Autumn 2013, Course Preview

We are all very excited about our Autumn series of Hot Topics courses, which start in Manchester on September 21^st and end in Cardiff on October 12^th.

·         All the presented Hot Topics will be new compared to 2012 so if you came a year ago, do come back
 

·         We have streamlined the paper book, and included more of our ever popular KISS summaries. Less text, more KISS!
 

·         The electronic version of the book has been developed to become an invaluable resource to use during your working day. It is instantly searchable. Original sources are hyperlinked, and the KISS summaries contain direct links to resources for you and your patients e.g. a KISS section on Achilles Tendinopathy gives a simple management algorithm and a link to the information sheet to give your patient with the appropriate evidence-based exercises to do, cluster headache has a link to the pre-filled home order oxygen form etc.
 

·        New to 2013, you will be emailed pre and post course MCQs so that you can test your knowledge and demonstrate your learning
 

·        For the first-time we have developed some of our own patient information sources to reflect current evidence for you to give your patients e.g. for patients requesting a PSA test, on low salt/high potassium diets in hypertension, low FODMAP diet in IBS etc
 

·       As ever, a broad range of topics will be discussed which reflect the incredible diversity of things we have to deal with primary care from the very complex to the seemingly simple….highlights will include new research, evidence reviews and guidelines on:

o   How best to manage patients with multimorbidity

o   New Vitamin D guidelines

o   Treatment resistant hypertension

o   New evidence and guidelines on TIA and stroke

o   Dementia

o   Depression

o   Eating disorders

o   Social anxiety & OCD

o   PSA, LUTs and prostate cancer

o   Headaches

o   Chronic non-cancer pain

o   Common sports injuries & MSK problems e.g. shin splints, plantar fasciitis etc

o   Gout

o   Detection of melanoma

o   Psoriasis

o   IBS

o   Liver disease

o   Obesity

o   Common infections

o   New vaccinations update
 

·         An extensive range of other topics, from the seemingly simple (e.g. acne, erectile dysfunction, polymyalgia….) to the very complex (e.g. medically unexplained symptoms, end of life care…) and are all fully updated and included in the book, all with invaluable links and resources
 

·         As ever we want you to have a relaxing and fun day out of the practice, so we will keep the atmosphere light, with some good new funny clips and we really hope you have an enjoyable day

With GPs being so busy, we are convinced that this model provides us the best way of practising patient-centred evidence based medicine. So, do come along and we look forward to seeing you next month!

Simon, Zoe, Neal and Gail

Patient advice Diet and IBS

Dietary Advice for IBS

 Research is increasingly showing that most people can control the troublesome symptoms of IBS through modification of their diet. This takes some commitment and trial and error, but the results can be very rewarding.

 ►Step One:

 Follow the dietary advice from the British Dietetic Association, by following the guidance in their BDA Food Fact Sheet on IBS

 This advice includes:

·         Cutting down on rich and fatty food

·         Cutting down on some high fibre foods, and especially those which produce a lot of gas such as beans and pulses

·         To eat soluble sources of fibre, such as golden linseeds

·         To try lactose-free dairy products

·         To try some probiotics

 Keep a symptom and food diary, looking to identify the triggers. If no significant improvement after 4 weeks then move to….

  ►Step Two

 This involves paying close attention to altering your diet to reduce your intake of FODMAPS

 FODMAPs are types of carbohydrates which are poorly absorbed and rapidly fermented by gut bacteria to produce gas and other symptoms of IBS. Recent research shows that 86% of patients can control their symptoms by cutting down on FODMAPs, and benefits are seen within 4 weeks.

 

However a low FODMAP diet is not simple to follow, as FODMAPS are found in a wide range of food sources. For example….

