The BJGP publishes videos and multimedia to highlight research findings, clinical impact, and top 10 articles. Here's a selection of BJGP videos. See BJGP YouTube playlist on RCGP's YouTube for more videos and updates. Also see BJGP's new YouTube channel. Accompanying podcasts are available at BJGP Audio. 

 

Targeting treatment for depression with Target-D​

New research examines a self-administered tool for depression. This RCT shows that 'Target-D', a person-centred clinical prediction tool and e-health platform matching management options to prognosis, results in greater improvement in depressive symptoms at 3 months than usual care. Target-D is administered via a set of questions on a tablet in the waiting room. Within minutes patients receive feedback and a suggestion of next steps for treatment. This approach could feasibly be implemented in routine practice to support more efficient and effective depression care without adding to GPs’ workload. Listen to the podcast interview with Prof. Jane Gunn.

 

Psychosis risk

GPs rarely encounter patients with psychosis, but more commonly see patients with psychotic symptoms that do not meet diagnostic criteria for psychotic disorder, such as hearing voices or having paranoid beliefs. One-third of these patients at risk will go on to develop psychosis within 3 years. Findings in this new study show that some GPs were not familiar with the concept of being at-risk of developing psychosis. Also, when patients met criteria for a more common mental health condition, such as depression or anxiety, GPs would not always screen for psychotic symptoms. In the podcast and video, Prof. Stanley Zammit and Daniela Strelchuk explain ways that GPs can screen for psychotic symptoms.

 

Media depictions of remote consulting throughout COVID-19

This new study by Oxford academics, led by Professor Trisha Greenhalgh, looked at newspaper coverage of the shift to remote consultations. It found that media depictions of remote GP consultations in the early months of the pandemic linked GPs with progress, efficiency, and safety; whereas media reports in more recent months have emphasised missed diagnoses, challenges to the therapeutic relationship, and digital inequalities. Perhaps rightly, the press have questioned why a policy originally introduced for infection control was then made permanent. Listen to the podcast interview with Dr Gilly Mroz and Professor Trisha Greenhalgh.

 

Reducing missed appointments

Missed appointments, or DNAs ('did not attends'), come at a great cost to general practice. While most view DNAs as a patient problem, this study, supported by the Health Foundation, highlights the appointment system itself as an integral cause of DNAs. This study shows the impact of quality improvement coaching, including sharing appointment system data, among practices. The findings illustrate how structural change to the appointment system can produce sustained reductions in DNA rates. Listen to the full podcast interview with Dr Tom Margham.

 

Association of non-malignant diseases with thrombocytosis

Previous research shows 11% of people with high platelet count in primary care are diagnosed with cancer in the following year. But what about diagnosing the 89%? A new study from the same team at University of Exeter flags up likely conditions. They found that inflammatory bowel disease, iron-deficiency anaemia, rheumatoid arthritis, COPD, and giant cell arteritis were more likely in patients with thrombocytosis than in those with a normal platelet count.

 

Recognising end of life in older people

Identification of end of life can be challenging for clinicians, particularly in older people living with frailty. In this study, fewer than half of people aged ≥75 years who died had a code in their electronic health record (EHR) to suggest that their death was anticipated by their GP. End-of-life codes in EHRs were entered near to death (median 4 months prior). In the minority of older decedents (aged ≥75 years) for whom end of life was recognised, only a small proportion were on the palliative care register or had their preferences for place of care or death recorded.

 

Mortality in the first COVID-19 pandemic peak

The COVID-19 pandemic has passed its first peak in many countries in Europe. A study from the University of Oxford examined the characteristics associated with excess deaths in the first COVID-19 pandemic peak. Findings were that male sex, population density, black ethnicity, and people with long-term conditions, including learning disability, had higher odds of mortality. Planning for subsequent peaks should take account of these findings. Listen to the podcast interview with Professor Simon de Lusignan.

 

Pregnancy abnormalities from ACE inhibitors and ARBs 

The adverse effects of ACE inhibitors and ARBs for pregnant women and their babies are known, but the recording of pre-pregnancy advice when prescribing these drugs is suboptimal, according to a new study from Queen Mary University of London. The study was conducted across 140 general practices in East London in women aged 15-45 years who were issued a prescription for an ACE inhibitor or ARB. Of over 300,000 women, 2651 were prescribed an ACE inhibitor or an ARB; and of these, 81.4% had no record of contraception prescription. Dr Elizabeth Lovegrove discusses the findings and their clinical relevance in a podcast interview.

 

COVID-19: twice the risk for ethnic minorities

Research by Hull et al. shows patients with south Asian and black ethnicity are at increased risk of suspected COVID-19, even when we take into account multimorbidity, obesity and social deprivation. This study of GP records also shows that GPs were adept at distinguishing symptoms of COVID-19 from common respiratory infections and saw large numbers of suspected cases. Daily counts of suspected cases recorded by GPs can act as an early warning system to detect new outbreaks of disease in the future. Watch the interview with Dr Sally Hull, who emphasises the importance of GPs recording and managing cases in their community.

 

Legacy of grief and COVID-19

Iona Heath, Former President of the RCGP, writes of the many unexpected kinds of grief from COVID-19. She states: ‘It will be very important to resist the temptation to pathologise, label, or precipitately refer on the sequelae of grief’. She emphasises we must acknowledge that some communities, particularly those subject to the structural violence of poverty and racism, have been significantly more exposed to loss of parents, life partners, children, and dear friends. She describes the power of relationship-building as an investment that has the potential to make future care easier for both patient and GP.

