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Exposure of children to domestic violence and abuse (DVA) is a form of child maltreatment with short- and long-term behavioural and mental health impact. Health care professionals are generally uncertain about how to respond to domestic violence and are particularly unclear about best practice with regards to children's exposure and their role in a multiagency response. In this systematic review, we report educational and structural or whole-system interventions that aim to improve professionals’ understanding of, and response to, DVA survivors and their children. We searched 22 bibliographic databases and contacted topic experts for studies reporting quantitative outcomes for any type of intervention aiming to improve professional responses to disclosure of DVA with child involvement. We included interventions for physicians, nurses, social workers and teachers. Twenty-one studies met the inclusion criteria: three randomised controlled trials (RCTs), 18 pre-post intervention surveys. There were 18 training and three system-level interventions. Training interventions generally had positive effects on participants’ knowledge, attitudes towards DVA and clinical competence. The results from the RCTs were consistent with the before-after surveys. Results from system-level interventions aimed to change organisational practice and inter-organisational collaboration demonstrates the benefit of coordinating system change in child welfare agencies with primary health care and other organisations. Implications for policy and research are discussed. © 2015 The Authors. Child Abuse Review published by John Wiley & Sons Ltd.\ud \ud \ud \ud ‘We searched 22 bibliographic databases and contacted topic experts’\ud \ud \ud Key Practitioner Messages\ud \ud •We reviewed published evidence on interventions aimed at improving professionals’ practice with domestic violence survivors and their children.\ud •Training programmes were found to improve participants’ knowledge, attitudes and clinical competence up to a year after delivery.\ud •Key elements of successful training include interactive discussion, booster sessions and involving specialist domestic violence practitioners.\ud •Whole-system approaches aiming to promote coordination and collaboration across agencies appear promising but require funding and high levels of commitment from partners.\ud \ud \ud \ud ‘Training programmes were found to improve participants' knowledge, attitudes and clinical competence up to a year after delivery’

‘I’m exhausted. I can’t do any more …‘ These could be the words of very many of us, as our profession deals with some of its most profound challenges to date. But can adversity stimulate creativity?1 Our profession is at a crossroads — we have reached our very own Reggie Perrin moment.2 It is time for us to leave behind our Scientific Bureaucratic Medicine3 chains (policed referral pathways, mandatory measurement …) on the proverbial beach. And instead to reimagine ourselves, our job, and our role within the context of an intellectual profession leading the highest standards of person-centred health care. It is time to embrace our inner scholar. ‘But I’m too busy seeing patients …’ At the 2016 RCGP Conference, we traced the path in the sand for this new way of thinking by tackling three myths about academic general practice: Yet scholarship is an integral part of daily clinical practice. Every time we …

Modernising Medical Careers saw the introduction of four-month attachments in primary care during the second Foundation Year, to foster a broader understanding of healthcare settings. The North West Deanery offered this opportunity to virtually all trainees. Previous work had captured poor impressions of undergraduate experience in general practice. This study aimed to explore Foundation Doctors' perceptions of Foundation primary care attachments before and after the experience. Qualitative methodology was used. Two focus groups were held with 12 trainees at the end of their first Foundation Year to explore their expectations of pending rotation in general practice. Eighteen individual interviews were conducted with Foundation Doctors after the attachment. Themed analysis of transcripts revealed a striking contrast between trainees' perceptions of general practice before and after undertaking F2 rotations. Undergraduate exposure and secondary care bias in training had a significant negative impact on trainees' perceptions of general practice. The one-to-one opportunities for educational supervision, the range of patients seen and the opportunity to understand communication at the primary/secondary interface dispelled these concerns. The findings highlighted the beneficial impact of foundation posts in general practice for training, career planning in general and, as outlined in the initial goals of the programme, the interaction between primary and secondary care.

The 2012 Society of Academic Primary CareConference held in Glasgow in October heardseven ‘dangerous ideas’ in a soapbox session,designed to be deliberately provocative. Each of thespeakers was allowed one slide and three minutesto state their case, followed by seven minutes oflively discussion. The one proviso was that speakershad to somehow justify their ideas while the audi-ence critically questioned and commented. Therather subversive suggestions included

Background: A multidisciplinary European Association of Palliative Care Taskforce was established to scope the extent of and learn what facilitates and hinders the development of palliative care in the community across Europe. Aim: To document the barriers and facilitators for palliative care in the community and to produce a resource toolkit that palliative care specialists, primary care health professionals or policymakers, service developers, educationalists and national groups more generally could use to facilitate the development of palliative care in their own country. Design: (1) A survey instrument was sent to general practitioners with knowledge of palliative care services in the community in a diverse sample of European countries. We also conducted an international systematic review of tools used to identify people for palliative care in the community. (2) A draft toolkit was then constructed suggesting how individual countries might best address these issues, and an online survey was then set up for general practitioners and specialists to make comments. Iterations of the toolkit were then presented at international palliative care and primary care conferences. Results: Being unable to identify appropriate patients for palliative care in the community was a major barrier internationally. The systematic review identified tools that might be used to help address this. Various facilitators such as national strategies were identified. A primary palliative care toolkit has been produced and refined, together with associated guidance. Conclusion: Many barriers and facilitators were identified. The primary palliative care toolkit can help community-based palliative care services to be established nationally.

