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Content ArticleDr Roberta Heale, Associate Editor of Evidence-Based Nursing, speaks to Dr Elaine Maxwell, Nurse and author of two National Institute for Health Research reviews on evidence on Long COVID in this BMJ Talk Medicine podcast. They discuss the variance in reported Long COVID statistics, the impact of vaccinations, symptoms, and research efforts.
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Content ArticleChen et al. examined the worldwide prevalence of post COVID-19 condition, through a systematic review and meta-analysis. The research, published in the Journal of Infectious Disease, assessed 23 symptoms reported across 36 of the studies and found that shortness of breath, sleep problems, and joint pain was widely reported by those who had recovered from the novel coronavirus infection. They analysed the prevalence of this condition globally and regionally, estimating the proportion of individuals facing long Covid in Asia, Europe and North America. They found that the global prevalence for post-Covid conditions at 30, 60, 90 and 120 days after infection was about 37, 25, 32, and 49%, respectively. The authors concluded that post COVID-19 condition prevalence is substantial; the health effects of COVID-19 appear to be prolonged and can exert stress on the healthcare system.
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Content ArticleFrom the perspective of patient partners, the Ontario SPOR SUPPORT Unit Engaging Multi-stakeholders for Patient Oriented-research Wider Effects and Reach Awards have facilitated successful patient-partnered research projects, which, in turn, have led to an evolution in patient partnerships and engagement strategies. The 15 projects profiled in this special issue point to the beneficial impacts of patient-partnered research.
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Content ArticleIn patient experience research, participants frequently report the impact that mesothelioma has on their mental health yet there have been very few studies specifically focused on mental health and mesothelioma. In patient experience research, participants frequently report the impact that mesothelioma has on their mental health yet there have been very few studies specifically focused on mental health and mesothelioma. This new study from the Mesothelioma UK research centre aims to create an understanding of the impact of mesothelioma on the mental health of patients, their families and close friends, and what people do to improve their mental health and well-being.
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Content ArticleThe medical symptom 'iceberg' and 'trivia' were defined in terms of people's own perceptions of their symptoms and their subsequent referral behaviour. The data were collected by household interviews of patients registered at a health centre and included information on personal and environmental characteristics. Bivariate and multivariate analysis was used to explore associations between those who were part of the symptom 'iceberg' or 'trivia', and factors which might have caused such incongruous referral behaviour.
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Content ArticleThis study in the British Journal of General Practice aimed to examine trends in prescribing for anxiety in UK primary care between 2003 and 2018. Anxiolytic drugs are a group of medications used to relieve anxiety. The authors analysed data from 2.5 million adults to determine prevalence, incidence rates and treatment duration for prescriptions of any anxiolytic, and also for each drug class. The authors found that, between 2003 and 2018: prevalence of any anxiolytic prescription increased, driven by increases in those starting treatment, rather than more long-term use. incident beta-blocker prescribing increased over the 16 years, whereas incident benzodiazepine prescriptions decreased. long-term prescribing of benzodiazepines declined, yet 44% of prescriptions in 2017 were longer than the recommended four weeks. incident prescriptions in each drug class have risen substantially in young adults in recent years. They conclude that increases in incident prescribing may reflect better detection of anxiety or increasing acceptability of medication. However, they also caution that prescribing approaches may cause unintended harm, as some prescribing is not based on robust evidence of effectiveness and may contradict guidelines. They highlight that there is limited evidence on the overall impact of taking antidepressants long term.
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Content ArticleAnnegret Hannawa investigated communication during Covid-19. She asked the questions: to what extent did communication by the Swiss traditional news media and by the Swiss Government, communication in the social media, and interpersonal communication affect Swiss residents' (1) trust, (2) willingness to vaccinate, (3) engagement in conspiracy theories, and (4) mental health? This video gives a short summary of the first results.
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Content ArticleCorporate interests have the potential to influence public debate and policymaking by influencing the research agenda, namely the initial step in conducting research, in which the purpose of the study is defined and the questions are framed. Fabbri et al. conducted a scoping review to identify and synthesise studies that explored the influence of industry sponsorship on research agendas across different fields. The authors concluded that corporate interests can drive research agendas away from questions that are the most relevant for public health. Strategies to counteract corporate influence on the research agenda are needed, including heightened disclosure of funding sources and conflicts of interest in published articles to allow an assessment of commercial biases. The authors also recommend policy actions beyond disclosure such as increasing funding for independent research and strict guidelines to regulate the interaction of research institutes with commercial entities.
