Primary Services Research Articles

Prescriptive Appropriateness in an Outpatient Primary and Secondary Cardiovascular Prevention Service.

In the absence of appropriateness specific guidelines, one important cause of health resources waste could be overuse of diagnostic procedures. Since arterial hypertension is a very frequent disease there could be such a risk in its management. To evaluate the prescriptive appropriateness of non-invasive diagnostic tests (echocardiography, carotid ultrasound, ECG exercise test, 24h Ambulatory Blood Pressure Monitoring-ABPM) in a primary and secondary prevention outpatient's service. 559 outpatients visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. 449 prescriptions were made (198 echocardiography, 148 carotid ultrasound, 85 24h ABPM and 18 ECG exercise testing). General appropriate prescriptions prevalence was 40.3%, 24h ABPM being the most appropriate one (49.4%) followed by echocardiography (43.9%), ECG exercise test, (38.9%) and carotid ultrasound (30.4%). Appropriateness was significantly higher for secondary prevention patients (61.6 vs. 35.3%, p < 0.001) particularly for heart and carotid ultrasound. Significant univariate correlations were identified between age, cardiovascular risk category, degree of prevention (primary vs. secondary), duration of hypertension and the presence of valvular heart disease and prescription appropriateness. However, at multivariate analysis these findings were not confirmed. Our study shows a relevant percentage of inappropriate prescriptions of non-invasive cardiologic exams particularly in the primary prevention setting.

A Literature Review of the Educational Gaps and Needs in Migraine Management: An Asian Perspective Within a Global Context.

Migraine is a common neurological disorder that presents considerable challenges to healthcare systems worldwide. These changes are especially relevant in rapidly developing regions such as Asia, with an increasingly productive population and ongoing advancements in healthcare systems and infrastructure. Despite its substantial impact, migraine management remains inadequate, potentially due to deficiencies in medical education. We hypothesized that significant gaps in basic and advanced medical training and continuing professional education contribute to the suboptimal management of migraine in various healthcare settings across Asia. A comprehensive literature review was conducted using PubMed and Google databases. The search focused on cross-sectional studies published in English from inception until September 2024 that examined educational needs among medical trainees and clinicians and clinical gaps in migraine management in Asia. These studies were then contextualized within a global perspective. The review identified significant shortcomings in migraine education at all levels of educational training in Asia, which also translated to poor management of migraines in clinical practice. Undergraduate medical curricula in Asia inadequately address headache disorders, while postgraduate training programs provide insufficient guidance in headache management, especially for complex cases. Primary care clinicians exhibited variable levels of understanding and frequently incorrectly diagnosed and managed migraine.Additionally, many Asian countries lack standardized clinical practice guidelines (CPGs) and specialized training programs for headache management. A multidimensional approach is required to tackle the pre-existing educational and clinical practice limitations. The approach should include improving the medical school curriculum, providing focused continuing medical education programs or developing migraine modules for primary care physicians (PCPs), and developing region-specific CPGs. Besides educational initiatives, integrating and coordinating systems of care, where primary and specialist services complement each other, are crucial for improving patient care. Robust education combined with comprehensive referral and linkage protocols ensures continuity of care across healthcare levels. Moreover, collaboration, communication, and cooperation among healthcare providers (HCPs) and organizations are vital to enhancing the quality of life and productivity of migraine patients in the region.A synergistic approach that combines robust collaboration with innovative educational delivery can catalyze the widespread adoption of evidence-based medicine (EBM).

Creative Leadership of Educational Institution Administrators in the Digital Era of Educational Institutions under the Nakhon Ratchasima Primary Educational Service Area Office 3

Creative Leadership of Educational Institution Administrators in the Digital Era of Educational Institutions under the Nakhon Ratchasima Primary Educational Service Area Office 3

Creative Leadership of Educational Institution Administrators Under the Jurisdiction of the Buriram Primary Educational Service Area Office 3

Creative Leadership of Educational Institution Administrators Under the Jurisdiction of the Buriram Primary Educational Service Area Office 3

Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with psychosis experience (NEON Trial): a pragmatic randomised controlled trial

