Pulse articles from September 2007

Pulse archives from September 2007

GPs get tough new diabetes targets.(general practitioners)
September 6, 2007... NICE to release ambitious plans for an intensive programme of weight loss and lipid lowering EXCLUSIVE By Lilian Anekwe GPs will be asked to implement an intensive programme of weight reduction and lipid lowering for patients with...

What NICE will recommend.(National Institute for Clinical Excellence)(Brief article)
September 6, 2007... * Simvastatin 40mg or equivalent for all patients with diabetes aged over 40 * Cholesterol targets of 5mmol/l and 3mmol/l total and LDL cholesterol, or 4 and 2 for at-risk patients such as those with CKD, proteinuria or albuminuria *...

Record breaches to be kept secret.(Brief article)
September 6, 2007... Common sense on IT Patients and their GPs will not be told if there are security alerts involving their Summary Care Records, Pulse can reveal. Connecting for Health has admitted it does not plan to contact them if security alerts are...

PBC failing as GPs go for `easy wins'.(practice based commissioning)(general practitioners)
September 6, 2007... Under-resourced GPs opting for `low-hanging fruit', not local priorities EXCLUSIVE By Gareth Iacobucci Practice-based commissioning is failing to improve patient care because under-resourced GPs are aiming for easy financial wins...

Fresh warning over statin switching.(Brief article)(Clinical report)
September 6, 2007... A pharmaceutical company study has reopened the row over statin switching after claiming it substantially increases the risk of death or cardiovascular events. Moving patients from atorvastatin to simvastatin raised the risk of death or...

Legal disputes soar as PCTs squeeze PMS practices.(primary care trusts and personal medical services)
September 6, 2007... EXCLUSIVE By Gareth Iacobucci A massive rise in the number of recorded disputes between PMS practices and PCTs is just the `tip of the iceberg', the GPC said this week. Statistics from the NHS Litigation Authority (NHSLA) show the...

`I'll take to the streets'.(protest by general practitioners)(Brief article)
September 6, 2007... Dr Ross Worthington, a GP in Haverhill and one of 46 PMS practices being represented by Suffolk LMC, is among those taking to the streets to protest at the weekend at PCT proposals he says amount to `more work for less money'. He said: `We...

InBrief: Tougher sentencing for attacks after GP stabbing.(Brief article)
September 6, 2007... The Scottish Executive is to increase sentences for attacks on GPs and primary care staff, after the stabbing of a female GP in Glasgow. Dr Helen Jackson, 56, is alleged to have been stabbed three times in the stomach while at her practice...

InBrief: Optometrist prescribers.(Brief article)
September 6, 2007... Optometrists are the latest group of health professions to be handed prescribing powers. The Department of Health announced that optometrists would be able to train as independent prescribers, with the power to prescribe any medicine for...

InBrief: Watchdog call to axe MPIG.(minimum practice income guarantee)(Brief article)
September 6, 2007... A public spending watchdog has called for the MPIG to be scrapped and core GMS services to be more strictly defined. The Wales Audit Office's review of the GMS contract also claimed there was a `significant risk' that practices would...

InBrief: Counselling shortfalls.(Report)(Brief article)
September 6, 2007... One in three mentally ill patients who wants access to counselling still cannot get it, a report from the Healthcare Commission concludes. The evaluation of community mental health services recorded some improvements, but found half of...

InBrief: GPC makes call to arms.(General Practitioner Committee)(Brief article)
September 6, 2007... The GPC is urging GPs to fight their corner in health minister Lord Ara Darzi's imminent review of the NHS. In a letter to LMCs, it calls for BMA members to take part in `clinical pathway groups', organised by strategic health authorities...

InBrief: U-turn over ephedrine.(Brief article)
September 6, 2007... The UK drug regulator has been forced into a U-turn over its plans to make products containing pseudoephidrine or ephedrine prescription-only to prevent their use in the manufacture of illegal drugs. The Medicines and Healthcare Products...

