Abstract
Website of the month
Cancer Research UK has launched a mobile phone game that is designed to help identify patterns in genetic data from cancer patients. Players choose an intended route through the densest part of ‘space' that they can find and fly through collecting Element Alpha on the way. The image of space is a visual representation of data from 2000 breast cancer patients. The human eye is better than current computers at spotting complex patterns, so researchers are hoping that a game played by many may allow speedier detection of cancer rather than just passenger genes.
www.cancerresearchuk.org/support-us/play-to-cure-genes-in-space
GP networks
The King’s Fund has published a report giving a vision of future health care run by ‘family care networks’ of GP practices delivering medical, social and community care. These would be based on a population-based capitation contract, with services defined by the needs of the local population. There is a huge amount to learn during your training. It is easier to focus on learning to treat patients and gaining the skills to pass all the examination components. Reports such as these will define the ways in which you work as independent practitioners. Once you have passed your hurdles, you may want to use some of your self-directed learning time to explore management and leadership opportunities.
www.kingsfund.org.uk/publications/commissioning-and-funding-general-practice
Acceptable medicines
The UK Medicines Service has produced a guide to identifying medicines that are acceptable to Muslim and Jewish patients. It gives a clear outline of the religious requirements, and how and where to recommend patients seek advice if the decision is complex.
www.medicinesresources.nhs.uk/upload/documents/Evidence/Medicines%20Q%20&%20 A/QA381_1KosherandHalal_FINAL.doc
Mental health of doctors
The British Medical Association is running surveys in three of the UK countries to explore the attitude of doctors to their own mental health. Doctors have higher than average levels of mental health problems, and the results will be used to inform the development of services.
Never events
Never events have frequently been discussed in hospital settings. Never events are events that cause, or potentially cause, severe harm to patients and could be prevented by the healthcare team or organisation. A recent British Journal of General Practice article suggests a preliminary lists of ten never events. The list includes prescribing errors, such as prescribing methotrexate daily instead of weekly, or prescribing medication to a patient where a previous severe reaction is recorded in the notes. System errors are also suggested, for example failing to send a two week wait letter, or the surgery receiving but not acting on an abnormal result. What would you put in your list of ten?
De Wet, C., O’Donnell, C. & Bowie, P. (2014). Developing a preliminary ‘never event’ list for general practice using consensus-building methods. British Journal of General Practice, 64, e159–e167. doi: 10.3399/bjgp14X677536
Mental health and smoking cessation
A recent review has shown improvements in mood in people who give up smoking. This improvement was noted in the general population and also in populations with mental health disorders. People with mental health problems have higher incidence of other health problems. This study may make it easier for us to give equal access to health promotion advice to patients with psychiatric disorders.
Taylor, G., McNeill, A., Girling, A., Farley, A., Lindson-Hawley, N., & Aveyard, P. (2014). Change in mental health after smoking cessation: systemic review and meta-analysis. British Medical Journal, 348, g1151. doi: 10.1136/bmj.g1151
Volunteer Scotland
Scotland’s only national centre for volunteering helps to match keen volunteers with opportunities. Partially funded by the Scottish Government, the benefits of volunteering to the individual and the community are recognised and further developed through research. One current project is looking at the role of GPs in signposting to local preventive care support offered by volunteer organisations.
Clinical trials
The UK Clinical Trials Gateway is designed to allow patients to identify trials that they may wish to participate in. It holds information on clinical trials taking place throughout the UK, based on data held on a variety of national registers. It extends to include information on international trials that have a UK branch. There is a facility to search by body system or clinical condition, and a map is created showing the location and titles of the current registered trials. Contact details and further information on the trial of interest are readily accessible, and patients are encouraged to discuss joining with their own doctor.
Combined contraception and venous thromboembolism
Since the publication of BNF 67 (March–September 2014), changes have been made to the information on risks of venous thromboembolism (VTE) in women taking combined hormonal contraceptives. The risk factors related to the patient are a key part of our history taking, but this new information illustrates the variation in thromboembolic risk by type of progestogen. Levonorgestrel, norgestimate and norethisterone carry the lowest risk, at 5–7 cases per 10 000 women per year of use. The highest risks came from desogestrel, drospirenone and gestodene, at 9–12 cases per 10 000 women per year of use. Although this is up to six times higher than the incidence among a non-pregnant woman who is not using combined hormonal contraception (2 per 10 000 women per year of use), this risk is substantially smaller than the 60 cases of venous thromboembolism per 100 000 pregnancies.
www.medicinescomplete.com/mc/bnf/current/PHP4869-combined-hormonal-contraceptives.htm#PHP4870
National Voices
National Voices is a coalition of health and social care charities. It works to achieve greater participation of patients, carers, families and voluntary organisations in the shaping of healthcare services. There are over 150 members, around 130 of these being charities and the rest professional and associate members. They are directly involved with the Department of Health through the Voluntary Sector Strategic Partner Programme. They also make a contribution to The Coalition for Collaborative Care, which the RCGP is a key partner in. The coalition focuses on the relationship between health and social care providers and people with long term conditions, and seeks to achieve care that meets the needs identified by the patients themselves. Through collaboration, each person is empowered to develop knowledge, skills and confidence to manage their own condition, with support where it is needed. It essentially helps take expert patients to the next level.
Chronic pain
The Scottish Intercollegiate Guidelines Network (SIGN) guideline on the management of chronic pain was published at the end of last year. It recommends the use of supported self-management throughout the patient journey, from early stages to long term therapy. Consideration of strong opioids for back pain and osteoarthritis is welcomed, but with the note that continuation should only occur if there is ongoing pain relief. Advice on staying active is ineffective as a sole intervention, highlighting the need for exercise therapy, regardless of the form it takes. Our role as GPs is also highlighted, indicating that we need to be aware of our own behaviours and interactions, which may inadvertently reinforce unhelpful patient behaviours.
SIGN 136: Management of chronic pain. www.sign.ac.uk/guidelines/fulltext/136/index.html
Cancer in Wales
The Wales Cancer Patient Experience Survey was published in January, detailing responses from 7352 patients. The feedback was predominantly positive, with the allocation of a clinical nurse specialist (CNS) correlating with more positive experiences. Clinical care was highly rated, but the impact of cancer on the patient as a person was less well addressed. Information provision regarding work, education, finance and benefits was not consistent.
Welsh Government policy requires every individual with cancer to have a key worker. However, this was not consistently reported, and the co-ordination between primary and secondary care, key workers and clinical nurse specialists was variable. The type of cancer was also related to how positive the experience was. Breast cancer patients generally had a good experience, with sarcoma, lung and urological cancers being less positive.
The results of the survey are relevant for us as GPs, highlighting the areas in which we are succeeding and building on them, but also identifying those that need further development.
Wales Cancer Patient Experience Survey, National Report 2014. http://wales.gov.uk/docs/dhss/publications/140117canceren.pdf
Motor neurone disease diagnosis
The Motor Neurone Disease Association has developed a ‘red flags’ tool that is designed to facilitate accurate referrals and timely diagnosis of motor neurone disease (MND). It offers some key symptoms and signs that should prompt you to consider the presence of MND. Although not a treatable disorder, there are benefits to be had from early diagnosis, such as optimising quality of life and making the most of functional abilities for as long as possible.