The Narrative Experiences Online (NEON) Intervention provides self-managed web-based access to mental health recovery narratives (n=659). We evaluated effectiveness and cost-effectiveness in improving quality of life for adults resident in England with mental health problems and recent psychosis experience. Prospectively registered pragmatic parallel-group randomised trial controlling for usual care, recruiting from statutory mental health services and through community engagement activities, with a 52-week primary endpoint (ISRCTN11152837). All trial procedures and the NEON Intervention were delivered by an integrated web-application. Randomisation was through an independently generated list (no stratification). Allocation was masked for statistical staff and the Chief Investigator but not participants. Intervention arm participants received immediate NEON Intervention access. Control arm participants received access after completing primary endpoint questionnaires. The primary outcome was quality of life through the Manchester Short Assessment (MANSA). Serious Adverse Events (SAEs) were collected through web-based safety report forms and identified from health service usage data. The primary analysis was by a prospectively described Intention To Treat principle excluding participants who had registered multiple times, with multiple imputation for missing data. Between 9 March 2020 and 1 March 2021, 739 participants were randomised (intervention:370; control: 369), providing more than 90% power to detect a baseline-adjusted difference of 0.25 in the MANSA score. Mean age was 34.8 years (standard deviation (SD) 12.0), 561 (75.9%) were white British, 443 (59.9%) were female, 609 (82.4%) had accessed specialist care mental health services, and 698 (94.5%) had accessed primary care mental health services. Mean baseline MANSA score was 3.7 for control and intervention arms (SD 0.9 and 1.0). 565 (76.5%) participants provided primary endpoint MANSA data with a mean score of 4.1 (SD 1.0) for both arms. We found no significant difference in Quality of Life between the two arms at the primary endpoint (baseline-adjusted difference 0.07, 95% CI-0.07 to 0.21, p=0.35). The incremental cost-effectiveness ratio (£110,501 per quality-adjusted life-year (QALY)) exceeded the prospectively defined cost-effectiveness threshold (£30,000 per QALY). 158(42.8%) control arm and 194 (52.4%) intervention arm participants accessed narratives outside of the NEON Intervention. There were no related serious adverse events (SAEs). 116 unrelated SAEs were reported by control arm participants, and 107 by intervention arm participants. Our findings do not indicate NEON Intervention access for all people with psychosis experience. Future research should consider a) evaluation with current mental health services users; b) optimisation to enable users to find hope-promoting narratives. National Institute for Health and Care Research (NIHR).

Association between receipt of a continuum of supportive housing services and mortality among Veterans with experience of housing instability

Veterans face elevated risk of suicide and homelessness, with housing instability being a significant, independent risk factor among this population. Addressing housing instability through primary, secondary, and tertiary prevention services is crucial for improving health and mortality outcomes, though research remains limited. The objective of this study is to assess the association between receipt of primary, secondary, and tertiary homelessness prevention services and risk of suicide and all-cause mortality among Veterans within 24 months of experiencing housing instability. Data were extracted from national U.S. Department of Veterans Affairs (VA) electronic health records (EHR), 2014-2019, and mortality data from National Death Index. Logistic regressions conducted in 2024 modeled suicide and all-cause mortality using a time-discreet survival framework with person-month as the unit of analysis. Cohort included 662,682 Veterans with indicators of housing instability in EHR. Veterans who received homeless services across the three levels of public health prevention had reduced odds of suicide compared to non-participants while Veterans exiting these programs had higher odds of suicide (p-value ranges <.001 - 0.05). Consistent results were found for all-cause mortality. Continued receipt of services to address housing instability is associated with reduced mortality risk. Exiting programs to address housing instability may be a vulnerable period for Veterans, and investment in homelessness prevention is crucial to reduce mortality and improve outcomes among Veterans. Ongoing support is essential to mitigate risks associated with program exit.

