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British J. of General Practice     Full-text available via subscription   (Followers: 41, SJR: 0.906, CiteScore: 1)
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British Journal of General Practice
Journal Prestige (SJR): 0.906
Citation Impact (citeScore): 1
Number of Followers: 41  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0960-1643 - ISSN (Online) 1478-5242
Published by RCGP Homepage  [1 journal]
  • Help-seeking behaviour in women diagnosed with gynaecological cancer: a
           systematic review

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      Authors: Pauline Williams; Marie-Claire Rebeiz, Leila Hojeij, Stephen J McCall
      Abstract: BackgroundIdentifying what prompts or hinders women’s help-seeking behaviour is essential to ensure timely diagnosis and management of gynaecological cancers.AimTo understand the factors that influence the help- seeking behaviour of women diagnosed with gynaecological cancer.Design and settingSystematic review and narrative synthesis of studies from high-income settings worldwide.MethodFive databases were searched for studies, of any design, that presented factors related to the help-seeking behaviour of women diagnosed with a gynaecological cancer. Data from the articles were extracted and presented using narrative synthesis, which was both inductive and deductive. The COM-B (capability, opportunity, motivation, behaviour) model of behaviour change was used as a framework.ResultsIn total, 21 studies were included in the review. Inductive synthesis presented three main themes of factors related to the help-seeking behaviour of women diagnosed with gynaecological cancer: patient factors, such as knowledge of symptoms; emotional factors, including previous healthcare experience, embarrassment, and trust; and practical factors, including time and resources. Deductive synthesis demonstrated that capability (namely, symptom knowledge), opportunity (having the required time and overcoming the cultural taboos surrounding gynaecological symptoms), and motivation (believing that seeking help is beneficial) are all required to initiate help-seeking behaviour.ConclusionAlthough it is a journey of defined steps, the help- seeking behaviour of women with symptoms diagnosed with gynaecological cancer is influenced by personal and societal factors. Interventions to improve help seeking will need to address the specific identified factors, as well as capability, opportunity, and motivation.
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/BJGP.2022.0071
      Issue No: Vol. 72, No. 725 (2022)
       
  • Medical treatment for heavy menstrual bleeding in primary care: 10-year
           data from the ECLIPSE trial

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      Authors: Joe Kai; Brittany Dutton, Yana Vinogradova, Nicholas Hilken, Janesh Gupta, Jane Daniels
      Abstract: BackgroundHeavy menstrual bleeding (HMB) is a common problem that can significantly affect women’s lives. There is a lack of evidence on long-term outcomes after seeking treatment.AimTo assess continuation rates of medical treatments and rates of surgery in women 10 years after initial management for HMB in primary care.Design and settingThis was a prospective observational cohort study.MethodWomen with HMB who participated in the ECLIPSE primary care trial (ISRCTN86566246) completed questionnaires 10 years after randomisation to the levonorgestrel-releasing intrauterine system (LNG-IUS) or other usual medical treatments (oral tranexamic acid, mefenamic acid, combined oestrogen–progestogen; or progesterone alone). Outcomes were rates of surgery, medical treatments, and quality of life using the 36-item Short-Form Health Survey (SF-36) and EuroQoL EQ-5D.ResultsThe responding cohort of 206 women was demographically and clinically representative of the original trial population. Mean age at baseline was 41.9 years (SD 4.9) and 53.7 years (SD 5.1) at follow-up. Over the 10-year follow-up, 60 of 206 (29.1%) women had surgery (hysterectomy n = 34, 16.5%; endometrial ablation n = 26, 12.6%). Between 5 and 10 years, 89 women (43.2%) ceased all medical treatments and 88 (42.7%) used LNG-IUS alone or in combination with other treatments. Fifty-six women (27.2%) were using LNG-IUS at 10 years. There were improvements over time in quality-of-life scores, with no evidence of differences in these or other outcomes between the two groups.ConclusionMedical treatments for women with HMB can be successfully initiated in primary care, with low rates of surgery and improvement in quality of life observed a decade later.
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp.2022.0260
      Issue No: Vol. 72, No. 725 (2022)
       
  • Effectiveness of preconception interventions in primary care: a systematic
           review

