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Showing posts from November, 2023

Should we shift from using 'junior doctors' to postgraduate doctors?

In the UK's National Health Service (NHS), the language we use to describe medical professionals holds significant weight. The term 'junior doctor,' a longstanding descriptor for doctors in training or those in their early postgraduate years in the UK, is now being re-evaluated. The British Medical Association (BMA) has highlighted the need for a terminology update to more accurately reflect the expertise and responsibilities of these vital healthcare professionals. Our article in BJGP Open discusses this issue further.  The Need for Change The term 'junior doctor' has been a staple in the UK medical lexicon for decades, but it fails to capture the breadth of experience and skill these doctors possess. These professionals, who may have up to a decade of training, are fully qualified and play a crucial role in patient care, performing a wide range of duties from diagnosis to complex medical procedures. The current term may inadvertently diminish their value and expe

Boosting Vaccine Uptake in Pregnancy: What Works and What Doesn't

Pregnancy is a time of anticipation and preparation. But it's also a time when expectant mothers must be vigilant about their health — not just for themselves but for their unborn children as well. Vaccinations against COVID-19, influenza, and pertussis are vital during this period, yet many pregnant women hesitate to get these lifesaving shots. Let's delve into recent research that sheds light on effective strategies to increase vaccine uptake among pregnant women. Our study published in the Journal of Travel Medicine reviewed studies from January 2012 to December 2022, following the gold-standard PRISMA guidelines, to identify interventions that successfully increase vaccine uptake in pregnant women. The meta-analysis focused on three key diseases: COVID-19, influenza, and pertussis — all of which pose significant risks to both mother and child. Key Findings Out of 2,681 articles, 39 studies were relevant, comprising over 168,000 participants from nine different countries. I

Primary Care Clinical Update 16 November 2023

1. Varicella (chickenpox) vaccination The Joint Committee on Vaccination and Immunisation (JCVI) has recommended a vaccine against varicella (chickenpox) should be added to the UK’s routine childhood immunisation programme. The vaccine would be offered to all children in 2 doses, at 12 and 18 months of age.  The JCVI has also recommended a temporary catch-up programme for older children be included in the initial rollout. Chickenpox cases were significantly reduced during the pandemic due to social restrictions, meaning there is currently a larger pool of children than usual without immunity. The catch-up programme would offer them protection against greater risks from the illness through later childhood or as adults, when chickenpox can be more severe. Many other countries (such as Germany, Canada, Australia and the USA) already offer children chickenpox vaccination. The final decision about approving the proposed programme lies with the Secretary of State for Health and Social Care.

Chickenpox vaccination in the UK

 The Joint Committee on Vaccination and Immunisation (JCVI) recommending the inclusion of the chickenpox vaccine in the UK's childhood immunisation schedule is a significant step for public health. This decision aligns the UK with many other countries that have already integrated the chickenpox (varicella) vaccine into their routine childhood immunisation programmes. The implementation of the chickenpox vaccine on a national scale offers several benefits: 1. Reduction in cases: Widespread vaccination among children has the potential over time to significantly reduce the incidence of chickenpox, a highly contagious disease, among children and the wider community. 2. Prevention of complications: While chickenpox is often mild, it can lead to serious complications such as secondary bacterial infections, pneumonia and encephalitis; and can be particularly severe in immunocompromised individuals. Vaccination will help reduce the risk of these complications. 3. Healthcare burden: By redu

How can the NHS provide personalised care to patients?

The objective for the NHS in England to provide high-quality, personalised care for all patients is a vision that requires a transformative approach to healthcare delivery. This shift signifies a move from the primarily finance and target-driven models of healthcare delivery that we have now to ones that are more patient-centred, emphasising the importance of individual patient needs and outcomes as well as the well-being of NHS staff. In the international context, healthcare systems around the world are grappling with similar challenges: how to deliver care that is both high-quality and cost-effective, while also addressing the needs of an aging population and the rise of chronic diseases. Many countries are looking towards patient-centred care as a solution. The World Health Organization (WHO) has also advocated for patient-centred care as part of its strategy to strengthen healthcare systems globally. It emphasizes that patient-centred approaches can lead to better health outcomes,

