Introduction and Objectives
The accuracy of conclusions based on Electronic Healthcare Record (EHR) research is highly dependent on the correct selection of descriptors (codes) by users. We aimed to evaluate the feasibility and acceptability of filmed vignette monologues as a resource-light method of assessing and comparing how different EHR users record the same clinical scenario.

Methods
Six short monologues of actors portraying patients presenting allergic conditions to their General Practitioners were filmed head-on then electronically distributed for the study; no researcher was present during data collection. The method was assessed by participant uptake, reported ease of completion by participants, compliance with instructions, the receipt of interpretable data by researchers, and participant perceptions of vignette quality, realism and information content.

Results
22 participants completed the study, reporting only minor difficulties. 132 screen prints were returned electronically, enabling analysis of codes, free text and EHR features. Participants assigned a quality rating of 7.7/10 (range 2-10) to the vignettes and rated the extent to which vignettes reflected real-life (86-100%). Between 1 and 2 hours were required to complete the task. Full compliance with instructions varied between participants but was largely successful.

Conclusions
Filmed monologues are a reproducible, standardized method which require few resources, yet allow clear assessment of clinicians’ and EHRs systems’ impact on documentation. The novel nature of this method necessitates clear instructions so participants can fully complete the study without face to face researcher oversight.

Objective: To assess the effect of coding quality on estimates of the incidence of diabetes in the UK between 1995 and 2014.

Design: A cross-sectional analysis examining diabetes coding from 1995 to 2014 and how the choice of codes (diagnosis codes vs codes which suggest diagnosis) and quality of coding affect estimated incidence.

Setting: Routine primary care data from 684 practices contributing to the UK Clinical Practice Research Datalink (data contributed from Vision (INPS) practices).

Main outcome measure: Incidence rates of diabetes and how they are affected by (1) GP coding and (2) excluding ‘poor’ quality practices with at least 10% incident patients inaccurately coded between 2004 and 2014.

Results: Incidence rates and accuracy of coding varied widely between practices and the trends differed according to selected category of code. If diagnosis codes were used, the incidence of type 2 increased sharply until 2004 (when the UK Quality Outcomes Framework was introduced), and then flattened off, until 2009, after which they decreased. If non-diagnosis codes were included, the numbers continued to increase until 2012. Although coding quality improved over time, 15% of the 666 practices that contributed data between 2004 and 2014 were labelled ‘poor’ quality. When these practices were dropped from the analyses, the downward trend in the incidence of type 2 after 2009 became less marked and incidence rates were higher.

Conclusions: In contrast to some previous reports, diabetes incidence (based on diagnostic codes) appears not to have increased since 2004 in the UK. Choice of codes can make a significant difference to incidence estimates, as can quality of recording. Codes and data quality should be checked when assessing incidence rates using GP data.

Background: 360 million consultations documented annually in England1 Accurate descriptors required for secondary data functions: Computerised decision support; Financial reimbursement; Audit; Disease prevalence monitoring and research Coding is not explicitly taught within the GP curriculum How do you research how clinicians document? Previous studies: use real patients2/actors3 interacting with clinician studied; Lack standardisation; Expensive. Why Allergy? Growing clinical problem; 2014 NICE guidelines4: Poor clinical documentation is a major issue in allergy; EHR can’t distinguish between intolerance and allergy; Incorrect labelling of patients; Adverse impact on patient care? Little known about coding practices in non-incentivised condition such as allergy. Method: A novel method developed to standardize research of EHR use. Filmed 6 short vignettes (21-50 secs) Monologue of common allergic presentations as if in consultation with a doctor. Digital photographs were included to replicate rashes. Electronic distribution of study files Documented vignettes in their own EHR Returned screen-prints to the researcher for analysis - Codes, free text and EHR functions Questionnaire - Exploring decision-making and validation of method Initially piloted on 1 GP and 2 trainees leading to refinements. Results 7 GPs and 15 GP trainees were recruited All successfully completed Data was returned from 4 different EHRs SystmOne (6), EmisLV (2), EmisWeb (6) and Vision (8) Screen prints effectively captured data with minor technical difficulties reported by 2 participants The study took 1 - 2 hours to complete: longer than expected from the pilot study.

Between 20% and 40% of young children suffer a feverish illness each year and many of these will present to their general practitioner. Although the majority of these children have benign, self-limiting illness, infection remains the leading cause of death in children under the age of 5 years. Appropriate assessment, management and referral of the febrile child are important skills to acquire for doctors working in primary care. This article outlines the signs and symptoms of serious infective illness in children under 5 years of age and describes current National Institute for Health and Clinical Excellence (NICE) guidelines for feverish illness in children and the use of the ‘traffic-light’ risk score in the context of face-to-face and remote assessment.