Challenges in oral health practice in Somalia: a call for regulatory strengthening and inclusion into primary healthcare services

BackgroundOral diseases remain a significant public health problem worldwide despite being largely preventable. Oral disorders such as dental caries, periodontal diseases, and oral cancers are highly prevalent chronic conditions that negatively impact quality of life. The oral health practice in Somalia has been evolving over the years, we therefore explored the challenges of oral health practice in a security-constrained poorly regulated environment to guide policy development.MethodsWe conducted a descriptive cross-sectional study among 15 oral health practitioners in Somalia. Using in-depth interviews, we gathered data on challenges working in private dental clinics and governmental institutions. Additionally, we gathered data on gender, age, marital status, profession, country of graduation, current location of practice, and years of clinical experience. Because the participants worked in different cities, we conducted interviews over the phone and recorded them. The data were analyzed via thematic analysis.ResultsIn this study, 9 of the participants were men and the median age was 29 years. Most of the participants (10) were dentists and remaining were dental specialists. The findings on challenges fall under four broad thematic areas: (1) Patient-related challenges; low patient literacy, preference for dental quacks, delay in seeking oral care, and dental phobia. (2) Institutional-related challenges: limited access to basic oral health services, oral health not an integral part of primary health care, and unregulated private dental clinics resulting in unqualified quacks practising as private caregivers. (3) Societal-related challenges, the absence of community-oriented preventive oral health services and low prioritization of oral health. (4) Personal-related challenges: female dentists in this study faced challenges related to the preference of male dentists and the shortage of oral health specialists in the country.ConclusionThis study reveals the need for the establishment and strengthening of regulation of oral services and its inclusion into the basic primary service package provided to the populace. It also calls for community enlightenment and more investment in dental health care in Somalia.Clinical trial numberNot applicable.

Does an innovative case-based payment scheme promote the hierarchical medical system? A tripartite evolutionary game analysis

BackgroundChina is striving to promote a hierarchical medical system (HMS) to improve the efficiency of health resource utilization and ensure health equity. An innovative payment scheme named the “Diagnosis-Intervention Package” (DIP) has been developed recently and implemented in 71 pilot cities nationwide. Although the impact of payment reform on medical expenditure and provider behavior has been demonstrated, there is little evidence on whether the reform promotes the HMS.MethodsThis study uses evolutionary game theory to formulate a tripartite evolutionary game model involving the local government (LG), superior medical institutions (SMI), and patients in implementing DIP payment reform. We also analyze the stability of each participant’s strategy and the sensitivity of parameters.ResultsThe results show that for LG, the additional social benefits created for other regions are crucial in influencing the evolution of the game system. SMI are more inclined to support the HMS when the proportion of patient reduction under the DIP payment scheme is low. For patients, the perceived medical quality of primary medical institutions (PMI) is the decisive factor in their strategies.ConclusionThe DIP payment scheme is more likely to promote the HMS in regions with an advanced policy framework, abundant medical resources, and high-quality primary medical services. Policymakers need to create effective incentives to boost support for the HMS from each participant. This study provides a feasible methodology for analyzing the impact of payment reforms that can be used in future research.

Gender and Racial/Ethnic Disparities in HIV Care and Viral Suppression at Jail Entry.

Women and racial/ethnic minorities living with HIV are less likely than White men to be engaged in HIV treatment when entering US jails. Few studies have examined the intersection of gender and race/ethnicity among incarcerated populations. The "Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative" (EnhanceLink) was a 10-site prospective cohort study of 1,270 people living with HIV in correctional facilities between 2008 and 2011. Using data from this study (N = 1,096), we assessed the likelihood of having a usual source of HIV care, utilizing ART, and viral suppression (HIV-1 RNA < 200 copies/ml) within 30days of incarceration among the following groups, stratified by current gender and race/ethnicity, relative to non-Hispanic White men: Non-Hispanic Black women, non-Hispanic Black men, Hispanic/Latina (Hispanic) women, Hispanic men, and non-Hispanic White women. Compared to non-Hispanic White men, non-Hispanic Black women were 20% less likely to report that they had access to HIV care before incarceration after adjusting for age, sexual orientation, incarceration history, and medical comorbidities (prevalence ratio (PR) = 0.8, 95% CI: 0.7-0.9, p = 0.0002). Non-Hispanic Black, Hispanic, and Non-Hispanic White women were 30% less likely to utilize ART (respectively) than White men after adjusting for the same potential confounders (PR = 0.7, 95% CI: 0.6-0.9, p = 0.002; PR = 0.7, 95% CI: 0.5-0.9, p = 0.02; PR = 0.7, 95% CI: 0.5-1.0, p = 0.03). Our findings underscore the importance of culturally informed, community-based HIV interventions that promote equitable access to HIV care.

