BMJ 2010: 341: 897 – 946 (30th October)

This issue contained a study on providing antenatal screening for thalassaemia and sickle-cell in general practice. We should, apparently, be offering this screening when pregnant women first book in, so that they have positive results as early as possible in time to consider their options.

OK, fine. I can see that that’s all very well in theory. What about the practicalities? When a woman comes to announce her pregnancy to me, I congratulate her, make brief enquiries into her state of health/smoking history/alcohol consumption/medications/LMP, check her heart sounds and blood pressure, give her the usual advice on folic acid and diet and avoiding animal poo, answer any burning questions she has, and advise her to book with the midwife for ongoing care. That fairly well takes care of a ten-minute consultation. If we then launch into a complicated and detailed topic such as antenatal screening, then that’s a whole further consultation in itself (and then some). That time has to come from somewhere, and, if we have to do it, it’s going to mean us working under time pressure while other patients sit and wait longer. If the Powers That Be think that screening should be discussed with women earlier in their pregnancies, then I think the answer is to make the initial midwife appointment earlier, not to blithely expect GPs to take it all on as a ‘while you’re here’.

(Interestingly, the GPs involved were interviewed for a qualitative study reported in that month’s BJGP, and I’m not the only one to have such concerns.)

Other points from this week: Some changes to BLS guidelines on chest compressions – they should be deeper and faster than previously recommended (5 – 6 cm having previously been 4 – 5, and 100 – 120 having previously been ‘about 100’ per minute). And beware those soft mattresses – if your resuscitee is lying on one, it may lead you to think you’re compressing more deeply than you actually are.

And Short Cuts reports a review of steroid injections for tennis elbow in the Lancet which confirms what we pretty much already thought – benefits are short-term, and longer-term they don’t help and may even make things worse compared to NSAIDs and physio. More means worse, too – multiple injections were associated with worse pain long-term than single injections (although, in fairness, it isn’t clarified whether this adjusted for the rather obvious potential reverse confounding problem). Whether this is true for tendons elsewhere (rotator cuff, patellar, Achilles) is uncertain, as there just wasn’t enough evidence. While on the topic, there is also not enough evidence to say whether patients should try or avoid lauromacrogol, platelet-rich plasma, sodium hyaluronate, prolotherapy, aprotinin, or botulinum toxin, so all of those are currently pigs in pokes. On the whole, my usual advice to patients with tendinosis of firstly giving it time and secondly trying physiotherapy still seems to be the safest option.


About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in BMJ, BMJ 2010, BMJ 341, Orthopaedics, Tendons, Uncategorized. Bookmark the permalink.

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