InBrief: Online life predictions.(Brief article)
September 6, 2007... Patients may soon be able to see into their own future - thanks to a new computer programme developed by a GP in Essex. Dr Chris Martin's `Laindon model' creates a graph predicting how long a patient is likely to live, based on factors such...

BNF raises alert on steroid suicide risk.(British National Formulary)
September 6, 2007... New edition of formulary warns GPs of possible psychiatric adverse effects By Lilian Anekwe GPs are being officially warned of the safety risks of systemic steroids after indications that they may raise the risk of suicide. The...

Other new BNF safety alerts.(British National Formulary)(Brief article)
September 6, 2007... * Rimonabant - contraindicated in major depressive illness (even if treated with antidepressants) and other psychiatric illnesses * Telithromycin - associated with a greater risk of myasthenia gravis, transient loss of consciousness,...

BNF highlights eGFR failures.(British National Formulary)(epidermal growth factor receptor)(Brief article)
September 6, 2007... The updated BNF will highlight the shortcomings of the estimated glomerular filtration rate calculation for predicting renal disease in patients at extremes of body weight. The September edition of the BNF will warn that while GPs should...

Calcium supplements cut fracture risk.(Brief article)(Clinical report)
September 6, 2007... Calcium supplementation reduces the risk of bone fracture and bone loss in older people, a `practice-changing' study has shown. The analysis of 29 randomised trials, published in the latest edition of The Lancet, found that calcium...

MediaWatch: `Pills worsen headaches'.(Brief article)
September 6, 2007... The story Overuse of painkillers such as paracetamol, aspirin or triptans worsen headaches in women suffering from migraines, the Daily Mail reports. The source City of London Migraine clinic called for a national campaign to warn people...

MediaWatch: `Statins for Alzheimer's'.(Brief article)(Clinical report)
September 6, 2007... The story Statins can ward off dementia and memory loss and protect against Alzheimer's disease, report the Independent and Times. The source Research in the journal Neurology studied 110 brains donated for medical research to the...

MediaWatch: `Surgery cure for diabetes'.(Brief article)(Clinical report)
September 6, 2007... The story Patients with type 2 diabetes could be offered gastric surgery after researchers found it had the potential to permanently cure the condition, say The Guardian and New Scientist. The source A small-scale clinical trial, published...

NICE inhaler go-ahead.(National Institute for Clinical Excellence)(Brief article)
September 6, 2007... Institute gives cautious backing to use of asthma combination devices By Emma Wilkinson NICE has given the go-ahead to use of combined inhalers for asthma - but has been criticised for not backing them as the preferred treatment...

Institute's inhaler guidelines.(Brief article)
September 6, 2007... Where an inhaled steroid is considered appropriate, the least costly product is recommended. For adults and children aged 12 years and older with chronic asthma in whom treatment with an inhaled steroid and long- acting Beta-agonist is...

MPs to back civil standard.(ministers)
September 6, 2007... Campaign faces uphill struggle as opposition parties give broad support to changes Campaign justice for GPs By Steve Nowottny Controversial plans to shake up medical regulation look set to make rapid progress through Parliament,...

GP in MMR row cleared by GMC.(general practitioner Jayne Donegan's view regarding the measles-mumps-rubella vaccine)(General Medical Council)(Brief article)
September 6, 2007... A GP who was at the centre of a storm of controversy for her views on the MMR vaccine has been cleared of professional misconduct by the GMC. Dr Jayne Donegan, a locum from Herne Hill, south London, had been accused by a High Court judge...

Row over therapy call for CFS.(chronic fatigue syndrome)
September 6, 2007... NICE guidance stresses use of psychological treatment for illness By Emma Wilkinson NICE guidance on diagnosing and managing chronic fatigue syndrome has reignited a long-running controversy over the root cause of the illness by...

ECG limitations highlighted.(Brief article)
September 6, 2007... An ECG is a useless test for ruling out left ventricular hypertrophy in patients with hypertension, a large systematic review has concluded. The findings contradict current guidance from the British Hypertension Society, which suggests...

Patients nervous over care records.(Survey)
September 6, 2007... Pulse survey shows patients expect to give explicit consent - and up to a quarter want to opt out altogether Common sense on IT By Christian Duffin Far more patients want to opt out of the Summary Care Record than Connecting for...