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      Authors: Nishadi N Withanage; Jessica R Botfield, Sonia Srinivasan, Kirsten I Black, Danielle Mazza
      Abstract: BackgroundPrimary care-based preconception care (PCC) has the potential to improve pregnancy outcomes, but the effectiveness is unclear.AimTo evaluate the effectiveness of primary care-based PCC delivered to reproductive-aged females and/or males to improve health knowledge, reduce preconception risk factors, and improve pregnancy outcomes.Design and settingA systematic review of primary care-based PCC.MethodOvid MEDLINE, Cochrane CENTRAL, Embase, Web of Science, Scopus, and CINAHL were searched for randomised controlled trials (RCTs) published between July 1999 and May 2021. Two reviewers independently evaluated article eligibility and quality.ResultsTwenty-eight articles reporting on 22 RCTs were included. All but one focused on females. Interventions included brief education (single session) (n = 8), intensive education (multiple sessions) (n = 9), supplementary medication (n = 7), and dietary modification (n = 4). Brief education improved health knowledge in females (n = 3) and males (n = 1), reduced alcohol/tobacco consumption (n = 2), and increased folate intake (n = 3). Intensive education reduced spontaneous pregnancy loss (n = 1), alcohol-exposed pregnancies (n = 2), and increased physical activity (n = 2). Supplementary medication increased folate intake (n = 4) and dietary modification reduced pre-eclampsia (n = 1) and increased birth weight (n = 1). Only eight articles reported on pregnancy outcomes, with a range of interventions used; of these, four reported improvements in pregnancy outcomes. Most RCTs were of low quality (n = 12).ConclusionPrimary care-based PCC including brief and intensive education, supplementary medication, and dietary modification are effective in improving health knowledge and reducing preconception risk factors in females, although there is limited evidence for males. Further research is required to determine whether primary care-based PCC can improve pregnancy outcomes.
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/BJGP.2022.0040
      Issue No: Vol. 72, No. 725 (2022)
       
  • Challenges and opportunities for cervical screening in women over the age
           of 50 years: a qualitative study

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      Authors: Alison Bravington; Hong Chen, Judith Dyson, Lesley Jones, Christopher Dalgliesh, Amee Bryan, Julietta Patnick, Una Macleod
      Abstract: BackgroundCervical cancer is a preventable disease. Cases in women age>50 years are predicted to rise by 60% in the next two decades, yet this group are less likely to attend for screening than younger women.AimTo seek novel solutions to the challenges of cervical screening in women>50 years of age by examining practitioner and service-user experiences.Design and settingSemi-structured interviews were conducted with 28 practitioners and 24 service users>50 years of age, recruited via UK primary care networks in Northern England in 2016–2017, to explore experiences related to cervical screening.MethodAn inductive thematic analysis was conducted to explore the data.ResultsFindings are presented under three key themes. The first, exploring the barriers to successful cervical screening, examines the influences of sexuality and early experiences of screening on attendance, and how preventive health care becomes a low priority as women age. The second, the role of relationships, explores how peer talk shapes attitudes towards cervical screening, how teamwork between practitioners engenders investment in cervical screening, and how interactions between service users and primary care over time can significantly affect intentions to screen. The third, what constitutes good practice, describes practical and sensitive approaches to screening tailored to women aged>50 years.ConclusionGood practice involves attention to structural and practical challenges, and an understanding of the role of relationships in shaping screening intentions. Experienced practitioners adapt procedures to increase sensitivity, and balance time invested in problem solving against the benefits of reaching practice targets for attendance. Building networks of expertise across multiple practices can increase practitioner skill in screening this age group.
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/BJGP.2022.0036
      Issue No: Vol. 72, No. 725 (2022)
       
  • Antibiotic consumption and time to recovery from uncomplicated urinary
           tract infection: secondary analysis of observational data from a
           point-of-care test trial

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      Authors: Amal Gadalla; Hannah Wise, Daniel Farewell, Kathryn Hughes, Carl Llor, Michael Moore, Theo JM Verheij, Paul Little, Christopher C Butler, Nick A Francis
      Abstract: BackgroundRandomised trials provide high-quality evidence on the effects of prescribing antibiotics for urinary tract infection (UTI) but may not reflect the effects in those who consume antibiotics. Moreover, they mostly compare different antibiotic types or regimens but rarely include a ‘no antibiotic’ group.AimTo estimate the effect of antibiotic consumption, rather than prescription, on time to recovery in females with uncomplicated UTI.Design and settingSecondary analysis of 14-day observational data from a point-of-care test trial for UTI in primary care in England, the Netherlands, Spain, and Wales, which ran from 2012 to 2014. Clinicians treated patients using their own judgement, providing immediate, delayed, or no antibiotic.MethodUTI-symptomatic females who either consumed or did not consume antibiotics during a 14-day follow-up were included. Antibiotic consumption was standardised across participants and grouped into either ≤3 or>3 standardised antibiotic days. To account for confounders, a robust propensity score matching analysis was conducted. Adjusted Kaplan–Meier and Cox proportional hazard models were employed to estimate time to recovery and hazard ratios, respectively.ResultsA total of n = 333 females who consumed antibiotics and n = 80 females who did not consume antibiotics were identified and included in the study. The adjusted median time to recovery was 2 days longer among patients who did not consume antibiotics (9 days, 95% confidence interval [CI] = 7 to 12) compared with those who did (7 days, 95% CI = 7 to 8). No difference was found between those who consumed ≤3 (7 days, 95% CI = 7 to 8) compared with>3 standardised antibiotic days (7 days, 95% CI = 6 to 9).ConclusionConsuming antibiotics was associated with a reduction in self-reported time to recovery, but more antibiotics exposure was not associated with faster recovery in this study.
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/BJGP.2022.0011
      Issue No: Vol. 72, No. 725 (2022)
       
