred to neurologists.MethodsA qualitative study using semi-structured interviews with nineteen adults aged 23-63, referred by their GPs to neurologists for primary headaches. Audio-recorded interviews were transcribed and analysed thematically.ResultsParticipants described recurring concerns about secondary organic causes for headache, like a brain tumour. They described their headaches as stressful and a vicious cycle, with further headaches occurring. Some reported catastrophic fears, leading them to attend A&E. Many believed they needed a brain scan, and over half had had a scan, all of which were normal. Many reported dissatisfaction with care and use of alternative therapies.ConclusionPeople referred to neurologists for headache described fear and distress, particularly about the possibility of a brain tumour. GPs now have open access to scanning. This may relieve physical concerns. Interventions to address health-related anxiety may help some consulters for headache too

Home-grown foreign language anxiety: Experiences of Welsh university students studying through the medium of English

University students studying in a language other than their first face significant barriers that can detrimentally impact their wellbeing and academic performance. The relationship between language, confidence and performance has been examined in a wide range of national and cultural contexts. However, little research has focused on the experience of Welsh- medium educated students studying in English at the university level. The goal of our study was to compare how Welsh students who completed their primary and secondary education in Welsh perceived their undergraduate university experience to those who completed their formative schooling in English. Using online and in-person questionnaires, we surveyed 125 Welsh undergraduate students studying at a Welsh university on their academic background, and three core areas of their university experience: attendance, contribution and satisfaction. Results indicate that course attendance and grade satisfaction are not statistically significantly associated with language. However, there was a statistically significant relationship between language of secondary education and student's contribution to lectures and seminars. Students educated primarily in Welsh were less likely to contribute to discussions than their first language English counterparts – a common outcome of foreign language anxiety. Although this lack of comfort and confidence did not appear to impact grade satisfaction, it may be related to, and lead to, further barriers and challenges regarding mental health, academic performance, and post-graduatio

Developing and assessing the acceptability of an epilepsy first aid training intervention for patients who visit UK emergency departments: A multi-method study of patients and professionals

Epilepsy affects around 1% of the UK population; 40% of whom experience two or more seizures annually. However, most Emergency Department (ED) visits by people with epilepsy (PWE) are clinically unnecessary. Evidence highlights that with correct training, seizures can be safely managed by patients and their families within the community. Arguably therefore, PWE who frequently visit the ED might benefit from a self-management intervention that improves their own and their families' confidence and ability in managing seizures. Currently, no such intervention is available for PWE attending the ED. A collaborative approach (patients, carers, health professionals) was adopted to develop a patient-focused, self-management intervention. An existing group-based seizure management course, offered by the Epilepsy Society, was adapted. Collaborative feedback was sought via a base-line document review, one-to-one semi-structured interviews, and focus group discussions. The applied framework provided a systematic approach from development through to implementation. Participant feedback overall was extremely positive. People with epilepsy who visit the ED reported a positive view of epilepsy seizure first aid training and associated educational materials. Their feedback was then used to develop the optimized intervention presented here. Strengths and perceived barriers to successful implementation and participation, as well as the practical and psychosocial benefits, were identified. We describe the developed intervention together with the process followed. This description, while being project-specific, provides a useful template to assist in the development of interventions more generally. Ongoing evaluation will determine the effects of the training intervention on participants' behavior

Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review

Limited evidence suggests experiences of immigrant women accessing and using UK maternity services were mixed but largely poor, and there were few rigorously evaluated interventions focused on improving care

Headache Diagnosis in Primary Care

Introduction: Doctors in primary care are responsible for diagnosing and managing patients with headache, but frequently lack confidence in doing so. We aimed to compare Family Practitioners’ (FPs) diagnosis of headaches to classification based on a symptom questionnaire, and to describe how classification links to other important clinical features. Methods: This was an observational study of patients attending primary care doctors for headache. Main outcome measures: Patients completed a questionnaire including the Headache Impact Test, the Migraine Disability Assessment Score, the Hospital Anxiety and Depression Scale, the Illness Perceptions Questionnaire, a satisfaction scale, a service use inventory and a symptom questionnaire rated by two Practitioners with Special Interest (PSIs) in Headache. Results: 255 patients completed questionnaires. There was low agreement between FP diagnosis and classification using the symptom questionnaire. FPs frequently did not use the diagnosis migraine, when patient reported symptoms which justified this. FPs did not classify patients with ≥15 days of headache separately as chronic daily headache (CDH), and this could be because the classification system used does not have that code. Patients classified as CDH using the symptom questionnaire reported more disability, more symptoms of anxiety and depression (HADS), more service use, and less satisfaction with FP care. Conclusion: Patients, who present with headache in primary care, tend to receive non-specific diagnoses. Having a system that would allow separate classification of people with headache of ≥ 15 days a month might help FPs to explore and address associated features with patients in terms of disability, psychological co-morbidity and cost, and improve satisfaction with care