First things first, Happy New Year! Resolution number 1, record more of my learning!
So, the spotty 20 year old I saw before Christmas had Measles confirmed on a viral swab. I've reviewed her notes and she missed her MMR, despite it being clearly recorded she was safe to have it and should do so.
The girl has epilepsy and learning difficulties so we think that's why her carers chose not to give it. She's been registered her whole life with the surgery.
A quick look at the Medscape App reminded me of all the points I had forgotten about Measles.
The girl presented with a florid rash , I was reminded of the 3 C's, which I hadn't asked about and learnt Vitamin A can reduce symptoms but I'm not sure if that's only for deficient individuals.
I also learnt that Measles directly suppresses immune response, making secondary bacterial infection a risk, not just viral sequelae.
So learning points?
Check childhood immunisations when reviewing patients with learning difficulties, consider diagnosis in unvaccinated individuals with 3 C's
My senior colleague saw 1 case in the 80s and none since so hopefully it will be a long time before I see another!
Tuesday, 1 January 2013
Thursday, 6 December 2012
Delicious Food and Dilemmas!
A wonderful Christmas meal atSilversmiths was my GP group treat for being so good in 2012!
We managed not to talk just about how great the food was, we also chewed over some meaty clinical dilemmas.
Ranging from pregabalin, it's use and misuse, chronic pain management in general and our frustrations with thesis services. Reorganising and managing reception/admin teams, nail biting and whether a particular little girl was in need of psychological assessment and knees!
A very pleasant and fruitful way to catch up and mull over some big issues for 3 hours!
We managed not to talk just about how great the food was, we also chewed over some meaty clinical dilemmas.
Ranging from pregabalin, it's use and misuse, chronic pain management in general and our frustrations with thesis services. Reorganising and managing reception/admin teams, nail biting and whether a particular little girl was in need of psychological assessment and knees!
A very pleasant and fruitful way to catch up and mull over some big issues for 3 hours!
Tuesday, 20 November 2012
Diagnosing patient's preference
Is it just me, or did I miss something? The editorial with the above title in BMJ this month make me chuckle, then sigh and shake my head!
http://www.bmj.com/content/345/bmj.e7745?etoc=
Surely this is what we spend our days in General Practice land doing already? I'm sure I was marked on it when I submitted videos for MRCGP nearly 10 years ago? Why are the words communication skills not used?
I particularly like the tantalising comments about the possibility of reducing costs by asking patients what they really want. I also liked the editorial comments about making the patient part of the team, making the decision together with clinicians.
I did, of course listen to the podcast and the authors seem very genuine and again, there is no mention of General Practice or any mention of communication skills training.
I guess if there is any change in secondary care as a result of these papers, that must be a good thing. I'm just amazed this is where they are at.
http://www.bmj.com/content/345/bmj.e7745?etoc=
Surely this is what we spend our days in General Practice land doing already? I'm sure I was marked on it when I submitted videos for MRCGP nearly 10 years ago? Why are the words communication skills not used?
I particularly like the tantalising comments about the possibility of reducing costs by asking patients what they really want. I also liked the editorial comments about making the patient part of the team, making the decision together with clinicians.
I did, of course listen to the podcast and the authors seem very genuine and again, there is no mention of General Practice or any mention of communication skills training.
I guess if there is any change in secondary care as a result of these papers, that must be a good thing. I'm just amazed this is where they are at.
Friday, 9 November 2012
Reading
Squeezing in some medical reading, which is harder for me than podcasts as you have to sit down!
I'm enjoying Will Self's Booker Prize short listed 'Umbrella' although there are no chapters and keeping up with the narrative requires a lot of concentration. He has a lot to say about medical care, labelling stigma and institutionalisation. I wonder how non medics find it to read. I know he wrote this when he was unwell, then found out to have Polycythaemia Rubra Vera and I've read articles by him about his experience as a patient-
http://www.guardian.co.uk/books/2011/oct/21/will-self-blood-disease
I keep reading other people's opinion of Ben Goldacre's Bad Pharma, once I've chewed through Umbrella that will be the next big read on my list!
I'm enjoying Will Self's Booker Prize short listed 'Umbrella' although there are no chapters and keeping up with the narrative requires a lot of concentration. He has a lot to say about medical care, labelling stigma and institutionalisation. I wonder how non medics find it to read. I know he wrote this when he was unwell, then found out to have Polycythaemia Rubra Vera and I've read articles by him about his experience as a patient-
http://www.guardian.co.uk/books/2011/oct/21/will-self-blood-disease
I keep reading other people's opinion of Ben Goldacre's Bad Pharma, once I've chewed through Umbrella that will be the next big read on my list!
Friday, 19 October 2012
Lots of stuff!
