Abstract
Website of the month
The National Institute for Health Research (NIHR) has a directory of current research. You can select primary care and search via topic. The entries give you information about the project and how you and/or your patients can participate.
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 for how the process could be improved.
Watts L (2018) Stepping up to adult services. BMJ 362(8169): 412–413. DOI: 10.1136/bmj.k3886.
Prescribing podcasts
I enjoyed reading Dr Dipesh Gopal’s Viewpoint piece of why he prescribes podcasts to patients. Like Dr Gopal, I have been recommending podcasts to patients presenting with a range of conditions. Dr Gopal identifies that for certain patients, this may be a better medium through which to provide information than via written documents. It is the responsibility of the healthcare professional to ensure the recommended materials are of good quality and from reputable sources and, as Dr Gopal highlights, ones that they have listened to and can ‘vouch for’. Podcasts, such as Dr Rangan Chatterjee’s ‘Feel Better, Live More’ and Dr Rupy Aujla ‘The Doctor’s Kitchen’, are hosted by UK-trained GPs with a wide range of experts and many helpful messages covering a range of issues. I would definitely recommend exploring and listening to some of these – it may even change aspects of your own lifestyle.
Gopal DP (2019) Why I prescribe podcasts to my patients. British Journal of General Practice 69(689): 621.
Poetry pharmacy
A place I am desperate to visit – the Poetry Pharmacy is a coffee shop and bookshop in Bishop’s Town, Shropshire. But more than this, the Poetry Pharmacy also provides individuals with the opportunity to visit the ‘Consulting Room’ and be prescribed a poem specific for their ailment. The individuals behind this venture, Deborah Alma and Dr Jim Sheard, have been operating for several years as the ‘Emergency Poet’, prescribing poems for the public from the back of their ambulance. If you live in the area, consultations on Friday afternoon are free.
Climate change
The ‘Green Impact for Health’ website, developed in 2014 by the RCGP in association with other academic and healthcare agencies, provides information and actions to work on for general practices to help improve ‘sustainability and environmental impact’. This would be a fantastic initiative to develop in practice if not already involved.
Unmet needs
Human Rights Watch interviewed 104 people to document assessment for social care. The report makes uncomfortable reading that may chime with issues described by our own patients. It gives examples of personal stories and makes recommendations to government, parliament, local government and the Department of Health and Social Care.
Unmet Needs (2019) Improper social care assessments for older people in England. Human Rights Watch. Available at: www.hrw.org/sites/default/files/report_pdf/uk0119_web3.pdf (accessed 6 December 2019)
Volunteers
The Kings Fund has produced a document looking at the role of volunteers in the NHS. NHS staff enjoy working with a variety of volunteers, but felt that the volunteers should be offered more training and that there should be more clarity about role boundaries.
Ross S, Fenney D, Ward D, et al. (2018) The role of volunteers in the NHS: Views from the front line. The King’s Fund. Available at: www.kingsfund.org.uk/publications/role-volunteers-nhs-views-front-line (accessed 6 December 2019)
Equality matters
The British Medical Association has produced a set of learning modules to promote equality for all medical students and doctors. Modules include micro-aggression and inclusive leadership.
Neuroplasticity and depression
Studies over recent years have suggested neuroplasticity – the remodelling of neurons within the brain – is involved both in mood disorders and in cognitive impairment when impaired or insufficient. Enhancing neuroplasticity through pharmacological and non-pharmacological means has been proposed as a means of treating these conditions, though this is very much at a developmental stage. One hypothetical way of enhancing neuroplasticity is through exercise. For me, this has just enhanced my enthusiasm for recommending exercise to patients with mood or memory disorders.
Albert PR (2019) Adult neuroplasticity: A new ‘cure’ for depression? Journal of Psychiatry and Neuroscience 44(3): 147–150. DOI: 10.1503/jpn.190072.
Environment and health
The European Centre for Environment and Human Health researches the links between the environment and human health. Recent projects include the Forest 404 Experiment (looking at the effects of listening to the sounds of nature) and research on the health of people who work in the fishing industry (some of the poorest health of all workers in England and Wales).
End-of-life care
A qualitative study on admissions to hospital near the end of life has shown that healthcare staff consider hospital admission when there is insufficient nursing provision or where family support (often present but under-supported) is not enough. A related resource problem is support for elderly people who are discharged from hospital. A 2-year cohort study has shown that people who are admitted as a ‘frailty crisis’ even for short stay or via ambulatory care, have increased risk mortality and morbidity.
In the current world of fragmented care, it is difficult to think of immediate solutions. If you are looking for a quality improvement project, review the support for your patients and what small changes could be valuable.
Hoare S, Kelly M and Barclay S (2019) Home care and end-of-life hospital admissions: A retrospective interview study in English primary and secondary care. British Journal of General Practice 69(685): 387. DOI: 10.3399/bjgp19X704561.
Keeble E, Roberts H, Williams C, et al. (2019) Outcomes of hospital admissions among frail older people: a 2-year cohort study. British Journal of General Practice 69(685): 386.
Social prescribing
Another great resource related to social prescribing is the ‘Social Prescribing Network’. The website provides a wide range of both interesting and useful links and documents, including information from their July 2019 conference and details of forthcoming conferences for 2020.
Vestibular migraine
Vestibular migraine was not a diagnosis that appeared in my differential when I was a GP trainee. Over the last 10 years I have seen increasing numbers of patients with this diagnosis, for many of whom it is disabling and career changing. Patients in this subgroup of ‘dizziness’ may experience significant diagnostic delay, particularly if they have a variant with no headache. As response to migraine prophylaxis may be good, it is useful to consider the diagnosis.
Li V, McArdle H and Trip S (2019) Vestibular migraine. BMJ 366(8207): 73–75. DOI: 10.1136/bmj.l4213.
Widening access
In July 2019, seven women, including Sophia Jex-Blake, were awarded posthumous medical degrees 150 years after they began their medical studies. Resistance from their male peers meant that although they studied the full medical course at Edinburgh University, they were prevented from graduating. I expect most of us cannot imagine a time when women were not allowed to study to become doctors. It would be good to look to a future where other groups of people who are disadvantaged by poverty and other barriers are all equally able to access education in early life and then study any subject of their choice.
Fertility awareness
Many women now regularly track their periods on apps. You may find you are asked about using the information to predict ‘fertile, or fecund, windows’ both to achieve and to prevent pregnancy. There is a helpful summary article in the BMJ discussing the pros and cons of some of these methods.
Urrutia R and Polis C (2019) Fertility awareness based methods for pregnancy prevention. BMJ 366(8207): 76–79. DOI: 10.1136/bmj.l4245.
Insomnia
Guidelines recommend that chronic insomnia should be treated with cognitive behaviour therapy for insomnia (CBT-I). In a systematic review of articles over the last decade CBT-I given over four to six sessions was associated with sustained improvement in a number of sleep outcomes.
Davidson J, Dickson D and Han H (2019) Cognitive behavioural treatment of insomnia in primary care: A systematic review of sleep outcomes. British Journal of General Practice 69(686): 440. DOI: 10.3399/bjgp19X705065.
ORCID iD
Kathryn Steven https://orcid.org/0000-0002-7534-2932