The essential role of daily exercise in enhancing health and well-being

Regular exercise is essential for good health, contributing to benefits that extend across the lifespan. In the United Kingdom, public health guidance emphasizes the importance of physical activity as a modifiable lifestyle factor that can significantly influence overall health and well-being. A dults are advised to engage in at least 150 minutes of moderate-intensity activity each week, or 75 minutes of vigorous-intensity activity, along with strength exercises on two or more days a week that work all the major muscles. Cardiovascular health sees marked improvements with regular physical activity. Exercise promotes heart efficiency, allowing it to pump blood more effectively, and reduces the risk of heart disease and stroke, which remain common health problems in the UK. Additionally, regular exercise can also help lower blood pressure and cholesterol levels, contributing to a healthier circulatory system. Bones also benefit from exercise, particularly weight-bearing activities

The Foundations of Good Health: Fruits, Vegetables, and Fibre

A diet rich in fruits and vegetables , complemented by a variety of high-fibre foods , is one of the foundations of good health. Eating at least five portions of fruits and vegetables daily is not just a number to aim for - it's essential for a healthier life. Here's a deeper dive into why these dietary staples are so crucial for your health: 1. The Powerhouse Pair: Fruits and Vegetables Rich in essential vitamins, minerals, and dietary fibre, yet low in calories, fruits and vegetables are the unsung heroes of a health-conscious diet. Regular consumption of this dynamic duo can significantly diminish the risk of chronic conditions such as heart disease, hypertension, and certain cancers. The presence of vitamin C, along with a symphony of phytonutrients, bolsters the body's health defences, offering a spectrum of benefits that go beyond basic nutrition. 2. The Fibre Effect: Sustenance and Protection High-fibre foods act as the body's natural sweep, promoting a robust di

Digital Tools for Enhancing Infectious Disease Screening in Migrants

The European Centre for Disease Control (ECDC) has highlighted a stark reality: migrants in Europe are disproportionately affected by undiagnosed infections, including tuberculosis, blood-borne viruses, and parasitic infections. Many migrants also fall into the category of being under-immunised. The call to action is clear — innovative strategies must be developed to deliver integrated multi-disease screening within primary care settings. Despite this call, the United Kingdom's response remains fragmented. Our recent in-depth qualitative study published in the Journal of Migration and Health delves into the current practices, barriers, and potential solutions to this pressing public health issue. Primary healthcare professionals from across the UK participated in two phases of this qualitative study through semi-structured telephone interviews. The first phase focused on clinical staff, including general practitioners, nurses, healthcare assistants, and pharmacists. The second pha

The UK government must be more proactive about addressing drug shortages

In a letter published in the British Medical Journal , I discuss why the UK government must be more proactive about drug addressing shortages in the NHS. The lack of drugs such as methylphenidate required for the treatment of attention deficit/hyperactivity disorder (ADHD) is the latest of many medication shortages we have seen in the UK in recent years.1 These shortages are now too frequent and waste the time of NHS staff such as general practitioners and pharmacists who have to spend time counselling patients and sourcing alternative drugs instead of focusing on more relevant work. They are also very stressful for patients who risk going without key drugs with potentially adverse consequences for their health. For people with ADHD, for example, this could mean going without medication that they require to function effectively at work and school and in their personal relationships. We need a much more proactive approach from the government, which needs to work with drugs manufacturers

The Frontline Clinical Experience: Navigating Uncertainty and Risk in the Early Days of Covid-19

As the Covid-19 Inquiry progresses, it provides an opportunity for reflection on the many challenges faced by healthcare workers like myself during the early days of the pandemic. At that time, the SARS-CoV-2 virus was a largely unknown entity; clinical guidelines were still under development; and personal protective equipment (PPE) was scarce. For those on the NHS frontline, the experience was marked by a mix of anxiety, urgency, and dedication to the patients we were trained to serve.  Unfamiliar Territory  In the initial stages, Covid-19 was a "novel" coronavirus, the key word being "novel." There was a scarcity of data, and the disease was manifesting in ways that were not entirely well understood. As primary care physicians, we were suddenly thrust into the realm of the unknown, treating patients with undifferentiated respiratory illnesses that did not yet have well-defined and evidence-based treatment protocols.  The Personal Risk Factor  One of the most daunt