GP articles from June 2009

GP archives from June 2009

Microalbuminuria test can detect CV and renal risks.
June 26, 2009... European Meeting of Hypertension; EU-style tests for CV and renal problems; Aggressive BP control. GPs should test for microalbuminuria to find patients at risk of cardiovascular and renal problems, experts say. The call comes after data...

Aggressive BP control can boost CV risk in diabetes.
June 26, 2009... Aggressive BP lowering could increase the risk of cardiovascular events among patients with type-2 diabetes, an international study has found. A subgroup analysis of the ONTARGET trial, involving 9,603 patients with type-2 diabetes who were...

Behind the headlines: Rituximab may 'stop RA in its tracks'.
June 26, 2009... Disease progression in rheumatoid arthritis (RA) can be 'stopped in its tracks' by early use of a biologic therapy, media reports have claimed. Rituximab (MabThera), currently recommended for patients who have not responded to other...

GPs hold the key to better fertility treatment.
June 26, 2009... Fertility Experts call for better GP access to fertility tests to improve diagnosis and management across the UK. A greater role for GPs would improve infertility management in the UK, according to a study in the north-east of England. The...

HPV fails to boost cancer detection.
June 26, 2009... Combining HPV tests with the current method of routine liquid-based cytology (LBC) screening does not appear to increase cervical cancer detection, UK research suggests. For this study, 24,510 women aged 20 to 64, attending practices or...

Opinion: Reflex response of no great value.
June 26, 2009... In one of the Marx Brothers' movies - I forget which - Groucho is accidentally jostled by a lady. 'Excuse me,' she says politely. 'Why, what'd you do?' he fires back. I saw this when I was young, and thought it to be the height of droll...

Opinion: Even more dependable than bad news.
June 26, 2009... Public information is an extraordinarily unpredictable thing. It was the late, great Douglas Adams who said that nothing in the Universe travels faster than bad news. He conceived a spacecraft powered by bad news that could reach the far...

Clinical: Journals Watch - Dermatitis and NHS careers.
June 26, 2009... Too busy to read all the journals? Let Dr Lizzie Croton keep you up to date with the latest research. - Cutaneous and respiratory symptoms in cleaners. Occup Med (Lond) 2009; 59: 249-54 Occupational dermatitis is common and has a big...

Clinical: ACE inhibitors and renal artery stenosis.(angiotensin converting enzyme inhibitors)(Disease/Disorder overview)
June 26, 2009... Dr Raj Thakkar outlines the risks and benefits of ACE inhibitor therapy in renal disease. Renal artery stenosis, defined as narrowing of the renal artery or arteries, can be uni- or bilateral. There are two likely pathological processes at...

Clinical: The basics - Insomnia.(Disease/Disorder overview)
June 26, 2009... Patients need careful assessment before prescribing, says Dr Keith Barnard. There was a time when patients presenting with insomnia were given a cursory assessment and prescribed a long-acting benzodiazepine or, even further back, a...

Clinical: Diagnosis and investigation of pityriasis rosea.(Disease/Disorder overview)
June 26, 2009... The cause of this common, self-limiting skin condition remains unclear, explains Dr Waseem Chaudhry. Pityriasis rosea occurs worldwide and affects all races. Reported incidence is 0.3-3 per cent. In temperate climates, it is more common...

Clinical: Tick-borne encephalitis.(Report)
June 26, 2009... TBE is a growing public health problem in Europe and globally, advises Professor Michael Kunze. Tick-borne encephalitis (TBE) is a rapidly growing public health problem in Europe and other parts of the world. Based on statistical modelling,...

Clinical: Review - Abnormal uterine bleeding.(Disease/Disorder overview)
June 26, 2009... Contributed by Mr Antonio V Antoniou, consultant gynaecologist and lead in minimal access surgery and urogynaecology, Newham University Hospital and London Independent Hospital, London Section 1: Epidemiology and aetiology Abnormal...

