Educational intervention to optimise serum immunoglobulin test use in Irish primary care: an interrupted time series with segmented regression analysis.

Abstract: Implementation science experts recommend that theory-based strategies, developed in collaboration with healthcare professionals, have greater chance of success.This study evaluated the impact of a theory-based strategy for optimising the […]

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Adherence to guidelines on documentation required for registration to London GP practice websites: a mixed-methods cross-sectional study.

Abstract: The most common obstacle to registration with a GP practice in the UK is difficulty presenting proof of address. NHS guidelines stipulate that inability to provide ID or proof […]

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GP views on their role in bullying disclosure by children and young people in the community: a cross-sectional qualitative study in English primary care.

Abstract: Bullying among children and young people (CYP) is a major public health concern that can lead to physical and mental health consequences. CYP may disclose bullying, and seek help […]

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Route to heart failure diagnosis in English primary care: a retrospective cohort study of variation.

Abstract: Despite the existence of evidence-based guidelines supporting the identification of heart failure (HF) in primary care, the proportion of patients diagnosed in this setting remains low. Understanding variation in […]

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Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes.

Practice guidelines recommend that chronic insomnia be treated first with cognitive behavioural therapy for insomnia (CBT-I), and that hypnotic medication be considered only when CBT-I is unsuccessful. Although there is evidence of CBT-I’s efficacy in research studies, systematic reviews of its effects in primary care are lacking.To review the effects on sleep outcomes of CBT-I delivered in primary care.Systematic review of articles published worldwide.Medline, PsycINFO, EMBASE, and CINAHL were searched for articles published from January 1987 until August 2018 that reported sleep results and on the use of CBT-I in general primary care settings. Two researchers independently assessed and then reached agreement on the included studies and the extracted data. Cohen’s d was used to measure effects on sleep diary outcomes and the Insomnia Severity Index.In total, 13 studies were included. Medium-to-large positive effects on self-reported sleep were found for CBT-I provided over 4-6 sessions. Improvements were generally well maintained for 3-12 months post-treatment. Studies of interventions in which the format or content veered substantially from conventional CBT-I were less conclusive. In only three studies was CBT-I delivered by a GP; usually, it was provided by nurses, psychologists, nurse practitioners, social workers, or counsellors. Six studies included advice on withdrawal from hypnotics.The findings support the effectiveness of multicomponent CBT-I in general primary care. Future studies should use standard sleep measures, examine daytime symptoms, and investigate the impact of hypnotic tapering interventions delivered in conjunction with CBT-I.

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