GP articles from May 2006

GP archives from May 2006

NSAIDs raise heart failure risk by 30%.(Non-Steroidal Anti-Inflammatory Drug )
May 26, 2006... NSAIDs should only be used in elderly patients as a last resort because they increase heart failure risk by a third, experts say. Prescribers are currently advised by the MHRA always to use NSAIDs at the lowest effective dose, for the...

Patient budgets cut chronic care costs.(healthcare under practice-based commissioning)(Brief article)
May 26, 2006... GPs could cut the cost of treating chronic disease by up to 40 per cent by giving patients partial control over individual budgets for their healthcare under practice-based commissioning. About 200 patients with chronic conditions have...

Hidden vCJD could emerge in 50 years.(homozygous methionine polymorphism at codon 129 in the gene)
May 26, 2006... The toll that vCJD will take on the UK could be larger and take longer to unfold than previous studies have suggested, UK researchers have found. Examination of over 12,000 appendix and tonsil tissue samples from patients in England and...

DNA micro-bubbles could treat diabetics.(gene therapy for diabetes)(Brief article)
May 26, 2006... Microscopic bubbles carrying fragments of DNA could be the solution to effective gene therapy for diabetes, say US researchers. They injected water-insoluble phospholipid micro-bubbles containing the human insulin gene into the...

Research brief: No lung cancer risk from cannabis.(Smoking cannabis)(Brief article)
May 26, 2006... Smoking cannabis does not increase lung cancer risk, even among heavy, long-term users, a US study has shown. Analysis of cannabis use among 611 people with lung cancer and 1,040 healthy controls, all of whom were aged 18-59 years, found no...

Research brief: Air pollution linked to mortality.(air pollution increases the risk of death)(Brief article)
May 26, 2006... Exposure to air pollution increases the risk of death for people with diabetes, heart failure, COPD and inflammatory diseases including rheumatoid arthritis, researchers told the American Thoracic Society's International Conference, in San...

Research brief: Heart deceleration predicts mortality.(left-ventricular ejection fraction)(Brief article)
May 26, 2006... Impaired heart rate deceleration capacity is a more accurate tool for assessing mortality risk in patients recovering from acute myocardial infarction than left-ventricular ejection fraction (LVEF), according to German researchers. Over 2,700...

Research brief: The noisy knee test.(creaking noises produced by the joints)(Brief article)
May 26, 2006... Arthritis should be assessed using a 'noisy knee' test, researchers in Lancashire have claimed. The researchers have developed a device for diagnosing osteoarthritis on the basis of the creaking noises produced by the joints (www.arc.org.uk).

GMC verdicts 'unfair to doctors'.(fitness-to-practise panels )
May 26, 2006... GMC fitness-to-practise panels are substandard and put doctors and patients at risk, according to the head of the Shipman inquiry. Dame Janet Smith, a High Court judge, said their decisions were often ill conceived and confusing and that...

Patients at increased risk from OTC triptans.(Modern Humanities Research Association (United Kingdom))(Brief article)
May 26, 2006... GPs believe that the switch of the first migraine drug from prescription-only to OTC, announced by the MHRA last week, could put patients at risk. The MHRA has determined that sumatriptan (Imigran) can be safely sold through pharmacies...

Scrips in England rise by 8% in early months of 2006.(drugs for obesity is 28 per cent higher)(Brief article)
May 26, 2006... The number of prescriptions issued in England over the first three months of 2006 is 8 per cent higher than the same quarter last year, while medication costs have fallen by 4 per cent, according to figures published by the Prescribing...

Screening for tuberous sclerosis.(embryo screening for tuberous sclerosis)(Brief article)
May 26, 2006... West London GP Dr Mandy Baum gave birth earlier this month to the first child born following embryo screening for tuberous sclerosis. Dr Baum's second son Joe (pictured) was diagnosed with tuberous sclerosis when he was 18 months old. The...

GPs need better-quality managers.(General practitioners)
May 26, 2006... General practice does not have enough staff of sufficient quality to absorb extra work from hospitals, according to the DoH's primary care czar. Dr David Colin-Thome told the House of Commons health select committee that despite an...