Clinical: Case Study - An unusual condition related to a cough.(Case study)
June 26, 2009... Investigations for a persistent cough revealed a more serious underlying problems, writes Dr Louise Newson. Mrs A, a 65-year-old woman presented with a three-month history of a persistent cough, lethargy and polyuria. Her husband had died six...

Clinical: At a Glance - Dental sinus versus basal cell carcinoma.(Disease/Disorder overview)
June 26, 2009... Dental Sinus Aetiology - Sinus track that drains on to the face or neck from a dental infection. - More commonly associated with mandibular teeth, less often the maxillary teeth. Presentation - Pimple, nodule, ulcer or indurated...

Clinical: Red Flag Symptoms - Dizziness.(Disease/Disorder overview)
June 26, 2009... Dr Tillmann Jacobi explores when GPs should be concerned about this common symptom. - Fainting, collapse - Hearing loss - Headaches - Vertigo - Chest pain - Behaviour changes Patients may find it difficult to describe their symptoms....

Education: Genetics - Recording a family history.(Report)
June 26, 2009... Dr John Spicer and Dr Imran Rafi explain how to create a genetic map. GPs and primary care team members take family histories every day in clinical practice, usually looking for patterns of polygenic disorders such as IHD, allergy, cancer or...

Education: How to deal with a complaint.
June 26, 2009... An apology and sympathy can go a long way to resolving a grievance, explains the MDDUS's medico-legal adviser Dr Jim Rodger. As a doctor, it is almost inevitable that you will have a complaint made about you at some point in your career....

MedEconomics: How to ... Check your seniority payments.(United Kingdom. National Health Service. Primary Care Trusts)
June 26, 2009... Use the 'two-thirds rule' to work out if you receive the correct level of payment, says Jenny Stone. Under the GMS contract, a GP who has been a principal in a practice for at least two years is entitled to seniority payments to reward their...

MedEconomics: Speech recognition software reviewed.
June 26, 2009... Dr Neil Paul finds there are snags to the Dragon Medial 10 software system that mar its potential usefulness to GPs. I was excited to be asked to review Nuance's new voice recognition software for doctors. But things did not start well....

MedEconomics: Ask the experts - Premises costs and retirement.
June 26, 2009... Q: Surgery loans We are a three-GP practice and built our surgery in 1993 under the cost rent scheme. We financed this by each taking out fixed interest loans and we receive fixed rate cost rent reimbursement. One partner is due to retire...

MedEconomics: Providing copies of patient notes.(Law overview)
June 26, 2009... Mark Shaw explains what practices can and cannot charge for depending on the law and situation. Being asked to provide a complete copy of a patient's notes - occasionally at the request of the individual concerned, but more frequently at the...

Dispensing: Practice Management - Managing risk in your dispensary.
June 26, 2009... Specific assessments must be done for the dispensary, writes Annette Arthur. Once basic health and safety procedures are in place in the dispensary (GP, 19 June), practices must look at compliance with the second tier of legal requirements....

Photography Competition 2009.
June 26, 2009... GP readers have a chance to show off their visual and creative flair in our holiday photography competition. The theme of this year's GP Photography Competition is 'Holidays', and we are looking forward to receiving many eye-catching images...

Plain Tales from the Surgery.
June 26, 2009... Plenty of h'omega 3 We all must have seen patients whose 'ead is 'urting, or who have hitchy h'eyes. Today I was a little baffled by a man with coronary heart disease who told me that he had 'a hake in the side of his chest'. I was not...

Swine flu: QOF suspension 'imminent'.(quality and outcomes framework )
June 26, 2009... GPs appeal for QOF to be suspended as workload soars in worst-hit areas. The QOF could be suspended within days in cities where GPs are being swamped with swine flu cases, as the virus continues to spread across the UK. Last week, health...

GP warning on threat from private providers.
June 26, 2009... Exclusive - Two thirds of GPs urge cap on private provision and back BMA's anti-commercialisation campaign. GPs have called for a cap on private providers in the NHS, warning that expansionist GP-led companies are as big a threat to general...

