GP articles from May 2005

GP archives from May 2005

Patients to buy own NHS care.(National Health Service)
May 27, 2005... Patients with long-term conditions should be allocated NHS money to commission their own treatment, according to one of the government's key health advisers. The proposal, which is expected to feature in the primary care White Paper,...

Teeth linked to heart problems.(Brief Article)
May 27, 2005... Tooth decay increases the risk of cardiac arrhythmia in the elderly, according to US research. In a group of 125 healthy people aged over 80 years, researchers found that those with three or more active root caries were more than twice as...

Care record security rules to allay privacy fears.(Brief Article)
May 27, 2005... Rules to guarantee that patients control access to their records under the NHS Care Records Service have been announced by the DoH. The initiative, rolled out in England from next year, will connect GP practices and more than 270 acute,...

Severe asthma is not the same disease as mild.
May 27, 2005... Severe asthma may actually be a different disease from mild or moderate asthma, according to UK research. The researchers found markers of epithelial cell activation in the lung tissue of patients with severe asthma that were not present...

CO worsens impact of noise on hearing.(Carbon monoxide)
May 27, 2005... CO increases the severity of hearing loss in people who work in a noisy environment, according to Canadian research. Researchers reported at the 149th annual meeting of the Acoustical Society of America in Vancouver last week that...

ECT reduces risk of MI in severe depression.
May 27, 2005... ECT can reduce the risk of heart attack in severely depressed patients with chronic heart failure, according to US research. The study found that ECT reduced levels of norepine-phrine, which is the stress hormone associated with raised MI...

Research brief: Combined HRT trebles DVT risk.
May 27, 2005... Women on combined HRT are three times more likely to develop DVT than women not taking HRT, according to Canadian researchers. Oestrogen-only HRT did not significantly increase the risk, the researchers found. The study included 95 women who...

Research brief: Measuring procalcitonin reduces antibiotic use.
May 27, 2005... Patients with pneumonia who had their procalcitonin level measured stopped taking antibiotics after six days, according to Swiss research. Patients who did not have the hormone level measured stopped at 12 days. Bacterial infection raises...

Research brief: No birth defect risk from atypical antipsychotics.
May 27, 2005... Canadian researchers studied 151 women who had taken an atypical antipsychotic during pregnancy: 60 women had taken olanzapine; 49 risperidone; 36 quetiapine; and six had taken clozapine. The incidence of major birth defects in women taking...

Research brief: Menopausal symptoms unaffected by herb.(Brief Article)
May 27, 2005... The herbal remedy Black Cohosh (Cimicifuga racemosa) does not reduce hot flashes or relieve symptoms of the menopause, according to US research presented at the American Society of Clinical Oncology meeting in Orlando, Florida last week. The...

Research brief: Stroke of genius.(Brief Article)
May 27, 2005... According to a Swiss study, brain damage from a minor stroke can alter an artist's style. Damage to the occipital lobe changed the way two artists chose colour and rendered detail (J Neurol Neurosurg Psychiatry. 2005; 76:797-803).

Adding ARBs to ACE inhibitors cuts mortality.
May 27, 2005... A combination of angiotensin-2 receptor blockers (ARBs) and ACE inhibitors should be considered for the treatment of some patients with heart failure, according to European Society of Cardiology (ESC) guidelines published last week. This...

Asthma raises risks of pneumococcal disease.(Brief Article)
May 27, 2005... Patients with asthma are more than twice as likely to develop invasive pneumococcal disease as other patients, US researchers have found. They claim that extending pneumococcal vaccination to all patients with asthma could be a...

Child protection.(Brief Article)
May 27, 2005... When Lincolnshire GP Dr Andrew Mowat treated a child he suspected was suffering abuse, he embarked on child protection training leading to him chairing a child protection team at his practice. 'There were two ways I realised I could respond:...