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Content Article
NIHR: Patient & public involvement in research resources
Patient Safety Learning posted an article in Research
Whether you’re just getting started with involving patients and the public in your work, or if you’re looking for some new techniques, there are some great resources out there. The NIHR have pulled together some of the best available resources to help you involve patients, service users, carers and family members in your research. -
Content ArticleThere is a well-described mismatch between the research that is done on a particular condition and the research that patients themselves would like to see done. Formal research priority-setting partnerships aim to reduce this mismatch by involving patients in the selection of topics for research. The National Institute for Health Research (NIHR) has strongly supported patient and public involvement (PPI) in research, produced national benchmarks for PPI, funded INVOLVE (www.invo.org.uk) which promotes patient involvement in all aspects of biomedical research, and written up some exemplar case studies. Trish Greenhalgh looks back at the history of patient involvement in research and suggests a vision for an institute for patient-led research.
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Content ArticleThis is the report of Professor Ben Goldacre’s review into how the efficient and safe use of health data for research and analysis can benefit patients and the healthcare sector. It sets out a practical vision of how the Department of Health and the NHS can curate, manage and analyse the huge volume of health data available in the UK, and then communicate and use that data to improve the quality, safety and efficiency of health services.
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Content ArticleThis book interrogates the assumption that evidence means the same thing to different constituencies and in different contexts by outlining a more nuanced and socially responsive approach to medical expertise that incorporates scientific and lay processes of making sense of the world and deciding how to act in it. In so doing, it provides a point of orientation for clinicians working at the coalface, whose experience is sometimes at odds with the type of rationality that underpins evidence-based medicine and that guides researchers conducting randomised controlled trials. The argument elaborated also has implications for policy makers in the healthcare system, who have to navigate similar pressures and contradictions between scientific and lay rationality to produce meaningful guidelines in the midst of a runaway pandemic. Debates within and beyond the medical establishment on the efficacy of measures such as mandatory face masks and lockdowns are examined in detail, as are various degrees of hesitancy towards vaccines and other pharmaceutical interventions. The authors demonstrate that it is ultimately through narratives that knowledge about medical and other phenomena is communicated to others, enters the public space, and provokes discussion and disagreements. Importantly, effective narratives can enhance the reception of that knowledge and reduce some of the sources of resistance and misunderstanding that continue to plague public communication about important medical issues such as pandemics. Access the introduction and excerpts from each chapter from the link below.
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Content ArticleBlood transfusion is considered one of the safer aspects of healthcare, however potentially avoidable patient-safety incidents led to 14 deaths in the UK in 2017. Improvement initiatives often focus on staff compliance with standard operating procedures. This fails to understand adaptations made in a complex, dynamic environment, so the aim of this study from Watt et al. is to examine the extent and nature of adaptations at all stages of the vein to vein transfusion process.
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Content ArticleThe positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study from Baxter et al. sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people. Based on identifiable qualitative differences between the positively deviant and comparison wards, 14 characteristics were hypothesised to facilitate exceptionally safe care on medical wards for older people. This paper explores five positively deviant characteristics that healthcare professionals considered to be most salient. These included the relational aspects of teamworking, specifically regarding staff knowing one another and working together in truly integrated multidisciplinary teams. The cultural and social context of positively deviant wards was perceived to influence the way in which practical tools (eg, safety briefings and bedside boards) were implemented. This study exemplifies that there are no ‘silver bullets’ to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes.
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Content ArticleGP practices are usually run separately from hospitals. In some places in England and Wales, the NHS organisations responsible for managing hospitals are now also running local GP practices. It is difficult in some areas for practices, which are small organisations, to recruit GPs and keep going. It is also desirable to coordinate GP services with hospital care. For these reasons, it may help if the organisations managing hospitals also run GP practices.
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Content ArticleEffective communication is critical for patient safety. One potential threat to communication in the operating room is incivility. Although examined in other industries, little has been done to examine how incivility impacts the ability to deliver safe care in a crisis. Katz et al. sought to determine how incivility influenced anaesthesiology resident performance during a standardised simulation scenario of occult haemorrhage.
