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Source: BMJ Open
Management: Family Practices

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Total 16 results found since Jan 2013.

Social bias in artificial intelligence algorithms designed to improve cardiovascular risk assessment relative to the Framingham Risk Score: a protocol for a systematic review
This study will employ an equity-lens to identify sources of bias (ie, race/ethnicity, gender and social stratum) in ML algorithms designed to improve CVD risk assessment relative to the FRS. A comprehensive literature search will be completed using MEDLINE, Embase and IEEE to answer the research question: do AI algorithms that are designed for the estimation of CVD risk and that compare performance with the FRS address the sources of bias inherent in the FRS? No study date filters will be imposed on the search, but English language filters will be applied. Studies describing a specific algorithm or ML approach that provid...
Source: BMJ Open - May 31, 2023 Category: General Medicine Authors: Garcha, I., Phillips, S. P. Tags: Open access, General practice / Family practice Source Type: research

Clinical code usage in UK general practice: a cohort study exploring 18 conditions over 14 years
Conclusions This is an under-reported research area and the findings suggest the codes’ usage diversity for most conditions remained overall stable throughout the study period. Generated mental health code lists can last for a long time unlike cardiometabolic conditions and cancer. Adopting more consistent and less diverse coding would help improve data quality in primary care. Future research is needed following the transfer to the Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) coding.
Source: BMJ Open - July 25, 2022 Category: General Medicine Authors: Zghebi, S. S., Reeves, D., Grigoroglou, C., McMillan, B., Ashcroft, D. M., Parisi, R., Kontopantelis, E. Tags: Open access, General practice / Family practice Source Type: research

Analysis of CYP2C19 genetic variants with ischaemic events in UK patients prescribed clopidogrel in primary care: a retrospective cohort study
Conclusions A substantial proportion of the UK population carry genetic variants that reduce metabolism of clopidogrel to its active form. In family practice patients on clopidogrel, CYP2C19 LoF variants are associated with substantially higher incidence of ischaemic events. Genotype-guided selection of antiplatelet medications may improve outcomes in patients carrying CYP2C19 genetic variants.
Source: BMJ Open - December 13, 2021 Category: General Medicine Authors: Pilling, L. C., Türkmen, D., Fullalove, H., Atkins, J. L., Delgado, J., Kuo, C.-L., Kuchel, G. A., Ferrucci, L., Bowden, J., Masoli, J. A. H., Melzer, D. Tags: Open access, Cardiovascular medicine Source Type: research

Statin prescribing for people with severe mental illnesses: a staggered cohort study of 'real-world impacts
Conclusions We found that statin prescribing to people with SMI in UK primary care was effective for lipid modification but not CVD events. The latter finding may reflect insufficient power to detect a smaller effect size than that observed in randomised controlled trials of statins in people without SMI.
Source: BMJ Open - March 6, 2017 Category: Journals (General) Authors: Blackburn, R., Osborn, D., Walters, K., Falcaro, M., Nazareth, I., Petersen, I. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice, Mental health Research Source Type: research

Comparison of self-perceived cardiovascular disease risk among smokers with Framingham and PROCAM scores: a cross-sectional analysis of baseline data from a randomised controlled trial
Conclusions Among smokers, misperception of their 10-year cardiovascular risk is common, with one-fifth underestimating it. These findings may help physicians target patients with such characteristics to help them change their health behaviour and adherence to risk-reduction therapy. Trial registration number NCT00548665; Post-results.
Source: BMJ Open - January 5, 2017 Category: Journals (General) Authors: Desgraz, B., Collet, T.-H., Rodondi, N., Cornuz, J., Clair, C. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice, Smoking and tobacco Research Source Type: research

Exclusion of patients with concomitant chronic conditions in ongoing randomised controlled trials targeting 10 common chronic conditions and registered at ClinicalTrials.gov: a systematic review of registration details
Conclusions Despite widespread multimorbidity, more than three-quarters of ongoing trials assessing interventions for patients with chronic conditions excluded patients with concomitant chronic conditions.
Source: BMJ Open - September 26, 2016 Category: Journals (General) Authors: Buffel du Vaure, C., Dechartres, A., Battin, C., Ravaud, P., Boutron, I. Tags: Open access, Evidence based practice, General practice / Family practice, Research methods Source Type: research

Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care
Conclusions Observed differential prescribing of OACs can result in channelling bias in comparative effectiveness research. Persistence patterns changed over follow-up time, but there are indications of improved persistence rates with apixaban over other OACs in the UK. A larger study with longer follow-up is needed to corroborate findings. This study is registered on ClinicalTrials.gov (NCT02488421).
Source: BMJ Open - September 25, 2016 Category: Journals (General) Authors: Johnson, M. E., Lefevre, C., Collings, S.-L., Evans, D., Kloss, S., Ridha, E., Maguire, A. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice Research Source Type: research

Barriers and facilitators to staying in work after stroke: insight from an online forum
Conclusions Despite having been able to return to work after a stroke, people may still experience difficulties in staying in work and risking losing their job. There is a need to improve awareness, in particular of invisible stroke-related impairments, among stroke survivors, work personnel and clinicians. This might be achieved through improved assessments of residual impairments in the workplace and in general practice. Future studies should investigate the effect of unrecognised fatigue and invisible impairments on staying in work following stroke, and explore the potential role for primary care in supporting stroke su...
Source: BMJ Open - April 5, 2016 Category: Journals (General) Authors: Balasooriya-Smeekens, C., Bateman, A., Mant, J., De Simoni, A. Tags: Open access, Cardiovascular medicine, General practice / Family practice, Occupational and environmental medicine, Qualitative research, Rehabilitation medicine, Research methods Source Type: research