BMA urges go-slow on records rollout.(British Medical Association)(Brief article)
September 6, 2007... The BMA has urged a go-slow approach to the rollout of electronic care records - but stopped short of calling for an outright boycott. In new guidance issued to GPs this week, the association said the care record project should not be...

PCTs widen scope of drug switch scheme.(primary care trusts)
September 6, 2007... Proton pump inhibitors overtake statins as source of greatest savings By Rashmi Wadehra Proton pump inhibitors have taken over from statins as the drug class that PCTs are keenest for GPs to switch. New prescribing figures have...

Flu test could cut vaccine workload.(Report)(Brief article)
September 6, 2007... Nearly half of all at-risk patients have pre-existing resistance to flu because of previous vaccination, new research suggests. Identifying them with a simple serological test would highlight those who do not need further vaccination, the...

JournalWatch: Bariatric surgery beneficial.(Brief article)(Clinical report)
September 6, 2007... Bariatric surgery for severely obese patients is associated both with long-term weight loss and reduced overall mortality, Swedish researchers have found. There was a 24% reduced risk of death in 1,471 patients who had had surgery (gastric...

JournalWatch: `Asthma' could be VCD.(vocal cord dysfunction)(Brief article)(Clinical report)
September 6, 2007... Children with acute breathing difficulties but normal oxygen levels are more likely to be suffering from vocal cord dysfunction than asthma, say US researchers. VCD is the sudden, abnormal narrowing of vocal cords and is characterised by...

JournalWatch: Cutting childhood obesity.(Brief article)
September 6, 2007... Treating gestational diabetes significantly reduces risk of childhood obesity, a US study has found. Researchers collected data from 1995 to 2000 on 9,439 women. Children of mothers with hyperglycaemia during pregnancy who were untreated...

JournalWatch: One in 50 children restless.(Report)(Brief article)
September 6, 2007... One in 50 children has restless legs syndrome, according to a new survey. The survey of 10,523 families found 1.9% of eight- to 11-year-olds and 2% of 12- to 17-year-olds met the criteria for, and gave convincing descriptions of, the...

JournalWatch: `High normal' BP a risk.(blood pressure)(Clinical report)
September 6, 2007... Women with `high normal' blood pressure of 130-9/ 80-9mmHg have a greatly increased risk of dying from cardiovascular disease or having a heart attack or stroke, according to a study of 39,322 initially healthy women. Researchers from the...

St John's wort cuts statins benefits.(Brief article)(Clinical report)
September 6, 2007... Patients taking St John's wort should be warned of a potentially dangerous interaction with atorvastatin. Taking the popular herbal remedy at the same time as the statin could reduce lipid-lowering efficacy, according to the results of a...

10% of adults say they self-test BP.(blood pressure)(Report)(Brief article)
September 6, 2007... Almost 10% of the adult population are self-testing their blood pressure, a survey suggests. People were more likely to have done so if they had a university degree, were retired, lived in an affluent area or had a chronic illness. ...

Call to hand budgets to patients.
September 6, 2007... Doctors cautiously welcome radical proposals to give patients individual NHS budgets to spend as they wish By Christian Duffin Radical proposals to hand patients their own `personalised budgets' to spend as they please on treatment...

`Cultural change' cuts alcohol-related deaths in doctors.(Report)(Brief article)
September 6, 2007... Alcohol-related deaths among doctors have been cut dramatically by `a cultural change towards drinking within the medical profession', according to a new report. Researchers from the Office of National Statistics found doctors, who in the...

Report brands OOH care `unsustainable'.(out-of-hours)
September 6, 2007... Costs doubled in a year and rotas are left unfilled, Audit Scotland warns By Christian Duffin Spiralling costs and a shortage of GPs have made out-of-hours care in Scotland `unsustainable' in its present form, according to a spending...

Opting out of OOH makes life better.(out-of-hours)(Survey)(Brief article)
September 6, 2007... GPs' work-life balance has improved dramatically since they gained the right to opt out of out-of-hours. A survey of 1,770 GPs by the public spending watchdog Audit Scotland showed that three quarters of GPs reported an improved work-life...

