Abstract
Transition to adult care
Over the years I have seen a variety of problems when children with long-term conditions transition to adult care. Lucy Watts gives a patient’s view of this and makes suggestions on how to improve the process.
Watts L (2018) Stepping up to adult services. BMJ 362(8169): 412–413. DOI: 10.1136/bmj.k3886.
Overdiagnosis group
I belong to the overdiagnosis group at the RCGP. We discuss online a variety of topics with evidence-based medicine as the theme. This year:
One of our members published an article about incidentalomas Council debated (and endorsed very quickly) a RCGP statement on screening Group members were involved in several sessions at the RCGP Conference Membership is open to all; you have to be prepared to declare any conflicts of interest
Increasing general practice in undergraduate education
In 2018, the RCGP and the Society for Academic Primary Care published recommendations stating that medical schools should aim to have 25% of clinical placements in general practice. This is perhaps both an opportunity and a challenge for medical schools, and also for GP practices trying to accommodate more medical students. For those interested in undergraduate education or teaching, consider contacting local universities to investigate what opportunities there are to get involved in the delivery of teaching.
sapc.ac.uk/sites/default/files/rcgp-curriculum-guidance-oct-2018.pdf
Ca125
Within my current practice, ordering a Ca125 test activates a warning about the test’s limitations for use in diagnosing ovarian cancer. However, a recent study of the test as used in primary care has identified that it is more effective than previously thought. The advice is to continue using this blood test in any women over the age of 50 with suspicious or unexplained gastrointestinal symptoms (including symptoms of irritable bowel syndrome (IBS)), genito-urinary symptoms or vague symptoms such as tiredness or weight loss.
Russell M, Graham C, D’Amato A, et al. (2019) Diagnosis of epithelial ovarian cancer using a combined protein biomarker panel. British Journal of Cancer 121: 483–489. DOI: 10.1038/s41416-019-0544-0.
Telephone support for mental health
A recent consultation made me reflect on the importance of asking patients what would be the most useful type of support for them. For patients presenting with mental health problems who have dyslexia, visual problems or who cannot access online or written material, listening services or telephone sources of support may be useful. England, Wales and Scotland offer different services, these can be found at the NHS website.
www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/
Bleach baths
This is a treatment strategy to aid management of atopic eczema that I had not come across before. Through reduction of bacterial load on the skin, bleach baths are thought to help symptoms for some individuals. A recent systematic review concluded that although bleach baths reduced the severity of atopic eczema, they were no more effective than water baths and that further studies were needed. They are still identified as a treatment strategy for patients. Useful resources can be found through the link from Oxford University Hospital.
Chopra R, Vakharia P, Sacotte R, et al. (2017) Efficacy of bleach baths in reducing severity of atopic dermatitis: A systematic review and meta-analysis. Annals of Allergy Asthma Immunology 119(5): 435–440. DOI: 10.1016/j.anai.2017.08.289.
www.ouh.nhs.uk/patient-guide/leaflets/files/14447Peczema.pdf
Sleep and migraine
After a very interesting letter from a local neurology colleague, I was interested to find out more about the very close link between migraine and sleep. While I had been aware that fatigue and being over-tired could contribute to migraine, I did not appreciate the importance for example of sticking to regular bedtimes and wake up times for sufferers of chronic migraine. A useful source of information is the Migraine Trust. In fact, sleep and circadian rhythms are increasingly recognised as contributing to health and various diseases. For those interested, I would recommend Professor Satchin Panda’s book ‘The Circadian Code’.
www.migrainetrust.org/living-with-migraine/coping-managing/sleep/
Panda S (2018) The Circadian Code. Penguin Books.
Fragility fracture
Having recently fractured my wrist, I am reminding myself of the definitions of a fragility fracture! These are identified as fractures that occur with no trauma or from standing height or less. In considering fracture repair and bone density, I recall a patient who recently informed me that she had not done any exercise since being diagnosed with osteoporosis. She had been told she had brittle bones and as a result thought she should not exercise. This highlighted both the importance of words used with patients in descriptions and explanations of osteoporosis, and the need to include lifestyle measures, such as exercise, in making management plans for patients. Helpful information sheets and exercise videos are available through the Royal Osteoporosis Society.
Dizzy patients
A recent Dutch study on vestibular disorders highlights the under use of the Epley manoeuvre and vestibular rehabilitation by GPs. The University of Southampton have produced an online ‘Balance Retraining’ programme, which they advise patients use working with their GP, and the site has a letter patients can print off and take to their GP (there is also a printable version of the balance retraining exercises).
van Vugt Vincent A, van der Wouden C, Essery R, et al. (2019) Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: Three armed randomised controlled trial. BMJ 367: l5922. DOI: 10.1136/bmj.l5922
Managing change
Change is difficult. One of our local Quality Improvement Initiatives showed us this video of children explaining the issues.
Vegetarianism
The EPIC (European Prospective Intervention into Cancer) trial, a UK-based prospective longitudinal study, has shown that fish eaters and vegetarians have lower rates of ischaemic heart disease. Compared with meat eaters, the vegetarians had a higher risk of stroke (mainly haemorrhagic). This was a single study, based on a UK population, showing association, not cause.
Tong T, Applebey P, Bradbury K, et al. (2019) Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow up. BMJ 366(8212): 274–275.
Dose responsive exercise
A systematic review and meta-analysis have suggested that all forms of physical activity, including low intensity exercise, are associated with a reduced risk of death in a dose-responsive manner. At our surgery we have been trying to focus on mobility of the house- and chair-bound, so this is a useful study to be able to quote.
Ekelund U, Tarp J, Steene-Johannessen J, et al. (2019) Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality. BMJ 366(8211): 228–229. DOI: 10.1136/bmj.l4570.
Addicted to eating
I was interested in an article written by a woman who struggled with her weight all her life until she started treating the problem as an addiction rather than as shameful behaviour. She found use of the word ‘sobriety’ and other terms used in addiction, helpful in finding new ways to manage her issues. I was struck that the article is anonymous and wonder what that says about current societal attitudes.
Anonymous (2019) What your patient is thinking. Addicted to eating. BMJ 366(8211): 247. DOI: 10.1136/bmj.l4776.
NHS Forest
The Centre for Sustainable healthcare has been involved in a variety of projects using ‘nature working’ as a route to wellbeing.
nhsforest.org/sites/default/files/Prescribing%20Green%20Space-3.pdf
Pocket guides
The Royal College of Nursing produces a variety of pocket guides, including women’s health, domestic abuse and modern slavery. They are designed to be easy to read, give bullet point information and list useful resources.
Leaflets are available from www.rcn.org.uk.
Fairhealth
Fairhealth produces free educational resources for healthcare professionals to help them think about and influence health inequalities.