Global sums slashed by up to pounds 20k.(global sum income )(Exeter payment system software)
May 27, 2005... Many practices are unaware that their global sum income has been slashed by up to pounds 20,000 because the cut has been hidden by their higher-than-expected earnings under the quality framework. Funding calculations for 2005/6 brought...

'Revalidation needed in stages' advises GPC.(General Practitioners Committee)(Brief Article)
May 27, 2005... Revalidation should be introduced gradually to avoid overburdening GPs and prompting many to retire early, the GPC has advised in a letter to the chief medical officer. The GPC also wants standards to be set by doctors themselves rather...

IT registration is not commitment to Choose and Book.(Information Technology)(Brief Article)
May 27, 2005... GPC leaders have warned the DoH that practices in England registering to access the NHS Spine are not agreeing to offer Choose and Book. Doctors and nurses are required to be registered and have a smartcard to access the Spine, which...

Benefits of sulfonylureas don't last.
May 27, 2005... Patients with type-2 diabetes whose glucose levels are not controlled by metformin alone only receive short-term benefit from the addition of a sulfonylurea, according to UK research published last week. The researchers analysed the...

Local needs not met by super-surgeries.(Brief Article)
May 27, 2005... NHS LIFT favours the 'super-surgery' which does not offer practices enough flexibility to meet local needs, according to the GPC's premises subcommittee chairman. Dr Peter Swinyard was responding to a report by the National Audit Office...

Patients in dark over emergency GP home visits.(General Practitioners)(Brief Article)
May 27, 2005... Most patients believe that GPs should make home visits on demand while one in five is unsure of what their out-of-hours service provides, according to a survey by Developing Patient Partnerships (DPP). Interviews with 1,003 patients in...

GPs back first commissioning co-op.(General Practitioners)
May 27, 2005... A not-for-profit organisation to provide and commission enh-anced and secondary care services on behalf of hundreds of East London GPs will be in operation by April 2006. The GP-led scheme aims to co-ordinate practice-based commissioning...

Air pollution linked to heart failure.
May 27, 2005... Raised levels of atmospheric pollution are associated with increased heart failure rates in elderly patients, according to a US study. The researchers estimated that a doubling in the average level of carbon monoxide would increase the...

Parents' mental health predicts risk of autism.
May 27, 2005... Premature birth and a parental history of psychiatric disorder are the two main predictors of autism, according to Danish research. The large case-control study used Danish national registry data to identify associations between autism,...

Choose and Book incentives should go directly to GPs.(General Practitioners)(Brief Article)
May 27, 2005... The GPC has criticised the DoH for directing Choose and Book incentive money to PCTs rather than GPs, and warned that uptake of the initiative might be slowed down as a result. Earlier this year the DoH announced pounds 95 million in...

Man's best friend can smell cancer.
May 27, 2005... Identifying cancer is the latest way dogs are helping the medical profession, says Rachel Bowden. While the health benefits of taking a dog for a brisk walk are well known, the medical reason for letting one sniff at your urine may be...

Behind the headlines: Vaccination to help smokers quit.
May 27, 2005... A nicotine vaccine could change smoking cessation treatment, writes Mark Pownall. What is the story? A vaccine against nicotine could see people immunised against addiction to smoking 'within five years', according to the media. ...

Coeliac disease does not reduce female fertility.
May 27, 2005... Women's fertility is not as adversely affected by coeliac disease as previously thought, according to researchers from the University of Nottingham. Dr Joe West, specialist registrar in gastroenterology at the University of Nottingham,...

Skin test antigen jab offers cure for warts.(Brief Article)
May 27, 2005... Warts can be cleared up by injecting them with a skin test antigen, according to US research. The researchers found that injecting warts with skin test antigens, which are normally used to test for immunity, stimulated an immune response...

Liverpool referral blacklist only for cosmetic surgery.(Brief Article)
May 27, 2005... A Liverpool referrals blacklist will only cover cosmetic surgery, GPs have been reassured. North, Central and South Liverpool PCTs have told Dr Rob Barnett, Liverpool LMC secretary, that a city-wide referrals ban on 'procedures of lower...