 

GPs' gut feelings in cancer diagnosis

A systematic review suggests GPs' gut feelings may have a role in cancer diagnosis. The studies, which used varied conceptualisations of 'gut feelings', showed associations with patients initially being unwell rather than with a suspicion of cancer. Pooled odds of a cancer diagnosis were four times higher when gut feelings were recorded, and became more predictive of cancer as clinical experience and familiarity with the patient increased. This may encourage GPs to acknowledge the diagnostic value of gut feelings and have more confidence in including them in their clinical assessment. Claire Friedemann Smith explains the findings in a video interview.

 

Racism and health​​

Dr Carter Singh is a full time GP partner at Willowbrook Medical Practice, Nottinghamshire. An 'expert-by-lived-experience' in racial inequality, it is this passion that motivates him to challenge discrimination, inequality, and marginalisation in the NHS. The August issue of the BJGP publishes Dr Singh’s letter on Asking questions along with an Editorial on Racism and Health by Paramjit Gill and Virinder Kalra, and an Editor’s briefing on Prejudice Plus Power = Racism. Life & Times looks at BAME excess deaths and chronic stress by Sarah Evans, Conversations about race and abuse in the NHS by Tariq Hussain, COVID-19 and equity by Gemma Ashwell et al, and indigenous health in the COVID-19 torch by Tim Senior. View the full contents of the August BJGP.

 

Unsafe prescribing of methotrexate

GPs in England continue to breach national guidelines on tablet strength designed to avoid accidental methotrexate overdose, according to research on trends in prescribing of methotrexate. High doses of methotrexate increase the risk of toxicity and 21 deaths have been attributed to methotrexate from 1993 to 2017. Doctors are advised to avoid 10mg tablets and prescribe only 2.5mg tablets. Here, Brian MacKenna, Pharmacist Researcher – University of Oxford, from the Evidence-based DataLab discusses the findings. Also watch videos on Practice and OpenPrescribing at BJGP Life.

 

Avoid the term ‘morning sickness’

According to new research, ‘morning sickness’ is a misnomer. It can happen at any time in a 24-hour period. In a video interview, author Professor Roger Gadsby explains why GPs should drop the unhelpful name ‘morning sickness’. He states that many pregnant women feel that it trivialises the problem. In an accompanying video interview Caitlin Dean, researcher, nurse specialist, and mother, states: 'Telling her she's got a bit of morning sickness is the most invalidating and upsetting thing you can do’. She asks that GPs talk about it in terms of ‘nausea and vomiting’. Article and videos are all available via ArticlePLUS. 

 

Hospitalisation and homelessness

Homeless people registered at a specialist surgery who had a combination of chronic physical illness, mental illness, plus alcohol and/or drug dependence – known as ‘trimorbidity’ – were four times more likely to have an unplanned hospital admission. The study, conducted in a specialist homeless practice in Brighton, showed that the three significant risk factors were enduring mental health problems and/or personality disorder, gastrointestinal disease and alcohol dependence. Catherine Himsworth discusses the findings in this short video.

 

Paramedics in primary care

The role of paramedics is expanding beyond the ambulance service into general practice. Georgette Eaton, herself a paramedic, and colleagues from Nuffield Department of Primary Care Health Sciences, University of Oxford, explored the role of paramedics in primary care.

 

Professor Martin Marshall at the BJGP Research Conference

BJGP Research Conference Plenary 1: The importance of research in taking the NHS into the next decade. Professor Martin Marshall, 12 March 2020, RCGP London. https://bjgp.org/conference | #BJGPRC

 

Dr Richard Vautrey at the BJGP Research Conference

BJGP Research Conference Plenary 2: The NHS and the current political climate. Dr Richard Vautrey, 12 March 2020, RCGP London. https://bjgp.org/conference | #BJGPRC 

 

Early GP referrals lead to longer surviving cancer patients​

A study analysed data of 1.4 million patients with cancer in England, and found that cancer patients from the highest referring GP practices had a lower mortality rate. The research highlights increases in primary care referrals and access to diagnostic tests which allows more cancers to be diagnosed. This has also led to the number of people diagnosed with cancer following an A&E presentation to drop from 1 in 4 to fewer than 1 in 5. 

 

BJGP Top 10 research

Countdown of top 10 research articles most read and published in 2019 – 10. End-of-life admissions, 9. Online triage, 8. Video consultations, 7. UK newspaper coverage of GPs, 6. Brain tumour diagnosis, 5. Inflammatory marker testing: sensitivity, 4. Hospital admissions of frail older people, 3. Multiple inflammatory marker testing, 2. Medication reviews, 1. Asylum seeker health. 

 

Safety netting to avoid missed diagnoses

The diagnostic strategy of safety-netting is examined by Edwards et al. who found use of safety netting in almost two-thirds of consultations, but actions required by patients were not always documented. In an accompanying paper, Edwards et al. report the development of a coding tool. Formalising safety netting may be particularly important in patients with low risk but not ‘no risk symptoms’ suggestive of cancer.

 

BJGP's impact, readership, and peer review

Find out in 90 seconds why authors publish with us. The BJGP publishes high-quality research and has the highest impact factor of all primary care journals worldwide, reaching 4.43 for 2018; additional journal metrics are the 5-year impact factor 4.187, Immediacy Index 1.380, Eigenfactor 0.00937, and Article Influence Score 1.370. View download statistics and top Altmetric scores, plus time from submission to first and final decisions.

 

BJGP's clinical research impact

The BJGP publishes high-quality research with clinical impact. This video shows the impact of research on: 1. Detecting multiple myeloma, 2. Avoiding unnecessary thyroid tests, 3. Recognising testicular cancer, 4. Detecting atrial fibrillation, 5. Cancer safety netting, 6. Extending prescription length, 7. Investigating weight loss, 8. Responding to maternal non-attendance, 9. Shortening antibiotic treatment for sore throat, 10. Prescribing exercise for postnatal depression, 11. C-reactive protein and acute cough.