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2011-2012 Editorials

 

Helping sick doctors get back to work

12 Dec 2012Paid-up subscribers

A qualitative study has found that many sick doctors complain of uncaring, unsupportive and judgemental colleagues. A supportive partnership, in which doctors feel valued by their colleagues and in which personal vulnerabilities are acknowledged and mitigated, will both protect us from developing health problems and facilitate a return to health and work should they occur.

Pertussis vaccination in pregnant women will protect neonates

31 Oct 2012Paid-up subscribers

A temporary programme to vaccinate pregnant women against pertussis has been developed following an increase in cases in young infants in England and Wales.

Statins underused for primary prevention in older patients

19 Sep 2012Paid-up subscribers

'A treatment-risk paradox where patients become less likely to receive appropriate treatment with advancing age has been observed in the secondary prevention of cardiovascular disease (CVD). This is particularly apparent for cholesterol-lowering treatment with one study showing the likelihood of statin treatment was 6% lower with each year increase in age. However, it is not clear if such a paradox exists in primary prevention and a recent UK study published in the BMJ addresses this issue...'

Do 5-ARIs have a role in preventing BPH?

21 Aug 2012Paid-up subscribers

Treating asymptomatic older men with 5-alpha reductase inhibitors may reduce their risk of developing benign prostatic hyperplasia (BPH). However, the case for prophylactic use of these drugs is still unproven. Dr Jonathan Rees, GPwSI Urology, Bristol, considers the implications of new data from the long-running Prostate Cancer Prevention Trial.

GPs’ vital role in end of life care

20 Jun 2012Paid-up subscribers

The aims of palliative care are to provide the best quality of life for patients and their families, and to facilitate a good death. The NICE quality standard on end of life care, published in November 2011, consists of 16 quality statements which inform patients of the standard of care which they should expect and define aspirational standards for clinical governance. If patients are to die well, they need to be prepared for death, to achieve a sense of control, to be free of pain, to be respected as an individual, and to spend meaningful time with close family and friends in familiar surroundings.

Reducing deaths from smoking

23 May 2012Paid-up subscribers

There are around 10 million smokers in the UK, half of whom will die prematurely, losing many years of life, unless they quit. Smoking is increasingly concentrated in the most disadvantaged sectors of society, and is now the biggest avoidable cause of social inequality in life expectancy in the UK. Preventing smoking depends on reducing the affordability of cigarettes, using the media to educate and promote health, making non-smoking the norm in public and workplaces, preventing advertising and promotion, preventing supply to children, and providing effective support to individuals who want to quit.

MI often presents without chest pain in women

21 Mar 2012Paid-up subscribers

The textbook presentation of myocardial infarction (MI) is not difficult to recognize but in the undifferentiated world of primary care presentations it can be far from clear. This difficulty is compounded by the sex and ethnicity of the patient and the presence of comorbidities such as diabetes. Women are often older than men at hospitalisation for MI and present less frequently with chest pain. It is generally accepted that patients without chest pain tend to present later and are treated less aggressively than those presenting with more typical symptoms. Furthermore, those presenting without pain have almost twice the short-term mortality rate.

National review aims to reduce asthma deaths

25 Feb 2012Registered users

Around 1,200 people die from asthma every year in the UK. A National Review of Asthma Deaths, led by the Royal College of Physicians, in collaboration with a consortium of professional bodies and patient organisations, will consider all asthma deaths in the UK during the 12 months from 1 February 2012.  This editorial includes a link for UK clinicians who want to participate.

Early ART improves life expectancy in HIV patients

24 Jan 2012Registered users

Life expectancy, at age 20, for patients treated for HIV increased by more than 15 years from 1996 to 2008, a large cohort study from the UK has shown. Mortality rates from HIV have decreased dramatically over the past few decades through the use of antiretroviral therapy (ART). The risk of death in patients treated successfully with ART is now similar to that of people with unhealthy lifestyles such as heavy smokers or drinkers, those who are obese or have chronic conditions such as diabetes. HIV infection has itself become a chronic disease with a good prognosis, provided treatment is commenced early and the patient maintains adherence to therapy. [With external links to current evidence]

Time to tackle obesity

16 Dec 2011Registered users

It is estimated that almost a quarter of the population of England are obese. Primary care physicians are familiar with the subsequent problems that can arise such as diabetes, cardiovascular disease and osteoarthritis to list but a few. At present the Quality and Outcomes Framework places little emphasis on obesity management and there are few options available in traditional models of primary care. There is certainly evidence to support the notion of centrally funded commercial weight loss programmes. Another option is for primary care teams to develop in-house obesity management programmes. Dr Peter Savill looks at recent evidence on the effectiveness of such options for treatment.

Strokes have declined but atrial fibrillation is still undertreated

22 Nov 2011Paid-up subscribers

Stroke is a major cause of morbidity and mortality. Primary care has a central role to play in prevention with the identification and management of hypertension, obesity, high cholesterol, atrial fibrillation (AF) and diabetes. A recent study has found that both the incidence of stroke and stroke deaths declined significantly over the past decade in the UK. This was accompanied by a notable increase in GP prescribing for primary and secondary prevention which is likely to have been a major contributing factor, the study authors conclude. However, the study also found underuse of anticoagulants in patients with AF at high risk of stroke, particularly in women.

Smoking: a preventable cause of rheumatoid arthritis

22 Feb 2011Paid-up subscribers

Rheumatoid arthritis (RA) affects 1% of the population.  Genetic and environmental factors have long been known to contribute to the development of RA. Exposure to cigarette smoke was first linked with RA more than twenty years ago. Smoking is now recognised as the most established environmental risk factor for the development of RA.