Alex Burrell is a GP in Bristol.
Yonder is a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature.
Screening for atrial fibrillation
Screening for atrial fibrillation (AF) is only recommended in certain high-risk populations, for example, following an unexplained ischaemic stroke, and there is currently insufficient evidence to support population-wide screening. This Irish randomised controlled cross- over trial aimed to determine whether using an external loop recorder (ELR) for 1 week in patients aged ≥55 years with a CHA2DS2- VASc score >2 increased the detection of AF compared to usual care with healthcare professional pulse screening.1 As you would expect, it did, with AF found in 32 (6.6%) of the ELR group and 5 (1.0%) of the control group (odds ratio 65, 95% confidence interval = 7.02 to 601.1; number needed to screen 15 [11–23]). All patients who had AF detected were anticoagulated. Participants were only followed up for 2 weeks and there is no cost- effectiveness analysis, so there are a lot of questions still to answer.
Antibiotics in care homes
Looking after patients in care homes presents several challenges, one of which is managing infections in this vulnerable group. Antibiotic resistance is more common than in the general population and the risk of adverse effects from antibiotics is higher.2,3 This Scottish study aimed to quantify prescribing rates of antibiotics for care home residents from April 2016 to March 2017 and explore the impact of resident, care home, and practice characteristics.4 In total, 6633 residents of 148 care homes were included, with a mean age of 84.7 (standard deviation [SD] 8.9) years and 47% having a diagnosis of dementia. A total of 14 977 antibiotic prescriptions were dispensed to 4306 residents (mean 1.62, SD 2.49 per resident) in the study year; amoxicillin made up 25% of all prescriptions. In multivariate analysis, prescribing was associated with increased resident age, comorbidity, and the care home’s microbiological culture sampling rate. General practice factors had no significant impact.
Hand foot, and mouth disease
Hand, foot, and mouth disease (HFMD) is a contagious communicable disease typically diagnosed in children aged <10 years. It is usually self- limiting but rarely can have neurological or respiratory complications. In England, HFMD is not required to be reported by law so there is limited epidemiological information; this retrospective observational study of GP consultations for HFMD from 2017– 2022 aimed to remedy this.5 In the pre-COVID-19 years, peak HFMD was from September– December, with mean weekly rates of 2.03–2.47 per 100 000 registered patients. The pandemic had the expected impact of a drop in rates, followed by an early surge in cases on lifting of restrictions. Across the study period, cases were most common in children aged 1–4 years followed by those aged <1 year, and incidence rates 20% higher in boys than in girls.
Asthma triple therapy
Treatment with inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), and long-acting muscarinic receptor antagonist is often referred to as ‘triple therapy’. It is well- established in chronic obstructive pulmonary disease, but less so in asthma. As I’m sure we all remember well from MRCGP exams, different guideline- producing organisations have different treatment pathways for long- term asthma management (the National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, and British Thoracic Society, for example), and there is some discrepancy between them as to where triple therapy should sit. This Delphi study aimed to define optimal prescribing of triple therapy in adult patients with asthma who were uncontrolled on ICS/LABA treatment.6 The study recommends that triple therapy, ideally delivered in a single combination inhaler to improve adherence, should be considered in patients poorly controlled on ICS/LABA before referral to secondary care. There are a host of other suggestions on how to optimise prescribing of triple therapy, essentially advising a multidisciplinary team approach to prescribing and careful assessment of response to treatment changes, with onward referral for patients who remain uncontrolled despite good adherence.
References
1. Murphy R, Waters R, Murphy A, et al. Risk-Based Screening of Atrial Fibrillation in General Practice (R-BEAT): a randomised cross-over trial. QJM 2025; DOI: 10.1093/qjmed/hcaf001.
2. Xie C, Taylor DM, Howden BP, Charles PG. Comparison of the bacterial isolates and antibiotic resistance patterns of elderly nursing home and general community patients. Intern Med J 2012; 42(7): e157–e164.
3. Marwick CA, Yu N, Lockhart MC, et al. Community-associated Clostridium difficile infection among older people in Tayside, Scotland, is associated with antibiotic exposure and care home residence: cohort study with nested case-control. J Antimicrob Chemother 2013; 68(12): 2927–2933.
4. De Souza N, Guthrie B, Grant S, et al. Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK. Age Ageing 2025; 54(1): afae288.
5. Bednarska NG, Smith S, Bardsley M, et al. Trends in general practitioner consultations for hand foot and mouth disease in England between 2017 and 2022. Epidemiol Infect 2025; 153: e22.
6. Russell REK, Attar-Zadeh D, Harper N, et al. Results from a UK consensus about the optimal prescribing of medium strength triple therapy in uncontrolled adult asthma patients in the NHS. J Family Med Prim Care 2024; 13(12): 5885–5893.
Featured photo by Ali Hajiluyi on Unsplash.