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Content ArticleThere is great disparity in the way we think about and address different sources of environmental infection. Governments have for decades promulgated a large amount of legislation and invested heavily in food safety, sanitation, and drinking water for public health purposes. By contrast, airborne pathogens and respiratory infections, whether seasonal influenza or COVID-19, are addressed fairly weakly, if at all, in terms of regulations, standards, and building design and operation, pertaining to the air we breathe. We suggest that the rapid growth in our understanding of the mechanisms behind respiratory infection transmission should drive a paradigm shift in how we view and address the transmission of respiratory infections to protect against unnecessary suffering and economic losses. It starts with a recognition that preventing respiratory infection, like reducing waterborne or foodborne disease, is a tractable problem.
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Content ArticleThis preprint study aimed to determine the prevalence of organ impairment in Long Covid at 6 and 12 months after initial acute Covid-19 infection. The authors found that single organ impairment persisted in 59% patients at 12 months post-Covid-19. The conclude that organ impairment in Long Covid has implications for symptoms, quality of life and longer-term health, and they highlight the need for prevention and integrated care of Long Covid.
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Content ArticleThroughout Jens Rasmussen’s career there has been a continued emphasis on the development of methods, techniques and tools for accident analysis and investigation. In this paper, Waterson et al. focus on the evolution and development of one specific example, namely Accimaps and their use for accident analysis.
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Content ArticlePatient safety, staff moral and system performance are at the heart of healthcare delivery. Investigation of adverse outcomes is one strategy that enables organisations to learn and improve. Healthcare is now understood as a complex, possibly the most complex, socio-technological system. Despite this the use of a 20th century linear investigation model is still recommended for the investigation of adverse outcomes. In this review, Isherwood and Waterson use data gathered from the investigation of a real life healthcare near incident and apply three different methodologies to the analysis of this data. They compare both the methodologies themselves and the outputs generated. This illustrates how different methodologies generate different system level recommendations. The authors conclude that system based models generate the strongest barriers to improve future performance. Healthcare providers and their regulatory bodies need to embrace system based methodologies if they are to effectively learn from, and reduce future, adverse outcomes.
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Content ArticleThe cornerstone of good general practice has long been recognised as lying in the quality of the relationship between doctor and patient. This focus on the interaction between GP and patient has been further reinforced in recent years by increasing attention on the patient’s experience of healthcare encounters. However, pleasing the patient is not always consistent with providing good-quality care. GPs are well aware that patients may demand an antibiotic when it is not judged clinically appropriate. The aim of this study from Ashworth et al. was to determine the relationship between antibiotic prescribing in general practice and reported patient satisfaction. The results found that patients were less satisfied in practices with frugal antibiotic prescribing. A cautious approach to antibiotic prescribing may require a trade-off in terms of patient satisfaction.
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Content ArticleMatthews et al. investigated inequalities in stillbirth rates by ethnicity to facilitate development of initiatives to target those at highest risk. They found that stillbirth rates declined in the UK, but substantial excess risk of stillbirth persists among babies of black and Asian ethnicities. The combined disadvantage for black, Pakistani and Bangladeshi ethnicities who are more likely to live in most deprived areas is associated with considerably higher rates. Key causes of death were congenital anomalies and placental causes. Improved strategies for investigation of stillbirth causes are needed to reduce unexplained deaths so that interventions can be targeted to reduce stillbirths.
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Content ArticleThe gender health gap is a long-standing, deeply entrenched problem that stretches back centuries - yet it is only finally starting to get the attention it deserves. In this discussion hosted by The Independent's Women's Correspondent Maya Oppenheim, Dr Jess Taylor, Le’Nise Brothers, Sandra Igwe and Dr Geeta Nargund explore the steps that must be taken to solve the gender health gap, including proper education of health professionals and engaging in open honest conversations.
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Content ArticleThe introduction of remote triage and assessment early in the pandemic raised questions about patient safety. Wieringa et al. sought to capture patients and clinicians’ experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care. Lessons from the pandemic suggest three key strategies are needed to prevent avoidable deaths and inequalities in the next crisis: (1) strengthen system resilience (including improved resourcing and staffing; support of new tools and processes; and recognising primary care’s role as the ‘risk sink’ of the healthcare system); (2) develop evidence-based triage and scoring systems; and (3) address social vulnerability.
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Content Article
In this blog, we take a look at why women have been historically underrepresented in clinical trials and medical research, and the ongoing implications this has on medication safety for women.