Mentally ill prefer GPs to lead care.
May 27, 2005... Patients with serious mental illness prefer to be treated by their own GP rather than a specialist, according to a focus group study. Researchers at Birmingham and Warwick Universities interviewed 39 GPs, eight practice nurses and 45...

Scottish Executive to publish quality data.(Brief Article)
May 27, 2005... Quality achievement data for practices in Scotland is expected to be published today. The Scottish Executive has said that it will publish the information as it wants to be open about GP performance. Health minister Andy Kerr said:...

Opinion: Sunday magazine plans for NHS.
May 27, 2005... 'How strong you were, how bright and gay, a prince of love in every way.' 'Ah yes,' replied Maurice Chevalier in velvety come-to-bed franglais, 'I remember it well'. Okay, maybe I wasn't exactly a prince of love when I was a junior...

Opinion: An open letter to Patricia Hewitt.
May 27, 2005... Congratulations on your appointment as health secretary. I envy you your position, because you have the opportunity to do so much good for so many. But, by the same token, you also have the power to interfere with the good work that doctors...

Leader: Time for global sums to add up correctly.(Black Wednesday)(Carr-Hill formula )
May 27, 2005... The memory of Black Wednesday will linger long in the minds of GPs. Being told your new pay deal could result in less income than you had before is not something you tend to forget. Nor is the subsequent discovery that the eventual...

Leader: Buying the carrot but not the stick.(Brief Article)
May 27, 2005... The DoH may find that the actual number of GPs in England participating in its Choose and Book initiative when it is rolled out initially may not match what it will predict over the coming months. As any sales person will tell you, an...

Practice: In practice with ... Dr Martin Carroll, Queen Mary 2.
May 27, 2005... This week Debbie Andalo visits a practice of no fixed abode How did you start in general practice? I started in anaesthetics but it was inside and I thought there must be more to life than just that. So I went into general practice...

Practice: Multi-agency approaches to child protection.
May 27, 2005... The best way to ensure a child's safety is by using holistic methods. Six years ago, Lincolnshire GP Dr Andrew Mowat had a child patient he suspected was suffering abuse but he did not know what to do about it. 'There were two ways...

Practice: Is a merger the right step for us to take?
May 27, 2005... Q: We are a three-GP practice with 5,000 patients. We have been approached by a neighbouring five-doctor practice to discuss a possible merger. What are the implications to be aware of? Where should we seek advice? The word merger is...

Practice: Prioritise tasks to ease the pressures.
May 27, 2005... Focusing on dealing with important issues should reduce urgent problems, says Bob Mathers. Prioritisation usually means having to deal with tasks passed on by others, so it is important to make sure others do things for themselves to...

Practice: GP access for the blind.(General Practitioners)
May 27, 2005... New guidelines will help GPs ensure that the visually impaired have access to services, says Lucie Benson. The Guide Dogs for the Blind Association has launched guidelines to advise GPs on how to ensure premises are easily accessible for...

Practice: Connected - A digital device that does it all.(Archos Video AV series)
May 27, 2005... One little box can handle your digital files, and record and play back music and TV, says Dr Nigel Stollery. These days it is quite common to find devices that perform more than one function, the most common being the mobile phone that...

Practice: Medicine on the web - Information on adult deafness.
May 27, 2005... Dr Keith Barnard recommends websites relating to the Clinical Review (page 53). Go to gponline.com for live links to these pages. DEAF PEOPLE AND THE HEALTH SERVICE I must say I have never had any special training concerning the...

Practice: Three reasons why I ... changed printers.(Brief Article)
May 27, 2005... Dr Nigel Kendall is delighted with his practice's move to non-standard printers. Any Windows-compatible printer would suit our clinical system, so I decided to shop around. 1. Low running costs The printer supplied with our...

