Abstract
Adult attention deficit hyperactivity disorder
Reading hospital letters at the end of the day can be a chore. It is however a good way of learning across the curriculum. Looking for learning needs across a series of letters can be an interesting tutorial. A recent letter from neurology made the process easier as they enclosed the links to the Royal Society of Psychiatry information on adult attention deficit hyperactivity disorder (ADHD) and also to an interesting YouTube video
www.youtube.com/watch?v=4r3XWj269_g
www.rcpsych.ac.uk/healthadvice/problemsanddisorders/adhdinadults.aspx
Antidepressants
A recent systematic review and network meta-analysis in The Lancet has shown that anti-depressants are an effective treatment for moderate to major depression. The study looked at data from 522 trials, with 116,477 participants and found that all antidepressants were more effective than placebo in adults with major depressive disorder. Some antidepressants were more efficacious with a higher response rate than others, and some antidepressants were better tolerated by participants than others. This review may help clinicians help patients with choice or dose of antidepressants, and help compliance and concordance with treatment.
Cipriani A, Furukawa T, Salanti G, et al. (2018) Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet 391(10128): 1357–1366. DOI: 10.1016/S0140-6736(17)32802-7.
Womens health
The Royal College of Obstetrics and Gynaecology and the Faculty of Sexual and Reproductive Health has worked with the Royal College of General Practice to produce a signposted online library bringing together e-learning, guidelines and RCGP accredited resources.
The information is divided into broad topics, such as pre-menopause and maternal health. Resources free to members are clearly labelled.
Sepsis
Health Education England has produced an e-learning resource on sepsis. The Think Sepsis programme contains a variety of videos and resources including a five-section, primary-care e-learning module. Seventy per cent of sepsis cases develop in the community, so resources that heighten our awareness are helpful. The RCGP website has a toolkit of resources.
www.e-lfh.org.uk/programmes/sepsis/
www.rcgp.org.uk/clinical-and-research/resources/toolkits/sepsis-toolkit.aspxiew
Degenerative cervical myelopathy
An article on degenerative cervical myelopathy (DCM) reminds us to consider DCM in patients over 50 who have progressive neurological symptoms, such as neck pain and stiffness, loss of dexterity and frequent falls. Of note, delay in diagnosis is sometimes caused by assuming the symptoms are owing to carpal tunnel syndrome.
Davies B, Mowforth O, Smith E, et al. (2018) Degenerative cervical myelopathy. BMJ 360(8142): 330–332.
Abdominal migraine
When I first started out as a GP I found dealing with parents who were worried about children with unexplained symptoms difficult to manage. I think this is a useful article because it supports the diagnosis of abdominal migraine as a positive decision, allowing appropriate management that avoids unnecessary treatment and investigation.
Angus-Leppan H, Saatci D, Sutcliffe A, et al. (2018) Abdominal migraine. BMJ 360(8143): 372–374.
Diets and exercise
It is hard to keep up-to-date with all of the trendy weight loss regimes. In this 12-month comparison of low fat and low carbohydrate diets results were similar, and neither genotype nor baseline insulin production predicted which diet might be better for any individual. I tend to suggest patients buy an attractive small plate and focus on portion size across a relatively ‘healthy’ range. I have found tools, such as motivational interviewing, health coaching and ‘conversations inviting change’, worthwhile.
Gardener C, Trepanowski J, Del Gobbo L, et al. (2018) Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion. The DIETFITS randomized clinical trial. Journal of the American Medical Association. 319(7): 667–679. DOI: 10.1001/jama.2018.0245.
Photography award
Several medically related photographs won prizes in the annual photographic competition run by the Engineering and Physical Sciences Research Council. They included a ‘Spiderman’ wearing neural sensors and a ‘placental pop art’ Warhol-style image of placental vasculature.
Child safety
A simple piece of advice that may help save lives is talking about practical steps parents can take to improve safety around the house. Many parents know to keep medication away from children, but there are other attractive household poisons, for example brightly coloured liquid detergent pods.
Public Health England/Science Photo Library.
Opioid prescriptions
There has been much publicity about the increase in addiction to prescribed painkillers in the UK. A recent study has suggested that each extra week of opioid prescription post-surgery is associated with a significant increase of dependence and overdose. I wonder how your surgery deals with patient requests for repeat prescriptions after surgery?
If you practice in England, you can use a free resource to look at your own surgery prescribing data and compare with Clinical Commissioning Group (CCG) and national trends.
The livewellwithpain.co.uk/ website has a variety of resources for you to try with patients who need help with chronic pain, and free leaflets and tools that can be downloaded and shared with them.
Brat G, Agniel D, Beam A, et al. (2018) Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: Retrospective cohort study. BMJ 360(8137): 103.
Endometriosis
Endometriosis often has a long delay between first symptoms and diagnosis. A nested case-control study of 366 women with endometriosis has suggested some combinations of symptoms that might lead to earlier diagnosis. These include presentations for menstrual pain and abdominal pain in the same year and lower gastrointestinal symptoms occurring within 90 days of presentation with gynaecological pain.
Burto C, Iversen L, Bhattacharya S, et al. (2017) Pointers to earlier diagnosis of endometriosis: A nested case-control study using electronic health records. British Journal of General Practice 67(665): 549.
Sepsis assessment
The Royal College of Physicians has recently updated its National Early Warning Score (NEWS2) for the assessment of acutely unwell adults. A free e-learning module has been made available for all health and social care staff. There is a primary care-related component. The tool talks about local protocols – it may be worth thinking about how these might be used in care homes, on home visits and for surgery attendances early and late in the day.
Resources for wellbeing
Public Health England has pulled together a wide variety of resources to help health professionals maximise opportunities to promote healthy living. The All Our Health topics include age-specific sections, e.g. ‘beginning well’ and adolescence, and lifestyle sections, e.g. physical activity and oral health. Each section gives some facts and figures and a set of resources including professional and patient information, e-learning and blogs with advice about motivational interviewing and brief conversations with patients.
www.gov.uk/government/collections/all-our-health-personalised-care-and-population-health
vivbennett.blog.gov.uk/2018/01/08/making-prevention-our-healthy-new-years-resolution-by-viv-bennett/
Obesity map
If you like mind maps, you might like the one demonstrating the complexity of factors affecting obesity produced as a Foresight project looking at obesity in the UK. The document, in its entirety, is very complicated, but for some patients I find it a very useful tool to zoom in from a ‘too big and complicated to deal with’ view to small aspects of ‘dietary habits’ that could be tackled.