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bjgp.org

Background Postural hypotension is associated with cognitive decline, falls, and all-cause mortality, representing a substantial burden on the NHS. Postural hypotension is often asymptomatic, making detection and treatment difficult. Currently, there is no systematic approach to measuring and managing postural hypotension in UK general practice. Aim To explore barriers to and facilitators of improving postural hypotension measurement and management. Design and setting This was a qualitative interview study with healthcare practitioners (HCPs) in general practices in England. Method Individual, remote, semi-structured interviews were conducted with a range of HCPs who measure blood pressure in general practice to explore their views and experiences of measuring and managing postural hypotension. Participants were identified from expressions of interest during a national survey. Interviews were video- and audio-recorded, transcribed verbatim, and analysed thematically. Results In total, 26 HCPs in 24 practices across nine clinical research networks in England were interviewed between March and July 2023. HCPs checked for postural hypotension when patients were older, reported dizziness, fatigue, or had chronic conditions. Despite awareness of clinical guidelines, various diagnostic definitions were provided and measurement protocols varied between participants. Sit-to-stand rather than supine-to-stand measurements were considered more feasible owing to time constraints and patient mobility. Education and training, as well as incentives and specialist clinics, were suggested as methods to improve postural hypotension measurement and management. Conclusion This is the first study, to our knowledge, to explore barriers to and facilitators of postural hypotension measurement in English general practice. Findings suggest a more systematic approach to measurement is needed to improve detection and management of postural hypotension in general practice.

pubmed.ncbi.nlm.nih.gov

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tandfonline.com

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scholar.google.com

google scholar provides a simple way to broadly search for scholarly literature. search across a wide variety of disciplines and sources: articles, theses, books, abstracts and court opinions.

cfp.ca

Problem addressed Black and immigrant populations across Canada have lower screening rates than Canadian-born white populations, predisposing them to increased cancer morbidity and mortality. Effective interventions are required to increase cancer screening rates among these populations. Objective of program To improve breast, colorectal, and cervical cancer screening rates at TAIBU Community Health Centre, which has a mandate to provide primary health care services to the Black and immigrant community in the greater Toronto area. Program description An Afrocentric quality improvement program was developed and implemented, consisting of provider audits, cancer screening education programs, a patient call-back program, and a mammography promotion day. Conclusion TAIBU Community Health Centre’s continuous quality improvement approach was successful in engaging health care providers and patients to increase cancer screening participation sustainably in a racially and socioeconomically diverse setting. Rates of breast, colorectal, and cervical cancer screening offered to eligible patients increased from 17% to 72%, 18% to 67%, and 59% to 70%, respectively, between 2011 and 2018.

ebm.bmj.com

Inconsistency is a key domain that determines the certainty of evidence. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach specifically defines inconsistency as the variability in results across studies, and not variability in study characteristics, eligibility criteria or design.1 Statistical measures of heterogeneity are often used to assess inconsistency, however, major limitations of such measures have been described. For example, Cochran’s Q test for homogeneity is usually underpowered to detect heterogeneity. The I2 index which is the most commonly used measure, underestimate true statistical heterogeneity when there are fewer than 10 studies in a meta-analysis, which is a common scenario, and is correlated with the sample size of the included studies.2 The I2 index is also often misunderstood as an indicator of the spread of the effect size. Borenstein demonstrates how a meta-analysis with I2 index of 25% can have more spread of the effect size than a meta-analysis with I2 index of 75%.3 Therefore, GRADE guidance on inconsistency recommended less reliance on statistical measures and instead, instructed to make judgements about whether studies in a meta-analysis provide estimates that are clinically importantly different from each other.1 However, there are no existing tools to facilitate this process making it highly subjective. Users are instructed to look at a forest plot and evaluate the similarity of point estimates of the included studies and the overlap of their CIs, and make a judgement based on values that they consider clinically important. Merely counting studies does not work because some studies can be outliers but may have a very small weight within the pooled effect estimate. Having multiple thresholds makes this task even more difficult. Furthermore, in the case of binary outcomes, decision thresholds are based on absolute treatment effects4 5 whereas …

bmjopenrespres.bmj.com

the open access companion journal to thorax, publishing high quality papers in respiratory medicine, critical care, sleep medicine and related areas.

inpractice.ai

Discover expert tips to streamline medical record review workflows, improve efficiency, and save time in your practice or legal case management.