Doctors split over nurse script rise.
September 6, 2007... As Pulse reveals a huge increase in nurse prescribing, GPs call for better training and increased supervision By Cato Pedder It is nine o'clock on Monday morning and Sheila Smith is looking down a patient's throat. She sees just a...

LETTER: I'm petitioning Downing Street on nurse prescribing.(Letter to the editor)
September 6, 2007... Concern over range of drugs prescribed by nurses has prompted petition From Dr Gee Shin, specialist registrar, London I read with interest your front-page article `Huge explosion in nurse prescribing' (News, 23 August). I was...

LETTER: Nurse prescribing data is flawed.(Letter to the editor)
September 6, 2007... From Dr Tim Hooson, Sheffield The figures quoted in your article `Huge explosion in nurse prescribing (Pulse, 23 August) should be taken with a pinch of salt. Our practice nurse has completed her prescribing course and is now an...

LETTER: Risky to take cash for off-list medical.(Letter to the editor)
September 6, 2007... From Dr F M Hirji, Hemel Hempstead, Hertfordshire Dr John Couch mentions doing medical examinations for patients who are not registered at his practice (`Pitching your private fees just right', 19 July). I find this very unusual...

LETTER: Worried about future for GP posts.(Letter to the editor)
September 6, 2007... Name and address supplied With regard to your article about the fall in GP vacancies (News, 23 August) I have been trying for a salaried post or a partnership since April. So far I have had no luck. I am now planning to apply to posts...

LETTER: Will IT bosses ever be brave enough to admit errors?(Letter to the editor)
September 6, 2007... Common sense on IT From Dr Mark McCartney, Pensilva, Cornwall I was interested to read the debate between Dr Paul Thornton and Dr Gillian Braunold of Connecting for Health (Opinion, 23 August). I still have concerns about patient...

LETTER: NHS watchdog has upped game on complaints.(Letter to the editor)
September 6, 2007... From Marcia Fry, head of operational development, Healthcare Commission Your article `Complaints revamp will fail GPs' (Comment, 2 August) raises concerns that the Healthcare Commission has not undertaken enough panel reviews while...

LETTER: Village life provides OOH lesson.(Letter to the editor)
September 6, 2007... From Dr Costi Stavrianakis, north London I have recently returned from a three-month sabbatical working in a village health post in Gambia. One of the things I learned there was the value of patient-held records - in many cases a...

LETTER: NHS site is evolving project.(Letter to the editor)
September 6, 2007... From Professor Sir Bruce Keogh, clinical advisory group chair, NHS Choices I am writing in response to `Choices site riddled with mistakes' (News, 12 July). The Choices delivery team has been working closely with the Information...

Co-proxamol ban makes a mockery of patient choice.
September 6, 2007... Co-proxamol debate If the Government is so keen on patient choice and empowerment, why is it taking away the optionof a drug so many rely on, asks Dr Howard Stoate The NHS is `moving away from the old monolithic, monopoly NHS to a...

PulseFinance: Ask the expert.
September 6, 2007... PBC Andrew Lockhart-Mirams on the consequences of disengaging from PBC Founded Lockharts Solicitors in 1995 and currently leads teams advising on NHS regulatory and employment law, premises and dispute resolution Q Our PCT is...

PulseFinance: Going green makes good financial sense.
September 6, 2007... Going green is not only socially responsible but can save you money, says Dr John Couch Green issues are the same for businesses as they are for private householders. The same areas are covered - efficient use of energy, reduction of...

HOW TO...Write a business plan.(Brief article)
September 6, 2007... With the increasing competitiveness and commercialisation of primary care and the introduction of private service providers, it is important to know how to put together a business plan, not only for submission to a potential purchaser but also...

PulseClinical: Where are we now? ADHD in adults.(attention deficit hyperactivity disorder)(Disease/Disorder overview)
September 6, 2007... Psychiatrists Dr Kiriakos Xenitidis, Dr Elena Paliokosta and Dr Stefanos Maltezos review the controversies over ADHD beyond childhood. Does it exist at all? If it does, how is it best diagnosed and treated? The efficacy of stimulant and...

