Abstract
Website of the month
MindEd is a free government-funded, open-access resource for health professionals, patients and carers. It provides online learning about common mental health problems for children, older adults and, soon to be added, learning disability. You can search for individual topics and themes that can be added to a personalised learning system.
Exercise and multiple sclerosis
The multiple sclerosis society website has a section on keeping active. There are videos showing different levels of activity and advice about types of activity that may be helpful for different symptoms or when having a relapse.
www.mssociety.org.uk/care-and-support/everyday-living/staying-active
Hyperemesis
Over my career, I have seen several women requesting terminations of pregnancy because of previous or current experience of hyperemesis gravidarum. A recent BMJ article summarises current guidelines and management. There is a pregnancy-unique quantification of emesis and nausea form (PUQE) to help assessment and a useful figure summarising first-, second- and third-line treatment options. A patient opinion piece gives ideas about use of language and advocates ensuring that we clarify the range of different treatment options available.
Dean C, Shemar M, Ostrowski G, et al. (2018) Management of severe pregnancy sickness and hyperemesis gravidarum. BMJ 363(8179): 410–411.
Davies R (2018) Constant sickness is not good news. BMJ 363(8179): 412.
Swimming and arthritis
In the past, the advice for knee pain was to avoid breast stroke when swimming. This came up in a recent consultation with a patient with knee arthritis. Exploring the Arthritis Research Campaign website, I found that the same advice also applies to patients with knee replacements and hip and knee arthritis. The advice applies because of the direction of force around the knee in breaststroke.
Family Lives
As GPs we often see parents or children with problems that relate to issues in the home. While support is sometimes available from health visitors, I recently came across a charity called ‘Family Lives’, which aims to provide support and advice to families. They have a free, confidential phone line that provides support about any aspect of parenting.
MSK – HQ
I recently also came across the Musculo-Skeletal Health Questionnaire, developed by Arthritis Research UK Primary Care Sciences Research Centre at the University of Keele and the University of Oxford. The questionnaire aims to establish the impact of a musculoskeletal condition on quality of life, and could be a useful tool to use in the management of patients with arthritis to look for improvement or deterioration in their symptoms.
Support for amputees
Two websites providing support and advice for patients and their families undergoing amputation are ‘Limbcare’, which educates and informs about all aspects of life after amputation, and ‘Finding your feet’. ‘Finding your Feet’ also runs local clubs for amputees in Glasgow, Aberdeen, Edinburgh, Dundee and Leeds, including activities such as swimming, Pilates and climbing.
Quinolones and tendonitis
When recently prescribing a long course of ciprofloxacin, a colleague reminded me of the importance of explaining the risk of tendonitis. Tendonitis can occur within 48 hours and up to several months after taking the drug. The risk is greater in patients over 60. Patients should be advised to stop taking the drug if they develop any tendon pain indicative of tendonitis.
Gluten-related neurological conditions
New to me this week are ‘gluten-related neurological conditions’. Gluten ataxia, gluten neuropathy and gluten encephalopathy are all rare disorders, but slightly more common in patients with coeliac disease, particularly if a gluten-free diet has not been adhered to – highlighting again the importance of communicating the need for a strict gluten-free diet.
University of the Third Age
I recently heard for the first time about the ‘U3A’. University of the Third Age is a UK-wide organisation that brings retired and semi-retired people together to learn, share experiences and have new ones. The U3A are not prescriptive about age, but are aimed at individuals no longer in full time employment. Members are encouraged to share their own knowledge and skills. For older patients this may be a good way to get out, meet people and try something new, particularly if feeling lonely or isolated.
Vitamin D and sunlight
As the sunnier months approach, hopefully the UK population will top up its vitamin D levels with some sensible sun exposure. A good resource on this for patients is the NHS choices website. However, regarding the subject of vitamin D supplementation, The Scientific Advisory Committee on Nutrition (SACN) recommends a reference nutrient intake of 10 micrograms per day (400 international units) of vitamin D, and to ensure that, for certain population groups (those not getting enough vitamin D either from their diet or from the sun in summer months), this recommendation is applicable throughout the year.
www.gov.uk/government/publications/sacn-vitamin-d-and-health-report
Social determinants of health
The Health Foundation has written a short booklet looking at health and wellbeing and what determines this. The booklet identifies moral, social and economic reasons for promoting wellbeing, and gives a variety of statistics about the inequities of opportunity that are related to variance in health. Current GP trainees are the policy makers and influencers of the future. This brief summary might give you food for thought.
Lovell N and Bibby J (2018) What makes us healthy? An introduction to the social determinants of health London. The Health Foundation Publishers. Available at www.health.org.uk (accessed January 2019)
Suicide and hormonal contraception
A large nationwide (Danish) prospective cohort study of about half a million women has shown that use of hormonal contraception is positively associated with suicide attempts and with suicides. The association peaked after 2 months of use, and the highest relative risk was in adolescent women.
Pregnancy, wanted or unwanted, is also related to suicide and mental health problems so we should not use this study to avoid prescribing hormonal contraception, perhaps more as a reminder to take a social and psychological history when we do prescribe.
Skovlund C, Morch L, Kessing L, et al. (2018) Association of hormonal contraception with suicide attempts and suicides. American Journal of Psychiatry 175(4): 336–342.
Hearing loss
There is new National Institute for Health and Care Excellence (NICE) guidance on the management of adult hearing loss. It is estimated that about four consultations in an average GP day relate to hearing loss.
One of the recommendations is that all adults should be referred to audiology services for assessment the first time they present, rather than ‘waiting until it is really bad’. Action for hearing Loss has a GP section giving advice about making surgeries accessible and dealing with patients with hearing loss or tinnitus. Patients can check their own hearing via an online link
www.actiononhearingloss.org.uk/how-we-help/health-and-social-care-professionals/gps/
NICE (2018) Hearing loss in adults: Assessment and management. Available at: www.nice.org.uk/guidance/ng98 (accessed 9 January 2019).
When should I worry?
Most children with minor illness who see a GP are still unwell 4 days later. A third of children who see their GP with a cough will still be coughing 2 weeks later. Many of these do not need to see their GP again.
A booklet produced by the University of Cardiff gives simple advice to parents and carers about the treatment of minor illness, and the red flags that mean they should seek help.