'Benign' ECG may be signal of AF.
June 26, 2009... A common ECG recording that has largely been considered to be of little significance could actually signal an increased risk of atrial fibrillation (AF), say US researchers. A lengthening of the PR interval is commonly seen on routine ECGs...

Cancer screen could help nine in 10 patients survive.
June 26, 2009... Nine out of 10 patients will survive early stage bowel cancer if it is picked up early, according to latest figures. The findings suggest that GPs should highlight to patients the importance of taking part in bowel cancer screening when...

DoH accepts patient survey results are 'unduly skewed'.
June 26, 2009... Up to 40% of practices appeal patient surveys. The DoH has accepted that the 2008/9 patient survey produced unreliable results - as in some areas up to 40 per cent of practices appeal against their score. DoH guidance to primary care...

PBC 'simulator' to help teach GPs.
June 26, 2009... A private healthcare firm has developed a practice-based commissioning 'simulator' with the backing of the NHS Alliance, to help GPs learn how to commission services. The tool, designed with the 'skill sets and experience of GPs and practice...

Migraine with aura linked to brain lesions in women.
June 26, 2009... Women who suffer from migraine with aura have an increased risk of developing brain lesions, according to a study carried out by researchers in Iceland. A cohort of 4,687 men and women born between 1907 and 1935 were assessed in 1967 and...

List cleaning costs GPs up to pounds 80,000.
June 26, 2009... Aggressive list cleaning forces practices to re-register hundreds of patients. Practices in London have reported losses of up to pounds 80,000 because of aggressive PCT list-cleaning operations. One practice lost 1,100 of its 6,500...

GP Diary.
June 26, 2009... Flu blues So, the pandemic is upon us. And it's going to be nasty. The worried well may create as much work as the sick, however. Suspected cases investigated in Northern Ireland: 157. Total cases confirmed: 14 You'll see a lot more...

Loophole leaves GPs on suspension without pay.
June 26, 2009... GMC and PCTs must act in parallel to protect rights. GPs awaiting fitness-to-practise hearings are being left without pay, thanks to a loophole in the regulations. Doctors awaiting a hearing are barred from working by the GMC, after review...

Scan methods cause damage.
June 26, 2009... Kidney damage caused by contrast agents used in medical imaging can have serious long-term effects, US research has found. Contrast agents used during cardiac angiography and CT scans are known to sometimes cause kidney damage, but this had...

NHS chief at odds with ministers over budget cuts.
June 26, 2009... Managers told to prepare for cuts up to 3 per cent. A rift appears to have developed between the DoH and senior NHS management over whether there will be cuts to the NHS budget beyond 2011. Speaking at the NHS Innova-tion Expo in London,...

High street access to Viagra given green light.
June 26, 2009... The erectile dysfunction drug Viagra was last week made available on the high street for the first time, under a scheme launched by the pharmacy chain Alliance Boots. Viagra will be made available in 29 stores across England and Wales. It...

NHS Alliance urges GPs to embrace wider role.
June 26, 2009... GPs warned against becoming complacent and encouraged to expand their role to cement their status. GPs must not be 'complacent' about their status in the NHS and the pay they receive as the NHS funding crisis hits, NHS Alliance chairman Dr...

GPs asked to report all child medication errors.
June 26, 2009... GPs are being urged to improve patient safety and report any errors made while treating children, after the National Patient Safety Agency (NPSA) found that just 4 per cent of safety reports are recorded by GPs. The report by the NPSA found...

Schizophrenia linked to increased risk of cancer.
June 26, 2009... Cancer is second biggest killer after suicide. Patients with schizophrenia are 50 per cent more likely to die of cancer than the general population, a French study shows. The researchers found cancer was the second most common cause of...

Dipstick test to diagnose appendicitis.
June 26, 2009... A urine test for appendicitis could soon be available that would simplify its diagnosis in children, US researchers have claimed. They have identified a protein present in the urine of children with appendicitis that could serve as a...