Clinical: Journals watch - Contraception, cancers and IBS.(usage of contrast-enhanced magnetic resonance imaging (CE MRI))
May 27, 2005... Is pressure of time limiting your reading? Allow Dr Gwen Lewis to tell you about the latest research. Emergency contraception - Fam Pract 2005; 22: 280-6 The UK has the highest teenage pregnancy rate in Europe, and sexual health is...

Clinical: Clarification of the use of triptans in migraine.
May 27, 2005... Triptans are effective and not as expensive as some GPs think, says Dr Sue Lipscombe. Triptans are now widely regarded as first-line treatment for moderate to severe migraine. Sumatriptan was first launched in the UK in 1991 as a...

Clinical: At a glance - Hay fever.
May 27, 2005... Definition - Symptom complex resulting from an allergic inflammatory reaction to pollen. - Also sometimes known as seasonal or intermittent allergic rhinitis. Epidemiology - Affects about one in five of the population at some time...

Clinical: The good old days - Arthritis deformans.
May 27, 2005... The changes that occur in this disfiguring disease are two-fold. The first change is at the junction of the periosteum and the synovial membrane, where there is an increase in bone formation. Sclerosis then takes place, the cancellous bone...

Clinical: Viewpoint - A different approach to depression.
May 27, 2005... Understanding the causes of depression helps recovery, say Ivan Tyrrell and Denise Winn. Depression accounts for an increasing proportion of GP consultations, and GPs often rely on prescribing antidepressants, especially because access...

Clinical: Equipment review - An inspired way to record an ECG.
May 27, 2005... With plenty of ECG machines around, Dr Gio Caranci tests one of the latest models. The latest innovation in ECG machines, the Seca Concept 5, is an inspired combination of simplicity and high-tech advances. All you need is the small...

Clinical: The basics - Management of gastritis.
May 27, 2005... Gastritis can be difficult to spot but its effects can be very serious, writes Dr Nicolette Price. Gastritis is defined as inflammation of the gastric mucosa. The most common causes of acute erosive gastritis are alcohol, drugs...

Clinical: Clinical review - Hearing loss in adults.
May 27, 2005... The essentials - Establish whether hearing loss is unilateral or bilateral. - There are more than 60 types of hereditary hearing loss. - Acoustic neuroma presents with deafness in 90 per cent of patients. - There are medico-legal issues...

Clinical: Ensuring patients take the medicine.
May 27, 2005... One patient in five does not even collect their prescription, say Dr Jim Kennedy and Geraldine Mynors. The level of prescribing is huge and is increasing rapidly. The average person in England received 13.1 prescription items in 2003, a...

Clinical: Clinical Q&A - The treatment of female alopecia.
May 27, 2005... One of our team of experts answers your question on androgenic alopecia. Q: What treatment would you recommend for a woman of childbearing age with androgenic alopecia? How optimistic should she be about achieving a significant...

Clinical: Compact guidelines - Commentary - Your weekly review of key GP guidance from MIMS.
May 27, 2005... Even the opponents of evidence-based medicine will concede that it does work in the management of CHD. A few years ago as a practice participating in the primary care collaborative, we began the arduous process of validating the CHD...

Registrar: Medico-legal issues - Working with advance directives.(Mental Capacity Act 2005)
May 27, 2005... GPs should comply with patients' wishes but also preserve life, says Dr Hugh Stewart of the MDU. An advance directive or living will is designed to ensure the treatment wishes of a patient are respected when they no longer have the...

Registrar: MRCGP Exam Update - The use of guidelines.
May 27, 2005... Current situation - Clinical guidelines have increasingly become a familiar part of clinical practice. - They have been defined as 'systematically developed statements to assist practitioner and patient decisions about appropriate...

Registrar: Pictorial - case study.(Brief Article)
May 27, 2005... The case A 16-year-old girl presented with severe blistering on her face, especially around the mouth with crusting on her lips, and fever. She also complained of a burning sensation in her eyes and photophobia. On examination,...

