Literature Collection

BACKGROUND: Cauda equina syndrome (CES) is a spinal emergency. Over half of known cases first present to primary care for initial assessment. In February 2023, the Getting It Right First Time (GIRFT) national programme launched new CES guidelines, which included an important change in practice: a new urgent referral route. AIM: This study aims to explore the awareness and use of the GIRFT guidelines in a primary care setting in England. DESIGN AND SETTING: A cross-sectional online survey was used to collect data from primary care clinicians working across England. METHOD: Using purposive sampling, the survey was shared with primary care clinicians across England and conducted between 21-10-2024 and 24-12-2024. The RE-AIM framework underpinned the survey design. Descriptive analysis was employed to interpret frequency and Likert data. RESULTS: A total of 515 responses were received from across all 42 integrated care boards in England. Of the 515 participants, 452 (88%) were aware of a CES guideline or pathway, with 297/515 (58%) being aware of the GIRFT guidelines. Two-thirds had access to a local CES pathway (n = 304/452, 67%). Nearly all clinicians highlighted that consulting either a local CES pathway or national guidelines supported their clinical decision making. CONCLUSION: This is the first study to investigate the awareness and utilisation of the GIRFT guidelines in primary care across England. The use of locally agreed CES pathways was shown to increase adherence to their recommendations in primary care. These findings suggest that using up-to-date local CES pathways can increase adherence to the GIRFT guidelines.

INTRODUCTION: This study implements the School-Family-Research Integrated Health Promotion Program for Overweight and Obesity (SFR-OO), which combines exercise and dietary interventions to combat adolescent obesity. It aims to enhance body composition, exercise motivation, SE, and physical fitness. By using a cross-lagged model, the study will explore causal relationships between self-esteem (SE), exercise self-efficacy (ESE), physical activity, and body composition. METHODS: Ninety-eight adolescents were randomly assigned to either the intervention group or the control group. The intervention group received the SFR-OO intervention for 12 weeks. Assessments included physical fitness tests, body composition, and psychological indicators. RESULTS: While both groups showed a time effect (p < 0.001), the intervention resulted in a significant decrease in body fat percentage (BFP) compared to the control group (p < 0.001, p < 0.038). Improvements were greater for knee push-ups, standing long jump, 4 x 10 meters round trip run and supine trunk raise time as well as psychometric measures (p < 0.001). In the intervention group, higher baseline MVPA significantly predicted greater reductions in BFP at 12 weeks (β = -0.169), whereas no such predictive relationship was found in the control group. DISCUSSION: The 12-week SFR-OO effectively enhanced adolescents' body composition, physical fitness, and psychological outcomes. However, SE and ESE did not significantly predict MVPA or BFP. MVPA modestly predicted reduced BFP only within the intervention group, suggesting a context-dependent effect. This study was registered with ClinicalTrials.gov under the registration number NCT06524908.

As the State moves forward to further refine and implement its modernization plan, New Mexico seeks to try a different approach to slowing the rate of growth in the program while avoiding cuts. Our vision is to build a service delivery system that delivers the right amount of care at the right time in the right setting. Our vision is to educate our recipients to become more savvy health care consumers, promote more integrated care, properly case manage the most at-risk members, involve members in their own wellness and pay providers for outcomes, rather than process. New Mexico believes that the up-front investment in seeding medical and health homes and investing in health literacy will return a healthier population and a reduction in the spiraling rate of growth.