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Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55 years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9–87.6%), with specificity 71.9% (95% CI 63.7–79.2%). ABPI sensitivity was 80.2% (95% CI 70.8–87.6%), with specificity 88.6% (95% CI 82–93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care. [ABSTRACT FROM AUTHOR]

Aim: To identify the research on childhood disability service adaptations and their impact on children and young people with long‐term disability during the COVID‐19 pandemic. Method: A mapping review was undertaken. We searched the World Health Organization Global COVID‐19 database using the search terms 'children', 'chronic/disabling conditions', and 'services/therapies'. Eligible papers reported service changes for children (0–19 years) with long‐term disability in any geographical or clinical setting between 1st January 2020 and 26th January 2022. Papers were charted across the effective practice and organization of care taxonomy of health system interventions and were narratively synthesized; an interactive map was produced. Results: Reduction of face‐to‐face care and usual provision had a huge impact on children and families. Adoption of telehealth provided continuity for the care and management of some conditions. There was limited evidence of changes to mental health services, transitions of care, social care, or child‐reported satisfaction or acceptability of service changes. Interpretation: The long‐term impacts of service change during the pandemic need full evaluation. However, widespread disruption seems to have had a profound impact on child and carer health and well‐being. Service recovery needs to be specific to the individual needs of children with a disability and their families. This should be done through coproduction to ensure that service changes meet needs and are accessible and equitable. [ABSTRACT FROM AUTHOR]

Background: Frailty is a key issue in current healthcare delivery and falls is an important component. Care and support planning (CSP) is an established approach to managing long term conditions (LTCs) and has potential to provide more person-centred care for those at risk of falling. This qualitative evaluation aimed to understand the barriers and success criteria involved in incorporating falls assessment and management into the CSP process. Methods: CSP for falls prevention was implemented in eight general practices in the North of England. Six of the eight practices participated in the qualitative evaluation. Seven group interviews were undertaken with staff (n = 31) that included practice nurses, health care assistants, nurses, and administrative staff (n = 2–8 per group). Observations of the falls and CSP training provided additional data. Interviews covered experiences and potential impacts of training, and processes of implementation of the programme, and were informed by normalisation process theory. Thematic analysis was undertaken using a team-based approach. Results: Although successfully implemented across the practices, how established CSP was and therefore 'organisational readiness' was an overarching theme that illustrated differences in how easily sites were able to implement the additional elements for frailty. The challenges, successes and impacts of implementation are demonstrated through this theme and four further themes: training resources and learning; positive impacts of the programme (including enabling easier conversations around 'frailty'); integrating work processes/work with patients; and dealing with uncertainty and complexity. Conclusions: Care and Support Planning services designed to target frailty and falls is feasible and can successfully be delivered in the primary care setting, if key enablers are promoted and challenges to implementation addressed from planning through to integration in practice. [ABSTRACT FROM AUTHOR]

Abstract Background With current policy in healthcare research, in the United Kingdom and internationally, focused on development of research excellence in individuals and teams, building capacity for implementation and translation of research is paramount among the professionals who use that research in daily practice. The judicious use of research outcomes and evaluation of best evidence and practice in healthcare is integrally linked to the research capacity and capabilities of the workforce. In addition to promoting high quality research, mechanisms for actively enhancing research capacity more generally must be in place to address the complexities that both undermine and facilitate this activity. Methods A comprehensive collaborative model for building research capacity in one health professional group, speech and language therapy, was developed in a region within the UK and is presented here. The North East of England and the strong research ethos of this profession in addressing complex interventions offered a fertile context for developing and implementing a model which integrated the healthcare and university sectors. Two key frameworks underpin this model. The first addresses the individual participants’ potential trajectory from research consciousness to research participative to research active. The second embeds a model developed for general practitioners into a broader framework of practice-academic partnership and knowledge and skills exchange, and considers external drivers and impacts on practice and patient outcomes as key elements. Results and discussion The integration of practice and academia has been successful in building a culture of research activity within one healthcare profession in a region in the UK and has resulted, to date, in a series of research related outcomes. Understanding the key components of this partnership and the explicit strategies used has driven the implementation of the model and are discussed here. Conclusions A strong, equitable collaboration between clinical and academic partners working towards a common outcome can enhance the use of research within the healthcare workforce and contribute actively to the research process. A set of propositions are specified to facilitate both transferability of this partnership model to other professional groups and clinical teams and evaluation of the model components.

In 2016, Sustainability and Transformation Partnerships were formed across the whole of England, bringing together care providers with commissioners and local authorities to plan local delivery of health and social care. Within this context, a small group of leaders working in broadly "evidence roles" within healthcare in the North East and North Cumbria (NENC), began discussing how those with the skills to support evidence-based practice might be able to better support healthcare decision-making at the system-wide level. The group focussed on the need for cultural change and making personal connections. Rather than provide "evidence products", our aim was to build relationships between policy and decision makers and those in evidence roles. This case study describes our progress to date in developing the network and supporting the work of healthcare decision-makers and policy makers in the North East and North Cumbria. [ABSTRACT FROM AUTHOR]

