Protocol for a realist review of General Practitioners’ Role in Advancing Practice in Care Homes (GRAPE study)

Introduction: Older people who live in care homes have a high level of need with complex health conditions. In addition to providing medical care to residents, general practitioners (GPs) play a role as gatekeeper for access to services, as well as leadership within healthcare provision. This review will describe how GPs were involved in initiatives to change arrangements of healthcare services in order to improve quality and experience of care. Methods and analysis: Following RAMESES quality and publication guidelines standards, we will proceed with realist review to develop theories of how GPs work with care home staff to bring about improvements. We identify when improvement in outcomes does not occur and why this may be the case. The first stage will include interviews with GPs to ask their views on improvement in care homes. These interviews will enable development of initial theories and give direction for the literature searches. In the second stage, we will use iterative literature searches to add depth and context to the early theories; databases will include Medline, Embase, CINAHL, PsycINFO and ASSIA. In stage 3, evidence that is judged as rigorous and relevant will be used to test the initial theories, and through the process, refine the theory statements. In the final stage, we will synthesise findings and provide recommendations for practice and policy-making. During the review, we will invite a context expert group to reflect on our findings. This group will have expertise in current trends in primary care and the care home sector both in UK and internationally. Ethics and dissemination: The study was approved by University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee: 354-1907. Findings will be shared through stakeholder networks, published in National Institute for Health Research journal and submitted for peer-reviewed journal publication

General practitioners’ role in improving health care in care homes: a realist review

Background Despite recent focus on improving health care in care homes, it is unclear what role general practitioners (GPs) should play. To provide evidence for future practice we set out to explore how GPs have been involved in such improvements. Methods Realist review incorporated theory-driven literature searches and stakeholder interviews, supplemented by focussed searches on GP-led medication reviews and end-of-life care. Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library were searched. Grey literature was identified through internet searches and professional networks. Studies were included based upon relevance. Data were coded to develop and test contexts, mechanisms, and outcomes for improvements involving GPs. Results Evidence was synthesized from 30 articles. Programme theories described: (i) “negotiated working with GPs,” where other professionals led improvement and GPs provided expertise; and (ii) “GP involvement in national/regional improvement programmes.” The expertise of GPs was vital to many improvement programmes, with their medical expertise or role as coordinators of primary care proving pivotal. GPs had limited training in quality improvement (QI) and care home improvement work had to be negotiated in the context of wider primary care commitments. Conclusions GPs are central to QI in health care in care homes. Their contributions relate to their specialist expertise and recognition as leaders of primary care but are challenged by available time and resources to develop this role

Reducing unplanned care, through cognitive behavioural psychological therapy for people with long term health conditions

Poster presentatio

Moving matters: signals and mechanisms in directed cell migration

The EMBO workshop on Cell Migration, held in Heidelberg this May, highlighted new trends in cell migration research, as well as the need to reassess current dogma. Key insights included altered ideas for the roles of Rac and inositol lipids, for the ways that groups of cells coordinate their migration and for the importance of considering movement from both a cell biological and mechanical perspective

MyosinV controls PTEN function and neuronal cell size

The tumour suppressor PTEN can inhibit proliferation and migration as well as control cell growth in different cell types1. PTEN functions predominately as a lipid phsophatase, converting PI(3,4,5)P(3) to PI(4,5)P(2), thereby antagonizing PI3K (Phosphoinositide 3-kinase) and its established downstream effector pathways2. However, much is unclear concerning the mechanisms that regulate PTEN movement to the cell membrane necessary for PTEN’s activity towards PI(3,4,5)P(3)3-5. Here we show a requirement for functional motor proteins in the control of PI3K signalling, involving a previously unknown association between PTEN and MyosinV. FRET measurements revealed that PTEN interacts directly with MyosinV, dependent on PTEN phosphorylation mediated by CK2 and/or GSK3. Inactivation of MyosinV-transport function in neurons increased cell size, which – in line with known attributes of PTEN-loss6, 7 - required PI3K and mTor. Our data demonstrate a myosin-based transport mechanism regulating PTEN function, providing new insights into the signalling networks regulating cell growth