A IMPORTÂNCIA DO PRÉ-NATAL NA ATENÇÃO PRIMÁRIA PARA A REDUÇÃO DE COMPLICAÇÕES OBSTÉTRICAS PARA GESTANTES: REVISÃO INTEGRATIVA

INTRODUCTION: Prenatal care is the complete health monitoring of pregnant women health through consultations. High maternal mortality hates in Brazil underscore the importance of prenatal care in primary health services to reduce pregnancy-related complications. Qualified monitoring is essential for early detection of problems, ensuring the health of both mother and baby, with nurses playing a central role in consultations and preventive strategies for pregnant women. OBJECTIVE: To explore the importance of prenatal care in primary health, highlighting its fundamental role in preventing obstetric complications in pregnant women. METHODOLOGY: This study is an integrative review guided by six steps of the review process. Articles were selected from databases, including Medical Literature Analysis and Retrieval System Online (MEDLINE), LILACS, Scientific Electronic Library (SciELO), and PubMed, following the established inclusion and exclusion criteria. RESULTS: Initially, 108 articles were identified, of which three were duplicates, 84 were excluded, and 14 were included in the study. DISCUSSION: The central role of primary care in gestational follow-up is discussed, emphasizing that the quality of care directly has a direct impact on both, maternal and fetal health. Failures in basic healthcare units that compromise the effectiveness of care are highlighted. Challenges in conducting essential diagnostic tests, such as rapid tests, are mentioned, alongside the need for preventive strategies to manage common obstetric complications. CONCLUSION: Effective prenatal follow-up enable early detection of adverse conditions, preventing negative outcomes for both mother and baby. This underscores the importance of nursing professionals and the Family Health Strategy (ESF) in providing comprehensive care, ensuring quality in prenatal services and ongoing education.

Development and Validation of a Machine Learning-Based Early Warning Model for Lichenoid Vulvar Disease: Prediction Model Development Study.

Given the complexity and diversity of lichenoid vulvar disease (LVD) risk factors, it is crucial to actively explore these factors and construct personalized warning models using relevant clinical variables to assess disease risk in patients. Yet, to date, there has been insufficient research, both nationwide and internationally, on risk factors and warning models for LVD. In light of these gaps, this study represents the first systematic exploration of the risk factors associated with LVD. The risk factors of LVD in women were explored and a medically evidence-based warning model was constructed to provide an early alert tool for the high-risk target population. The model can be applied in the clinic to identify high-risk patients and evaluate its accuracy and practicality in predicting LVD in women. Simultaneously, it can also enhance the diagnostic and treatment proficiency of medical personnel in primary community health service centers, which is of great significance in reducing overall health care spending and disease burden. A total of 2990 patients who attended West China Second Hospital of Sichuan University from January 2013 to December 2017 were selected as the study candidates and were divided into 1218 cases in the normal vulvovagina group (group 0) and 1772 cases in the lichenoid vulvar disease group (group 1) according to the results of the case examination. We investigated and collected routine examination data from patients for intergroup comparisons, included factors with significant differences in multifactorial analysis, and constructed logistic regression, random forests, gradient boosting machine (GBM), adaboost, eXtreme Gradient Boosting, and Categorical Boosting analysis models. The predictive efficacy of these six models was evaluated using receiver operating characteristic curve and area under the curve. Univariate analysis revealed that vaginitis, urinary incontinence, humidity of the long-term residential environment, spicy dietary habits, regular intake of coffee or caffeinated beverages, daily sleep duration, diabetes mellitus, smoking history, presence of autoimmune diseases, menopausal status, and hypertension were all significant risk factors affecting female LVD. Furthermore, the area under the receiver operating characteristic curve, accuracy, sensitivity, and F1-score of the GBM warning model were notably higher than the other 5 predictive analysis models. The GBM analysis model indicated that menopausal status had the strongest impact on female LVD, showing a positive correlation, followed by the presence of autoimmune diseases, which also displayed a positive dependency. In accordance with evidence-based medicine, the construction of a predictive warning model for female LVD can be used to identify high-risk populations at an early stage, aiding in the formulation of effective preventive measures, which is of paramount importance for reducing the incidence of LVD in women.

Development and evaluation of a caregiver checklist for primary care.