Food Group	High FODMAPs examples	Suitable alternatives
Fruit	Apples, Peaches, pears, plums	Banana, grapes, oranges, strawberries
Vegetables	Mushrooms, onions, garlic, cauliflower, asparagus	Potato, tomato, carrot, green beans, lettuce, peppers
Protein	Legumes and nuts	Fresh chicken, pork, lamb, beef, eggs
Breads and cereals	Wheat, rye, barley	Corn, oats, rice
Dairy	Milk, yoghurt, cheese ice-cream	Butter, lactose-free dairy products
Other	Honey, sorbitol, fructose	Golden syrup, regular sugar

 

Ideally, your doctor should be able to refer you to a dietitian trained in this approach. If this is not possible, then the team at Monash University in Melbourne who have developed this research have produced a range of  Information materials on FODMAPS which you can follow. This includes a book you can order, and also an excellent low FODMAP app for iphone and ipad, which can instantly tell you whether any food is high or low in FODMAPs.

There is also an American diet book available Amazon link

 If your symptoms continue, then obviously go back to your doctor.

This approach takes commitment, but if it works (which for most people it will) your IBS will be controlled without needing to take any drugs. Good luck!!

 

 

 

BP: how to monitor at home and lower it naturally

High Blood Pressure:

How to monitor at home and lower it naturally

(Please feel free to cut/paste and adapt as you wish. This leaflet is best used electronically to access the links)

 There is increasing evidence that measuring blood pressure at home is a useful and accurate way to assess blood pressure. Below are a few important tips on the correct procedure for monitoring your blood pressure at home, as well as advice as to how to lower it naturally.

 It can be scary being diagnosed with high blood pressure. But, if you understand it and take control of it there is a lot that you can do to lower it and to reduce your risk of a heart attack or stroke.  Keeping your blood pressure down is a highly effective way of helping to prevent heart attacks and strokes in later life. Imagine the heating system in a house – the lower the pressure the water is being pumped through the pipes, the longer the pipes will last…

 If you smoke, this is much more dangerous with high blood pressure and we strongly urge you to stop. We can help you with this. It seems hard, but people succeed at it all the time and then live longer and healthier lives as a result.

 ► How to monitor your blood pressure at home

 Make sure you have a validated monitor with an appropriate cuff size. Click here for a list of validated monitors from the British Hypertension Society. One of these costs just £15. Once you have the monitor, follow these simple instructions:

• Measure from the upper arm
• Take your blood pressure whilst seated, with your arm and back supported, legs uncrossed and whilst you are not talking (talking and crossed legs increase blood pressure)
• Measure your blood pressure in both arms, and if there is a consistent difference of more than 10mmHg then always use arm with higher reading, and let your doctor know.
• Take two readings, at least a minute apart, morning and evening for 7 days recording the lower of the two readings onto a sheet of paper or a computer spreadsheet.
• The systolic reading is the upper reading (when your heart beats) and the diastolic reading the lower one (in between beats).
• Once you have completed 7 days of measurements, calculate the average of all the readings. Your doctor will want to know the average, and also the range from the lowest to the highest readings you have got.
• Monitor for a week every 3 months, or every 4 weeks after a change in your medication dosage.

 ►What should my ‘ideal’ blood pressure be?

This varies according to your age and other conditions, and your doctor will discuss with you what your individual ideal ‘target’ should be. But, general ‘targets’ for the average of your readings are

• For people under 80, less than 140 systolic and less than 90 diastolic
• For people over 80, less than 150 systolic and less than 90 diastolic

If you have diabetes, kidney disease or other conditions these ‘targets’ may be lower. If the average of the readings is OK, but you have some very high readings (e.g. more than 180 or more than 110) then let your dr or nurse know.

► How to lower Blood Pressure Naturally

 The good news is there is a lot you can do to reduce blood pressure naturally. Even if you are on medication, reducing your BP further through lifestyle change will reduce your risk of a future heart attack or stroke. The research is incredibly strong that regular exercise, losing some weight, relaxation exercises and changing what you eat is very beneficial for your blood pressure. One of the many advantages of home BP monitoring is that you can soon start to see the benefits of making these changes!

