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Abstract Background Long-term opioid use is associated with dependency, addiction, and serious adverse events. Although a framework to reduce inappropriate opioid prescribing exists, there is no consensus on prescribing indicators for preventable opioid-related problems in patients with chronic pain in primary care in the UK. This study aimed to identify opioid prescription scenarios for developing indicators for prescribing opioids to patients with chronic pain in primary care. Methods Scenarios of opioid prescribing indicators were identified from a literature review, guidelines, and government reports. Twenty-one indicators were identified and presented in various opioid scenarios concerning opioid-related harm and adverse effects, drug-drug interactions, and drug-disease interactions in certain disease conditions. After receiving ethics approval, two rounds of electronic Delphi panel technique surveys were conducted with 24 expert panellists from the UK (clinicians, pharmacists, and independent prescribers) from August 2020 to February 2021. Each indicator was rated on a 1–9 scale from inappropriate to appropriate. The score’s median, 30th and 70th percentiles, and disagreement index were calculated. Results The panel unanimously agreed that 15 out of the 21 opioid prescribing scenarios were inappropriate, primarily due to their potential for causing harm to patients. This consensus was reflected in the low appropriateness scores (median ranging from 1 to 3). There were no scenarios with a high consensus that prescribing was appropriate. The indicators were considered inappropriate due to drug-disease interactions (n = 8), drug-drug interactions (n = 2), adverse effects (n = 3), and prescribed dose and duration (n = 2). Examples included prescribing opioids during pregnancy, concurrently with benzodiazepines, long-term without a laxative prescription and prescribing > 120-mg morphine milligram equivalent per day or long-term duration over 3 months after surgery. Conclusions The high agreement on opioid prescribing indicators indicates that these potentially hazardous consequences are relevant and concerning to healthcare practitioners. Future research is needed to evaluate the feasibility and implementation of these indicators within primary care settings. This research will provide valuable insights and evidence to support opioid prescribing and deprescribing strategies. Moreover, the findings will be crucial in informing primary care practitioners and shaping quality outcome frameworks and other initiatives to enhance the safety and quality of care in primary care settings.

Leisure time physical activity (LTPA) has been frequently reported as a method of improving happiness. However, the effects of LTPA sufficiency and age differences in adults have been less discussed in the literature. The aim of this study was to examine the relationship between LTPA sufficiency and happiness based on an age stratification perspective. A total of 16,412 data observations from the Taiwanese Physical Activity Annual Survey (PAAS) were used for this study. Multivariate logistic regression analyses were applied to examine the odds ratio of the LTPA-sufficient population on happiness. The odds of happiness were 2.5-3 times higher among LTPA-sufficient young adults (25-29 years old) than among the insufficient group. However, unexpectedly, a negative association was observed between sufficient LTPA and happiness in 35- to 39-year-old men. Intrapersonal differences (e.g., achievement goals and motivational level) and the environment (social context) might play a fundamental role in the LPTA-happiness relationship. Sufficient LTPA was associated with increased happiness among Taiwanese adults. However, the relationships between sufficient LTPA and happiness were not consistent when stratified by age. Further research on the relevant mechanism underlying this phenomenon is warranted. Trial registration: This study was approved by the Institutional Review Board of Chung Shan Medical University Hospital (CRREC-104-015), registered on 18 October 2016., Author(s): Po-Fu Lee [sup.1] [sup.2] , Frank Jing-Horng Lu [sup.3] , Diane L. Gill [sup.4] , Yi-Hsiang Chiu [sup.5] , Yu-Hsuan Kuo [sup.5] , Chien-Chang Ho [sup.6] [sup.7] [sup.8] Author [...]

Objectives The aim of this study was to explore the barriers and facilitators faced by clinical academics (CAs) in the Greater Manchester region, with particular attention to the experiences of minoritised groups.Design A qualitative study using semistructured interviews and focus groups was conducted. A reflexive thematic analysis was applied to identify key themes.Setting University of Manchester and National Health Service Trusts in the Greater Manchester region.Participants The sample of this study was composed of 43 participants, including CAs, senior stakeholders, clinicians and medical and dental students.Results Six themes were identified. CAs face several barriers and facilitators, some of which—(1) funding insecurity and (2) high workload between the clinic and academia—are common to all the CAs. Other barriers, including (3) discrimination that translates into struggles with self-worth and feeling of not belonging, (4) being or being perceived as foreign and (5) unequal distribution of care duties, particularly affect people from minoritised groups. In contrast, (6) mentorship was commonly identified as one of the most important facilitators.Conclusions Cultural and structural interventions are needed, such as introducing financial support for early career CAs and intercalating healthcare students to promote wider social and cultural change and increase the feelings of belonging and representation across the entire CA pipeline.