12% of doctors will be without a job to go to.(national health services)(Brief article)
May 26, 2006... The NHS will have a 12 per cent 'oversupply' of doctors by next year that will leave hundreds of medical graduates unable to find work, NHS Employers says. This means that about 550 graduates will be unable to find any kind of doctor's...

Marketing ploys to boost take-up of healthy living.(Brief article)
May 26, 2006... The NHS could persuade more patients to adopt healthy living initiatives by using commercial marketing techniques, UK experts have said. Strategies used by global brands such as Nike have proven effective in changing health behaviour in...

European Stroke Conference: Lipid lowering reduces risk of second stroke.(Stroke Prevention by Aggressive Reduction in Cholesterol Levels )
May 26, 2006... Lipid lowering therapy, secondary care referral and AF diagnosis. Aggressive lipid lowering therapy can reduce the risk of a further stroke in patients who have suffered a stroke or TIA by 16 per cent, even if their lipid levels are...

GPs most likely to treat TIA patients first.(emergency care)(Brief article)
May 26, 2006... GPs are likely to be the first medical consultation for patients who have had a TIA, according to UK research presented at the conference. Dr Matthew Giles, specialist registrar in geriatric and general medicine in the Oxford region,...

Rapid referral boosts rates of thrombolysis.(secondary care)(Brief article)
May 26, 2006... Patients with symptoms that could indicate stroke should be referred to secondary care without delay, GPs were advised. Professor Kennedy Lees, professor of cerebrovascular medicine at the University of Glasgow and director of the stroke...

AF diagnosis 'unreliable'.(European Stroke Conference)(Brief article)
May 26, 2006... GPs' ability to diagnose AF based on ECG traces is not sufficient to be utilised in a screening programme, researchers told the European Stroke Conference last week. The study found that GPs correctly identified 79 out of 99 cases of AF....

PCT cuts threaten coeliac care.(gluten-free foods on prescription for patients)
May 26, 2006... GPs should resist pressure from PCTs to cut costs by denying coeliac patients gluten-free foods on prescription, GP experts have advised. The high cost of gluten-free foods and patient immobility mean that patients often fail to adhere...

PCT numbers halved in bid to save pounds 250m.
May 26, 2006... PCTs are to be restructured so that 70 per cent share the same boundaries as local authorities. Edward Davies investigates. PCT numbers will be cut from 303 to 152 in the latest restructuring of primary care organisations in England. ...

Call to end Choose and Book.(national health services)
May 26, 2006... GP concern over the DoH choice agenda, referral systems and changes to the GMS contract are issues set to dominate this year's LMCs conference. Motions submitted to the BMA by LMCs include calls for the Choose and Book IT system to be...

Compensation ruling to hit practice funds.(national health services)(Brief article)
May 26, 2006... A landmark legal ruling forcing the NHS to compensate patients who undergo treatment abroad might put practice-based commissioning at risk, the BMA has warned. The European Court of Justice ruled last week that the NHS must refund the...

Gene therapy for wounds.(repair in patients with diabetes)(Brief article)
May 26, 2006... Diabetic wounds, such as the foot ulcer pictured, could soon be treated using a topical gene therapy. US researchers found that topical application of a treatment containing DNA encoding for the Sonic hedgehog gene, which has previously been...

Exception reporting on basis of age 'unethical'.(glomular filtration rate )(Brief article)
May 26, 2006... GPs should not exception report patients with an estimated glomular filtration rate (eGFR) indicative of stage three chronic kidney disease (CKD) solely on the basis of age, according to a DoH adviser. Doubts over the accuracy of the eGFR...

RA bone loss.(inflammatory joint disorders)(Brief article)
May 26, 2006... A UK study of 74 patients with undifferentiated hand arthritis showed that hand bone loss over 12 months was five to eight times greater in patients who were diagnosed with RA, than in those with other inflammatory joint disorders (Ann Rheum...

GPs act on concerns over colleagues' clinical skills.(general medical center)(Brief article)
May 26, 2006... Three out of 10 GPs have raised concerns about a colleague's clinical knowledge and skills, according to a GMC survey. Around half of GPs overall have suspected that a medical colleague is performing badly in some way, the survey shows....