 To help reduce your blood pressure naturally you should look at:

 Œ Exercise

 Regular exercise will reduce your blood pressure. It is important to do at least 30 minutes every day, enough to get you slightly out of breath. Brisk walking is fine and or you may prefer other activities to lower blood pressure. It is important this becomes part of daily life.

  Diet

 If you are overweight, even small amounts of weight loss may improve your BP. Work hard on this and also aim to decrease

• Salt, sodium and potassium
• Eating a low sodium and low salt but potassium rich diet is very important, and brings rapid benefits in reducing BP
• Eat no added salt, and eat mostly low salt foods
• This means label watching and looking for <300mg salt per 100g of food whenever possible
• For simple information on reducing salt click here and boosting potassium click here
• Total and saturated fat and red meats (replace with low fat dairy products, fish and poultry)
• Sugar and sweet drinks (enjoy small amounts of plain, dark chocolate as your ‘treat’; this actually helps bring BP down!)
• Refined carbohydrate (white bread, pasta etc; switch to whole grain ‘brown’ varieties)
• Alcohol (except very modest quantities, less than 1-2 drinks daily)
• Excessive caffeine (1 or 2 cups of coffee/tea a day are fine)
• And increase fruits, vegetables and whole grains in the diet

 For more information on your diet and lowering BP:

·         see  Blood Pressure UK advice

·         The DASH diet is a diet plan (low salt, high fruit and veg) which has been shown to effectively reduce BP very quickly, irrespective of weight loss, and books (DASH diet book and DASH diet plan) are easily available

 Ž Relaxation exercises and stress reduction

 Relaxation exercises and stress reduction have been shown to reduce blood pressure.

• 15 minutes of meditative slow breathing (reducing your breathing rate to less than 10 breaths per minute) at least 4 times a week produces sustained reductions in BP.
• Mindfulness is a form of meditative relaxation which is helpful for a wide range of stress-induced problems, but which also reduces blood pressure and is highly recommended as a healthy daily practice (See the book Mindfulness: a practical guide to finding piece in a frantic world)
• For smartphone users, see the Breathe Away High Blood Pressure app

 For more information on high BP see NHS information on high BP

 

Dr Simon Curtis, NB Medical Education, August 2013

 

 

 

 

 

 

 

 

 

 

PSA screening: Information to give men

Information to give asymptomatic men who request a ‘screening’ PSA test

Based on  BMJ2014;348:g2559 and   BMJ 2013;346;f325

·         GPs have received expert guidance, from the UK and the US, that they can ‘improve the health of their patients by advising them AGAINST having the PSA test’. This is because, based on research involving hundreds of thousands of people over many years, we now know that:

o   The test is unlikely to prevent you dying from prostate cancer over the next 10 or 15 years or help you to live longer

o   Elevated PSA levels are common and lead to additional tests which can be harmful

o   PSA testing finds cancers which may never cause problems. But once these cancers are found it is hard not to treat it. These treatments can result in significant side effects such as impotence and urinary incontinence

o   By choosing not to have a PSA test you can have a similar length of life and avoid the potential harms associated with tests, procedures and treatments

·         For every 1,000 men who are screened with a PSA test

• 1 death from prostate cancer will be prevented
• 100 will receive a false positive and will need prostate biopsy
• 100 will be diagnosed with prostate cancer and most likely receive potentially harmful treatment, which they may never have needed
• Biopsies and treatment are associated with significant harms

This UK view agrees with US Screening Recommendations 2012 which does NOT recommend screening for prostate cancer at any age as the benefits of screening for prostate cancer by measuring PSA does not outweigh harms.

If despite this advice, you still want to have a PSA test then it is recommended that the test is restricted to men aged from 55 to 69. If your PSA test is found to be low (2 or less) no further PSA testing is recommended, as your lifetime risk of developing significant prostate cancer is very low and continued testing is more likely to cause you harm. If your PSA is found to be greater than 2, you may benefit from continued screening.