Research Briefs.(Report)(Brief article)
June 26, 2009... Bariatric surgery link to kidney stones A common type of weight-loss surgery doubles the risk of kidney stones (J Urol 2009; 181:573-77). GPs back overeating 'addiction' theory Two-thirds of GPs believe overeating is a form of...

Jabs for children could prevent swine flu.
June 26, 2009... Research suggests targeting vaccinations at children as first batches of swine flu jab produced. Vaccinating children appears to be the most effective way of using limited vaccine supplies to control the spread of swine flu, say UK...

Antivirals backed for pregnancy.
June 26, 2009... Pregnant women are at high risk from swine flu and should be treated with antivirals if exposed to the H1N1 virus, Japanese research shows. The risk of morbidity from influenza is higher in pregnant women and mortality rates have been higher...

RCGP shifts stance on patient record sharing.
June 26, 2009... RCGP accused of being 'out of touch'. The RCGP has done an about-face and declared its support for the Summary Care Record (SCR) - placing the college on a collision course with the GP profession. In a letter to the BMJ, RCGP chairman...

Choose and Book search updated to boost usability.
June 26, 2009... The new version of the Choose and Book system will allow GPs to search for services using SNOMED clinical terms and colloquial language. At present, GPs wishing to refer patients can search by type of service, named clinicians or by using a...

GPs facing a lottery in NHS money crisis.
June 26, 2009... Managers may target primary care budgets to plug pounds 15 billion gap. Tom Ireland reports. Just as GPs' first pay rise in four years starts to trickle through, a new era of NHS austerity has reared its head. GP leaders warn it will be a...

Opinion: Your say online ... Managers plot GP contract change to save funds.
June 26, 2009... - Whether it is banks that screw up or ministers that steal from the public purse, instead of throwing the vermin in jail it seems to have opened up a GP and doctor bashing session with renewed vigour. - We need to cut the number of managers,...

Opinion: Ballot box.
June 26, 2009... 61% of GPs think that MMR jabs should be compulsory for children Source: Healthcare Republic. -------------------- Did you find this article useful? Why not subscribe to the magazine? Please call 08451 55 73 55 for more information or...

Editorial: DoH must turn pandemic plans into action.(Editorial)
June 26, 2009... GPs are doing an admirable job dealing with the outbreak of swine flu, but there is concern that national and local management is not up to scratch. This week, Dr Peter Holden, the GPC lead for pandemic flu, tells GP that the DoH should be...

Opinion: Freedom to choose works both ways.
June 26, 2009... How should we proceed over euthanasia and assisted suicide? Legislation on the latter is currently before parliament. Many doctors believe in it strongly: others object just as vociferously. I have always felt that, in a truly free society,...

Independent Nurse: Darzi centres fail to deliver pay and job benefits for nurses.
June 22, 2009... GP-led healthcare centres are offering nurses pay and conditions that are worse than Agenda for Change (AfC), nursing leaders have warned. In guidance earlier this year former health minister Ben Bradshaw said he expected the centres to...

Independent Nurse: NHS staff still miss out on appropriate training.
June 22, 2009... NHS staff are still not receiving appropriate training nearly three years after the implementation of Agenda for Change (AfC), MPs have warned. The Knowledge and Skills Framework (KSF) was introduced as part of AfC to ensure staff had...

Independent Nurse: Vaccinating children will help control the spread of swine flu.
June 22, 2009... Vaccinating children appears to be the most effective way of using limited vaccine supplies to control the spread of swine flu, say UK researchers. Last week, Novartis announced that the first batch of a H1N1 flu vaccine had been...

Independent Nurse: MP behind NMC inquiry deselected.
June 22, 2009... Nursing and Midwifery Council whistleblower champion Jim Devine has been deselected as a Labour MP over expenses claims. Mr Devine, 56, a former psychiatric nurse, famously dubbed the NMC 'dysfunctional' in a Westminster debate last year...