Background Many primary care patients with raised blood pressure or depression drink potentially hazardous levels of alcohol. Brief interventions (BI) to reduce alcohol consumption may improve comorbid conditions and reduce the risk of future alcohol problems. However, research has not established their effectiveness in this patient population. This study aimed to establish the feasibility of definitive trials of BI to reduce excessive drinking in primary care patients with hypertension or mild to moderate depression. Methods Thirteen general practices in North East England were randomized to the intervention or control arm of one of two parallel pilot trials. Adult patients drinking excessively and diagnosed with hypertension or mild-to-moderate depression received the Alcohol Use Disorders Identification Test (AUDIT) by postal survey. Consenting respondents scoring more than 7 on AUDIT (score range 0 to 40) received brief alcohol consumption advice plus an information leaflet (intervention) or an information leaflet alone (control) with follow-up at six months. Measurements included the numbers of patients eligible, recruited, and retained, and the AUDIT score and systolic/diastolic blood pressure of each patient or the nine-item Patient Health Questionnaire (PHQ-9) score. Acceptability was assessed via practitioner feedback and patient willingness to be screened, recruited, and retained at followup. Results In the hypertension trial, 1709 of 33,813 adult patients (5.1%) were eligible and were surveyed. Among the eligible patients, 468 (27.4%) returned questionnaires; 166 (9.6% of those surveyed) screened positively on AUDIT and 83 (4.8% of those surveyed) were recruited (50.0% of positive screens). Sixty-seven cases (80.7% of recruited patients) completed follow-up at six months. In the depression trial, 1,044 of 73,146 adult patients (1.4%) were eligible and surveyed. Among these eligible patients, 215 (20.6%) responded; 104 (10.0% of those surveyed) screened positively on AUDIT and 29 (2.8% of those surveyed) were recruited (27.9% of positive screens). Nineteen cases (65.5% of recruited patients) completed follow-up at six months. Conclusions Recruitment and retention rates were higher in the hypertension trial than in the depression trial. A full brief intervention trial appears feasible for primary care patients with hypertension who drink excessively. High AUDIT scores in the depression trial suggest the importance of alcohol intervention in this group. However, future work may require alternative screening and measurement procedures. [ABSTRACT FROM AUTHOR]

In this article, we report on our interpretation of past and current literature on negotiating risk and resilience in the everyday lives of people living with dementia. We undertook the literature review on which this article is based as part of an ongoing qualitative study designed to explore issues of risk and resilience from the point of view of people living with dementia in urban and rural communities. We carried out a search of international, peer-reviewed publications in 2012 with an emphasis on UK policy and practice. We also accessed UK Government documents and reports for background detail. We found that there is a personal, collective, practice and policy-based will to secure robust and positive responses to risk and to work with individual and collective notions of resilience. However, there is a competing practice narrative of vulnerability and protection, and a concern with litigation that undermines positive responses to risk. There is some recognition that for community dementia services to be responsive and proactive to the needs and wishes of their users, risk and resilience need to be considered from within complex and diverse, local perspectives and lifelong knowledge. We would add to this by emphasising that an understanding of local context is also needed to fully appreciate complex and nuanced positioning of the person living with dementia. Resources may or may not be in place, but how and why they are used (or not used), and how the person with dementia may be influenced (or not) by others and by localised contexts, may have far-reaching implications for policy and practice. [ABSTRACT FROM AUTHOR]

Anecdotal discussion among breastfeeding peer supporters and the infant-feeding co-ordinator suggested that breastfeeding peer support provided by breastfeeding peer supporters may offer benefits to breastfeeding women and their families other than increasing breastfeeding initiation and sustainability. The aim of this research was to determine whether there was evidence to support this. The research team used focus groups to obtain information from 16 local women who had received breastfeeding peer support from breastfeeding peer supporters. The key themes that emerged were - improved mental health, increased self-esteem or confidence, parenting skills, improved family diet, breastfeeding sustainability and poor hospital experience. The findings suggest that breastfeeding peer supporters supporting mothers to breastfeed, with the intention of increasing both breastfeeding rates and sustainability, may have additional benefits in several aspects of families' lives. Breastfeeding peer support may play an important role in helping to attain targets such as reducing obesity and postnatal depression. [ABSTRACT FROM AUTHOR]

The article discusses aspects of diagnosing peripheral arterial disease (PAD) in general practice medicine. Topics include limitations of ankle-brachial pressure index (ABPI) in diagnosing PAD, use of photoplethysmography (PPG) in the diagnosis and management of PAD in general practice, and diagnostic challenges for PAD.

Local government organisations face challenges in health and social care decision-making. Disparities in engagement and use of research within local government to underpin decision-making can affect public health policy and practice outcomes. We aimed to understand how research is used within local authorities to aid decision-making and its barriers and enablers. We used an academic definition of research, incorporating methods that would traditionally be used in health and social care sciences. A mixed-methods design was used. All staff within an English local authority (n=2881) were invited to participate in an online survey to explore the use of research in their role. A purposive convenience sample of survey responders were invited to one of six online recorded focus groups to further explore their responses. Ethics approval was obtained from Northumbria University Ethics Committee. Participant information and consent information was emailed to the full sample, with replies granting written informed consent. Regression analysis and statistical tests were analysed using SPSSv.26. Thematic framework analysis was used for focus group data. 124 staff responded to the survey and 20 participants attended focus groups. Results indicated that likely enablers were enthusiasm in engagement among staff (79%, n=98) agreed or strongly agreed); however, only being a senior manager or manager was a statistically significant predictor for undertaking research (manager β=3·021, SE=0·852, p=0·0010; senior managers β=3·992, SE=1·212, p=0·0010). Lack of time was notably the biggest barrier (47%, n=58) strongly agreed or agreed). Confidence in engaging as a research partner was average (44%, n=54) agreed or strongly agreed) and confidence in commissioning research from external partners was low (27%, n=34) agreed or strongly agreed). In the focus group, with the exception of the public health department personnel, participants' definitions of research were vague compared with traditional definitions., with secondary research of non-peer reviewed literature dominating research activity. The findings provided rich evidence of a lack of understanding of what research entails. Major challenges included limited knowledge of how to engage in research and shortage of time. For research-informed decision-making and evidence-based policies and practices, an understanding of research that is sympathetic to the needs of local government decision-makers is needed. Conceptualisation of research might have to deviate from traditional academic norms. NIHR Public Health Research. [ABSTRACT FROM AUTHOR]