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Annals of Internal Medicine, Ahead of Print.

Introduction
Wales has higher rates of bowel cancer incidence and mortality than other UK nations, with over 2300 new cases and 900 deaths annually. Regional disparities in bowel cancer mortality underscore the need for a better understanding of patient experiences of bowel cancer care in Wales as well as exploring potential areas for improvement. This evaluation aimed to explore the experiences of individuals with a history of bowel cancer and their caregivers in Wales, UK, examining diagnosis, treatment and aftercare. The study also explored patient and caregiver recommendations to inform potential improvements in service delivery, addressing the gaps in quality and accessibility of bowel cancer care across Wales.

Methods
This qualitative mixed-methods study used a combination of online surveys, interviews and focus groups to explore the experiences of individuals with bowel cancer and their caregivers in Wales. 71 survey responses were received, of which 23 individual interviews and 3 focus groups with 19 participants were conducted. Interviews and focus groups followed semistructured topic guides using a grounded theory methodology, with manual iterative coding of transcripts to identify themes and subthemes.

Setting
Focusing on people with a history of bowel cancer, and their caregivers, who had received bowel cancer care from the Welsh National Health Service.

Results
Thematic analysis of interview and focus group transcripts uncovered a central theme highlighting the role of effective communication in ensuring high-quality bowel cancer care. Four subthemes emerged from the data: (a) suspicion to diagnosis, which revealed barriers to early detection and the effects of miscommunication; (b) disparities and decision-making in treatment access, where geographic and socio-economic differences affected treatment and support options; (c) communication and coordination of care, emphasising gaps in the continuity of care; and (d) life after cancer, identifying unmet needs for sustained support post-treatment. Several potential areas for improvement to bowel cancer care in Wales were also suggested, including changes to bowel screening eligibility, empowering shared decision-making, tailoring support services for younger individuals with bowel cancer and improving aftercare support.

Conclusions
This study highlighted a perceived ‘postcode lottery’ in bowel cancer care across Wales, with marked disparities between rural and urban areas. Findings advocate for targeted improvements to make care and support services more equitable and accessible across Wales.

Objective
To explore the robustness of the patient-sharing network and validate the association between strength and persistence of physicians’ relationships in China.

Design, setting and participants
We conducted a patient-sharing network analysis to describe the persistence of patient-sharing relationships and logistic regression to analyse factors associating with the persistence of patient-sharing relationships in the Yinzhou Health Information System from 1 January 2010 to 31 December 2018; all outpatient records that had a hypertension diagnosis were included in this study.

Outcome measures
The persistence ratio was defined as the proportion of the patient-sharing relationships in a given year that continued to exist in the following year, the 1-, 2- and 3-year persistence to test the robustness of the findings.

Results
This study included 3916 physicians from 42 public healthcare facilities in Yinzhou. The 1-year persistence ratio fluctuated around 80%, and the 3-year persistence ratio was around 60% over the study period. The strength of the relationship, tie characteristics and physician specialty were important factors associating with the persistence of the relationships. The persistence of the relationships increased significantly as the strength of the relationships increased (for relationships with strength [3, 5), OR=3.987, 95% CI 3.896 to 4.08; for relationships with strength [5, 7), OR=6.379, 95% CI 6.147 to 6.626; and for relationships with strength [7, 9), OR=8.373, 95% CI 7.941 to 8.829). Physicians from the same healthcare institution were more likely to form ties that persisted for at least 1 year compared with physicians from different institutions (OR=1.510, 95% CI 1.480 to 1.540).

Conclusions
Our study showed that physicians frequently formed relationships with other physicians through sharing patients in Yinzhou, China, and these relationships had similar rates of persistence to studies conducted in developed countries, which indicated that findings of social network analyses conducted in developed countries still hold value in developing countries.

Introduction
Over the last 20 years, the pharmacist’s role in healthcare has evolved, moving towards patient-centred care, collaboration and medication therapy management. Patient engagement in research is similarly being recognised as a transformative approach to healthcare due to its positive impact on outcomes and research relevance. However, patient engagement in pharmacy practice research is nascent. Therefore, we present a protocol for a scoping review to map the current state of patient engagement in pharmacy practice research, identifying its extent, range, nature, barriers, facilitators, impacts and gaps.

