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  • 1
    Online Resource
    Online Resource
    Drug treatments affecting ACE2 in COVID-19 infection: a systematic review protocol
    Royal College of General Practitioners ; 2020
    In:  BJGP Open Vol. 4, No. 3 ( 2020-08), p. bjgpopen20X101115-
    Details
    In: BJGP Open, Royal College of General Practitioners, Vol. 4, No. 3 ( 2020-08), p. bjgpopen20X101115-
    Abstract: The SARS-CoV-2 virus causing COVID-19 binds human angiotensin-converting enzyme 2 (ACE2) receptors in human tissues. ACE2 expression may be associated with COVID-19 infection and mortality rates. Routinely prescribed drugs that up- or down-regulate ACE2 expression are, therefore, of critical research interest as agents that might promote or reduce risk of COVID-19 infection in a susceptible population. Aim To collate evidence on routinely prescribed drug treatments in the UK that could up- or down-regulate ACE2, and thus potentially affect COVID-19 infection. Design & setting Systematic review of studies published in MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library, and Web of Science from inception to 1 April 2020. Method A systematic review will be conducted in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Inclusion criteria will be: (1) assesses the effect of drug exposure on ACE2 level of expression or activity; (2) the drug is included in the British National Formulary ( BNF ) and, therefore, available to prescribe in the UK; and (3) a control, placebo, or sham group is included as comparator. Exclusion criteria will be: (1) ACE2 measurement in utero; (2) ACE2 measurement in children aged 〈 18 years; (3) drug not in the BNF ; and (4) review article. Quality will be assessed using the Cochrane risk of bias tool for human studies, and the SYstematic Review Center for Laboratory animal Experimentation (SYRCLE) risk of bias tool for animal studies. Results Data will be reported in summary tables and narrative synthesis. Conclusion This systematic review will identify drug therapies that may increase or decrease ACE2 expression. This might identify medications increasing risk of COVID-19 transmission, or as targets for intervention in mitigating transmission.
    Type of Medium: Online Resource
    ISSN: 2398-3795
    URL: Article
    DOI: 10.3399/bjgpopen20X101115
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2020
    detail.hit.zdb_id: 2881009-0
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  • 2
    Online Resource
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    Exploring patient views of empathic optimistic communication for osteoarthritis in primary care: a qualitative interview study using vignettes
    Royal College of General Practitioners ; 2021
    In:  BJGP Open Vol. 5, No. 3 ( 2021-06), p. BJGPO.2021.0014-
    Details
    In: BJGP Open, Royal College of General Practitioners, Vol. 5, No. 3 ( 2021-06), p. BJGPO.2021.0014-
    Abstract: Osteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach. Aim To explore patients’ perspectives on clinician communication of empathy and optimism in primary care OA consultations. Design & setting Vignette study with qualitative semi-structured interviews. Purposefully sampled patients ( n = 33) aged 〉 45 years with hip or knee OA from GP practices in Wessex (Hampshire, Dorest, Wiltshire, and Somerset). Method Fifteen participants watched two filmed OA consultations with a GP, and 18 participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a ‘neutral’ approach. Semi-structured interviews were conducted with all participants and analysed using thematic analysis. Results Patients recognised that empathic communication enhanced interactions, helping to engender a sense of trust in their clinician. They felt it was acceptable for GPs to convey optimism only if it was realistic, personalised, and embedded within an empathic consultation. Discussing patients’ experiences and views with them, and conveying an accurate understanding of these experiences improves the credibility of optimistic messages. Conclusion Patients value communication with empathy and optimism, but it requires a fine balance to ensure messages remain realistic and trustworthy. Increased use of a realistic optimistic approach within an empathic consultation could enhance consultations for OA and other chronic conditions, and improve patient outcomes. Digital training to help GPs implement these findings is being developed.