Family caregivers serve vital functions in older adults' health care, but their own needs are not systematically assessed in routine care delivery. The present study employed a user-centered approach to develop and evaluate a pragmatic checklist to support proactive identification and discussion of caregivers' concerns in primary care. Checklist development proceeded according to a preestablished methodology involving domain identification, item generation, overall construction, and revision. The checklist subsequently underwent formal evaluation by 25 subject matter experts (SMEs), including primary care clinicians, family caregivers, and health services researchers who assessed the checklist's content validity and appraised its overall utility, ease of use, and mode of administration. The checklist showed excellent content validity. None of the items were found to be superfluous, indicating that the checklist covered relevant content domains. Subject matter experts reported that the checklist was easy to use, just the right length, and would be helpful in identifying and prompting a discussion about caregivers' needs. Their preferences regarding how the checklist should be administered were variable. Minor revisions to the checklist focused on enhancing its applicability to caregivers from low- and middle-income families and those from underrepresented backgrounds. Results indicate that the checklist is an appropriate tool for identifying caregivers' needs and concerns. Findings lay the groundwork for pilot testing in primary care to confirm the checklist's clinical feasibility and evaluate its preliminary impact on family-centered care quality and outcomes for primary care clinics. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Implementation of Immunization Services Through a Pediatric Urgent Care Clinic.

Pediatric urgent care (PUC) centers may bolster immunization campaigns by offering vaccination during acute care visits, but few such programs have been described. We conducted a quality improvement initiative at an academically affiliated federally qualified health center that provides primary, specialty, and PUC services to children. Our PUC began offering routine immunizations in July 2020. The percentage of visits by eligible patients age ≤21 years during which immunization screening (process) and administration (outcome) occurred was measured from March 1, 2021, to February 19, 2023. Administration rates were measured across age, sex, race, language, and medical home groups. Data were analyzed with statistical process control methods. Grievance and adverse event data were monitored (balancing). We completed 4 plan-do-study-act cycles. Provider-facing bundles that included training, decision support, electronic health record signaling, and financial incentives were not associated with meaningful changes in screening and administration (cycles 1-3). A dedicated nurse vaccinator (DNV) was added on October 31, 2022 (cycle 4). The mean screening rate increased from 44.7% to 67.4% during the DNV period, and the mean administration rate increased from 26.5% to 50.8%. Lower administration rates were observed during visits by Black and English-speaking patients, and by patients empaneled outside our site. Provider-facing interventions alone were not effective at increasing vaccine screening and administration in our PUC, but marked improvement was observed with the addition of a DNV. Future interventions are needed to address disparities. Additional investigation is needed to determine whether our results are reproducible in other PUCs with access to vaccines.

The clearing strategy of primary frequency control ancillary services market from the point of view ISO in the presence of synchronous generations and virtual power plants based on responsive loads

Since the increase in penetration of renewable energy sources connected to the system reduces the inertia of power systems, the penetration of these sources leads to increase in the requirements of primary frequency control (PFC) services. Fortunately, with the expansion of network intelligence platforms, responsive loads (RL) can be effectively useful in ancillary services in the near future and can be used like traditional power plants. Since these equipment have a high rate of change of status, if they are visible in the market by aggregating (with virtual power plant (VPP)), they can compete with synchronous generations (SG). Because the response speed of the participants in the market can affect the decision independent system operator (ISO) in determining the winning units, therefore in this article, we have proposed a market framework to create competition between SGs and VPPs in providing ancillary services. In the proposed framework, ISO minimizes the weighted sum of power purchase costs from VPPs and SGs. The proposed weighting coefficients express the response speed of each unit. In fact, the desired objective function is affected by two terms, cost and speed. The presented model has been simulated on a test system including four SGs units and one VPP unit in matrix laboratory (MATLAB) software and checked under five different scenarios. The comparison of the obtained results indicates an increase in the possibility of accepting units with a smaller weighting factor and a higher response speed (the meaning of accepting units are market players, i.e. SGs and VPPs).

Hospital Dental Admissions and Caries Experience Among Children With Neurodevelopmental Disabilities: A Population-Based Record Linkage Cohort Study.