PulseClinical: GI disease - Options in reflux when PPIs fail.(gastrointestinal)(proton pump inhibitors)(Disease/Disorder overview)
September 6, 2007... Dr Stuart Bloom and Dr George Webster review what is on offer when maximum doses of medical treatment no longer relieve GORD symptoms Endoscopic approach Endoscopic gastroplication was developed in the 1990s by Swain. Currently there...

PulseClinical: Asthma.(Disease/Disorder overview)
September 6, 2007... As major revisions to asthma guidance and QOF negotiations loom, Dr Kevin Gruffydd Jones launches our new series highlighting five key issues When the British Thoracic Society and the Scottish Intercollegiate Guidelines Network revise...

PulseClinical: Erectile dysfunction.(Disease/Disorder overview)
September 6, 2007... 1 Always do the tests - even if the cause seems obvious. Erectile dysfunction is closely associated with cardiovascular disease and all patients should have a fasting blood glucose, lipids and morning testosterone checked, and re-measured at...

PulseClinical: Need to know Thyroid disease.(Disease/Disorder overview)
September 6, 2007... Dr Shahrad Taheri and Professor Stafford Lightman answer GP Dr Colin Kenny's questions on the wide range of conditions affecting the thyroid gland that can present in primary care 1. Should I treat a raised thyroid stimulating hormone (at...

Do psychological and educational interventions work in eczema?(Report)
September 6, 2007... A summary of a new Cochrane review that could apply to your next consultation What is the effectiveness of psychological and educational interventions in managing children with atopic eczema? Psychological and educational interventions...

How I...set up an alcohol harm reduction programme.
September 6, 2007... Alcohol misuse is a major challenge for the NHS, says GP Dr Stefan Janikiewicz, but simple primary care screening can bring about dramatic improvements Excessive drinking and alcohol misuse is, arguably, the biggest national problem facing...

PulseClinical: What to tell parents about peanuts allergy.
September 6, 2007... Allergies are becoming increasingly common, and parents may fall prey to unproven fringe therapies. Professor Gideon Lack gives an evidence- based guide to diagnosis and treatment The prevalence of peanut allergy has unequivocally increased...

PulseClinical: LEAP STUDY.(Learning Early about Peanut Allergy)(Brief article)
September 6, 2007... The LEAP (Learning Early about Peanut Allergy) study is an interventional research study of the best dietary strategy to prevent peanut allergy. It is based at the Evelina Children's Hospital, part of Guy's & St Thomas' NHS Foundation Trust in...

PulseClinical: Cardiovascular interventions to prolong life.
September 6, 2007... Q In older patients with cardiovascular disease, do evidence-based interventions prolong life or decrease cardiovascular events? Synopsis To put it bluntly: as we age, if one thing doesn't get us, something else will. That is why it is...

PulseRegister: My perfect reading list.(List)
September 6, 2007... As new registrars, you will be faced with a daunting choice of books to help you through the exams, although not many are specifically tailored for the nMRCGP. Dr Karen O'Reilly, who sat the MRCGP exam in 2001 and then again `for fun' in 2005,...

PulseRegistrar: Should you refer for MRI in low back pain?(magnetic resonance imaging)(Case study)
September 6, 2007... Dr Steve Brown discusses LEARNING POINTS When faced with a request for a referral from another health care professional: * Take a careful history and do a good examination * Do not show irritation with the request even if you...

PulseRegistrar: Paper, paper everywhere.
September 6, 2007... Our diarist discovers that the paperwork, not passing exams, is the tough part of qualifying as a GP GEOFF TIPPER'S Registrar diary `You look a bit peaky, doctor.' My patients have a right to be worried. For you see, I've just managed...

Getting the most out of your educational supervisor.
September 6, 2007... The educational supervisor is a new role, created to ensure your educational needs are met under the nMRCGP - Dr Mandy Fry explains what to expect from them The role of educational supervisor will vary between deaneries and even between...