Independent Nurse: GPs reject calls for hep B jabs for nurses.
June 22, 2009... GPs have rejected calls to negotiate PCT funding to immunise practice nurses and other at-risk staff against hepatitis B. Doctors in East Yorkshire proposed the motion at the annual conference of local medical committees in London this...

Independent Nurse: News in brief.
June 22, 2009... SEXUAL HEALTH: Best practice guidance for sexual and reproductive health nurses has been launched by the RCN. The Safer Health Competences document, available at www.rcn.org.uk, outlines the skills that sexual and reproductive health...

Independent Nurse: Return community nurses to practice-based teams say GPs.
June 22, 2009... GPs have vociferously backed a call to return to practice-based primary care teams. Removing health visitors from surgeries has endangered vulnerable children, doctors say. In a unanimous vote at the annual conference of their local...

Independent Nurse: Vital Statistics - IVF treatment.
June 22, 2009... 27% of PCTs now offer three cycles of IVF 5% of PCTs offered the three cycles in 2007 30 Upper BMI limit for women who want to undergo IVF In 2007, just 5 per cent of PCTs offered women the option of three full cycles of IVF...

Independent Nurse: Journals Watch.
June 22, 2009... Bypass boosts CV outcomes Compared with intensive medical therapy alone, prompt coronary bypass surgery can improve cardiovascular outcomes for patients with type-2 diabetes and heart disease, new research shows. Over 2,000 patients were...

Independent Nurse: HIV tests at check ups may reduce stigma.
June 22, 2009... Offering a rapid HIV test as part of a general check up could help to boost testing rates and is acceptable to patients, UK research suggests. A quarter of patients living with HIV in Britain are currently unaware of their infection. ...

Independent Nurse: PCT quality scores reveal mixed results.
June 22, 2009... Fewer than half of PCTs are fully compliant with standards they are expected to achieve for services they provide themselves, according to a report published on Thursday by an NHS watchdog. The Care Quality Commission (CQC) says that 46...

Independent Nurse: Wealth and ethnicity linked to screening.
June 22, 2009... White British women are more likely to attend cervical screening than women from minority ethnic groups, and women who own a car or home are more likely to have had a mammogram, a UK study shows. The findings highlight the need for...

Independent Nurse: Lowering BP too fast could increase CV risk.
June 22, 2009... Aggressive blood pressure (BP) lowering could increase the risk of cardiovascular events among patients with type-2 diabetes, an international study has found. A subgroup analysis of the ONTARGET trial, involving 9,603 diabetic patients...

Independent Nurse: Calls for changes to HPV testing methods.
June 22, 2009... Combining HPV testing with the current method of routine liquid-based cytology (LBC) screening does not appear to increase the detection of cervical cancer, UK research suggests. Previous studies have proposed that testing for HPV in the...

Independent Nurse: Practices face cuts as funding crisis looms.
June 22, 2009... Nurses face increased workloads and GP practices could see funding cuts as NHS managers prepare for the drastic funding shortfalls predicted over the next decade. Policymakers are planning to target QOF income and review practices'...

Independent Nurse: NICE will not change Alzheimer's advice.
June 22, 2009... NICE has announced it will not change draft Alzheimer's guidance restricting the use of cholinesterase inhibitors, after a High Court appeal. NICE was forced to release details of the economic model it used to assess the drugs in...

Independent Nurse: Unite launches drive against privatisation.
June 22, 2009... Health union Unite has launched a campaign calling for the end of the privatisation of the NHS. The campaign, Health B4 Profit, appears to chime with the BMA's anti-marketisation drive launched earlier this month. The union published...

Independent Nurse: World Outbreak Information - Week beginning 22 June.
June 22, 2009... Swine flu The WHO has reported 28,774 cases of H1N1 influenza A in 74 countries, and 17 deaths. The total number of cases reported in the UK has risen to around 1,500. There are currently no travel or trade restrictions from the WHO, but...

