Research Posters 2035 – 2041
2035 Interventions for improving modifiable risk factors in secondary stroke prevention
Stroke is the second highest cause of deaths worldwide, with approximately 152,000 strokes per year in the UK. Post-stroke, survivors are 15 times more likely to have a further event in the following year. Many recurrent strokes are attributable to a relatively small number of often inadequately managed modifiable risk factors. Primary care professionals are on the front line and play a crucial role to educate monitor and facilitate modification of these risk factors.
The study objective is to update a 2014 Cochrane review of service delivery interventions for improving modifiable risk factor control in the secondary prevention of strokes. In the previous review, educational/behavioural interventions were not generally associated with clear differences in outcome. However, changes to service organisation conferred an improvement. Our update identified fifteen additional studies, most deemed of adequate quality. Over half were predominately focused on organisational interventions, and the remainder focused on educational/behavioural interventions for patients.
A range of interventions were employed, which were often delivered by non-physicians, including nurses and pharmacists. Collectively, both intervention types typically conferred an improvement when delivered as a high intensity intervention followed up by non-physicians who were guided by protocols. For example allocating patients to specific blood pressure targets, managed by non-physicians.
The review will provide clinicians/stroke services with a framework upon which to guide management of risk factors in secondary stroke prevention in the community.
2036 Assessing dementia risk in general practice: a qualitative study of the attitudes and views of members of the public
Aims/Objectives: Initiatives have been developed to promote “timely diagnosis” of dementia in primary care including identifying people at risk (case finding) and providing them with information about risk reduction. We do not know what the general public think of such initiatives. This qualitative study aims to explore members of the public views of case finding and tools to assess dementia risk in primary care.
Content of presentation: This poster highlights the results of 6 focus groups with member of the general public (n=31) exploring their views of case finding, dementia risk and tools to identify people at risk in primary care
Relevance/Impact: There is growing evidence that dementia risk for populations can be reduced and that ““what is good for your heart is good for your brain”. Despite this is it not known what the general public know about dementia risk reduction or what they think of initiatives to identify people at risk of developing dementia in order to give tailored advice.
Outcomes: The focus group discussions were audio recorded, transcribed and subjected to thematic analysis. Emerging themes included: limitations of case finding, objective measures of risk versus self-reporting questionnaires and the need for information on risk.
Discussion: This study has provided a valuable insight into the general public views of dementia risk. It is envisaged the results of this study should inform the development of new approaches to “timely diagnosis” of dementia and risk reduction. Future research should focus on acceptable methods of identifying people at risk and education on initiating and maintaining behaviour change.
2037 It’s not just for girls: why are more female medical students specialising in general practice than their male counterparts?
Abstract: Aims:This study investigated factors that influence medical students in their intended career choices and explored the reasons why a higher proportion of female students seem attracted to a career in general practice (HSCIC, 2014).
Relevance:The current trend of medical career choices highlights an increasing gender disparity amongst medical students in relation to general practice employment (Mayorova et al, 2005). Given the current feminisation of primary care, it is essential to pay attention to these gender-related differences when it comes to career preferences of medical students to be able to better understand when and why these perceptions evolve. Therefore, the focus of my research was exploring the gender-related perceptions of medical students towards general practice and the implications this has for the future primary care workforce.
Content: A mixed-methods approach was taken. An online survey was circulated to medical students to gauge their opinions on general practice and was further used as a recruitment tool for focus groups. Two focus groups were conducted and thematic analysis was carried out to identify the key themes.
Outcomes: The main themes covered the opportunity for a work-life balance, placement experiences and role models, feminisation of work places and the perception of general practice as a ‘pink’ profession, lacking specialism.
Discussion: The results showed that there was a strongly gendered perception of general practice amongst medical students. This has implications for medical schools and for the primary care profession. Educational programmes centred on gender awareness, better career advice and teaching by positive GP role models in the current MBChB medical curricula could begin to address this issue.
2038 Poor adherence to gonorrhoea treatment guidelines in general practice in England
Diagnoses of gonorrhoea are on the increase in England and, in response to emerging antimicrobial resistance, treatment guidelines have changed twice since 2004. The currently recommended treatment is dual therapy with 500mg ceftriaxone (intramuscularly) and 1g azithromycin (orally). The objective of this analysis was to determine the extent of adherence to national gonorrhoea treatment guidelines among general practices (GPs) in England.
We analysed data from GPs in England included in the Clinical Practice Research Datalink, an anonymised extract of visits to a nationally representative sample of GPs. The number of gonorrhoea episodes diagnosed by GPs from 2011—2014 and the proportion that was treated were determined. Tests of linear trends in proportions were performed.
From 2011—2014, an estimated 4,150 gonorrhoea diagnoses were made by GPs in England. The proportion of episodes treated each year by GPs fluctuated between 50-52% (p=0729). Amongst those treated, the proportion given the recommended dual therapy ranged from 11- 5% (2011—2014; p=0.488). Most cases were prescribed non-recommended therapies; for example, from 2011—2014, the proportion of gonorrhoea diagnoses for which azithromycin monotherapy was prescribed ranged from 7-30% (p=0.166).
GPs make an important contribution to the management of gonorrhoea in England, but there is a need to improve adherence to current treatment guidelines. Prompt and correct treatment of gonorrhoea is essential to prevent treatment failure and the further emergence of antimicrobial resistance.