Don't take surgery cover for granted.
September 6, 2007... You could save money by switching insurance, but you need to check more than the price, says Stuart Smith Over the past few years many doctors have saved money, in some cases several hundred pounds, by switching their surgery insurance...

PulseCareers: Time out working in a rural African health centre.
September 6, 2007... Dr Costi Stavrianakis explains what it was like to take three months out of general practice to be a volunteer in Gambia A few years ago I travelled around east Africa and was totally captivated by this amazing continent. So, soon after...

CareerCoach: Landing that job.(Brief article)
September 6, 2007... About 70% of our communication is non-verbal so at a job interview you need to get it right - Dr Steve Brown gives some pointers * A firm (but not too firm) handshake is good at the start and the end of the interview. Dry your palms just...

CareerTaster: Becoming a police surgeon.
September 6, 2007... Frustrated by the current lack of partnerships, Dr Ruth Chapman is looking for a new challenge and over the coming weeks will be shadowing GPs in various positions to see which general practice role is for her. This week, she writes about...

PulseComment: Let's make the case.(Brief article)
September 6, 2007... GPs probably suspected they faced an uphill struggle in the fight against proposed changes to the standard of proof for fitness-to- practise cases. The size of that task became clearer this week, as both the Conservatives and LibDems admitted...

LAST WORD: Dr Alan Begg.
September 6, 2007... Dr Alan Begg... on bubbly, Scotland and heart disease The best thing about my practice is appreciative patients. And the worst is the high running costs of a PFI health centre. My greatest fear is losing the `buzz' from contact...

Fresh fears over global sum revamp.
September 13, 2007... NHS managers prepare to force through proposed formula against wishes of many GPs By Steve Nowottny NHS negotiators are determined to push through changes to the global sum formula which could have a devastating effect on some...

Are you a winner or a loser?(Brief article)
September 13, 2007... Earlier this year a review group, including negotiators from the GPC, NHS Employers and the Department of Health proposed a radical reshaping of the global sum formula. The proposals would see some practices lose up to 18% of their global...

Government steps up spin campaign on opening hours.
September 13, 2007... Patient survey findings ignored as Johnson attacks GP hours `anomaly' By Gareth Iacobucci Health secretary Alan Johnson confirmed GPs' fears this week as he pressed ahead with plans to force surgeries to extend their opening hours,...

Concerns raised by drug switch pioneer.(Brief article)
September 13, 2007... The GP academic whose research identified huge potential savings from drug switching has hit out at the crude way his work has been interpreted by PCTs, amid concerns some schemes are fuelling a rash of adverse events. Professor Mike...

MPs go easy on care record plans.(medical personnel)
September 13, 2007... Common sense on IT The health select committee's long-awaited report into the electronic patient record appears to have largely let Connecting for Health off the hook, while expressing some concerns over data security. The report from...

GPs' pay criticised in Wanless review of extra NHS billions.(general practitioners)(Derek Wanless)(Brief article)
September 13, 2007... The Government adviser who recommended the surge in funding for the NHS has warned much of the money has not been well spent - with the GP contract among those areas singled out for criticism. Sir Derek Wanless, commissioned by the King's...

InBrief: Pill may reduce Ca risk.(cancer)(Report)(Brief article)
September 13, 2007... Women taking the oral contraceptive pill can be reassured it does not increase their risk of cancer and may even reduce the risk, concludes a 36-year UK study. The RCGP Oral Contraception Study, published online by the BMJ, found that in...

InBrief: New move to salvage PBC.(Brief article)
September 13, 2007... The NHS Alliance will this week reveal a string of new initiatives aimed at salvaging practice-based commissioning, including a campaign to improve co-operation between PCTs and GPs and the accuracy of data available for commissioners. ...

InBrief: Scripts not in guidelines.(Report)(Brief article)
September 13, 2007... Fifteen per cent of all GP antibiotic prescriptions are for compounds usually reserved for relatively rare conditions, according to a study of 13 practices in the north-west of England. Researchers studying GP adherence to local PCT...