Registrar: What they forgot to tell you ... cauterising Little's area.(Brief Article)
May 27, 2005... Epistaxes arising from Little's area (or Kiesselbach's plexus) often follow infection in the nares. Trying an appropriate topical antibiotic first may help. If this fails, get a good view of the nasal septum with a speculum and identify...

Registrar: How to ... claim allowances.
May 27, 2005... - Your contract Your contract is based on the standard BMA contract with the addition of an educational contract and other small changes that reflect your locality. - Your salary Your salary as a GP registrar should be based on...

GP Life: Motoring - Why I'd spend pounds 20,000 on the GTi.
May 27, 2005... Dr Tony Rimmer puts the disappointment of previous Golf GTis behind him. The Golf GTi is back, apparently. I was keen to believe, but approached the Mark 5 Golf with a little healthy scepticism. I remember the excitement of driving the...

GP Life: Free Time - Snooker and stress management.
May 27, 2005... Playing snooker is a diverting and relaxing pastime for GPs, explains Dr Dan Rushen. I increasingly find that there is more work and stress and less time and enjoyment in general practice, and from reading GP I know I am not alone. ...

GP Life: Musical GP aims to hit the right notes.(General Practitioner)
May 27, 2005... A lifetime of guitar playing has led Dr Paul Marfleet and his band to the release of a CD. My musical 'career' has in some ways always paralleled my medical one right from my student days. I had learned to play guitar from 60s sheet...

GP Life: A repository of prosthetic excellence.(General Practitioner)
May 27, 2005... The Thackray Medical Museum has won many awards, and Dr Jeremy Sager's approval. In August 1981, my first SHO post was medicine for the elderly - or geriatrics as it was then - based in the Ashley Wing (the former workhouse) at St James'...

Plain Tales from the Surgery.
May 27, 2005... STIs OR WMDs Patients seem to look up everything on the internet these days. A female patient of mine came in to see me with chlamydia and wanted to know why the incidence is rising so fast. I offered to refer her to the GUM...

Mary Selby: Marks of achievement.
May 27, 2005... Our home is almost becoming an art gallery these days, as the children's art work is framed and hung. The kind of thing we have on the walls is far more appealing than the Damien Hirst pickled stuff of the London galleries, and the...

Independent Nurse: Asthma - QOF targets should cover peak flow variability, say asthma specialists.(Quality and Outcomes Framework)
May 27, 2005... Nurses have cautiously welcomed doctors' calls for asthma and COPD indicators to be overhauled as part of the current review of the GMS quality and outcomes framework (QOF). The General Practice Airways Group (GPIAG) has proposed that...

Independent Nurse: Arthritis - Less inflammation in psoriatic arthritis.(Brief Article)
May 27, 2005... Prescribing ciclosporin A (CSA) for patients with active psoriatic arthritis who are not responding well to methotrexate (MTX) reduces signs of inflammation but does not reduce pain or improve quality of life, according to a UK, Belgian and...

Independent Nurse: Mortality - Scottish mortality rates are worsening.
May 27, 2005... Scotland's mortality, even after allowing for deprivation, is worsening, says a new study from the University of Glasgow. Researchers examined mortality data from the 1981, 1991 and 2001 censuses. They found that by 1991 measures of...

Independent Nurse: Journals Watch - Little benefit in giving aspirin to healthy 70-year-olds.(Brief Article)
May 27, 2005... An Australian team has modelled the broad implications of routine use of low-dose aspirin in a population of 20,000 men and women aged between 70 and 74 with no CVD. They found the benefits of aspirin in preventing heart disease were offset...

Independent Nurse: Journals Watch - Statins have additional benefits compared to ezetimibe.(Brief Article)
May 27, 2005... Both simvastatin and ezetimibe produce similar reductions in cholesterol, but simvastatin appears to have beneficial effects on arterial and endothelial function, a new study shows. The research suggests this appears to be at least in part...

Independent Nurse: Journals Watch - No evidence for combination therapy in simple hypertension.(Brief Article)
May 27, 2005... A UK review has found that although some studies have shown a reduction in blood pressure from the combination of ACE inhibitor with an angiotensin receptor blocker (ARB) the only one which looked at larger doses or longer-acting ACE...