Within Aotearoa | New Zealand, rates of largely preventable severe caries and dental hospitalisations among children are increasing and inequalities exist. However, little population-based empirical evidence exists describing this oral health burden among children with neurodevelopmental disabilities (NDDs). This study aimed to estimate and compare the rates of dental hospital admissions in a near-national population of children aged ≤ 14 years with attention-deficit hyperactivity disorder, autism, intellectual disability or any NDD after accounting for key confounding variables. Caries status for these children was derived from an oral health screening at 4 years and also examined. The cohort were children who had their B4 School Check (B4SC) national health screening assessment undertaken between 1 January 2011 and 31 December 2018 and followed until 1 January 2020 (the study end date). Linked administrative databases, which include NDD indication and dental hospital records, were utilised. Dental hospital admissions were assessed using unadjusted and adjusted Cox proportional hazard regression models treating NDD as a discrete time-varying covariate. Caries status at 4 years of age was investigated cross-sectionally and the area under the receiver operating characteristic curve used to assess predictive accuracy. The eligible sample included 433 569 children (48.6% female) with a mean age of 9.3 years at the study end date. Overall, 16 359 (3.8%) children had at least one NDD indication and 38 574 (8.9%) had at least one dental hospitalisation. In adjusted analyses, the hazard ratio of dental hospitalisation admissions was 3.40 (95% CI: 3.22-3.60) for children indicated with any NDD compared to their non-NDD counterparts. At 4 years of age B4SC screening, 465 (17.6%) children out of 2640 indicated with any NDD had visible caries compared to 61 026 (14.3%) from 427 254 children without NDD indication (prevalence ratio = 1.24 [95% CI: 1.14-1.35]). However, the area under the receiver operating characteristic curve for this association was 0.52 (95% CI: 0.51-0.52), suggesting negligible predictive capacity. Children with NDDs in Aotearoa, New Zealand suffer from substantial oral health inequities. Targeted preventive strategies and adaptation to primary oral health services are needed to meet the needs of neurodiverse children and redress this substantial inequity. However, targeting children with NDDs at the B4SC is unlikely to mitigate these oral health inequities.

Nutritional guidance needs and influence factors for gastric cancer survivors in primary healthcare setting: a cross-sectional survey.

This study aimed to build a comprehensive understanding of the nutritional guidance needs of gastric cancer survivors in the primary healthcare setting that could be fulfilled by community health service centers as part of their primary healthcare services. Gastric cancer survivors were invited to participate in a questionnaire-based survey by convenience sampling method from the community health center. Relationships between nutritional demand and potential influence factors were examined by a multivariable logistic regression model. A total of 200 gastric cancer survivors were recruited from the community health service center in Shanghai, China, from whom we obtained 194 valid questionnaires, resulting in a 97.0% response rate. Of these gastric survivor participants, 48 individuals (24.7%) expressed a need for nutritional guidance administered by community health service centers, whereas 146 participants (75.3%) held the perspective that such guidance was unnecessary. Preferences for nutritional guidance included having a dietitian as the provider (68.8%), home-based engagement (72.9%), face-to-face consultation (68.8%), individual counseling (87.5%), and beginning immediately post-discharge (89.6%). A notable reluctance (66.7%) towards financial contribution was also observed. After adjusting for confounders, participants with higher income level (odds ratio (OR) = 4.45, 95% confidence interval (CI) = 1.39-15.50), history of food intake reduction (OR = 14.96, 95% CI = 3.49-82.28), and gastrointestinal symptoms (OR = 4.40, 95% CI = 1.35-14.33) were more likely to seek nutritional guidance. Gastric cancer survivors have a certain need for nutritional guidance administered by primary health service centers. Personal guidance by the primary health service center should be provided to gastric cancer survivors to support their dietary and nutritional intake needs. There is a need to develop and implement nutritional guidance programs in community health service centers as part of their primary healthcare services for gastric cancer survivors.

Access to psychological therapies amongst patients with a mental health diagnosis in primary care: a data linkage study.

