Abstract
Women with epilepsy
Another large study has shown higher risk of a range of serious pregnancy complications including pre-eclampsia, embolism, stroke and mental health conditions in women with epilepsy compared with those without epilepsy. The risks of some anti-epileptic medication, such as sodium valproate, means that we should regularly be discussing contraception with women with epilepsy. We also need to find ways to discuss the importance of preconception planning. This might make an interesting quality improvement topic.
Razaz N, Igland J, Bjørk M, et al. (2024) Risk of perinatal and maternal morbidity and mortality among pregnant women with epilepsy. Journal of the American Medical Association Neurology 81(9): 985–995. DOI: 10.1001/jamaneurol.2024.2375.
New asthma guidelines
Joint guidelines issued by the British Thoracic Society, National Institute for Health and Care Excellence and the Scottish Intercollegiate Guidelines Network have standardised asthma recommendations across the United Kingdom. Doctors have been advised to stop prescribing short-acting beta agonists alone for people over 12 years with a new diagnosis of asthma, and instead prescribe a low dose combination inhaler. The guidelines emphasise treating immediately if the patient is acutely unwell or highly symptomatic. A variety of options, including assessment of eosinophil count and fractional exhaled nitric oxide, are suggested. There may be geographical variation in the availability of testing.
British Thoracic Society, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines (2024) Asthma: Diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN). NICE guideline [NG245]. Available at: www.nice.org.uk/guidance/ng245 (accessed 30 January 2025).
Chocolate
A large prospective cohort study has shown that increased consumption of dark but not milk chocolate was associated with a lower risk of type 2 diabetes. Conversely increased consumption of milk but not dark chocolate was associated with long-term weight gain. I think I probably need to find an alternative to ‘it’s been a tough day at the surgery, only Dairy Milk will do.’
Liu B, Zong G, Zhu L, et al. (2024) Intake of chocolate and risk of type 2 diabetes. BMJ 387(8451): 314. DOI: 10.1136/bmj-2023-078386.
Direct to consumer tests
We are seeing increasing numbers of patients wanting to discuss data from wearables or advertisements for blood and other sorts of testing. Dr Gram and her colleagues have written an informative article discussing the potential risks and benefits of such tests and highlight the need for high quality, regulated information about the tests.
Gram E, Copp T, Woloshi S, et al. (2024) Direct-to-consumer tests: Emerging trends are cause for concern. BMJ 387(8451): 319–321. DOI: 10.1136/bmj-2024-080460.
Academic medicine
The BMJ has launched a Commission on the Future of Academic Medicine. In the context of workforce shortage and health budget restrictions, money is being pushed purely into service delivery. The co-chairs have produced a list of misalignments in goals and drivers of scientific agendas, for example distancing of universities from healthcare, poor rewards for academic careers and barriers to teaching. Newly qualified GPs could and should be contributing to clinical research. The RCGP has a research hub giving pointers for all stages of GP careers.
O’Ryan M, Saxena S and Baum F (2024) Time for a revolution in academic medicine? BMJ 2024: 387. DOI: 10.1136/bmj.q2508.
www.rcgp.org.uk/representing-you/research-at-rcgp/research-engagement-hub
Guidelines in frailty
Supervising a variety of clinicians in the surgery highlights the complexity of managing frail patients with multiple medical conditions. A BMJ summary article discusses the limitations and challenges in managing heart failure in older people with frailty. The authors acknowledge the use of guidelines to promote best practice but point out that trials often exclude people with moderate or severe frailty and that being frail may increase the risk of harm from medication. They promote an individual approach recognising the uncertainty of evidence available for management of heart failure (and other conditions) in this population.
Woodford H, McKenzie D and Pollock L (2024) Appropriate management of heart failure in older people with frailty. BMJ 387(8452): 361–363.
Psoriatic arthropathy
About a third of patients with psoriasis also develop psoriatic arthritis. Over the last couple of decades our understanding of the other risks, such as cardiovascular disease, and of management of the disease has changed and improved. A recent BMJ article discusses the symptoms, prognosis, diagnosis and treatment.
Khartoum F and Gladman D (2024) Advances in the management of psoriatic arthritis in adults. BMJ 387(8452): 368–372.
Support after cardiac arrest
I was touched by Lynsey Duncan’s description of giving cardiopulmonary resuscitation to a family member at home.
Lynsey highlights Chest Heart and Stroke Scotland’s helpline for anyone who has participated in or witnessed an out-of-hospital cardiac arrest.
The Resuscitation Council has resources for responder wellbeing, that is relevant to both healthcare workers and anyone involved in the aftermath of resuscitation.
www.resus.org.uk/responder-wellbeing
Duncan L (2024) Giving CPR left me seeking reassurance. BMJ 387(8452): 373.
Healthy children
The healthy child programme provides health and social care support from birth to age 19. An article for professionals produced by patient.info gives a useful summary of the programme and some of the evidence, including equity data.
Movement and health
I attend a regular online meeting where people share management ideas and stories about supporting people with chronic pain. Two video resources giving a variety of help that people can access, free of charge, from their own homes feel like a valuable addition to my ‘toolkit’. The Virtual Village Hall has a downloadable leaflet, and patients can sign up for weekly emails telling them what is available. ‘We are undefeatable’ has a wide variety of suggestions including first steps, 5 min workouts and patient stories.
virtualvillagehall.royalvoluntaryservice.org.uk/flex-page/about
Adverse conditions
We are often pushed to treat and make decisions about patients in very far-from-perfect circumstances.
A recent Medical Defence Union article discussed a fictional case of being asked to assess and treat a patient in an ambulance queue. The points made would be applicable to other similar complex circumstances and included being sure that your trust has formal operational policies supporting you under such supposedly exceptional circumstances, ensuring that you discuss the limitations of ambulance care with the patient, maintaining confidentiality and dignity, and keeping contemporaneous records. The article is a salient reminder of the importance of raising concerns even if such exceptional care is becoming the norm.
The article can be found online.
Mein E (2024) Treating patients in the backs of ambulance. Available at: mdujournal.themdu.com (accessed 30 January 2025).
Finding long-term jobs
The job market is very complex with shortages of both long-term and locum posts. Many of us prefer the psychological ‘safety’ of a permanent post, but it can be difficult to decide whether a team feels like the right one to join. The Psychological Safety Collective has a variety of resources to help organisations develop safer, more equitable and diverse teams. Looking at a team you wish to join and asking whether they subscribe to some of the key attributes of a safer workplace (e.g. shared norms, less visible power hierarchies, encouraging improvement) might help you decide.
Psychological Safety Collective (2024) Ten ways to foster psychological safety in the workplace. Available at: psychsafety.com/top-10-ways-to-foster-psychological-safety-in-the-workplace (accessed 30 January 2025).