Background\ud \ud Whilst there has been no clear consensus on the potential for earlier diagnosis of lung cancer, recent research has suggested that the time between symptom onset and consultation can be long enough to plausibly affect prognosis. In this article, we present findings from a qualitative study involving in-depth interviews with patients who had been diagnosed with lung cancer (n = 11), and people who were at heightened risk of developing the disease (n = 14).\ud \ud \ud Methods\ud \ud A grounded theory methodology was drawn upon to conduct thematic and narrative based approaches to analysis.\ud \ud \ud Results\ud \ud The paper focuses on three main themes which emerged from the study: i) fatalism and resignation in pathways to help-seeking and the process of diagnosis; ii) Awareness of smoking risk and response to cessation information and advice. iii) The role of social and other networks on help-seeking. Key findings included: poor awareness among participants of the symptoms of lung cancer; ambivalence about the dangers of smoking; the perception of lung cancer as part of a homogenisation of multiple illnesses; close social networks as a key trigger in help-seeking.\ud \ud \ud Conclusions\ud \ud We suggest that future smoking cessation and lung cancer awareness campaigns could usefully capitalise on the influence of close social networks, and would benefit from taking a ‘softer’ approach.

People with Chronic Obstructive Pulmonary Disease (COPD) are at heightened risk of developing lung cancer. Recent research has suggested that in people who have the disease, the time between symptom onset and consultation can be long enough to significantly affect prognosis. The regular and routine clinical encounters that people with COPD engage in provide an opportunity for them to highlight new symptoms of concern, and for clinicians to be watchful for new symptomatic indicators. We present a micro-analysis of naturalistic data from a corpus of such encounters with the aim of exploring the interactional factors within these routine consultations which influence when and how new symptoms of concern are raised. Our hypothesis is that although the underlying aim of the review consultation is the same in both settings, the different consultation structures oriented to by nurses and GPs have a tangible effect on how new and concerning symptomatic information is introduced. Conversation analysis (CA) was used to examine 39 naturalistic review consultation recordings in two clinical settings; GP led (n = 16), and practice nurse led (n = 23). We describe three interactional formats by which patients chose to present new symptomatic concerns; ‘direct’, ‘embedded’, and ‘oblique’. Both settings provided interactional ‘slots’ for patients to offer new and concerning symptomatic information. However, the structure of nurse led encounters tended to limit opportunities for patients to develop extended symptom narratives which in turn facilitated ‘oblique’ formats. We suggest that the attenuation of the ‘oblique’ format in this particular clinical setting has implications relating to the psycho-social idiosyncrasies of lung cancer and the maintenance of interactional conditions that encourage patients to disclose new symptomatic concerns.

Background Patients with severe chronic obstructive pulmonary disease have a burden of symptoms at least equivalent to that of patients with terminal cancer yet palliative care provision is less well established. A significant obstacle to providing palliative care for patients with COPD is the challenge associated with identifying those at risk of death when the condition is associated with such an unpredictable illness trajectory. Prognostic indicator tools may help overcome this but no systematic review has considered the utility of COPD specific prognostic indicator tools in primary care settings. Aim To explore whether multidimensional prognostic indicator tools in COPD can predict 12-month mortality in patients being managed in primary care. Methods This systematic review employs the discipline of narrative synthesis following the approach recommended by the Centre for Reviews and Dissemination (CRD). An extensive search incorporating relevant conference proceedings was conducted, followed by data extraction through tabulation, quality assessment by two researchers and synthesis of available data. Results 22 individual tools were identified from 37 relevant papers. Four tools: the ADO index, HADO score, DOSE index and TARDIS were developed with a specific focus on primary care. Only the BODE index had been validated in sufficient cohorts for its efficacy to be confidently established; however the BODE index, with its 6-min walking test, lacks utility in primary care settings. No studies have assessed the prognostic approach currently recommended in UK clinical practice. Conclusions No current multidimensional prognostic indicator tools are sufficiently validated to be recommended for widespread use in UK primary care to identify patients at risk of death in the next 12-months. The research conducted to date suggests that there is scope to further validate some of the proposed tools and more work is required to understand the accuracy and applicability of prognostic indicator tools for use in COPD.

(2007). Medical Students’ Perceptions of Primary Care: The Influence of Tutors, Peers and The Curriculum. Education for Primary Care: Vol. 18, No. 3, pp. 364-372.