A recent study in British Journal of Sports Medicine showed that people who go for runs, bike rides or swim are less likely to die from influenza and pneumonia. Interestingly the NHS guidance is 150 minutes per week plus muscle strengthening exercise twice a week which is not an insignificant amount and I suspect more than most would consider doing. Telling our patients these facts, encouraging exercise in an attempt to improve diabetes and blood pressure control, osteoarthritis or PCOS management could probably be the most impactful management we can offer – certainly on a population basis. I thoroughly enjoy any of these activities and have become much better at fitting them in around work and four children – usually by being back before the children (or husband) wakes up! Even if it can feel selfish at times, I have absolutely needed to do this to continue staying on top with the different jobs and be the best parent I can. General practice continues to be incredibly intense and I enjoy seeing colleagues who have also come to the same realisation to stay well – I am particularly jealous of a colleague who is amazing at Capoeira. This time of year is a bit of a challenge for me with the shorter days and change in weather but still love the times we can get out!
I am very aware however the fine balance between enjoying exercise and how it can tip over into something different so was really pleased to see the article by Dr Shanley et al in InnovAiT discussing this in more detail. The relative energy deficiency in sport (RED-S) is a familiar concept of how an individual could be affected, although I have to admit the term itself was new to me. The significance of the condition seems to be for those who are still developing or where it is such that it is impacting on longer term health – for example bone density. I am intrigued how this is considered by many athletes for whom I suspect the tight control on intake versus activity is under constant scrutiny. Also more generally for many people who use exercise as a weight control method. Do we think that the body positive movement isn’t where it needs to be? How does this sit with social media, the low carb and macro nutrient diets? I am also interested in the very close overlap with overtraining or disordered eating more generally. For us in primary care do we need to consider as an option in ‘Tired All the Time’ as well as the amenorrhoeic presentations in a specific subset of our population?
I am very fortunate to lead on Palliative and End of Life Care for our ICB so was really interested to read the audit by Hindmarsh and Paris. It is helpful to be reminded of the difference between an advance directive and a ReSPECT form, when each are used and who holds them. The authors highlight the gap in NICE guidance on this area. I still find it strange that we don’t openly discuss future planning and even more so that when we try we either don’t do it terribly well or don’t document is – as was shown in this audit. We would expect a pregnant woman to have the opportunity to discuss a birth plan, it is time that planning for the end of life is as common place.
Do you know the most common reason for hospital admission for under 16s? It may not be what you’d expect but it is a very useful indicator of neglect…dental caries. An interesting summary by Dr Heath is a helpful guide to what we should consider as GPs.
Post-Coital bleeding is a significant symptom which I imagine most GPs will quickly refer on using the NG12 / 2 week wait pathway. However, as with most things in medicine there are always complexities in presentation so this article by Dr Ahmed will prove incredibly useful to refresh our memories.
A condition which causes huge amount of distress and embarrassment for female patients is that of vulval pruritus. Usually, a woman will have tried numerous treatments and waited a long time before presenting and can be up to 10 years before reaching a diagnosis. Do you feel confident on the differential diagnoses? This incredibly helpful summary by Dr Freeman is well worth a read.
In our ICB, I was able to help set up a specific pathway for people with Down syndrome to have baseline assessment and as well as a direct route for consideration of dementia. We know that the onset of dementia is much earlier but the standard memory assessment teams often do not feel equipped to diagnose people with a learning disability without an established baseline. The article by Dr Lewis et al talks us through clinical features to consider as well as potential management options.
Here is a great AKT question to leave you with – good luck!
You see a 44-year-old patient with known polycystic ovarian syndrome and recently diagnosed with impaired glucose tolerance using a 2-hour 75 g oral glucose tolerance test. She is asking for advice on a suitable management plan.
What is the SINGLE MOST appropriate management option? Select ONE option ONLY.
A. No further action is needed
B. Repeat the 2-hour 75 g oral glucose tolerance test annually and if the patient becomes pregnant at 26–28 weeks
C. Repeat the 2-hour 75 g oral glucose tolerance test every 6 months and if the patient becomes pregnant at 26–28 weeks
D. Repeat the 2-hour 75 g oral glucose tolerance test only if the patient becomes pregnant at 26–28 weeks
Answer DOI: https://doi.org/10.1177/17557380231162465o