Behind the Headlines: Does fish oil boost exam grades?(fish oil supplements can boost academic achievement)
May 26, 2006... Jo Carlowe investigates reports that fish oil supplements enhance exam performance. What is the story? With GCSE season fast approaching, media claims that fish oil supplements can boost academic achievement have raised the hopes of...

GPs wary of rise in home births.(department of health)(home births)
May 26, 2006... DoH moves to encourage home births are raising concerns about patient safety. The DoH plans to encourage a dramatic increase in home births, according to widespread speculation. Despite official denials, DoH sources reported in the...

Leader: Workforce planning is either feast or famine.(National Health Service)
May 26, 2006... It was not so long ago that the BMA was loudly demanding that another 10,000 new doctors were needed to fill the gaps in NHS services. Now we are hearing warnings of a glut. The NHS Employers organisation told MPs last week that by next...

Leader: Gimmicks no longer alien to NHS.(Brief article)
May 26, 2006... A free Big Mac with every stone lost or a My Little Pony buggy toy with each completed course of MMR. Experts are advocating health services learning from large corporations when it comes to marketing public health. Among the suggestions are...

Opinion: Long live the Viagra drug reps.
May 26, 2006... I was at a meeting the other night, and afterwards was having a beer with a few colleagues when we were joined by the sponsoring drug rep. We GPs are an easy-going folk, so he settled handily into the company, bought a round, generally...

Opinion: Pulling a fast one with statistics.
May 26, 2006... Statistics are a dangerous weapon and require careful handling. I've always felt that those who use them should be licensed. No, I'm serious. You shouldn't be allowed to use statistics publicly without possessing proper...

Journals Watch: Diabetes and post-MI depression.
May 26, 2006... Too busy to keep up with the journals? Allow Dr Elizabeth Croton to be your guide to the latest findings. LIPID LOWERING TREATMENT WORKS FOR DIABETIC PATIENTS BMJ 2006; 332: 1,115-8 Diabetes is an independent risk factor for...

Clinical: Management of breathlessness.
May 26, 2006... Breathlessness causes many non-cancer patients distress. Dr Simon Auty advises. Breathlessness is a significant problem in many chronic diseases including end-stage heart failure, advanced COPD, and advanced motor neurone disease (MND)....

Clinical: Ulcerative colitis and Crohn's disease.
May 26, 2006... Dr Jim Price offers an update on inflammatory bowel disorders. Inflammatory bowel disease is an umbrella term covering a range of conditions, the two most common being ulcerative colitis and Crohn's disease. Ulcerative colitis (UC)...

Clinical: An update on psoriatic arthritis.(Brief article)
May 26, 2006... Psoriasis and psoriatic arthritis require careful management. The prevalence of psoriasis in the general population is 1-2 per cent, and the prevalence of psoriatic arthritis (PsA) is around 0.3 per cent. A GP practice of 5,000...

Clinical: Resolving sports injuries to the elbow.
May 26, 2006... An overview of tennis and golfer's elbow by Dr Emma Lackey and Mr Ron Sutton. Tennis elbow is a lateral epicondylitis at the origin of the wrist extensors. In golfer's elbow the medial epicondyle is affected at the common flexor...

Clinical: Equipment Review - An ear irrigator that improves wax removal.
May 26, 2006... As the demand for extracting wax grows, Dr Peter Standing reviews a new syringing model. If all the ear wax removed in one year was placed end to end it would form a ceruminous thread from Bognor Regis to Bridlington. Extracting wax...

Clinical: Practice Dilemma - A patient claims to have allergies.
May 26, 2006... A new patient says she has food allergies, but her records say she does not. What should you do? THE DILEMMA During her registration check, Sam, a 19-year-old second-year medical student, told us that she had multiple proven food...

Clinical: Clinical Q&A - Anaemia and MMR or pertussis vaccines.
May 26, 2006... Our team of experts answer your queries on vaccines and macrocytic anaemia. Pertussis vaccine and MMR have caused serious concerns to parents because of the alleged links with brain damage, autism and bowel problems. What should...