Methods and analysis
This protocol was developed in collaboration with persons with lived experience (PWLE). The scoping review will be conducted using established methodological frameworks and guided by the Best Practice Guidance and Reporting Items for the Development of Scoping Review Protocols and the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) checklists. A comprehensive search involving three large databases, Medline (Ovid; 1946–Present), Embase (Ovid; 1974–Present) and Scopus (Elsevier), grey literature sources, forward and backward reference checking and consultation will be completed to retrieve the relevant literature. We will include published and unpublished research related to pharmacy practice that adopts patient engagement in research approach. Full-text screening will occur to determine eligibility for inclusion. Data will then be charted using a comprehensive extraction form. Qualitative data will be synthesised using basic qualitative content analysis, and quantitative data will be analysed using descriptive statistics. Regular meetings with PWLE and the research team will guide data analysis, interpretation and dissemination.

Ethics and dissemination
Ethics approval was not required for this protocol as we did not collect participant data. Findings may be disseminated through peer-reviewed publications, conference presentations, social media and knowledge user meetings, as informed by the perspectives of PWLE. Knowledge gained from this review will inform the development of strategies that support patient engagement, advance pharmacy practice research and have the potential to improve health outcomes and patient experiences.

Objectives
To analyse, compare and present the 10-year diagnosis-specific antibiotic prescribing trends for paediatric inpatients at a non-teaching hospital (NTH) and a teaching hospital (TH) in India.

Design and setting
A prospective, observational study of antibiotic prescriptions in paediatric departments of two private-sector hospitals in central India. Inpatients were grouped into clinically confirmed infections, suspected infections and no infections.

Outcomes
Patients in the NTH and TH and duration of antibiotic prescription, the ratio of prescribed daily dose and defined daily dose i.e. PDD* per 100 bed days, diagnosis-specific patterns and trends, adherence to the Access, Watch and Reserve (AWaRe) classification and prescribing guidelines with significant p value

Objectives
Authentic patient and family engagement in child health research is defined as researchers working in partnership with patients and families on all aspects of the research process, including refining the research question, tailoring the intervention, devising study procedures and disseminating study findings. While there is good evidence of a positive impact of patient engagement on the research process, on research teams and on patient partners, there are few empirical data on the impact of patient and family engagement on research quality and dissemination. We conducted a systematic review to compare research quality and dissemination metrics for paediatric randomised controlled trials (RCTs) that engaged patients and families in the research process with trials that did not.

Design
Systematic review using the Cochrane Highly Sensitive Search to identify RCTs.

Data sources
Ovid MEDLINE from 1 January 2011 through to 31 December 2020.

Eligibility criteria
We included RCTs involving children and youth (

Objective
To assess whether patient experience is better for patients followed in a primary care team (PCT) than for patients with traditional follow-up in usual care.

Design
A cross-sectional survey based on a self-administered questionnaire.

Setting
Pays de la Loire geographical area (located on the French west coast).

Patients and methods
Patients over 75 or over 65 years of age with at least one chronic disease were included. A sample of 9900 frail elderly patients was invited to answer a 23-item questionnaire that investigated four dimensions: ‘communication and patient-centred care’, ‘availability and accessibility’, ‘coordination’ and ‘caregiver’. Their answers were then analysed depending on whether they were followed in a mature PCT, in an emerging PCT or in usual care. The associations between follow-up in a PCT and patient experience were tested with generalised estimation equation models with a Poisson link function, adjusted for sex, age, educational level and the place of residence (French department).

Results
A total of 4078 responses were received. The result of the assessment for the ‘communication and patient-centred care’ dimension was improved for the participants in the PCT group for the following items: ‘Health professionals were concerned about the impact my health had on my everyday life.’ (RR=1.22, 95% CI (1.04; 1.43)), ‘I have received help to better adapt my everyday life to my health.’ (RR=1.25, 95% CI (1.05; 1.50)), ‘I could take part in decisions concerning my health and care.’ (RR=1.19, 95% CI (1.01; 1.42)) and ‘My consent was requested prior to the transmission of the information between health professionals.’ (RR=1.27, 95% CI (1.09; 1.48)). These assessments were not different between the PCT group and usual care group for other dimensions: ‘availability and accessibility’, ‘coordination’ and ‘caregiver’.

