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Objectives: Identification of patients at increased mortality risk is important in the context of increasing multimorbidity and an ageing population, to help facilitate the planning and delivery of services. The aim of this study was to examine one-year all-cause mortality in a cohort of primary care patients in whom inflammatory markers including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and plasma viscosity (PV), had been tested.Design: Observational cohort study using GP Electronic Health Records from the Clinical Practice Research Datalink, with linkage to ONS Death Registry.Setting: UK Primary Care.Participants: 159,325 patients with inflammatory marker tests done in 2014 and 39,928 age, sex and practice matched controls without inflammatory marker testing. ONS Death registry data was available for 109,966 participants.Primary and secondary outcome measures: One-year mortality in those with raised inflammatory markers compared to normal inflammatory markers and untested controls. Sub-analyses stratified one-year mortality by age-group, gender and cause of death.Results: Patients with a raised inflammatory marker (n=47,797) had an overall one-year all-cause mortality of 6.89%, compared to 1.41% in those with normal inflammatory markers (pConclusions: Inflammatory markers are a strong predictor of all-cause mortality in primary care, with a c-statistic comparable to several previously developed frailty indices. Future research should consider the added value of CRP testing, in combination with other risk factors, to improve prediction of mortality in primary care. Evidence based interventions for frailty are needed alongside predictive tools.

A 500m exploratory well was drilled in the Ross River region in the Yukon to determine if the area warrants further geothermal research. The well is located along a laterally extensive dextral strike-slip fault, named the Tintina fault. Core analyses were conducted to evaluate the potential for development as a geothermal system. A geothermal gradient of 30.6 ºC/km was measured by a thermistor line. There is discussion of developing a greenhouse that can be heated by a direct use geothermal system, with the aim of reducing emissions from importing fresh produce, and to provide employment for the community.

© British Journal of General Practice. Background: Eczema is common in children but adherence to treatments is poor. Written action plans (WAPs) have been shown to help in asthma but the potential value, format, and content of an eczema WAP is unknown. Aim: To explore the potential role of an eczema WAP, and to design an eczema-specific WAP. Design and setting: A qualitative study of parents of children with eczema, primary and secondary care health professionals, and other stakeholders. Method: A total of 41 semi-structured one-to-one interviews and two focus groups were audiorecorded, transcribed, and analysed thematically. Results: Reported challenges of managing eczema included: parental confusion about treatment application; lack of verbal and written advice from GPs; differing beliefs about the cause and management of eczema; re-prescribing of failed treatments; and parents feeling unsupported by their GP. An eczema WAP was viewed as an educational tool that could help address these problems. Participants expressed a preference for a WAP that gives clear, individualised guidance on treatment use, presented in a step-up/step-down approach. Participants also wanted more general information about eczema, its potential triggers, and how to manage problem symptoms. Conclusion: An eczema WAP may help overcome some of the difficulties of managing eczema, and support families and clinicians in the management of the condition. Further evaluation is needed to determine if the eczema WAP the authors have developed is both acceptable and improves the outcomes for affected children and their families.

Background: Eczema is common among children, and in the UK the majority are managed by GPs. The most common cause of poor disease control is incorrect use of topical treatments. There is a lack of research into the challenges faced by GPs in diagnosing and managing this condition. Aim: To explore the experiences of GPs in assessing and managing children with eczema. Design and setting: Qualitative study in primary care in England. Method: Semi-structured interviews with 15 GPs were audiorecorded, transcribed verbatim, and analysed thematically using the framework method. Results: GPs described a paucity of dermatology training. Although most GPs were confident diagnosing uncomplicated eczema, they reported using a trial-and-error approach to prescribing emollients, and were uncertain about quantities of topical treatments to issue. Mild and moderate potency topical corticosteroids (TCS) were commonly used, but most GPs lacked confidence in recommending potent TCS, and viewed parents or carers to be fearful of using all strengths of TCS. GPs perceived adherence to treatments to be low, but provision of information to support self-care was variable. Routine review of medication use or disease control was uncommon, which GPs attributed to service constraints. Participants' views on the causes and management of eczema were perceived to be at odds with parents and carers, who were said to be overly focused on an underlying cause, such as allergy. Conclusion: GP uncertainty in managing eczema, lack of routine information and review, and perceived dissonance with parents around causation and management may be contributing to low concordance with treatments.