  • Patient safety, self-injection, and B12 deficiency: a UK cross-sectional
           survey

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      Authors: Natasha Tyler; Alexander Hodkinson, Naeem Ahlam, Sally Giles, Andrew Zhou, Maria Panagioti
      Abstract: BackgroundIndividuals with vitamin B12 deficiency (including pernicious anaemia) often report being ‘let down’ or stigmatised by general practice systems and policy, and choose instead to self-medicate via injection; the association between this and perceptions of safe primary care in this group of people is unknown.AimTo examine the association between self-medication for vitamin B12 deficiency and patient-reported safety in primary care.Design and settingA UK cross-sectional online survey.MethodThe survey consisted of the three components: demographics; the validated Primary Care Patient Measure of Safety; and questions about self-medication for vitamin B12 deficiency. Multivariable logistic regression analyses and thematic synthesis were undertaken.ResultsResponses from 1297 participants indicated 508 (39.2%) self-medicated via injection. Perceived primary care safety was low. Those who self-medicated via injection reported a significantly lower level of patient safety in primary care including adverse patient-related factors (odds ratio 0.82, 95% confidence interval = 0.73 to 0.92), and patients>34 years of age were significantly more likely to self-medicate via injection. Many reported that treatment under the guidance of a clinician was preferable to self-medication, but felt they had no other choice to regain quality of life. Almost half felt that the doctor did not always consider what they wanted for their care.ConclusionTo the authors’ knowledge, this is the largest study to date examining patient safety and vitamin B12 deficiency. It found that four out of 10 patients with B12 deficiency self-medicate via injection. Patients who self-medicated perceived primary care as less safe. Providing patient-centred care and treating these patients with dignity and respect is a policy priority to reduce unsafe health behaviours.
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/BJGP.2021.0711
      Issue No: Vol. 72, No. 725 (2022)
       
  • Predictors for inappropriate proton pump inhibitor use: observational
           study in primary care

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      Authors: Lieke Maria Koggel; Marten Alexander Lantinga, Frederike Leonie Buchner, Joost Paulus Hubertus Drenth, Jacqueline Sarah Frankema, Edwin Johannes Heeregrave, Mette Heringa, Mattiȷs Everard Numans, Peter Derk Siersema
      Abstract: BackgroundProton pump inhibitor (PPI) indications are limited to gastrointestinal disorders and ulcer prophylaxis. However, PPIs are among the most frequently prescribed drugs.AimTo evaluate the appropriateness of PPI prescriptions and identify predictive factors for inappropriate PPI use.Design and settingObservational study using a Dutch primary care database with all new PPI prescriptions between 2016 and 2018.MethodIndividual patient data and details on PPI use were collected. The appropriateness of initiation and continuation of PPI prescriptions was evaluated using the applicable guidelines.ResultsIn total, 148 926 patients (aged ≥18 years) from 27 general practices were evaluated. A total of 23 601 (16%) patients started PPI therapy (mean age 57 [SD 17] years, 59% female). Valid PPI indications at initiation were seen in 10 466 PPI users (44%). Predictors for inappropriately initiated PPI use were older age (odds ratio [OR] 1.03, 95% confidence interval [CI] = 1.03 to 1.03), and use of non-selective non-steroidal anti-inflammatory drugs (OR 5.15, 95% CI = 4.70 to 5.65), adenosine diphosphate receptor inhibitors (OR 5.07, 95% CI = 3.46 to 7.41), COX-2 inhibitors (also known as coxibs) (OR 3.93, 95% CI = 2.92 to 5.28), and low-dose aspirin (OR 3.83, 95% CI = 3.07 to 4.77). Despite an initial valid indication, PPI use was inaccurately continued in 32% of patients on short-course therapy for dyspepsia and in 11% of patients on ulcer prophylaxis.ConclusionMore than half of PPI users in primary care were found to have an inappropriate indication, with unnecessary ulcer prophylaxis related to drug use being one of the leading causes. Future initiatives to reduce PPI use for unnecessary ulcer prophylaxis and timely deprescription if PPI is no longer indicated, are needed.
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/BJGP.2022.0178
      Issue No: Vol. 72, No. 725 (2022)
       
