Abstract
New Year
Kathryn and I would like to take the opportunity to wish you all a good 2024. Writing this in September with doctors strikes, rising waiting lists and an accelerated winter vaccines programme, I think all that we can predict is that GPs will be busy. I have just been to a ‘flourishing’ meeting where a group of medical students through to retired GPs talked about ways to stay human in our difficult roles. The flourishing website has details of the symposium and many other resources.
Paris Olympics
One of the exciting events on the horizon for 2024 is the Paris Olympics. Is this an opportunity for your practice to promote physical activity either by organising staff-related activities or sweepstakes, or advertising to patients some of the sports that are available to learn or get involved in locally?
QOF 2024/25
GP practices in England will also be on the lookout for the new Quality and Outcomes Framework (QOF) 2024/25, which is predicted to become more ‘streamlined and focused’ this year. For GPSTs, the new QOF might provide opportunities for new audit projects in the year ahead.
Emollients
At this time of year when the weather is cold and the heating is on, it is important that patients with dry skin conditions, such a varicose eczema, remember to keep their skin well moisturised as a matter of routine. The National Eczema Society has a helpful webpage on emollients to direct patients to for information about how and when to use them, and how to select the right emollient for them.
https://eczema.org/information-and-advice/treatments-for-eczema/emollients
Demand evidence and think critically
I was fortunate enough to recently attend a fantastic lunchtime seminar by Dr Margaret McCartney. Dr McCartney has published widely on critical issues affecting healthcare today, including conflict of interest declaration among doctors, the need for a continued drive towards evidence-based practice and education of patients as a means to assist in true informed decision making. Perhaps an interesting place to start with her work is the piece from the BMJ.
McCartney, M (2018). Margaret McCartney: A summary of four and a half years of columns in one column. BMJ 362: k3745. DOI: 10.1136/bmj.k3745.
Image reproduced with permission from (and thanks to) Dr Margaret McCartney.
Managing oedema
I seem to have seen a lot of patients with swollen ankles recently, so have been looking for additional patient resources. The page below from the NHS is quite helpful, though I often also add that patients should be aiming to have ankles at least as high or higher than hips.
Child development
Foundation Years is a collection of resources for people working in the early years sector. Resources for parents include sections on preparing to be a parent, immunisation and child development.
Tongue tie
Information about tongue tie has changed a great deal over the last decade. The Breastfeeding Network has brought together a set of information resources.
www.breastfeedingnetwork.org.uk/help-and-support-on-tongue-tie/
Pregnancy in primary care
This BMJ Practice Pointer article summarises some of the common problems pregnant women consult about during pregnancy. Topics include managing pre-existing hypertension, symphysis pubis dysfunction, anaemia at different stages of pregnancy and reduced foetal movement.
Munro K, Griffin L and Banerjee A (2023) Ask the expert: Diagnosis and management of complications in pregnancy in primary care. BMJ 382(8393): 200–203. DOI: 10.1136/bmj.p1345.
Familial hypercholesterolaemia
Familial hypercholesterolaemia is most commonly caused by a mutation in the low density lipoprotein (LDL) gene. People with this condition have about a 20-fold increase in premature coronary artery disease.
If you are looking for a quality improvement project, this BMJ article highlights the guidance for identifying people at risk and gives a useful box of ideas for processes that could be introduced in your practice.
McErlean S, Mbakaya B and Kennedy C (2023) Familial hypercholesterolaemia. BMJ 382(8392): 157–160. DOI: 10.1136/bmj-2022-073280.
Lymphoma and breast implants
I recently saw an elderly patient with a hot red breast. She had breast implants in her 60s. People with breast implants can develop aplastic large cell lymphomas, typically presenting with painless breast swelling or asymmetry.
Brennan C, Moorhouse A, Vermeland R, et al. (2023) Anaplastic large cell lymphoma in people with breast implants. BMJ 382: e073834. DOI: 10.1136/bmj-2022-073834.
Breathing problems after COVID
There are long waiting lists for most services, including post-COVID services.
A recent Practice Pointer article might give you some background knowledge to help you listen and take a history from people who have persistent breathlessness after COVID. There is a useful box giving ideas for questions that might point to breathing pattern disorder.
Evans R, Pick A, Lardner R, et al. (2023) Breathing difficulties after COVID-19: A guide for primary care. BMJ 381(8388): 493–495. DOI: 10.1136/bmj-2023-074937.
Risks of HRT
The latest study suggesting an association between the use of hormone replacement therapy (HRT) and development of dementia has added to the complexity of discussing HRT with patients.
The study was a nested control study based in Denmark using national data on all women aged 50–60 years over a 19-year period. The study demonstrated association, not causation, between HRT use and dementia; with a variety of possible confounding features discussed.
The BMJ from the week before highlighted a BMJ Known Unknowns webinar, reflecting on the complexities of discussing treatments when we do not have totally clear facts. The webinar series can be accessed at BMj.com/known-unknowns.
Pourhadi N, Morch L, Holm E, et al. (2023) Menopausal hormone therapy and dementia. BMJ 381: e072770. DOI: 10.1136/bmj-2022-072770.
Leaf N (2023) HRT for treating menopause: Known unknowns. BMJ 382(8388) 478. DOI: 10.1136/bmj.p1364.
Thromboembolism
A cohort study of over two million Danish women has shown an additional risk of venous thromboembolism for women on the combined hormonal contraceptive who take non-steroidal anti-inflammatories, particularly diclofenac. This may become an addition to the complex risk conversations we have with women when we issue prescriptions for the combined pill.
Meaidi A, Mascolo A, Sessi M, et al. (2023) Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs. BMJ 382(8397): 355–356. DOI: 10.1136/bmj-2022-074450.
