Abstract
Perinatal support
COVID-19 has affected all of us. At the start, pregnant women had the fear of the unknown, many had deliveries very different from those planned, and had to deal with new babies without family input.
A rapid review during COVID has flagged some key points.
Asian women are twice, mixed ethnicity women three times and black women five times more likely to die during pregnancy. Of women who die during pregnancy, half had features where it is thought action taken might have changed the outcome. Black, Asian and Minority Ethnicity (BAME) women with other serious illnesses are at greater risk of complications of COVID-19. The most common causes of death after 6 weeks are suicide and cancer. Referral on more than one occasion with mental health symptoms should be treated as a red flag.
The GP contract update from 2020 specifies that practices should deliver a maternal check at 6–8 weeks, additional to the 6–8-week baby check. It might be worth looking at how your practice has changed systems to respond to these recommendations.
Knight M, Bunch K, Cairns A, et al.; on behalf of MBEEACE-UK (2020) Saving Lives, Improving Mothers’ CareRapid report: Learning from SARS-CoV-2-related and associated maternal deaths in the UK Maternal, Neonatal Perinatal Epidemiology Unit University of Oxford. Available at: www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/MBRRACE-UK_Maternal_Report_2020_v10_FINAL.pdf
Addiction to opiates
I imagine we are all struggling with patients who have ended up on larger doses of opiates or atypical analgesics but are still in pain. This Family Medicine article gives an interesting slant on how medicine and pain management has come to this predicament.
Hughes J, Kale N, and Day P (2019) OxyContin and the McDonaldization of chronic pain therapy in the USA. Family Medicine and Community Health 7: e000069. DOI: 10.1136/fmch-2018-000069.
Chest X-rays and lung cancer
A systematic review has concluded that chest X-ray has only about 77–80% sensitivity in the detection of lung cancer in symptomatic patients. This is not a new suggestion, so may be already reflected in your local guidelines. It is however worth remembering that a normal chest X-ray should not give full reassurance in a patient you believe to be at risk.
Bradley S, Abraham S, Callister M, et al. (2019) Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: A systematic review. British Journal of General Practice 69(689): e827–e835. DOI: 10.3399/bjgp19X706853.
World Sleep Day
World Sleep Day falls on 19 March 2021. Sleep is something I am passionate about, and think we should all be interested in, for our own health, the health of our patients and the health of our colleagues. The BMJ Opinion blog highlights the need to move away from a work culture that allows doctors to become sleep deprived, risking the health of themselves and others. Some other great resources on sleep are also highlighted.
Morgan M and Brindley P (2019) Why it’s time we all woke up to the importance of sleep. BMJ Opinion. Available at: blogs.bmj.com/bmj/2019/07/28/matt-morgan-and-peter-brindley-why-its-time-we-all-woke-up-to-the-importance-of-sleep
Walker M (2017) Why We Sleep. Penguin Random House UK.
Chatterjee R (2019) Feel better, live more: Why Sleep is the most important pillar of health. Available at: drchatterjee.com/why-sleep-is-the-most-important-pillar-of-health-with-professor-matthew-walker/
Ballet and health
This week I had the wonderful opportunity to hear how Scottish Ballet have developed programmes for individuals with Parkinson’s disease, dementia and multiple sclerosis. Run by dancers, these programmes offer people the chance to express themselves through movement and to meet and chat with others going through the same condition. Currently classes are running via Zoom. A similar programme, ‘Dance for Parkinsons’ is run by the English Ballet. Scottish Ballet are keen for clinicians to know about the enormous benefits dance offers to people with these conditions.
E-cigarettes
Staying up to date is hard work. I have found it hard to decide how to advise people about the use of e-cigarettes. Last year a BMJ State of the Art Review summarised the available information about the possible pathophysiology involved with vaping. Particularly for some of my very young patients, I find it useful to have some evidence about the science behind possible harms.
Gotts J, Jordan’s S, McOnnell S, et al. (2019) What are the respiratory effects of e-cigarettes. BMJ 367(8222): 283–286. DOI: 10.1136/bmj.l5275.
Transition
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 to improve the process.
Watts L (2018) Stepping up to adult services. BMJ 362(8169): 412–413. DOI: 10.1136/bmj.k3886.
Prescribing lifestyle medicine
This week I completed the Clinical Education ‘Prescribing Lifestyle Medicine’ course run by Dr Panja, Dr Chatterjee and Dr Ash. I would whole-heartedly recommend this excellent course. It was the perfect introduction to lifestyle medicine, covering in depth the physiology, pathology and immunology underlying the non-communicable diseases afflicting society today but also being clinically relevant, with real case scenarios explored. Participants are equipped with the tools to start implementing lifestyle approaches into the next morning surgery and I am very much looking forward to putting what I learned into practice.
Heart failure
An updated Cochrane review found no evidence that exercise-based rehabilitation reduces all-cause mortality, but there is some evidence for reduction of all-cause hospital admissions. Studies exist showing improvement in health-related quality of life, but the evidence is of low quality.
Long L, Mordi I, Bridges C, et al. (2019) Exercise-based cardiac rehabilitation for heart failure. Available at: www.cochrane.org/CD003331/VASC_exercise-based-cardiac-rehabilitation-heart-failure
Healthy lifestyles
A large prospective cohort study using data from the Nurses’ Health Study and the Health Professionals Follow-up Study showed that a healthy lifestyle in middle age increases disease-free life expectancy. Although the data applies to American health professionals, it is a pointer to the benefits of healthy living.
Li Y, Schoufour J, Wang D, et al. (2020) Healthy lifestyle and life expectancy free of cancer, cardiovascular disease and type 2 diabetes. BMJ 368: l6669. DOI: 10.1136/bmj.l6669.
Using big data
STAT is a United States media company that produces news features and podcasts about health, technology and science. I was interested in an article summarising some of the potential biases in databases and the inequalities that can result from not accounting for this in machine learning.
Rose S (2019) Machine learning for clinical decision-making: Pay attention to what you don’t see. Available at: www.statnews.com/2019/12/12/machine-learning-clinical-decision-making-limitations/
Magnesium deficiency
One condition discussed on the lifestyle medicine course last week was magnesium deficiency. I have to confess to not having known much about this. Various studies suggest that 15–30% of the population may have suboptimal magnesium levels. In addition to the consequences of frank magnesium deficiency, the authors of a recent BMJ article argue that suboptimal levels increase the risk of cardiovascular disease and argues for a ‘greater public health effort’ to educate patients and doctors about magnesium deficiency.
DiNicolantonio J, O’Keefe J and Wilson W (2018) Subclinical magnesium deficiency: A principal driver of cardiovascular disease and a public health crisis. Open Heart 5: e000668. DOI: 10.1136/openhrt-2017-000668.
Gestational diabetes
A systematic review and meta-analysis of 20 studies involving follow-up of over a million women has shown that women with gestational diabetes have an increased risk of developing type 2 diabetes mellitus. This might give you ideas for quality improvement activity in your practice.
Vounzoulaki E, Khunti K, Tan B, et al. (2020) Progression to type 2 diabetes in women with a known history of gestational diabetes. BMJ 369(8245): 22. DOI: 10.1136/bmj.m1361.
ORCID iDs
Dr Clare Etherington https://orcid.org/0000-0002-1446-627X
Dr Kathryn Steven https://orcid.org/0000-0002-7534-2932