Essential workers? An institutional ethnographic lens on pandemic GP placements.

BACKGROUND: Clinical placements for medical students in the United Kingdom (UK) came to an abrupt halt in March 2020. The rapidly evolving Covid19 pandemic created specific challenges for educators, balancing safety concerns for patients, students and healthcare staff alongside the imperative to continue to train future clinicians. Organisations such as the Medical Schools Council (MSC) published guidance to help plan return of students to clinical placements. This study aimed to examine how GP education leads made decisions around students returning to clinical placements for the 20/21 academic year. METHOD: Data collection and analysis was informed by an Institutional Ethnographic approach. Five GP education leads from medical schools throughout the UK were interviewed (over MS TEAMS™). Interviews focused on the work the participants did to plan students' return to clinical placements and how they used texts to inform this work. Analysis focused on the interplay between the interview and textual data. RESULTS AND DISCUSSION: GP education leads actively used MSC guidance which confirmed students to be 'essential workers', an unquestioned and unquestionable phrase at the time. This permitted students to return to clinical placements by affording the GP education leads authority to ask or persuade GP tutors to accept them. Furthermore, by describing teaching as 'essential work' in its own right in the guidance, this extended what the GP tutors came to expect to do as 'essential workers' themselves. CONCLUSION: GP education leads activated authoritarian phrases such as 'essential workers' and 'essential work' contained within MSC guidance to direct students' return to clinical placements in GP settings.

Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial.

BACKGROUND: The safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. We aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths associated with COVID-19 in this population. METHODS: PANORAMIC was a UK-based, national, multicentre, open-label, multigroup, prospective, platform adaptive randomised controlled trial. Eligible participants were aged 50 years or older-or aged 18 years or older with relevant comorbidities-and had been unwell with confirmed COVID-19 for 5 days or fewer in the community. Participants were randomly assigned (1:1) to receive 800 mg molnupiravir twice daily for 5 days plus usual care or usual care only. A secure, web-based system (Spinnaker) was used for randomisation, which was stratified by age (<50 years vs ≥50 years) and vaccination status (yes vs no). COVID-19 outcomes were tracked via a self-completed online daily diary for 28 days after randomisation. The primary outcome was all-cause hospitalisation or death within 28 days of randomisation, which was analysed using Bayesian models in all eligible participants who were randomly assigned. This trial is registered with ISRCTN, number 30448031. FINDINGS: Between Dec 8, 2021, and April 27, 2022, 26 411 participants were randomly assigned, 12 821 to molnupiravir plus usual care, 12 962 to usual care alone, and 628 to other treatment groups (which will be reported separately). 12 529 participants from the molnupiravir plus usual care group, and 12 525 from the usual care group were included in the primary analysis population. The mean age of the population was 56·6 years (SD 12·6), and 24 290 (94%) of 25 708 participants had had at least three doses of a SARS-CoV-2 vaccine. Hospitalisations or deaths were recorded in 105 (1%) of 12 529 participants in the molnupiravir plus usual care group versus 98 (1%) of 12 525 in the usual care group (adjusted odds ratio 1·06 [95% Bayesian credible interval 0·81-1·41]; probability of superiority 0·33). There was no evidence of treatment interaction between subgroups. Serious adverse events were recorded for 50 (0·4%) of 12 774 participants in the molnupiravir plus usual care group and for 45 (0·3%) of 12 934 in the usual care group. None of these events were judged to be related to molnupiravir. INTERPRETATION: Molnupiravir did not reduce the frequency of COVID-19-associated hospitalisations or death among high-risk vaccinated adults in the community. FUNDING: UK National Institute for Health and Care Research.

Exploration of sedentary behaviour among GPs: a cross-sectional study.

BACKGROUND: Sedentary behaviour, which may have increased among GPs due to increasing use of telemedicine, is associated with many illnesses and increased all-cause mortality. AIM: To explore levels of sedentary behaviour among GPs and General Practice Specialty Trainees (GPSTs). DESIGN & SETTING: Sequential, cross-sectional design (initial online sedentary behaviour questionnaire and subsequent thigh-worn accelerometer substudy) of GPs and GPSTs in Northern Ireland. METHOD: Self-reported questionnaire data were aggregated and compared with device-measured accelerometry data. RESULTS: Data from 353 participants (17.7% of GPs and GPSTs in Northern Ireland) revealed doctors in general practice self-reported higher workday sedentary time (10.33 hours, SD 2.97) than those in secondary care (7.9 hours, SD 3.43 [mean difference {MD} 2.43 hours; P<0.001]). An active workstation (for example, sit-stand desk), was used by 5.6% of participants in general practice, while 86.0% of those without one would consider using one in future. Active workstation users self-reported lower workday sedentary time (7.88 hours, SD 3.2) than non-users (10.47 hours, SD 2.88 [MD -2.58 hours, P = 0.001]). Accelerometer substudy participants underestimated their workday sedentary time by 0.17 hours (95% confidence interval [CI] = -1.86 to 2.20; P = 0.865), and non-workday sedentary time by 2.67 hours (95% CI = 0.99 to 4.35; P = 0.003). Most GPs (80.7%) reported increased workday sitting time compared to prior to the COVID-19 pandemic, while 87.0% would prefer less workday sitting time. CONCLUSION: GPs have high levels of workday sedentary time, which may be detrimental to their health. It is imperative to develop methods to address sedentary behaviour among GPs on workdays, both for their own health and the health of their patients.

Sedentary behaviour among general practitioners: a systematic review.

BACKGROUND: Sedentary behaviour is when someone is awake, in a sitting, lying or reclining posture and is an independent risk factor for multiple causes of morbidity and mortality. A dose-response relationship has been demonstrated, whereby increasing sedentary time corresponds with increasing mortality rate. This study aimed to identify current levels of sedentary behaviour among General Practitioners (GPs), by examining and synthesising how sedentary behaviour has been measured in the primary care literature. METHODS: A systematic review was conducted to identify studies relating to levels of sedentary behaviour among GPs. Searches were performed using Medline®, Embase®, PscycINFO, Web of Science and the Cochrane Library, from inception of databases until January 2020, with a subsequent search of grey literature. Articles were assessed for quality and bias, with extraction of relevant data. RESULTS: The search criteria returned 1707 studies. Thirty four full texts were reviewed and 2 studies included in the final review. Both were cross-sectional surveys using self-reported estimation of sedentary time within the International Physical Activity Questionnaire (IPAQ). Keohane et al. examined GP trainees and GP trainers in Ireland. 60% reported spending in excess of 7 h sitting each day, 24% between 4 and 7 h, and 16% less than or equal to 4 h. Suija et al. examined female GPs in Estonia. The mean reported daily sitting time was 6 h and 36 min, with 56% sitting for over 6 h per day. Both studies were of satisfactory methodological quality but had a high risk of bias. CONCLUSION: There is a paucity of research examining current levels of sedentary behaviour among GPs. Objective data is needed to determine GPs' current levels of sedentary behaviour, particularly in light of the increase in remote consulting as a result of the COVID-19 pandemic.