    Type of Medium: Online Resource
    ISSN: 2398-3795
    URL: Article
    DOI: 10.3399/BJGPO.2021.0014
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2021
    detail.hit.zdb_id: 2881009-0
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  • 3
    Online Resource
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    Clinician views on optimism and empathy in primary care consultations: a qualitative interview study
    Royal College of General Practitioners ; 2022
    In:  BJGP Open Vol. 6, No. 3 ( 2022-09), p. BJGPO.2021.0221-
    Details
    In: BJGP Open, Royal College of General Practitioners, Vol. 6, No. 3 ( 2022-09), p. BJGPO.2021.0221-
    Abstract: Practitioner expressions of optimism and empathy may improve treatment engagement, adherence, and patient satisfaction but are not delivered consistently amid the challenges of everyday clinical practice. Aim To explore primary care practitioner (PCP) views about optimistic and empathic communication in consultations; and to identify behavioural, attitudinal, and/or contextual issues likely to encourage or deter PCPs from practising such communication. Design & setting Qualitative interview study with 20 PCPs (GPs, practice nurses, and primary care physiotherapists). Method Semi-structured telephone interviews with 20 PCPs. Data were analysed thematically. Results A conceptual mismatch between optimism and patient expectations became apparent; when asked how PCPs communicate about the likely effects of a treatment, answers were focussed around managing patient expectations. When prompted, it became clear PCPs were open to communicating optimistically with patients, but emphasised the need for realism. Concerns arose that patients may not be receptive to optimistic messages, especially when holding negative expectations. PCPs felt that expressing empathy is fundamental to all clinical consultations, noting that it can be challenging. Some PCPs worried that increasing expressions of empathy might increase their risk of clinician burnout and felt guilty about (appropriately) communicating empathy while maintaining some emotional distance. Conclusion PCPs agreed expressing realistic optimism during consultations could aid communication and would constitute a novel change to practice. PCPs strive for clinical empathy but can struggle to manage emotional self-protection. Specific training to help PCPs express realistic optimism and empathy, and better utilise efficient non-verbal skills could help these issues.
    Type of Medium: Online Resource
    ISSN: 2398-3795
    URL: Article
    DOI: 10.3399/BJGPO.2021.0221
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2022
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  • 4
    Online Resource
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    Improving Empathy in Healthcare Consultations—a Secondary Analysis of Interventions
    Springer Science and Business Media LLC ; 2020
    In:  Journal of General Internal Medicine Vol. 35, No. 10 ( 2020-10), p. 3007-3014
    Details
    In: Journal of General Internal Medicine, Springer Science and Business Media LLC, Vol. 35, No. 10 ( 2020-10), p. 3007-3014
    Abstract: A recent systematic review of randomised trials suggested that empathic communication improves patient health outcomes. However, the methods for training healthcare practitioners (medical professionals; HCPs) in empathy and the empathic behaviours demonstrated within the trials were heterogeneous, making the evidence difficult to implement in routine clinical practice. In this secondary analysis of seven trials in the review, we aimed to identify (1) the methods used to train HCPs, (2) the empathy behaviours they were trained to perform and (3) behaviour change techniques (BCTs) used to encourage the adoption of those behaviours. This detailed understanding of interventions is necessary to inform implementation in clinical practice. We conducted a content analysis of intervention descriptions, using an inductive approach to identify training methods and empathy behaviours and a deductive approach to describe the BCTs used. The most commonly used methods to train HCPs to enhance empathy were face-to-face training ( n  = 5), role-playing ( n  = 3) and videos (self or model; n  = 3). Duration of training was varied, with both long and short training having high effect sizes. The most frequently targeted empathy behaviours were providing explanations of treatment ( n  = 5), providing non-specific empathic responses (e.g. expressing understanding) and displaying a friendly manner and using non-verbal behaviours (e.g. nodding, leaning forward, n  = 4). The BCT most used to encourage HCPs to adopt empathy behaviours was “Instruction on how to perform behaviour” (e.g. a video demonstration, n  = 5), followed by “Credible source” (e.g. delivered by a psychologist, n  = 4) and “Behavioural practice” ( n  = 3 e.g. role-playing). We compared the effect sizes of studies but could not extrapolate meaningful conclusions due to high levels of variation in training methods, empathy skills and BCTs. Moreover, the methods used to train HCPs were often poorly described which limits study replication and clinical implementation. This analysis of empathy training can inform future research, intervention reporting standards and clinical practice.