Clinical: At a Glance - Fissured tongue versus geographic tongue.(Brief article)
May 26, 2006... FISSURED TONGUE Discriminatory features - Also known as 'scrotal tongue' or 'lingua plicata'. - Benign condition. Usually painless. - One or more shallow or deep grooves or fissures, which extend to the edges of the tongue....

Clinical: The Good Old Days - Consumption and cod liver oil.(Brief article)
May 26, 2006... Consumption is a portion only of a constitutional malady, which frequently develops its intensity in respiratory organs. Its nature should be impressed upon the mind of the people, for if it is regarded only as a disease of the lungs, no...

Clinical: Dealing with long-term illness.
May 26, 2006... The essentials - Over 2.7 million people currently claim state incapacity benefit in the UK. - Unemployment brings poverty, isolation and risk-taking behaviour. - People on long-term benefit perceive barriers to their return to...

Clinical: Incapacity Benefit - Web resources about long-term illness.
May 26, 2006... Websites related to this week's Clinical Review selected by Dr Keith Barnard. I have always found it difficult to assimilate all the bureaucracy surrounding incapacity benefit, despite the plethora of leaflets that arrive in my in-tray....

Registrar: Prescribing - Setting up a practice formulary.
May 26, 2006... Setting up a local formulary allows GPs to reflect on their prescribing habits, says Dr Anthony Crockett. A formulary is merely a list of medications that users agree to use or are encouraged to use preferentially. All doctors in the UK...

Registrar: MRCGP Exam Update - Treating prehypertension.
May 26, 2006... Current situation - Prehypertension or high normal BP is considered a precursor to stage-1 hypertension and a predictor of excessive cardiovascular risk. - There has been much work done recently that has demonstrated the benefits of...

Registrar: Pictorial Case Study.(Brief article)
May 26, 2006... The case A 52-year-old woman presented complaining of a red rash over her cheeks. The rash was burning and not itchy. Red papules were distributed over her cheeks, forehead and chin. There were a few pustules and she had nasal...

MedEconomics: GP Finance - How to ... provide essential travel vaccinations.
May 26, 2006... Clarify the rules for the vaccinations for which GPs can and cannot charge, advises Dr Nigel Higson. As the summer holiday season gets under way, practices will experience an increase in demand for travel health advice and vaccinations....

MedEconomics: GPs can gain from nurse prescribing.
May 26, 2006... Extended nurse prescribing benefits GPs, nurses and patients, says nurse prescriber Tina Carney. It started with district nurses and health visitors independently prescribing a very small range of products. Then in 2002 came the...

MedEconomics: How healthcare assistants fit into a practice.
May 26, 2006... The range of tasks HCAs can undertake is wide, writes Dr Ruth Chambers. Healthcare assistants (HCAs) can prove a valuable addition to the practice team. Their numbers have burgeoned in recent years as practices have addressed the quality...

MedEconomics: Self-Employment - Pensions, splits and self-employment.
May 26, 2006... I started working as a locum GP in late April this year and I have been told that I should contact my local tax office to obtain a unique tax reference (UTR) because I am self-employed. Can you explain what this is about? Do I also need to...

MedEconomics: GP consulting room printer earns top marks.(Product/service evaluation)
May 26, 2006... Printers are just as important as the PC that drives them. Dr David Matthews tests one for GPs. Printers are generally considered to be one of the most un-exciting bits of IT kit. People become really enthusiastic about the 'fastest...

MedEconomics: Avoiding age-related bias at work.
May 26, 2006... New rules of employment will mean major changes for GPs and their staff, says lawyer Lynne Abbess. GP employers will need to master a new set of legal rules for dealing with staff when the Employment Equality (Age) Regulations 2006 come...

GP Life: The new Italian that purrs.(Alfa Romeos 159)
May 26, 2006... Alfa Romeos are objects of desire, designed to stand out proud and loud from the flat white noise of modern society. Alfa Romeos aren't meant to blend in. Alfa Romeos are objects of desire, designed to stand out proud and loud from the...

GP Life: When I travel, I always take ... satellite navigation.(Brief article)
May 26, 2006... Model Garmin eTrex Legend C, with Garmin Auto Navigation Kit Price pounds 167.54, navigation kit pounds 159 Available www.amazon.co.uk and www.askdirect.co.uk, navigation kit from www.globalpositioningsystems.co.uk Kids and cars just...

