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CPD frameworks
These frameworks, associated with all articles, prompt drafting of personal learning, reflection and planning.
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Reflection on a journal article
Stages of reflection on a situation
Reflection of a team, practice or group
External reference on reflection
Reflective practice in health care and how to reflect effectively
Koshy K, Limb C et al. International Journal of Surgical Oncology. 2017 2:e20
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Special interest: Addiction
Clinical reviews on addiction
Patients prescribed opioids for analgesia at risk of dependence
25 Jul 2018
A systematic review and meta-analysis has estimated that the incidence of iatrogenic opioid dependence or abuse in patients prescribed opioids for pain is almost 1 in 20.
Marked regional variations identified in primary care opioid prescribing
23 Apr 2018
Opioid prescribing rates are increasing and show notable geographical variations across England. They are highest in the North and in areas of social deprivation, a study on primary care prescribing has shown. Virtually all the low prescribing areas were in the south of England and nine of the ten highest prescribing areas were northern clinical commissioning groups (CCGs).
Benzodiazepines and Z-drugs are being widely used long term
23 Jan 2018
A UK primary care survey has found that many patients are taking benzodiazepines or Z-drugs, recommended for short-term use, for at least a year.
Are differing emotional responses to alcohol associated with choice of drink?
20 Dec 2017
Emotional responses to drinking appear to vary according to the type of drink imbibed and differ between men and women, an analysis of data from the Global Drug Survey (GDS) has found.
Mortality risk raised during induction with methadone in opioid substitution therapy
23 Nov 2017
Patients undergoing opioid substitution treatment have an increased mortality risk during the induction phase with methadone but not with buprenorphine, a meta-analysis has found. Mortality risk is also raised in the period immediately after leaving treatment with both drugs.
Gambling linked to mental health problems
22 Jun 2017
Patients with depression and those who drink at risky levels are more than twice as likely to report gambling problems, a UK primary care study has shown.
Benzodiazepine and opioid co-prescribing raises risk of opioid overdose
24 Apr 2017
Stopping concurrent benzodiazepine and opioid prescribing could reduce the risk of inpatient admissions for opioid overdose and attendance at emergency departments by 15%, a study from the US has found.
Drinking levels in young women are approaching those of men
15 Dec 2016
The traditional gender difference in alcohol misuse and alcohol-related harm, where men have been at much higher risk than women is changing, a recent study has confirmed.
Continuing in methadone treatment associated with reduced risk of death
23 May 2016
Risk of mortality from all causes increases following cessation of methadone substitution treatment, a study in Addiction has confirmed. The risk was highest during the first four weeks after stopping treatment.
Smoking cessation
Can nicotine preloading help smokers quit?
25 Jul 2018
The use of a nicotine patch before quitting may have a modest effect on abstinence, a large pragmatic randomised trial has found. A total of 1,792 adults were enrolled from Nottingham, Birmingham, Bristol, and London.
|Quitting smoking improves survival in patients with lung cancer
22 Mar 2018
Patients with lung cancer who stop smoking have lower all cause mortality rates compared with those who continue to smoke, a UK retrospective cohort study has found.
Editorials
|Identifying at-risk drinkers in primary care
23 Sep 2014
It has been estimated that around 20% of patients attending their GP are at risk from their drinking or have an alcohol use disorder. Without using specific screening tools GPs may typically detect about 40% of cases they see, but miss the majority. The study authors suggest a single or two question approach to initial screening, followed by either the CAGE or AUDIT test for those who are positive, and onward referral for those who test positive on the more in-depth questionnaire.
Hepatitis infection
Can hepatitis C infection be managed in primary care?
25 Jul 2014
With appropriate training and supervision GPs could treat patients with hepatitis C in the community, a systematic review has concluded.The researchers searched a range of medical databases (including Medline, Cinahl, PsycINFO, Cochrane, Web of Science and Embase) for studies that evaluated antiviral treatment for hepatitis C either initiated or maintained by GPs, published between 2000 and 2013.
Case finding for hepatitis C in general practice
23 Jun 2014
Identifying, and testing, patients at risk of hepatitis C (HCV) infection by GPs mainly focuses on people who inject drugs (PWID) but migrants from medium- or high-prevalence countries are often overlooked, a UK study has found. Six GP practices in Bristol, serving a total population of 73,814 patients, took part in the study. Three had a high prevalence of PWID and three a low prevalence.
|Should men who have sex with men be screened for hepatitis C?
21 Feb 2013
Reports of acute HCV infection in HIV-positive men who have sex with men (MSM) have emerged where sexual exposure was the only risk factor. In a systematic review, HIV-positive MSM had approximately four times the risk of acquiring acute HCV infection compared with HIV-negative MSM. The data suggest it would be reasonable to consider routine screening for HCV in HIV-positive MSM.
Mildly raised ALT levels may point to hidden hepatitis C
12 Dec 2012
Patients with slightly elevated alanine aminotransferase (ALT) levels are at increased risk of hepatitis C infection and should undergo further investigation, a study from the Netherlands has concluded.
High hepatitis C prevalence in injecting drug users
01 Sep 2007
Hepatitis C (HCV) infection is common in illicit drug users, and can lead to severe morbidity and mortality. Although all illicit drug users may put themselves at risk of acquiring HCV infection, a new study confirms that those with a long history of drug use and those who inject (particularly with shared needles or using preparation equipment such as spoons) are most at risk.
HIV infection
Which indicator conditions predict HIV?
25 Jul 2013
A UK study using The Health Improvement Network (THIN) database to identify symptoms and clinical diagnoses associated with HIV infection has assessed their predictive value in diagnosing HIV in primary care. The THIN database contains anonymised patient records from 386 UK general practices; these include sociodemographic data, diagnoses, treatments, clinical measurements, laboratory results, secondary care referrals and hospital diagnoses. [With external links to current evidence]
Male injecting drug users who have sex with men at greater risk of HIV
24 Jun 2013
Men who inject drugs (IDUs) and have sex with men (MSM) have a four-fold higher risk of HIV than those who only have sex with women (MSW), a national survey has found. Prevalence of hepatitis C (HCV) was also a third higher in the former group. IDUs in England, Wales and Northern Ireland have been recruited into a voluntary unlinked anonymous cross-sectional survey annually since 1990. The survey includes an oral swab for HIV and HCV and a questionnaire on demographics and risk behaviours. A total of 8,671 male IDUs who reported having had sex and injecting drug use in the previous 12 months took part in the survey for the first time between 1998 and 2007. Median age was 29 and median period of injecting drug use seven years.
|Should men who have sex with men be screened for hepatitis C?
21 Feb 2013
Reports of acute HCV infection in HIV-positive men who have sex with men (MSM) have emerged where sexual exposure was the only risk factor. In a systematic review, HIV-positive MSM had approximately four times the risk of acquiring acute HCV infection compared with HIV-negative MSM. The data suggest it would be reasonable to consider routine screening for HCV in HIV-positive MSM.
Use of opiate substitution linked to fall in HIV transmission
21 Feb 2013
Methadone treatment was associated with more than a 50% reduction in the risk of HIV transmission in injecting drug users, in a meta-analysis published in the BMJ.
Which GP and patient characteristics influence HIV testing?
19 Sep 2011
GPs who are under 35 and working in metropolitan areas are more likely to offer HIV tests, a study from Australia has found. Patients deemed to be at risk by their GP or who present for screening are most likely to be tested. The study used data from a cross-sectional, national survey of GP activity called BEACH (Bettering the Evaluation and Care of Health). This database has been running since 2000; each year, approximately 1,000 GPs from a national, rolling sample are recruited. [With external links to current evidence]