    Type of Medium: Online Resource
    ISSN: 0884-8734 , 1525-1497
    URL: Article
    DOI: 10.1007/s11606-020-05994-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2006784-7
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  • 5
    Online Resource
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    Data_Sheet_1.PDF
    Frontiers Media SA ; 2021
    In:  Frontiers in Pain Research Vol. 2 ( 2021-8-24)
    Details
    In: Frontiers in Pain Research, Frontiers Media SA, Vol. 2 ( 2021-8-24)
    Abstract: Background: Empathic communication and positive messages are important components of “placebo” effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is common, costly and difficult to manage. Digital interventions can be effective tools for changing practitioner behavior. This paper describes the systematic planning, development and optimization of an online intervention—“Empathico”–to help primary healthcare practitioners enhance their communication of clinical empathy and realistic optimism during consultations. Methods: The Person-Based Approach to intervention development was used. This entailed integrating insights from placebo and behavior change theory and evidence, and conducting primary and secondary qualitative research. Systematic literature reviews identified barriers, facilitators, and promising methods for enhancing clinical empathy and realistic optimism. Qualitative studies explored practitioners' and patients' perspectives, initially on the communication of clinical empathy and realistic optimism and subsequently on different iterations of the Empathico intervention. Insights from the literature reviews, qualitative studies and public contributor input were integrated into a logic model, behavioral analysis and principles that guided intervention development and optimization. Results: The Empathico intervention comprises 7 sections: Introduction, Empathy, Optimism, Application of Empathico for Osteoarthritis, Reflection on my Consultations, Setting Goals and Further Resources. Iterative refinement of Empathico, using feedback from patients and practitioners, resulted in highly positive feedback and helped to (1) contextualize evidence-based recommendations from placebo studies within the complexities of primary healthcare consultations and (2) ensure the intervention addressed practitioners' and patients' concerns and priorities. Conclusions: We have developed an evidence-based, theoretically-grounded intervention that should enable practitioners to better harness placebo effects of communication in consultations. The extensive use of qualitative research throughout the development and optimization process ensured that Empathico is highly acceptable and meaningful to practitioners. This means that practitioners are more likely to engage with Empathico and make changes to enhance their communication of clinical empathy and realistic optimism in clinical practice. Empathico is now ready to be evaluated in a large-scale randomized trial to explore its impact on patient outcomes.
    Type of Medium: Online Resource
    ISSN: 2673-561X
    URL: Article
    URL: Article
    DOI: 10.3389/fpain.2021.721222
    DOI: 10.3389/fpain.2021.721222.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 3035397-X
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  • 6
    Online Resource
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    Clinical scores in primary care
    Royal College of General Practitioners ; 2020
    In:  British Journal of General Practice Vol. 70, No. 693 ( 2020-04), p. 163-163
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 70, No. 693 ( 2020-04), p. 163-163
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp20X708941
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2020
    detail.hit.zdb_id: 2097982-4
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  • 7
    Online Resource
    Online Resource
    Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: A meta-ethnography
    Elsevier BV ; 2022
    In:  Patient Education and Counseling Vol. 105, No. 7 ( 2022-07), p. 1865-1877
    Details
    In: Patient Education and Counseling, Elsevier BV, Vol. 105, No. 7 ( 2022-07), p. 1865-1877
    Type of Medium: Online Resource
    ISSN: 0738-3991
    URL: Article
    DOI: 10.1016/j.pec.2022.01.009
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2019572-2
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  • 8
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    Integrating primary care and social services for older adults with multimorbidity: a qualitative study
    Royal College of General Practitioners ; 2021
    In:  British Journal of General Practice Vol. 71, No. 711 ( 2021-10), p. e753-e761
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 71, No. 711 ( 2021-10), p. e753-e761