2039 The effects of exercise on depressive symptoms in care home residents: a systematic review
Objective: There is growing evidence that physical activity can be effective in the treatment of depression in adults. However, evidence to support the delivery of exercise interventions in care homes for older adults with depression remains inconclusive. This systematic review attempts to address this issue through the review of randomised controlled trials of exercise interventions delivered in the care home setting.
Methods: A comprehensive literature search for randomised controlled trials was conducted using the following databases: Medline, Embase, CINAHL, PsycINFO and the Cochrane Central Register of Controlled Trials. A manual search of reference lists was also performed to find relevant studies. Trials were included if care home residents were 60 years or older and without cognitive impairment. The primary outcome measure was change in depression severity following intervention. Secondary outcomes were quality of life and adverse events.
Results: Three studies were included in the qualitative synthesis (n=214). Findings from the studies suggest short-term benefits of exercise for depressive symptoms and quality of life. The interpretation of these findings is limited by low methodological quality of the studies and small sample sizes.
Conclusion: Exercise appears to be effective in the reduction of depressive symptoms in elderly care home residents. Further research is needed to establish the effectiveness and feasibility of delivering exercise interventions in the care home setting and to explore methods of increasing participation in exercise programmes.
2039 How can GPs help us bridge the knowledge translation gap? A qualitative study
Objectives Considerable time, effort and funding are devoted to obtaining high quality research evidence that answers important clinical questions. However, a crucial challenge is then how to ensure this research evidence is accessible, acceptable and actually implemented by clinicians to improve patient outcomes. This qualitative interview study with GPs explores what factors may influence their uptake of trial results into day-to-day clinical practice.
Design Qualitative interview study using a maximum variation sample with thematic analysis through constant comparison. SettingSemi-structured interviews with practising UK GP’s.
Participants 41 GPs with a range of characteristics, including length of time in practice, practice setting and deprivation.
Results Key themes emerged, including the conduct of the RCT, policy and practice changes that may arise as a result of the study, overall applicability of the study to practice (external validity) and difficulties adapting evidence to local circumstances. These factors all influenced whether the GPs felt it was likely they would implement the findings of the study or continue with current practice. GPs also expressed a range of views regarding how they interpret research statistics, and how they use and discuss ‘evidence’ with patients.
Discussion It is crucial we take time to explore and understand factors that may influence the uptake of research findings. This study focuses on GPs thoughts regarding the results of a single study, but nonetheless provides important insights into challenges in effective translation of any health research to primary care practice. It also identifies key opportunities to bridge this ‘knowledge translation gap’, ensuring that research findings lead on to real improvements in patient care.
2040 Perspectives of South Asian migrants on involvement in general practice
Aim: To explore the attitudes of South Asian communities, the largest ethnic minority in UK, on getting involved in general practice service improvement.
Relevance: South Asian patients have more negative experiences of general practice. Policy suggests one mechanism for addressing negative experiences is to involve patients in service improvement. In general practice this is through patient participation groups which are now a contractual requirement. These groups are supposed to be representative of the practice population. However evidence suggests that ethnic minorities, South Asians in particular, are poorly represented. The reason behind this remains unknown. Exclusion of the largest ethnic minority from these groups is concerning as it undermines the equity principle of the NHS.
Content: Four focus groups were conducted in Urdu with 22 participants recruited through existing South Asian community groups in Leeds. Thematic analysis was carried out to identify the key themes.Outcomes: Involvement was a difficult concept to explore as there is not a word for involvement in Urdu. Participants viewed involvement as either complaining or reporting problems. Barriers to involvement included language, the lack of understanding of their value in the process of involvement, and previous negative experiences.
Discussion: Changes need to be made at general practice and national policy level to raise awareness and support involvement of South Asians in service improvement mechanisms, so that their experiences can be addressed. This is imperative for the NHS to truly meet its goals of providing fair health care for all and tackle inequalities in health.
2041 Interpretating d-dimer: it’s not that straightforward! Assessing the influence of CRP, renal functions and age on d-dimer in the diagnosis of Pulmonary embolism
Awangku Ahmad Syukri Pengiran Hj Abdul Rahim
Aims PE can be quite difficult to diagnose. It is common and can be fatal without treatment. As per NICE guideline, where patients are considered to be of lower risks for PE based on the Wells score, d-dimer can beused to stratify patients. There appears to be a wide variation in clinicians’ interpretation of d-dimer values in PE diagnosis. Apart from d-dimer, other biochemical variables including CRP, WCC, neutrophils: lymphocytes, U&Es are often included in the initial investigations. This study assessed the influence of these variables on d-dimer and subsequent predictability of PE.
Methods A Retrospective, single institutional analysis (Scarborough General Hospital). Consecutive patients who had CTPA for suspected PE, between Jan 2013 and Jan 2014, were identified via IMPAX and included in the study if they also had d-dimer and other biochemical profiles requested. Formal reports of CTPA by local radiologists were used. Linear/Binary logistic regressions, using SPSS v20, were used to create models and to assess which of the variables affect d-dimer and significantly predict PE.
Results In total, 193 patients who underwent CTPA were included, which of whom, 40 had PE (20.7%).Where CTPA showed no evidence of PE, other causes of raised d-dimer were identified including heart failure, pneumonia, pericardial and pleural effusion. Higher magnitudes ofd-dimer were associated with increased probability of PE. Multiple regression analyses demonstrated 3 variables, age, CRP and creatinine which appeared to influence d-dimer. Adjusting these variables subsequently improve the specificity of the diagnosis of Pulmonary embolism.
Conclusions Whilst d-dimer remained the current best parameter, it should be interpreted with some cautions particularly in patients with poor renal functions, underlying infections and increasing age.