Significant numbers of people in England have fallen into a gap between primary care psychological therapies and specialist mental health services. We aim to examine pathways to care by looking at demographic variation in detection and referral to primary and secondary psychological services in south London. Longitudinal descriptive study using a record linkage between a primary care database (Lambeth DataNet) and a secondary care mental health database (CRIS). We extracted data on mental health diagnosis, prescriptions and episodes of care in mental health services for all patients of working age registered from 1 January 2008 to 1 March 2018 (pre-covid era). Of those with a mental disorder detected in primary care (n = 110,419; 26.8%); 33.7% (n = 37,253) received no treatment; 21.3% (n = 23,548) exclusively accessed psychological treatment within NHS Talking Therapies and 7.6% accessed secondary care psychological therapies. People from minoritised groups were more likely to be prescribed psychotropic medication as the only treatment offered compared to the White British group. Men, Black African and Asian groups were less likely to access NHS Talking Therapies. People with a personality disorder diagnosis had the highest prevalence and number of NHS Talking Therapies treatment episodes (48.0%, n = 960), a similar percentage (44.1%, n = 881) received secondary care psychology treatment. Our study highlights marked inequalities in access to psychological therapies for men and people from some minoritised ethnic groups across primary and secondary care and how individuals with personality disorders are offered multiple short-term courses in NHS Talking Therapies even where this is not recommended treatment.

A review of UK primary care pathways for acute ophthalmic conditions.

Care pathways for the management of acute ophthalmic conditions have developed and transformed significantly over recent years, owing to a combination of legislative changes, policy implementation and the pressing requirement to redistribute increased demand away from traditional secondary care providers through collaboration with primary care. Following UK healthcare devolution in 1999, each nation has developed and implemented their own strategies for managing the growing demands on acute ophthalmology services. Local commissioning across England has seen Enhanced Service Pathways develop to provide acute eye care by primary care optometrists, with provision and access dependent upon locality. Northern Ireland has seen the implementation of a nationwide Primary Eyecare Acute Referral Service, whilst in Scotland and Wales, the respective Governments have redesigned primary care optometry General Ophthalmic Service contracts to incorporate provision of extended investigations and management of acute conditions by optometrists across the nation, recognising the added benefit of optometrists with higher qualifications. This narrative review summarises both peer reviewed and appropriate grey literature articles reporting on acute eye care pathways in primary care. Despite significant progress, particularly during the global COVID-19 pandemic, there is arguably still a great deal of further research and evaluation required relating to pathway innovation, the role of professionals with higher qualifications, including independent prescribing, the role of telemedicine, reassurance around clinical safety, and how digital interconnectivity could potentially add value to collaborative schemes to meet the growing demand on acute eyecare.

Conversations with patients about death - experienced GPs' reflections and experiences.

The ageing population in Norway is steadily increasing, and both the number and complexity of patient-related tasks assigned to the primary health service, including GPs, are growing. This study aimed to investigate how experienced GPs conducted and reflected on conversations with their patients about death. Semi-structured in-depth interviews with ten experienced GPs, all specialists in general practice, were analysed using cross-case thematic analysis. Almost all the GPs viewed talking about death with their patients as a natural part of a GP's duties. The conversations were perceived as both challenging and meaningful. Having sufficient time for the conversation and getting to know the patients over time were considered valuable factors for good conversations. The GPs looked for golden moments in which to address the topic. The content of the conversation could vary, from specific measures to alleviate symptoms to the more existential and philosophical. The GPs expressed that they lacked formal competence and largely relied on their experience and belief in their communication skills when interacting with patients. Several described the lack of clarity on treatment intensity from the specialist health service as a barrier to initiating and conducting good conversations about death. Most of the GPs in this study talked to their patients about death and considered it a natural and necessary part of the GP's role.

Automating 5G network slice management for industrial applications

The transition to Industry 4.0 introduces new use cases with unique communication requirements, demanding wireless technologies capable of dynamically adjusting their performance to meet various demands. Leveraging network slicing, 5G technology offers the flexibility to support such use cases. However, the usage and deployment of network slices in networks are complex tasks. To increase the adoption of 5G, there is a need for mechanisms that automate the deployment and management of network slices. This paper introduces a design for a network slice manager capable of such mechanisms in 5G networks. This design adheres to related standards, facilitating interoperability with other software, while also considering the capabilities and limitations of the technology. The proposed design can provision custom slices tailored to meet the unique requirements of verticals, offering communication performance across the spectrum of the three primary 5G services (eMBB, URLLC, and mMTC/mIoT). To access the proposed design, a Proof-of-Concept (PoC) prototype was developed and evaluated. The evaluation results demonstrate the flexibility of the proposed solution for deploying slices adjusted to the vertical use cases. Additionally, the slices generated by the PoC maintain a high TRL (Technology Readiness Level) equivalent to that of the commercial-graded network used.