Yesterday I had a wonder day devoted to studying, I was on the RCGP Alcohol Management in Primary Care Course and in addition I squeezed in 2 podcasts from Inside Health! one on the bus there and one back.
So the first had one really interesting interview with a neurology profesor about who can stop their anti-epileptics and when they can do it.
The second had a good article about benign essential tremor again from specialist, but a different one. How to diagnose, features that suggest alternative diagnoses and alarming features of a tremor.
The course was excellent too! Delivered by the wonderful Jenny Keen of the Primary care substance misuse team.
A very productive day!
So the first had one really interesting interview with a neurology profesor about who can stop their anti-epileptics and when they can do it.
The second had a good article about benign essential tremor again from specialist, but a different one. How to diagnose, features that suggest alternative diagnoses and alarming features of a tremor.
The course was excellent too! Delivered by the wonderful Jenny Keen of the Primary care substance misuse team.
A very productive day!
Tuesday, 16 October 2012
BMJ podcasts
I don't know why but I've had to re-subscribe to this podcast again and have missed a lot of them. But the latest 2 are great-
12/10/12- Over treatment is discussed mainly with reference to the American system but very pertinent to the UK when changes by the coalition government are in process.
5/10/12 discussed the recent advert by the British Heart Foundation to encourage the public to try hands only resuscitation. Apparently the campaign was hugely successful and viewed by a lot of the public. Perhaps I should be encouraging my patients to look at the advert?
http://www.bhf.org.uk/heart-health/life-saving-skills/hands-only-cpr.aspx
12/10/12- Over treatment is discussed mainly with reference to the American system but very pertinent to the UK when changes by the coalition government are in process.
5/10/12 discussed the recent advert by the British Heart Foundation to encourage the public to try hands only resuscitation. Apparently the campaign was hugely successful and viewed by a lot of the public. Perhaps I should be encouraging my patients to look at the advert?
http://www.bhf.org.uk/heart-health/life-saving-skills/hands-only-cpr.aspx
Wednesday, 3 October 2012
B12 and Vitamin D + a new resource
2 Important topics, both covered on Inside Health on 4th September, with interesting opinions and research from 2 specialists.
Firstly, a study showing taking Vitamin D can improve recovery from TB and a discussion about how Vitamin D might be modulating immune response. Apparently one of the first ever randomised controlled trials, conducted by the Brompton Hospital in the last century found patients recieving sunlight or cod liver oil were more likely to survive TB than those who didn't.
Secondly, a specialist who feels we under diagnose and under treat B12 deficiency. He feels anyone with a level under 300 mcg is deficient or at least has an indadequate level. He also believes we should treat with im hydroxycobalamin not to BNF recommended doses in every case- we should be administering more frequently in certain people and using response to treatment instead to judge the amount needed.
This is timely for me as I'm just starting an audit in measuring B12/FBC in patients taking metformin- at Wincobank that is over 400 patients. Other drugs to consider B12 deficiency include phenytoin, h2 receptor antagonists and PPis.
Finally a new resource recommended in the back of the MPS magazine- an app for the iPhone called Medscape. It's from the States, is a free resource and is an encyclopaedia of pretty much everything- Drugs, Conditions, Procedures Drug interactions & calculators. Looks pretty useful, navigated around the app quite easily and have used it to check a drug interaction. I note it also has information about herbal medicines in this category, so could be very useful. I will report back!
www.medscape.com
Firstly, a study showing taking Vitamin D can improve recovery from TB and a discussion about how Vitamin D might be modulating immune response. Apparently one of the first ever randomised controlled trials, conducted by the Brompton Hospital in the last century found patients recieving sunlight or cod liver oil were more likely to survive TB than those who didn't.
Secondly, a specialist who feels we under diagnose and under treat B12 deficiency. He feels anyone with a level under 300 mcg is deficient or at least has an indadequate level. He also believes we should treat with im hydroxycobalamin not to BNF recommended doses in every case- we should be administering more frequently in certain people and using response to treatment instead to judge the amount needed.
This is timely for me as I'm just starting an audit in measuring B12/FBC in patients taking metformin- at Wincobank that is over 400 patients. Other drugs to consider B12 deficiency include phenytoin, h2 receptor antagonists and PPis.
Finally a new resource recommended in the back of the MPS magazine- an app for the iPhone called Medscape. It's from the States, is a free resource and is an encyclopaedia of pretty much everything- Drugs, Conditions, Procedures Drug interactions & calculators. Looks pretty useful, navigated around the app quite easily and have used it to check a drug interaction. I note it also has information about herbal medicines in this category, so could be very useful. I will report back!
www.medscape.com
Subscribe to:
Posts (Atom)