  • UK newspapers 'on the warpath’: media analysis of general practice
           remote consulting in 2021

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      Authors: Gilly Mroz; Chrysanthi Papoutsi, Trisha Greenhalgh
      Abstract: BackgroundFollowing a large-scale, pandemic-driven shift to remote consulting in UK general practice in 2020, 2021 saw a partial return to in-person consultations. This occurred in the context of extreme workload pressures because of backlogs, staff shortages, and task shifting.AimTo study media depictions of remote consultations in UK general practice at a time of system stress.Design and settingThematic analysis of national newspaper articles about remote GP consultations from two time periods: 13–26 May 2021, following an NHS England letter, and 14–27 October 2021, following a government-backed directive, both stipulating a return to in-person consulting.MethodArticles were identified through, and retrieved from, LexisNexis. A coding system of themes and narrative devices was developed iteratively to inform data analysis.ResultsIn total, 25 articles reported on the letter and 75 on the directive. Newspaper coverage of remote consulting was strikingly negative. The right-leaning press in particular praised the return to in-person consultations, depicting remote care as creating access barriers and compromising safety. Two newspapers led national campaigns pressuring the government to require GPs to offer in-person consultations. GPs were quoted as reluctant to return to an ‘in-person by default’ service (as it would further pressurise a system already close to breaking point).ConclusionRemote consultations have become associated in the media with poor practice. Some newspapers were actively leading the ‘war’ on general practice rather than merely reporting on it. Proactive dialogue between practitioners and the media might help minimise polarisation and improve perceptions around general practice.
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/BJGP.2022.0258
      Issue No: Vol. 72, No. 725 (2022)
       
  • Liver disease management as routine work in primary care: a qualitative
           interview study to guide implementation

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      Authors: Helen Jarvis; Tom Sanders, Barbara Hanratty
      Abstract: BackgroundMorbidity from liver disease is rising in the UK. Most cases are caused by alcohol or non-alcoholic fatty liver disease (NAFLD) and treatable if caught early. Liver disease pathways have been shown to increase detection in the community, but have not been adopted into routine primary care work.AimTo explore primary care healthcare professional (HCP) experiences and understanding of chronic liver disease, and where it might fit into management of long-term conditions.Design and settingQualitative interview study with 20 HCPs in primary care in the north of England.MethodA semi-structured approach informed by a theory of implementation (normalisation process theory [NPT]). Data collection and analysis were concurrent. Interview data were analysed using thematic analysis.ResultsParticipants identified the following key areas for action: incentivised frameworks and protocols to drive understanding, organise, and sustain practice; inclusion of common liver diseases into multimorbidity care to reduce complexity and workload; a need to define the GP role within a lifestyle-focused treatment pathway; and education/local champions to initiate and legitimise individual and organisational participation in change.ConclusionTo embed chronic liver disease management in routine primary care work, researchers and policymakers must be aware of the implementation challenges. These findings can guide the adoption of effective pathways and help bridge the implementation gap.
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/BJGP.2022.0094
      Issue No: Vol. 72, No. 725 (2022)
       
  • Listen to Your Patient

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      Authors: Nada Khan
      Pages: 555 - 555
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721181
      Issue No: Vol. 72, No. 725 (2022)
       
  • Women’s health matters

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      Authors: Anne Connolly; Dame Lesley Regan
      Pages: 556 - 557
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721193
      Issue No: Vol. 72, No. 725 (2022)
       
  • Implications of the changes to patient online records access in English
           primary care

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      Authors: Brian McMillan; Gail Davidge, Charlotte Blease, Jessica Watson
      Pages: 558 - 559
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721205
      Issue No: Vol. 72, No. 725 (2022)
       
  • Levelling up medical education: getting comfortable with being
           uncomfortable

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      Authors: Vijay Nayar
      Pages: 560 - 561
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721217
      Issue No: Vol. 72, No. 725 (2022)
       
  • The Medical Licensing Assessment and the therapeutic illusion

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      Authors: Max Cooper; Sangeetha Sornalingam, Jason Heath
      Pages: 564 - 564
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721229
      Issue No: Vol. 72, No. 725 (2022)
       