Independent Nurse: Journals Watch - A light diet.(Brief Article)
May 27, 2005... In his book Living Through the Energy of Light, Dr Michael Werner claims all his energy comes from sunlight and that all he has ingested for four years is water and 'a little fruit juice'.

Independent Nurse: Calls for district nurse formulary to be scrapped.
May 27, 2005... The district nurse and health visitor formulary should be scrapped and community nurses should instead train as independent and supplementary prescribers, a leading nurse has proposed. Barbara Stuttle, chair of the Association for Nurse...

Independent Nurse: Vaccine in sight.(Brief Article)
May 27, 2005... A vaccine to combat pneumonic plague could soon be available. US researchers combined two proteins from the plague bacteria, Yersinia pestis. When injected into mice, which were then exposed to the plague bacteria, the animals survived while...

Independent Nurse: QOF shows Wales has more chronic disease.(Quality and Outcomes Framework)(Brief Article)
May 27, 2005... Welsh practices have more chronic disease patients than English practices according to new prevalence figures released by the Welsh Assembly. In fact Wales tops the UK prevalence scales in six of the 10 domains of the quality and...

Independent Nurse: Childhood obesity factors uncovered.(Brief Article)
May 27, 2005... Eight aspects of early life put UK children at greater risk of obesity according to new research. The study, involving 8, 234 children aged seven years and a further sample of 909 children, found four factors were independently associated...

Independent Nurse: What The Papers Said.(Brief Article)
May 27, 2005... 'Nicotine vaccine is set to stub out smoking' - The Times 'Jab doubles chance of quitting smoking' - Daily Mail 'Anti-smoking vaccine may be available in five years' - The Guardian WHAT DID THE PRESS SAY? A vaccine that...

Independent Nurse: Advanced Practice - Pressure to work beyond competence.
May 27, 2005... More than one in five advanced nurses sometimes feel they are expected to work beyond their competence, according to a survey on advanced nurses. The joint RCN and DoH survey found 24 per cent of the 480 respondents sometimes felt...

Independent Nurse: RCN will lobby over refused referrals.(referrals refusals)(Brief Article)
May 27, 2005... The RCN intends to lobby nationally over the issue of referrals after a survey showed that a third of nurses have had a referral refused for no other reason than it was not written by a doctor. Primary care nurses were twice as likely as...

Independent Nurse: Practices to achieve 90% of QOF points.(Quality and Outcome Framework)(Brief Article)
May 27, 2005... The government has confirmed that it expects practices to have achieved, on average, over 90 per cent of the quality and outcome framework (QOF) points on offer last year. Nigel Crisp, chief executive of the NHS, reported the figures in...

Independent Nurse: Vital Statistics - Activity in primary care.(Brief Article)(Illustration)
May 27, 2005... 2.8% increase in calls to NHS Direct during 2004/5 30.7% rise in patients attending walk-in centres 0% increase in GP referrals to outpatients in the last year Source: DoH: Chief Executive's Report to the NHS, May 2005.

Independent Nurse: Combination therapy has time limit.
May 27, 2005... Glycaemic control amongst patients with type-2 diabetes may decline in as little as six months after the start of combination therapy, a new study has suggested. Researchers analysed the records of 2,220 patients from the UK who had been...

Independent Nurse: NHS patients stay in hospital for longer.(Brief Article)
May 27, 2005... NHS patients stay in hospital three-and-a-half times longer than those treated by the independent US healthcare provider Kaiser Permanente, new research shows. Professor Chris Ham of the University of Birmingham measured bed days among...

Independent Nurse: World Outbreak Information - Week beginning 23 May.(Brief Article)
May 27, 2005... CANADA There are media reports of an outbreak of rubella in a group of religious communities in Ontario in May. Rubella is a particular problem for pregnant women. Travellers with children should ensure they are up to date with their...