Plain tales from the surgery.
May 26, 2006... SWEET AND SOUR I have a patient who speaks very little English, so whenever possible he brings along his son to translate for us. Unfortunately, our 'translator' could not make it to a recent emergency appointment, but he had kindly...

Mary Selby: Cracking the Da Selbi code.(Brief article)
May 26, 2006... Jones ascended the narrow stair into the surgery. Could this be the place he had read of in ancient texts? The door opened with a gentle swish, and he held his breath. The first rays of the rising sun were aligned perfectly with the...

Independent Nurse: Number of PCTs in England to halve as DoH reveals mergers.
May 26, 2006... The number of PCTs in England has been reduced from 303 to 152 after health secretary Patricia Hewitt announced the final mergers last week. Ms Hewitt said bigger PCTs would be able to deliver better value for money through greater...

Independent Nurse: Two-thirds of premises are not fit for purpose.(Brief article)
May 26, 2006... Almost two thirds of UK practice premises are inadequate for current needs and a quarter pose health and safety risks to staff and patients, according to a BMA survey. The survey of 251 practices found three quarters were inadequate for...

Independent Nurse: New community nursing model.(Brief article)
May 26, 2006... Community nurses will take on a greater role in co-ordinating patient care under plans to remodel nursing outside of hospitals in Scotland. Initial proposals emerging from an ongoing review of nursing in the community were revealed at...

Independent Nurse: Call for changes to MMR jab schedule.(Brief article)
May 26, 2006... GPs are calling for a change to the MMR immunisation schedule after research has shown that one in seven children given two doses have low mumps antibody levels. A study by the Health Protection Agency (HPA) to be published in the...

Independent Nurse: Patients 'do not want care at home'.(Brief article)
May 26, 2006... A mind shift amongst patients may be needed if government plans to deliver care closer to home are to work. Alison Jarvis, project officer on the review of nursing in the community for the Scottish Executive, said she recently spoke to a...

Independent Nurse: Incontinence.(Nice)(Brief article)
May 26, 2006... NICE has issued provisional guidelines on the Management of urinary incontinence in women. It recommends bladder diaries, for a minimum of three days, be used for the initial assessment. Supervised pelvic floor muscle exercises should be...

Independent Nurse: Practice-based Commissioning.(RCGP)(Brief article)
May 26, 2006... The RCGP has launched a toolkit to help practices redesign local services through practice-based commissioning. It provides examples of redesigned services and questions to assess the validity of plans, including if the plan introduces...

Independent Nurse: Hypertension.(primary care clinicians)(Brief article)
May 26, 2006... An international survey has found 70 per cent of primary care clinicians believe their hypertension patients have achieved their blood pressure goal of 140/90mmHg or lower. However, worldwide figures show only 30-50 per cent of patients are...

Independent Nurse: Research.(Brief article)
May 26, 2006... A new school for primary care research covering five universities has just received funding of pounds 3 million per year from the government to increase the evidence base for primary care practice. The research will focus on interventions for...

Independent Nurse: Job cuts.(NHS Direct)(Brief article)
May 26, 2006... NHS Direct has launched a staff consultation on a reorganisation that will see 12 of its contact centres close, a further 19 under threat and 413 staff posts lost. The plans are the result of increased competition in the market and a smaller...

Independent Nurse: Personal budgets for patients could cut costs by up to 40%.(Brief article)
May 26, 2006... A PCT is considering the idea of giving patients with chronic diseases their own indicative budgets through practice-based commissioning. Lance Gardner, projects director at North East Lincolnshire PCT and a former nurse, told an RCGP...

Independent Nurse: Journals Watch - Combination therapy is recommended after mini-strokes.(Brief article)
May 26, 2006... A European/Australasian study compared dipyridamole and aspirin with aspirin monotherapy in more than 2,600 patients who had suffered a minor stroke. Those on combination therapy had fewer circulatory events (13 per cent) compared with those...