  • Lessons learned from advocacy to promote Registered Reports

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      Authors: Stephen H Bradley; Kelly E Lloyd, David Mellor, Peter J Gill, Georgia C Richards
      Pages: 564 - 565
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721241
      Issue No: Vol. 72, No. 725 (2022)
       
  • The serotonin theory of depression and why we use antidepressants

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      Authors: Marion Brown
      Pages: 565 - 565
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721253
      Issue No: Vol. 72, No. 725 (2022)
       
  • Data quality is an illusion

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      Authors: Pablo Millares Martin
      Pages: 566 - 566
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721265
      Issue No: Vol. 72, No. 725 (2022)
       
  • Pathways to being an academic GP in Ireland

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      Authors: Maryam Ranjbaran; Liam Glynn, Patrick Redmond
      Pages: 566 - 566
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721277
      Issue No: Vol. 72, No. 725 (2022)
       
  • GDP

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      Authors: Joseph Lee
      Pages: 566 - 566
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721289
      Issue No: Vol. 72, No. 725 (2022)
       
  • All talk and no continuity action

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      Authors: Vernon Needham
      Pages: 567 - 567
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721301
      Issue No: Vol. 72, No. 725 (2022)
       
  • Continuity of care

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      Authors: Peter Perkins
      Pages: 567 - 567
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721313
      Issue No: Vol. 72, No. 725 (2022)
       
  • Editor’s response

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      Authors: Euan Lawson
      Pages: 567 - 567
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721469
      Issue No: Vol. 72, No. 725 (2022)
       
  • Reading for practical wisdom

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      Authors: Andrew Papanikitas
      Pages: 577 - 577
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721325
      Issue No: Vol. 72, No. 725 (2022)
       
  • An ethical challenge' Crowdfunded cancer care in the UK

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      Authors: Peter Young; Rebecca te Water Naude
      Pages: 578 - 579
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721337
      Issue No: Vol. 72, No. 725 (2022)
       
  • 'Delicate diagnosis’: avoiding harms in difficult, disputed, and
           desired diagnoses

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      Authors: Margaret McCartney; Natalie Armstrong, Graham Martin, David Nunan, Owen Richards, Frank Sullivan
      Pages: 580 - 581
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721349
      Issue No: Vol. 72, No. 725 (2022)
       
  • Yonder: Psychotropic medication discontinuation, post-migration stressors,
           suicide prevention, and role modelling

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      Authors: Ahmed Rashid
      Pages: 582 - 582
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721361
      Issue No: Vol. 72, No. 725 (2022)
       
  • Medical musings: GPs should be the orchestra

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      Authors: David Mummery
      Pages: 583 - 583
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721373
      Issue No: Vol. 72, No. 725 (2022)
       
  • The MRCGP Recorded Consultation Assessment: a perspective from three
           inner-city trainees

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      Authors: Agalya Ramanathan; Eleanor Southgate, Sarah Pocknell
      Pages: 584 - 584
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721385
      Issue No: Vol. 72, No. 725 (2022)
       
  • Books: The Immortal Life of Henrietta Lacks

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      Authors: Hannah Milton
      Pages: 585 - 585
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721397
      Issue No: Vol. 72, No. 725 (2022)
       
  • Books: Reading to Stay Alive. Tolstoy, Hopkins and The Dilemma of
           Existence

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      Authors: Austin O’Carroll
      Pages: 586 - 586
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721409
      Issue No: Vol. 72, No. 725 (2022)
       
  • Books: Why We Get the Wrong Politicians

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      Authors: Andrew Papanikitas
      Pages: 587 - 587
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721421
      Issue No: Vol. 72, No. 725 (2022)
       
  • Pulp fiction, resilience, or something else'

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      Authors: Ben Hoban
      Pages: 588 - 588
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721433
      Issue No: Vol. 72, No. 725 (2022)
       
  • Developing a research agenda for social prescribing in the UK using
           lessons from the US

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      Authors: Sahil Sandhu; Josephine M Wildman, Hugh Alderwick, John Wildman, Laura M Gottlieb
      Pages: 589 - 592
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721445
      Issue No: Vol. 72, No. 725 (2022)
       
  • Headache in pregnancy: a brief practical guide

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      Authors: Katherine Phillips; Jessica Davison, Benjamin Wakerley
      Pages: 593 - 594
      PubDate: 2022-11-24T16:05:21-08:00
      DOI: 10.3399/bjgp22X721457
      Issue No: Vol. 72, No. 725 (2022)
       
 
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