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Abstract Background Older people with multiple long-term conditions (multimorbidity) (MLTC-M) experience difficulties accessing and interacting with health and care services. Breakdowns in communication between patients and staff can threaten patient safety. To improve communication and reduce risks to patient safety in primary care, we developed an intervention: Safer Patients Empowered to Engage and Communicate about Health (SPEECH). SPEECH comprises a booklet for patients and an associated guide for staff. The booklet is designed to provide patients with information about staff and services, skills to prepare and explain, and confidence to speak up and ask. Methods A single-arm mixed methods feasibility study with embedded process evaluation. General practices in the North West of England were recruited. Participating practices invited patients aged 65+ with MLTC-M who had an appointment scheduled during the study period. Patients were asked to complete questionnaires at baseline and follow-up (four to eight weeks after being sent the patient booklet), including the Consultation and Relational Empathy measure, Empowerment Scale, Multimorbidity Treatment Burden Questionnaire, and Primary Care Patient Measure of Safety. Staff completed questionnaires at the end of the study period. A sub-sample of patients and staff were interviewed about the study processes and intervention. Patients and the public were involved in all aspects of the study, from generation of the initial idea to interpretation of findings. Results Our target of four general practices were recruited within 50 days of the study information being sent out. A fifth practice was recruited later to boost patient recruitment. We received expressions of interest from 55 patients (approx. 12% of those invited). Our target of 40 patient participants completed baseline questionnaires and were sent the SPEECH booklet. Of these, 38 (95%) completed follow-up. Patients found the intervention and study processes acceptable, and staff found the intervention acceptable and feasible to deliver. Conclusions Our findings suggest the intervention is acceptable, and it would be feasible to deliver a trial to assess effectiveness. Prior to further evaluation, study processes and the intervention will be updated to incorporate suggestions from participants. Trial registration The study was registered on the ISRCTN registry (ISRCTN13196605: https://doi.org/10.1186/ISRCTN13196605 ).

Background: Treatment burden represents the work patients undertake because of their health care, and the impact of that effort on the patient. Most research has focused on older adults (aged >65 years) with multiple long-term conditions (multimorbidity) (MLTC-M), but there are now more younger adults (aged 18–65 years) living with MLTC-M and they may experience treatment burden differently. Understanding experiences of treatment burden, and identifying those most at risk of high treatment burden, are important for designing primary care services to meet their needs. Aim: To understand the treatment burden associated with MLTC-M, for people aged 18–65 years, and how primary care services affect this burden. Design & setting: Mixed-methods study in up to 33 primary care practices in two UK regions. Method: The following two approaches will be used: (i) in-depth qualitative interviews with adults living with MLTC-M (approximately 40 participants) to understand their experiences of treatment burden and the impact of primary care, with a think-aloud aspect to explore face validity of a novel short treatment burden questionnaire (STBQ) for routine clinical use in the initial 15 interviews; (ii) cross-sectional patient survey (approximately 1000 participants), with linked routine medical record data to examine the factors associated with treatment burden for people living with MLTC-M, and to test the validity of STBQ. Conclusion: This study will generate in-depth understanding of the treatment burden experienced by people aged 18–65 years living with MLTC-M, and how primary care services affect this burden. This will inform further development and testing of interventions to reduce treatment burden, and potentially influence MLTC-M trajectories and improve health outcomes.

Abstract Clinical practice guidelines (CPGs) translate evidence into recommendations to improve patient care and outcomes. To provide an overview of schizophrenia CPGs, we conducted a systematic literature review of English-language CPGs and synthesized current recommendations for the acute and maintenance management with antipsychotics. Searches for schizophrenia CPGs were conducted in MEDLINE/Embase from 1/1/2004–12/19/2019 and in guideline websites until 06/01/2020. Of 19 CPGs, 17 (89.5%) commented on first-episode schizophrenia (FES), with all recommending antipsychotic monotherapy, but without agreement on preferred antipsychotic. Of 18 CPGs commenting on maintenance therapy, 10 (55.6%) made no recommendations on the appropriate maximum duration of maintenance therapy, noting instead individualization of care. Eighteen (94.7%) CPGs commented on long-acting injectable antipsychotics (LAIs), mainly in cases of nonadherence (77.8%), maintenance care (72.2%), or patient preference (66.7%), with 5 (27.8%) CPGs recommending LAIs for FES. For treatment-resistant schizophrenia, 15/15 CPGs recommended clozapine. Only 7/19 (38.8%) CPGs included a treatment algorithm.

Stormwater drains are common features at city beaches. Stormwater impact from drains is well understood, but the extent and impact of dry-weather flows on water quality and therefore on swimmers is not. Traditional beach monitoring may not be sensitive or frequent enough to assess this risk from drains, and investigation of dry-weather pollution is limited by relatively slow turnaround times for laboratory analysis. This case study describes lessons learned from a trial of citizen science and water quality sensors to monitor drains for dry-weather flows. This involved the use of smartphones and data-collection platforms for community monitoring at signed drains and by trained citizen scientists. Monitoring consisted of photos, observations, and water sampling. A key lesson from the trial was how citizen science can enhance data collected by sensors or by traditional monitoring. Citizen scientists collected data that sensors could not provide on flows, such as size and colour at outlets, and whether flows reached the bay. When combined with sensor data, drains were risk profiled, with higher-risk drains investigated further. Another lesson learned was to adequately resource in-person engagement and communications to motivate and retain citizen scientists. Underestimating resources for engagement translated into less data collected. Community data from signs was a valuable addition, but could have been maximised by simplifying data collection and ensuring signs were close to where observations or photos needed to be taken. The approaches trialled and lessons learned from this project are informative for the design and delivery of similar projects.

Objectives Primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.Design Focus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.Setting Focus groups and interviews were conducted in community settings in the UK.Participants Fifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.Results Participants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.Conclusions Discussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

A nivel mundial existe una tendencia cada vez mayor de desplazamiento de personas en zonas rurales, particularmente en pequeños asentamientos, a los centros urbanos. Este desplazamiento es más común en grupos de edad jóvenes, afectando industrias tradicionales como la agricultura y sus servicios asociados, amenazando por ende la sostenibilidad de asentamientos rurales. En algunos pueblos de zonas rurales, la disminución de población y reducción de la agricultura ha conducido a su deterioro social y económico. Este articulo presenta el caso de pequeños asentamientos, dos en Italia y dos en Australia en los cuales se ha fortalecido eficazmente la localidad para desarrollar una prospera industria del turismo. Este artículo provee una comparación y evaluación de los registros del número de visitantes y el aporte del turismo en estas regiones, demostrando su éxito y tendencias de crecimiento. También se presenta como a menudo otras industrias, aparte del turismo en conjunto con características únicas o activos de una zona, crean un atractivo importante para los turistas. De este modo se están proporcionando beneficios económicos, sociales y ambientales significativos a estas áreas.