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At the heart of general practice since 1960

Clinical round-up: October

This month’s journal digest 

Vitamin D ‘cuts risk of severe asthma attack’

Vitamin D supplements are ‘likely’ to reduce severe asthma exacerbations when taken alongside standard medication, according to a new Cochrane review.

Researchers from Queen Mary University of London found giving an oral vitamin D supplement significantly cut the risk of severe asthma exacerbations requiring admission or emergency department attendance, from 6% to around 3%, compared with asthmatic patients not given vitamin D. Patients on vitamin D also experienced fewer asthma attacks needing treatment with oral steroids, compared with those not on vitamin D.

The review featured 435 children and 658 adults with a diagnosis of asthma. Lead author Professor Adrian Martineau, professor of respiratory infection and immunity at the university, said the results were ‘exciting’.

But he added: ‘It is not yet clear whether vitamin D supplements can reduce the risk of severe asthma attacks in all patients, or whether this effect is just seen in those who have low vitamin D levels to start with.’

The RCGP called the study ‘encouraging’, but cautioned it was ‘too early’ to recommend regular vitamin D supplementation to patients with asthma.

Cochrane Database Syst Rev 2016, online 5 Sep

RTI risk tool ‘could reduce antibiotic use’

Researchers have designed a new tool to help GPs to determine which children with coughs and respiratory tract infections are most at risk of hospitalisation, and thus reduce unnecessary antibiotic prescribing.

Researchers at the University of Bristol found seven characteristics that GPs could use to identify children at varying levels of risk of hospitalisation from cough and RTI: short duration of illness (less than three days); high temperature; age (younger than 24 months); recession; wheeze; asthma; and vomiting.

The study looked at 8,390 children from 224 GP practices and found there was a 1% risk of hospitalisation following an RTI. With two or three characteristics this risk increased to 1.5%; with four or more it rose to 12%.

The authors recommended that GPs should prescribe no antibiotics, or delay antibiotic treatment, for children at low or normal risk – those with three or fewer characteristics.

Lead author Professor Alastair Hay, a GP and professor of primary care at the University of Bristol, said: ‘We believe use of this algorithm could represent a step-change in the care of children with coughs and respiratory tract infections in primary care.’

But GPC prescribing subcommittee chair Dr Andrew Green told Pulse the tool would need ‘proper evaluation’ before use.

Lancet Respiratory Medicine 2016, online 1 Sep

Experience ‘no help in predicting survival’

Palliative care doctors are not good at predicting how long terminally ill patients will survive, according to new research.

A review conducted by a group from University College London found that no subgroup of palliative care clinicians, including nurses and other healthcare professionals, was consistently better than any other in terms of prognostic ability, and that ‘frequently inaccurate’ predictions ranged from an 86-day underestimate to a 93-day overestimate.

The review looked at 42 existing papers, including 4,642 records of predictions in total.

Professor Paddy Stone, professor of palliative and end-of-life care at the Marie Curie Research Department at UCL, said: ‘This research suggests that there is no simple way to identify which doctors are better at predicting survival.

‘Being more senior or experienced does not necessarily make one a better prognosticator.’

PLoS One 2016, online 25 Aug

E-cigarettes may have helped 18,000 quit

E-cigarettes may have helped 18,000 people in England give up smoking in 2015, according to a new study.

Researchers from University College London found that as the use of e-cigarettes increased, more people successfully quit smoking. But they warned that firm conclusions about cause and effect could not be drawn.

Data were collected from more than 170,000 smokers aged 16 and over taking part in the Smoking Toolkit study, where the relationship between changes in e-cigarette use and prevalence of quit attempts was analysed, as well as the success of those attempts.

E-cigarette use among people trying to quit smoking was found to be negatively associated with nicotine replacement therapy on prescription.

The findings were welcomed by Cancer Research UK, but the charity said prescription medication and smoking- cessation services remain the most effective way to quit smoking.

The research follows backing from Public Health England and the Department of Health for the use of licensed e-cigarettes as a prescribing option, alongside available forms of NRT, to help people quit.

BMJ 2016, online 13 Sep

Named-GP policy ‘has no impact’

Assigning elderly patients a ‘named GP’ has no effect on the continuity of care they receive, a study has revealed.

Researchers at The Health Foundation found the policy had no impact over a nine-month period, compared with younger patients receiving usual care. Impact was measured by a ‘usual provider of care’ index, which looks at how often a patient saw the same GP.

They also found no change in the number of GP contacts, diagnostic tests or referrals per person.

They concluded: ‘The introduction of named accountable GPs in England did not improve longitudinal continuity of care over nine months. Consequently, no changes were detected in numbers of GP visits, referrals to specialist care and diagnostic tests.’

But the Department of Health stated it was too early to write off the policy.

BMJ Open 2016, online 16 Sep

CPD tip of the month: When to prescribe autoinjectors

  • Autoinjectors should be prescribed in oral allergy syndrome for patients who:
  • Have had an anaphylactic reaction
  • Have had angio-oedema without anaphylaxis, but are at high risk of anaphylaxis. Examples include those exposed to tiny amounts of the allergen or who have comorbidities such as asthma or COPD.
  • Consider also in a patient with a previous mild-to-moderate reaction who is going to a remote area, or with a previous mild or moderate reaction to trace amounts of an allergen or to a peanut or tree nut (excluding OAS).
  • Autoinjectors should be given in twos in case the first has no effect.

Case-based learning: oral allergy syndrome

1.5 CPD hours

pulse-learning.co.uk

 

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