News round up week beginning 22nd August 2010
In this week's roundup of the news, Dr Harry Brown discusses:
* A new risk equation is described for diabetes, is this a sign of times to come?
* Always consider the possibility of an ectopic pregnancy, which is still the leading cause of first trimester death.
* The BMA have tried to lay down some ground rules for the new era of GP commissioning.
Another risk equation
One of the major revolutions in primary care over the past 20 years has been the enormous growth of IT. In general practice, we have moved from routine use of paper medical records to the everyday use of electronic medical records. One by-product of this has been the growth of risk equations, where data are scooped up and used to calculate the risk of developing a disease. The best current example is seen with cardiovascular risk equations. Not surprisingly, further risk scores are being developed and another recently reported is highlighted in the univadis GP news service (click here). The simple score may detect those people who are at risk of developing type 2 diabetes and so target them with further investigations or intervention. It sounds promising and maybe in years to come we will be mining our electronic records to find people at high risk of developing multiple future diseases. The next challenge will be to alter the natural history of the potential condition.
Never forget the ectopic pregnancy
A timely reminder appeared in the univadis GP news service (click here), which reviewed a paper in the British Medical Journal. Both articles are well worth a read. The big learning point is one I am sure many of us are already aware of, but is worth repeating - in a woman who has amenorrhea and abdominal pain, think of pregnancy and specifically the risk of an ectopic pregnancy. It is easy to overlook (12% of cases were overlooked at first review) and the consequences of a delayed diagnosis can be serious. It is good to see this kind of important clinical scenario highlighted - although I am sure we are all aware of the seriousness of an ectopic, it is well worth another look. This is still the number one cause of death in the first trimester of pregnancy, a deeply unsatisfactory statistic about a treatable disorder.
GP commissioning guidelines
The British Medical Association (BMA) has already waded into the debate over the proposed National Health Service (NHS) reforms, laying down some guidelines and advice on professional behaviour in the new GP commissioning landscape. As described in the univadis GP news service (click here), GPs' first responsibility should always be to their patients. This is self evident and a basic principle of medical practice, but it is worth restating. After all, with GPs controlling large chunks of the NHS budgets in the near future, it may be easy to lose sight of professional responsibilities. It is also stated that GPs must not personally profit from commissioning budgets. It is good to see the BMA laying down some ground rules for doctors, but expect this area to be a big battle ground for years to come.
Dr Harry Brown, editor-in-chief
By Dr Harry Brown