    Abstract: Growing demand from an increasingly ageing population with multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could utilise resources more efficiently, and improve experiences for patients, their families, and carers. There is limited evidence on progress including key barriers to and drivers of integration to inform large-scale national change. Aim To elicit stakeholder views on drivers and barriers of integrated primary care and social services, and highlight opportunities for successful implementation. Design and setting A qualitative interview study. Method Semi-structured interviews with maximum variation sampling to capture stakeholder views across services and professions. Results Thirty-seven interviews were conducted across England with people including GPs, nurses, social care staff, commissioners, local government officials, voluntary and private sector workers, patients, and carers. Drivers of integration included groups of like-minded individuals supported by good leadership, expanded interface roles to bridge gaps between systems, and co-location of services. Barriers included structural and interdisciplinary tension between professions, organisational self-interest, and challenges in record sharing. Conclusion Drivers and barriers to integration identified in other contexts are also present in primary care and social services. Benefits of integration are unlikely to be realised if these are not addressed in the design and execution of new initiatives. Efforts should go beyond local- and professional-level change to include wider systems- and policy-level initiatives. This will support a more systems-wide approach to integrated care reform, which is necessary to meet the complex and growing needs of an ageing multimorbid population.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/BJGP.2020.1100
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2021
    detail.hit.zdb_id: 2097982-4
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  • 9
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    Integrated primary care and social services for older adults with multimorbidity in England: a scoping review
    Springer Science and Business Media LLC ; 2021
    In:  BMC Geriatrics Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Geriatrics, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in England. Methods A scoping review was conducted involving systematic searches of a range of electronic academic and policy databases. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis was used to summarise findings. Articles were included if published in English and related to primary care, social care and multimorbidity in older adults in England. Conceptually, the review was framed using the Rainbow Model of Integrated Care. Results The search yielded 7656 articles of which 84 were included. Three themes were identified: (1) a focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care for older adults with multimorbidity; (2) the need for policymakers to allow time for integration to embed, to enable new structures and relationships to develop and mature; and (3) the inherent tension between top-down and bottom-up driven approaches to integrated care requires a whole-systems structure, while allowing for local flexibilities. Conclusions There is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in England. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.
    Type of Medium: Online Resource
    ISSN: 1471-2318
    URL: Article
    DOI: 10.1186/s12877-021-02618-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2059865-8
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  • 10
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    Currently prescribed drugs in the UK that could upregulate or downregulate ACE2 in COVID-19 disease: a systematic review
    BMJ ; 2020
    In:  BMJ Open Vol. 10, No. 9 ( 2020-09), p. e040644-
    Details
    In: BMJ Open, BMJ, Vol. 10, No. 9 ( 2020-09), p. e040644-
    Abstract: To review evidence on routinely prescribed drugs in the UK that could upregulate or downregulate ACE2 and potentially affect COVID-19 disease. Design Systematic review. Data source MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science. Study selection Any design with animal or human models examining a currently prescribed UK drug compared with a control, placebo or sham group, and reporting an effect on ACE2 level, activity or gene expression. Data extraction and synthesis MEDLINE, EMBASE, CINAHL, the Cochrane Library, Web of Science and OpenGrey from inception to 1 April 2020. Methodological quality was assessed using the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) risk-of-bias tool for animal studies and Cochrane risk-of-bias tool for human studies. Results We screened 3360 titles and included 112 studies with 21 different drug classes identified as influencing ACE2 activity. Ten studies were in humans and one hundred and two were in animal models None examined ACE2 in human lungs. The most frequently examined drugs were angiotensin receptor blockers (ARBs) (n=55) and ACE inhibitors (ACE-I) (n=22). More studies reported upregulation than downregulation with ACE-I (n=22), ARBs (n=55), insulin (n=8), thiazolidinedione (n=7) aldosterone agonists (n=3), statins (n=5), oestrogens (n=5) calcium channel blockers (n=3) glucagon-like peptide 1 (GLP-1) agonists (n=2) and Non-steroidal anti-inflammatory drugs (NSAIDs) (n=2). Conclusions There is an abundance of the academic literature and media reports on the potential of drugs that could attenuate or exacerbate COVID-19 disease. This is leading to trials of repurposed drugs and uncertainty among patients and clinicians concerning continuation or cessation of prescribed medications. Our review indicates that the impact of currently prescribed drugs on ACE2 has been poorly studied in vivo, particularly in human lungs where the SARS-CoV-2 virus appears to enact its pathogenic effects. We found no convincing evidence to justify starting or stopping currently prescribed drugs to influence outcomes of COVID-19 disease.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-040644
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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