Confusion is a common cause of acute admissions, encompassing dementia, delirium and depression (Bostwick, 2000). Because of this diagnostic challenge, acute confusion is often misdiagnosed and undertreated; one study found this to be the case in 94% of older people in hospitals (Ski and O'Connell, 2006). For a foundation doctor it can be difficult to know where to start with such a patient and yet this type of admission is extremely common. This article raises awareness of the appropriate management of a patient with confusion as part of good medical practice and thus improve the quality of care for patients with dementia and delirium in hospitals.

Recreational SCUBA (self-contained underwater breathing apparatus) is defined as diving to a depth of 40 metres without decompression stops. This has become increasingly popular over the last two decades, with around 100 000 individuals in the UK participating in diving (British Thoracic Society, 2003; Edmonds, Lowry, Pennefather & Walker, 2005). This article considers what GPs need to know about contraindications to diving, professional liability associated with documenting fitness to dive and the role of diving medicine specialists.

Exploiting the information contained within electronic healthcare records (EHR) data will be key to addressing major challenges to public health both nationally and globally, ultimately offering a means of maximising efficiency and equality in care. There are, however, significant challenges in using EHRs effectively and particularly in ensuring the quality of data recorded. Incorrect or missing data could render records as useless or indeed misleading such that conclusions drawn from the data could have a negative impact. Amongst other difficulties, recording data can be time consuming to the extent of conflicting with the GP’s primary focus of patient consultation in an already time-constrained environment. Understanding the requirements of and the demands upon GPs must be central to addressing the issue of data quality (DQ) within EHRs.
As part of on-going work into DQ at the Clinical Practice Research Datalink (CPRD) and in collaboration with the University of Sussex (UoS), a workshop session was held at the SAPC (Society for Academic Primary Care) conference in 2014 with the aim of exploring issues of DQ in primary care EHRs from the perspective of different users of GP data and with particular focus on how and why data is recorded in the first instance. The intended outcome was a furthered understanding of both the challenges and the direct benefits to GPs of ensuring high quality data with a view to establishing a workable approach to recording data and maximising benefits to all users of EHRs.

Rhinitis is characterized by nasal discharge, congestion, blockage and sneezing. These symptoms can have a variety of aetiologies, including allergic, non-allergic or infective causes. This article focuses on the diagnosis and management of patients with non-allergic non-infective rhinitis, but clearly, there are overlaps with the
management of rhinitis due to other causes. Non-allergic rhinitis is very common; it is estimated to affect almost one in four adults, particularly elderly patients.

Saudi Arabia is a rapidly developing, oil-rich country. In less than a century it has been transformed from a desolate desert landscape into an affluent kingdom of modern cities, skyscrapers and international airports. Originally inhabited by nomadic Bedu, King Abdul-Aziz Al Saud led a movement in 1932 to unite this vast area of distinct tribal regions into one nation. It is now the largest country in the Middle East with a population of 28 000 000 people (Ministry of Health (MoH), 2012). The development of the Saudi Arabian healthcare system and the challenges it faces are considered within this article.

Background The rate of new HIV infections in the UK continues to rise, with one-quarter of cases undiagnosed. Opt-out HIV testing — in which tests are routinely offered to all patients, with the offer to decline — have proved effective in antenatal care. Pilot studies of HIV opt-out testing at GP registration and acute medical admission to hospital have described service-level issues and the clinician’s perspective, but not the views of the general public.

Aim To further understand the public’s perspective on opt-out testing for HIV in England.

Design and setting Focus groups (n = 9) with a total of 54 participants in Brighton, England, where HIV prevalence is high.

Method Quota sampling on sexual orientation, age, sex, and testing experience was applied to groups with high and low HIV prevalences, and analysed using framework analysis.

Results Opt-out testing for HIV was acceptable. Testing on GP registration was regarded as a more appropriate setting than acute medical admission. Participants from groups in which HIV has a higher prevalence felt HIV testing required consideration that may not be possible during acute hospital admission. However, there was concern that screening would still be targeted at groups in which HIV prevalence is higher, based on clinicians’ judgement of patients’ behaviours, sexuality, or ethnicity.

Conclusion The opt-out method of testing for HIV must be routinely offered to all who are eligible, to increase test uptake and to prevent communities feeling targeted. Any pressure to test is likely to be poorly received. Inaccurate concerns about medical records being shared with financial services are a disincentive to test. Primary care should be an active setting for opt-out HIV testing.