Independent Nurse: News Focus - Labour changes ministers at the DoH.(United Kingdom. Department of Health)(United Kingdom. National Health Service)
June 22, 2009... Gordon Brown's struggle to stay in power has brought some new faces to the DoH. Jonn Elledge reports. It is typical of British politics. A minister arrives at the DoH knowing nothing of the NHS and even less about primary care. There...

Independent Nurse: Opinion - Online ... see who's saying what at www.healthcarerepublic.com.
June 22, 2009... I'm glad to see Unite campaigning against privatisation, but why just when it is community services being privatised? Why were they not campaigning against privatisation of GP services? I have tried to set up a patient participation group...

Independent Nurse: Opinion - An education in learning disability nursing.
June 22, 2009... Working with people with learning disabilities has not always been a popular choice for student nurses. The number of places is small compared to adult nursing, and, having turned away from it, many nurses never give it another thought....

Independent Nurse: Opinion - In my view - We can improve life for people with arthritis.
June 22, 2009... A worrying 90 per cent of calls to Arthritis Care's helpline in the last 12 months have been cries for help over pain. Pain is the chief reason people visit GP surgeries, and arthritis and musculoskeletal disorders are its commonest...

Independent Nurse: Editorial - Nurses deserve fair pay in all settings.(Editorial)
June 22, 2009... When the DoH announced it was to establish GP-led health centres across England, nurses greeted the news positively. Many felt that they would offer possibilities for career development and, hopefully, improved pay. However, while...

Independent Nurse: Clinical - Breaking the infection chain.
June 22, 2009... Robust infection control in primary and community care is vital, writes Barry Hill. Just as they do in the hospital environment, healthcare-associated infections (HAIs) present a significant risk in primary care and community settings....

Independent Nurse: Clinical - Advising travellers on bite prevention - Insect-borne disease.
June 22, 2009... Travellers need to be advised on bite prevention measures to minimise the risk of disease, writes Sandra Grieve. There are millions of insects. Many transmit disease and cause illness; others simply cause a nuisance. The principal vectors...

Independent Nurse: Clinical - Medical management of erectile dysfunction.
June 22, 2009... Several pharmacological options are available for men with erectile problems. Dr David Morris explains. The discovery of sildenafil as an effective, well-tolerated and convenient treatment for erectile dysfunction (ED), and the subsequent...

Independent Nurse: Clinical - Understanding the role of vitamin D.
June 22, 2009... Research suggests that vitamin D benefits more than just bone health, says Dr Frankie Phillips. Vitamin D is an essential nutrient. Apart from maintaining bone health, evidence is emerging that vitamin D may have a role to play in a...

Independent Nurse: Clinical Focus - Malaria.(Clinical report)
June 22, 2009... Overall key points: - P falciparum is the deadliest form, accounting for 80 per cent of cases and 90 per cent of deaths. - A thick and thin blood film is the gold standard investigation for malaria infection. - Practitioners...

Independent Nurse: Clinical - Identifying non-infective rashes in children.
June 22, 2009... Several non-infectious rashes that can occur in children are outlined by Dr Terrina Dickson. A detailed history and associated symptoms, together with careful examination, will help to narrow the differential diagnosis when identifying...

Independent Nurse: Professional - Supporting victims of childhood sexual abuse.
June 22, 2009... Health professionals can help patients recover from psychosexual trauma, writes Graham Wilmer. They call 'it' childhood sexual abuse; sometimes 'it' is even shortened to three little letters - 'CSA'. When you read a newspaper report...

Independent Nurse: Professional - Rise of the GP-led health centres.
June 22, 2009... As the new 'super-surgeries' open, we consider the possible opportunities for nurses. Joe Lepper reports. GP-led health centres form the centrepiece of ministers' plans to improve patient access to primary care services. These...

Independent Nurse: Professional - Resources - Worth a look.
June 22, 2009... Dementia Awareness Week, 5-11 July Dementia Awareness week takes place in England and Wales from 5-11 July with a theme of 'be head strong'. It aims to make people aware of the things they can do to reduce their risk of developing...