Abstract
Website of the month
This useful free website lets you check for drug interactions with drugs used in the treatment of Human Immunodeficiency Virus. HIViChart is also a free app available for use on smart devices.
Supporting doctors with mental health problems
The General Medical Council has worked with the Medical Schools Council to produce guidance on helping medical students who have mental health problems. Some of the advice applies equally to all qualified doctors and might help you deal with a colleague who is a patient. The document reminds us that mental health problems in health professionals are more common than in equivalently educated members of the general population and that acknowledgement of a problem and engagement with care often means that the problem does not need referring to the GMC. It also gives many ideas for resources available.
GMC. (2013). Supporting medical students with mental health conditions. Retrieved from www.gmc-uk.org/Supporting_medical_students_with_mental_health_conditions___July_ 13.pdf_52834713.pdf
Resilience
Surveys of GP morale demonstrate high levels of stress and burnout. The College of Medicine has produced resources and a film looking at the problem and giving advice about techniques that can be used to improve resilience.
College of Medicine. (2013). Creating resilience, preventing GP burnout. Retrieved from www.collegeofmedicine.org.uk/creating-resilience-preventing-gp-burnout?dm_i= PC7,1RU1P,6WOJB6,6BOD1,1
College of Medicine Annual Conference. (2013). Pulse magazine resilience survey results. Retrieved from http://vimeo.com/70852956?dm_i=PC7,1RU1P,6WOJB6,6BOSY,1
Support for carers
The Royal College of General Practitioners has been at the forefront of drawing attention to carers. There are a variety of websites that can be used to help co-ordinate the care of people who are unwell.
Lotsahelpinghands allows people to volunteer or ask for help from the local community.
Caring Bridge facilitates the creation of a personalised website facilitating carers to stay in touch with one another. There is also a Support Planner that allows co-ordination of meal planning, sitting, pet care and other tasks.
If you have a practice website or patient group newsletter you could collect websites such as these as a resource for patients
Writing competition
Hektoen International is running two international essay competitions. Entries for the Vesalius Prize, including topics on medical history, famous physicians, medicine in literature and famous hospitals should be submitted by 1 December 2013. There is more time available to submit entries for the annual essay prize that has a deadline of 1 March 2014. Details of both competitions can be found at http://hekint.org/
Resource for adolescents
An online forum to encourage teenagers to access mental health information and support has been launched. The moderated site facilitates peer mentor, health professional and counsellor discussions. The service uses a similar model to the volunteer-led peer-support online Beat Bullying Group.
New role for antibiotics
When I first trained as a doctor we were not taught about Helicobacter. I think we would have been surprised to be told that ulcers might be caused by a bacterial infection. Other diseases also have proposed infective causation. A recent study showed that minocycline treatment for three months gave improvement in mood and functioning in children with Fragile X syndrome. There has been recent publicity about successful treatment of a sub-group of people with chronic sciatica for propionobacterium acnes. The diagnosis of chronic infection is made on an magnetic resonance imaging (MRI) scan so we may well have patients requesting complex (with implications for funding) investigations and treatment.
Leigh, M. J., Nguyen, D. V., Mu, Y., Winarni, T. I., Schneider, A., Chechi, T.,… Hagerman, R. J. (2013). A randomised double-blind, placebo-controlled trial of minocycline in children and adolescents with Fragile X syndrome. Journal of Developmental and Behavioural Pediatrics, 34(3), 147–155. doi: 10.1097/DBP.0b013e318287cd17
Albert, H., Sorensen, J., Christensen, B., & Manniche, C. (2013). Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modictype 1 changes): a double-blind randomized clinical controlled trial of efficacy. European Spine Journal, 22(4), 697–707. doi: 10.1007/s00586-013-2675-y
Metoclopramide warning
In August 2013, the Medicines and Healthcare Products Regulatory Agency (MHRA) recommended changes that include restrictions on the dose and duration of use of metoclopramide. This is to help minimise the risk of potentially serious neurological adverse effects, such as short-term extra-pyramidal disorders and tardive dyskinesia.
Metoclopramide should only be prescribed for short-term use, i.e. up to five days. For adults, the maximum dose in 24 hours is 30 mg usually as 10 mg up to three times a day per kg bodyweight. In children, the risk of acute neurological side effects is greater, so its use is totally contraindicated in children under one, and for those aged 1–18 years limited to specific chemotherapy-related and post-operative vomiting. In children aged one year or older, the recommended dose is 0.1–0.15 mg per kg bodyweight, repeated up to three times a day with a maximum dose in 24 hours of 0.5 mg per kg.
MHRA. (2013). Metaclopramide: risk of neurological adverse effects- restricted dose and duration of use. Retrieved from www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON300404
MHRA update: nitrofurantoin
Nitrofurantoin is commonly used in the treatment of urinary tract infections (UTI). Its efficacy depends upon its renal excretion into the urinary tract. Thus, in patients with renal failure, this can result in treatment failure.
Nitrofurantoin is contraindicated in those with creatinine clearance lower than 60 millilitres per minute. Many local prescribing protocols use nitrofurantoin as a first line drug so you could consider checking your protocols for the management of UTI.
MHRA. (2013). Nitrofurantoin: reminder on precautions for use, especially renal impairment (elderly) patients. Retrieved from www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON300402
NICE: acute kidney injury
Acute kidney injury is seen in 13–18% of all people admitted to hospital, with older adults being particularly affected. According to new guidance published by National Institute for Health and Care Excellence (NICE), GPs should measure the creatinine levels of all patients aged 65 years and over with a serious acute illness to detect those with acute kidney injury. Serum creatinine should also be measured in adults with conditions such as heart failure, liver disease and diabetes. You could evaluate how this new guidance may be implemented at your surgery, thinking of topics such as patient acceptability, workload and resources.
NICE. (2013). Acute kidney injury: prevention, detection and management of acute kidney injury up to the point of renal replacement therapy. Retrieved from www.nice.org.uk/CG169
NICE quality standards for headaches
NICE has released a quality standard for headaches.
People with primary headache (no known cause) should be given a classification of their headache type, e.g. migraine or tension headache.
Patients should we warned about the risk of generating headaches by taking too much medication.
People with symptoms of migraine or tension headaches without other symptoms should not be referred for brain scans.
People with migraine should be offered triptans with either non-steroidal anti-inflammatory medication or paracetamol.
NICE recognises that raising awareness of headaches in both the general public and health professions is an area where more guidance is needed.
NICE. (2013). QS42 Headaches in young people and adults. Retrieved from http://publications.nice.org.uk/headaches-in-young-people-and-adults-qs42