Conclusion
This study suggests an improved patient experience in regard to the communication perspective for patients in the PCT group. However, it remains unclear whether interprofessional collaboration (IPC) improves overall patient experience. Additional research could explore aspects of IPC that influence patient experience, providing insights to enhance strategies for improving PCTs.

Objectives
This study aims to explore the perceptions of patients affected by COVID-19 and their families regarding the challenges faced, coping strategies used and lessons learnt in Pakistan.

Design
A qualitative exploratory descriptive approach was used to explore the real-time experiences of the participants.

Setting
The study was carried out in a tertiary care hospital in Karachi, Pakistan.

Participants
Purposive and snowball sampling methods were used to enrol 22 dyads of adult patients diagnosed with COVID-19 and their respective family members (FMs) (spouse, children, siblings or any other FM sharing a residence in Karachi, Pakistan, with the patient before quarantine). The 44 participants, with 23 females and 21 males, had an average age of 43.2 years.

Results
We identified five key themes: practising a healthy diet and physical activity to boost immunity; developing workplace policies for job security, safety and mental well-being; encouraging digitalisation of health through teleconsultation and virtual learning; using technology and artificial intelligence to transform healthcare delivery systems; and empowering resilience and community unity to promote mental well-being.

Conclusion
The study summarises the opinions of people directly affected by COVID-19 and the stakeholders of systemic challenges. The findings of the study can guide further strengthening of the healthcare system and improvements of organisational policies to facilitate better preparation of marginalised communities for future pandemics.

This JAMA Patient Page describes peptic ulcers and their causes, signs and symptoms, diagnosis, and treatment options.

This JAMA Insights explores effective communication strategies for clinicians who do not specialize in treating obesity in how to introduce conversations about weight loss with their patients and offer them support and treatment.

L’allarme burnout e dequalificazione per i sanitari

L’allarme burnout e dequalificazione per i sanitari

Objectives
The aim of this study is to explore patients with persistent somatic symptoms and functional disorders’ (PSS/FD) experiences of and preferences for multidisciplinary care across Europe. A further aim is to compare the experiences of and preferences for multidisciplinary care of patients to those of healthcare professionals (HCPs) in the Netherlands.

Design
Cross-sectional online survey.

Setting
Patients with PSS/FD from across Europe (Germany, Italy, the Netherlands and Poland) and HCPs working in the care for PSS/FD across all levels of care in the Netherlands.

Primary and secondary outcome measures
Outcome measures for both patients and HCPs related to experiences of multidisciplinary care, communication between professionals and patients, as well as the main point of contact for patients.

Results
600 patients responded (Germany: n=198; Italy: n=174; Netherlands: n=137; Poland; n=91), and 152 HCPs responded from the Netherlands. Compared with the other countries, patients from the Netherlands generally received less multidisciplinary care, from fewer disciplines. Regarding most variables related to interprofessional communication, patients in Italy rated their experience significantly better than in most other countries. Generally, patients preferred either their general practitioner (GP) or a medical specialist as their main point of contact, and not mental health professionals. In contrast, HCPs preferred mental health professionals as the main point of patient contact, followed by GPs. In all variables, patients in the Netherlands rated interprofessional communication significantly lower than HCPs in the Netherlands did.

Conclusions
Patients have different experiences of interdisciplinary communication, also reporting lower-quality communication than HCPs, though differences are seen between countries. Future studies should look at the reasons for this and how this can lead to improved care for PSS/FD.

Objectives
Transient loss of consciousness (TLOC) is one of the most common neurological complaints in the Emergency Department (ED), but little is known about the patient perspective. We aimed to explore patient perceptions of diagnostic assessment for TLOC.

Setting
ED, Acute Medical Unit and Syncope and Neurology clinics in a single tertiary teaching hospital in the north of England.

Participants
20 adult patients (60% female, age range 17–90 years) attending or referred with a first presentation of TLOC.

Primary and secondary outcome measures
Exploratory thematic analysis of semistructured qualitative interviews.

Results
We identified three themes within the data: satisfaction with care, unanswered questions and being left in limbo/no man’s land. Participants explored these themes through four topics: communication; the role of investigations; the role of authority and the social context of care.

Conclusions
Communication (including differential diagnosis, significance of investigations and further assessments, and interim safety advice) is emphasised in supporting ongoing self-management, even before a definitive diagnosis is made.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.