Independent Nurse: Journals Watch - No evidence yet for methods to prevent smoking relapse.(Brief article)
May 26, 2006... UK researchers reviewed 42 studies that tested interventions designed to prevent quitters from relapsing within a year. Studies focused on skills training and pharmacotherapy but the review found neither method appeared to be successful....

Independent Nurse: Journals Watch - Three questions distinguish urinary incontinence types.(Brief article)
May 26, 2006... US researchers enrolled 301 women over the age of 40 with untreated incontinence. They were asked three questions - whether they leaked urine, when they leaked and when they leaked most. A urologist then evaluated their condition. The three...

Independent Nurse: Journals Watch - Prickle diet hope for slimmers.(Brief article)
May 26, 2006... A cactus used by the South African San tribe to keep hunger pangs at bay while on long hunting trips is being used to develop a new slimming pill. The active ingredient in the bitter-tasting hoodia plant can help people eat 1,000 fewer...

Independent Nurse: Corticosteroids do not stop asthma.(Brief article)
May 26, 2006... Using inhaled corticosteroids as a preventive treatment in children to stop them developing asthma does not work, according to two new studies. In the first study, US researchers gave 285 children aged 2-3 and at high risk of developing...

Independent Nurse: Give CVD prevention to lower risk patients.(Chemical vapor deposition)(Brief article)
May 26, 2006... CVD primary prevention should be targeted at patients with a modifiable risk as low as 5 per cent, say Dutch researchers. This is despite current guidelines advocating interventions for those with a 20 per cent or greater 10-year CVD risk....

Independent Nurse: Vital Statistics - Malaria in the UK.
May 26, 2006... 150% increase in travel to popular malaria-risk destinations in the past 10 years 27 UK travellers contracted malaria between October 2005 and January 2006 9 Britons die from malaria on average every year Latest figures from the...

Independent Nurse: World Outbreak Information - Week beginning 22 May.(malaria breaksout)(Brief article)
May 26, 2006... INDIA A large outbreak of malaria has been reported in Assam in May. Over 335,000 cases and 500 deaths have been recorded. The worst affected areas are Lakhimpur and Golaghat. Travellers should take steps to avoid bites, take malaria...

Independent Nurse: Practice travel clinics under threat.(Brief article)
May 26, 2006... Nurses could lose their work in travel health to pharmacists because of a lack of GP interest and extended non-medical prescribing rights, a Scottish nursing conference has been told. At the annual Scottish Practice Nurse Association...

Independent Nurse: Nurse information services to increase.(Brief article)
May 26, 2006... Practice nurses will spend more of their time giving patients information about managing their health in the future, according to a survey conducted by Developing Patient Partnerships. A survey of 100 GPs, 118 practice managers and 102...

Independent Nurse: Government plan to boost access to CBT.(Brief article)
May 26, 2006... Two new pilot sites have been set up by the DoH to trial methods of increasing access to cognitive behavioural therapy (CBT). The demonstration sites in Doncaster, Yorkshire, and Newham, east London, will include voluntary sector, community...

Independent Nurse: News focus - Do practice nurses lose out on pay?
May 26, 2006... Amid calls for GPs to share profits with their staff, Judy Sands asks if nurses should be part of GMS contract negotiations. At last month's RCN Congress, health secretary Patricia Hewitt argued that the RCN should negotiate with the BMA...

Independent Nurse: News focus - Slow start for AfC skills framework.
May 26, 2006... The Knowledge and Skills Framework is meant to give nurses a clear career path. Christian Duffin reports on its progress. Nurses are often divided over the appeal of Agenda for Change (AfC). The RCN's Practice Nurse Association has...

Independent Nurse: Letter - A protocol for X-ray referrals helped us.(Brief article)
May 26, 2006... In our PCT we have overcome the problem of refused X-ray referrals by writing a protocol. This was done in conjunction with the radiographers and radiologists, setting out what type of X-rays nurses would want to request and in what...

Independent Nurse: Editorial - Investment in practice premises is vital.(Editorial)
May 26, 2006... According to a recent survey of GPs, general practice is, quite literally, bursting at the seams. Almost 60 per cent of respondents to a BMA survey said their premises were not suitable for their present needs and three quarters felt...