Understanding stroke survivors and informal carers experiences of and need for primary care and community health services--a systematic review of the qualitative literature: protocol
Introduction Despite the rising prevalence of stroke, no comprehensive model of postacute stroke care exists. Research on stroke has focused on acute care and early supported discharge, with less attention dedicated to longer term support in the community. Likewise, relatively little research has focused on long-term support for informal carers. This review aims to synthesise and appraise extant qualitative evidence on: (1) long-term healthcare needs of stroke survivors and informal carers, and (2) their experiences of primary care and community health services. The review will inform the development of a primary care mode...
Source: BMJ Open - January 6, 2016 Category: Journals (General) Authors: Aziz, N. A., Pindus, D. M., Mullis, R., Walter, F. M., Mant, J., Lim, Rundell, Hobbs Tags: Open access, General practice / Family practice, Qualitative research, Research methods Protocol Source Type: research

Implementing guidelines to routinely prevent chronic vascular disease in primary care: the Preventive Evidence into Practice cluster randomised controlled trial
Conclusions This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit. Trial registration number Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.
Source: BMJ Open - December 11, 2015 Category: Journals (General) Authors: Harris, M. F., Parker, S. M., Litt, J., van Driel, M., Russell, G., Mazza, D., Jayasinghe, U. W., Del Mar, C., Lloyd, J., Smith, J., Zwar, N., Taylor, R., Powell Davies, G., On behalf of the Preventive Evidence into Practice (PEP) Partnership Group, On be Tags: Open access, Cardiovascular medicine, Evidence based practice, General practice / Family practice, Health services research, Public health, Diabetes and Endocrinology Source Type: research

Evaluating quality and its determinants in lipid control for secondary prevention of heart disease and stroke in primary care: a study in an inner London Borough
Conclusions In this study, the key factor that explained poor lipid control in people with CVD was having no current prescription record of a statin. Women were more likely to have poorly controlled cholesterol (independent of comorbid risk factors and after adjusting for age, ethnicity, deprivation index and practice-level variation). Women with CVD should be offered statin prescription and may require higher statin dosage for improved control.
Source: BMJ Open - December 9, 2015 Category: Journals (General) Authors: Dodhia, H., Kun, L., Logan Ellis, H., Crompton, J., Wierzbicki, A. S., Williams, H., Hodgkinson, A., Balazs, J. Tags: Open access, Cardiovascular medicine, General practice / Family practice, Health services research Source Type: research

Primary Care Atrial Fibrillation Service: outcomes from consultant-led anticoagulation assessment clinics in the primary care setting in the UK
Conclusions Systematic identification of patients with AF with high stroke-risk and consultation in PCAF consultant-led clinics effectively delivers oral anticoagulation to high-risk patients with AF in the community.
Source: BMJ Open - December 9, 2015 Category: Journals (General) Authors: Das, M., Panter, L., Wynn, G. J., Taylor, R. M., Connor, N., Mills, J. D., Kirchhof, P., Gupta, D. Tags: Open access, Cardiovascular medicine, General practice / Family practice, Pharmacology and therapeutics Research Source Type: research

Systematic review of rehabilitation programmes initiated within 90 days of a transient ischaemic attack or 'minor' stroke: a protocol
Discussion This review will be of value to clinicians and healthcare professionals working in TIA and stroke services as well as to general practitioners/family physicians who care for these patients in the community and to researchers involved in designing and evaluating rehabilitation interventions. Trial registration number CRD42015016450.
Source: BMJ Open - June 18, 2015 Category: Journals (General) Authors: Heron, N., Kee, F., Donnelly, M., Cupples, M. E. Tags: Open access, Cardiovascular medicine, General practice / Family practice, Neurology, Rehabilitation medicine, Sports and exercise medicine Protocol Source Type: research

A retrospective cohort study to investigate fatigue, psychological or cognitive impairment after TIA: protocol paper
Introduction Transient ischaemic attack (TIA) is defined by short-lasting, stroke-like symptoms, and is recognised as a medical emergency. Symptoms are assumed to completely resolve, and treatment is focused on secondary stroke/TIA prevention. However, evidence suggests that patients with TIA may experience ongoing residual impairments, which they do not receive therapy for as standard practice. TIA-induced sequelae could impact on patients’ quality of life and ability to return to work or social activities. We aim to investigate whether TIA is associated with subsequent consultation for fatigue, psychological or cog...
Source: BMJ Open - May 3, 2015 Category: Journals (General) Authors: Moran, G. M., Calvert, M., Feltham, M. G., Ryan, R., Marshall, T. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice Protocol Source Type: research

Retrospective case review of missed opportunities for primary prevention of stroke and TIA in primary care: protocol paper
This study will investigate: (1) the proportion of strokes/TIAs with prior missed opportunities for prevention in primary care; (2) the influence of patient characteristics on missed prevention opportunities and (3) how the proportion of missed prevention opportunities has changed over time. Methods and analysis A retrospective case review will identify first-ever stroke and patients with TIA between 2000 and 2013 using anonymised electronic medical records extracted from the health improvement network (THIN) database. Four categories of missed opportunities for stroke/TIA prevention will be sought: untreated high blood p...
Source: BMJ Open - November 11, 2014 Category: Journals (General) Authors: Moran, G. M., Calvert, M., Feltham, M. G., Marshall, T. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice, Global health Protocol Source Type: research