Abstract
Website of the month
People with autism die much younger than the rest of the population. Epilepsy is a major cause of death. In high functioning people with autistic spectrum disorder, suicide is nearly ten times more common. The website of the charity Autistica gives a variety of stories looking at different aspects of autism. One of these is currently featured on the RCGP website; the story of a young man whose diagnosis in his teens led to a change in his support and performance, allowing him to complete a doctorate.
www.rcgp.org.uk/clinical-and-research/clinical-news/the-benefits-of-an-autism-diagnosis.aspx
Manchester
Over six billion pounds a year of health and social care is being devolved to a partnership of Greater Manchester local authorities and NHS organisations. Changes to a lesser or greater extent are being planned and delivered wherever you are training. These changes will define the environments in which you will work, so I think it is worth using some of your protected training time to look at your local developments.
UK Medical Eligibility Criteria
The new UK Medical Eligibility Criteria were published in April 2016. They give guidance on the safety of contraceptive methods with regard to medical conditions and patient characteristics. Long-acting reversible methods are now presented first, a reflection of the importance of promoting their use in many conditions where pregnancy, especially unplanned, might pose significant risks to health. Several conditions, e.g. history of bariatric surgery and atrial fibrillation, have been added, as has a resource on the diagnosis of migraine. The full document is available on www.fsrh.org, along with some useful summary sheets.
Inflammatory markers
I suspect I bore our registrars with advice to just perform specific blood tests for which they want an answer. I was interested to read a qualitative study questioning the use of ‘screening’ inflammatory markers.
Watso, J., De Salis, I., Hamilton, W., & Salisbury, C. (2016). ‘I’m fishing really’ – inflammatory marker testing in primary care: A qualitative study. British Journal of General Practice 66(644), 138–139
Telephone triage
Our practice is too busy. We have a growing demand for appointments and are exploring ways of altering access. A recent British Journal of General Practice study did not save overall clinician time. You might find it useful to look at the different ways your local training practices are using to balance demand and clinician recruitment issues.
Holt, T., Fletcher, E., Warren, F., Richards, S., Salisbury, C., Calitri, R.,…, Campbell, J. (2016). Telephone triage systems in UK general practice: Analysis of consultation duration during the index day in a pragmatic randomised controlled trial. British Journal of General Practice, 66(644), 142–143
Prostate testing
I find consultations discussing screening for prostate cancer difficult. Current Prostate Cancer UK advice is to discuss prostate cancer screening with asymptomatic men from 45 who are at a higher-than-average risk (e.g. family history of prostate cancer or black men). More controversial is the advice to discuss baseline tests with men in their 40 s, to help assess future risk. The full consensus statements are available at prostatecanceruk.org/PSAconsensus.
Hydrolysed formula
On a weekly basis, advertisements for a variety of infant milk products fall out of my journals as I open them. I regularly see worried mothers being pressurised by family and friends to give up breast feeding and move to ‘less allergic’ preparations. A recent systemic review and meta-analysis looked at intervention trials involving over 19 000 participants and stretching back over 50 years. There was no consistent evidence that partially or extensively hydrolysed formulas reduced the risk of allergic or autoimmune outcomes.
Boyle, R., Lerodiakonou, D., Khan, T., Chivinge, J., Robinson, Z., Geoghagen, N.,…, Leonardi-Bee, J. (2016). Hydrolysed formula and risk of allergic or autoimmune disease: Systematic review and meta-analysis. BMJ, 352i974. Retrieved from www.bmj.com/content/352/bmj.i194
Genomics
Patients are likely to come and ask us questions about the use of genomics. Health Education England has produced a series of videos, free to access, for health professionals to learn about genomics. Topics include introductions to genomics and to bioinformatics.
Mefirst
Mefirst is an education and training resource intended to help health professionals communicate with children. There is a session working through the stages of the mefirst model.
How do I know that you are going to listen to me? Why am I here? What are my choices? How do you know what is important to me? What decision have we made? What will happen next?
There are also stories, videos and a site where resources can be shared.
Patient perspective
The Journal of Patient Experience gives a view of healthcare from the patient’s point of view. When we are very busy, patients who attend frequently can make me feel irritated. A student view of such a patient made me reflect about the individuals behind such attendees.
Shoemake, J. (2016). Student perspectives with a high-utilising patient. The Journal of Patient Experience, 3(1), 24–25. Retrieved from jpx.sagepub.com/content/3/1/24.full.pdf+html
The Honest Mums’ Club
Hannah Oakland is a mum who writes a blog and has now written a book describing her journey through two children and associated postnatal depression. She describes her efforts to be a ‘good mother’, her magnified guilt when she feels that she is not and the different ways, including antidepressants, that she tries to cope.
Oakland, H. (2016). The Honest Mums’ Club. Darton, Longman and Todd, London
Concerns
Sharing concerns about patient safety is one of our duties as doctors. Health Education England has produced a film on raining concerns.
Home Oxygen Order Form
Do you know how or when to prescribe home oxygen? You might find discussion of a Home Oxygen Order Form a useful tutorial. It might be worth making a list of some of the slightly less common things, such as getting catheters changed, organising syringe drivers or utilising the local admissions avoidance team, and finding out in advance how to arrange them, rather than have to work it out at 6 pm on a Friday evening.
Fibroids
Ulipristal has been licensed for preoperative treatment for women with fibroids, and for intermittent use in women with moderate to severe symptoms from uterine fibroids. Because of the potential side effect of endometrial thickening, periodic ultrasound is recommended if repeated courses are used.
GOLD
The Global Initiative for Chronic Obstructive Lung Disease gives up-to-date guidelines on the management of chronic obstructive pulmonary disease. Patients are divided into four groups on the basis of their symptoms and risk of exacerbation. There is a table assessing the features of chronic obstructive pulmonary disease (COPD) and asthma, which allows identification of the (rare) asthma-COPD overlap syndrome.
Learning together
The Royal College of Paediatrics and the RCGP have produced a joint position paper, Learning Together to Improve Child Health, advocating working and learning together. The pilot scheme, which ran in London where I work, brought GP and paediatric trainees together in child health clinics. As well as being a good and enjoyable learning environment, there were positive patient outcomes, including reduced emergency department attendances, fewer onward paediatric referrals and better adherence to national guidance. The full document and a summary can be read on the Royal College of Physicians’ website. I hope it gives you ideas to try out in your own areas.