No sooner had I shared the young persons mental health links, a friend & colleague sent me her far more comprehensive list. I will eventually get round to putting a page in my resources but I have also uploaded a file with the hyperlinks on which you can download. It is here: 20190301-adult mh and I hope it is useful.
Category: Uncategorized
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Mental Health and Self-Harm in Young People
I just added a new page to my resources. I received a letter from CAMHS today with some excellent links to various tools and information leaflets for young people, parents, carers and professionals. I’ve put these on a page and I hope it will be of use to people. The page is currently unformatted but the hyperlinks all work (I think). I will correct the formatting in due course as it upsets my obsessive nature!
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My Iraq experiences
Not really educational but a reflection. With the Chilcott enquiry published today, I thought about my own experiences of the Iraq War (or the third Iraq war as it was known by the locals). I remember thinking ‘this isn’t a good idea’ when it kicked off and worrying about my military colleagues who deployed on Op Telic 1 (the war fighting phase although it was all a bit hairy). On my tours there and to Afghanistan, I used to write newsletters which were meant to be a bit of light hearted look at the British Army machine and how it worked and interacted (or not) with the locals. I’ve just re-read them & smiled to myself as we were already wondering ‘what on earth was going on’ and ‘what are we meant to be doing’ in 2004/5, let alone some 11 years later.
I’m going to hopefully share them now. I think they still read okay. They are when I deployed on Op Telic 5 in 2004/5. This was after I had deployed on Op Telic 2 in 2003, just after the war fighting had supposedly finished.
On reflection, a lot of my operational experiences was mundane primary care. It also involved doing favours and being continually amazed by how the logistical support provided to the US troops was second to none compared to our hand to mouth existence.
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Introduction
Dear All
If you are coming to this for the first time, do not be alarmed by the content. I had to start with something so I imported the Salisbury Plain site into this site. My aim is to combine PBSGL, the Salisbury Plain Trainers Group and DMS Trainers into one as much of the education that goes on is applicable to all three. I simply don’t have the time to post to all of them as well!
The first thing I would ask you to do is to go to twitter.com and get an account. It’s free and fairly simple to do. Once done, search for dmstrainers and follow. I will accept & follow you back. That’s it! As we mature as an on-line group, so we can fine tune how we interact with each other and share best practice, in clinical, leadership and educational domains.
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OSELTAMIVIR TREATMENT FOR INFLUENZA IN ADULTS: A META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS (Dobson et al., 2015)
I was interested to read about a new drug NICE have approved for HUS which by all accounts is massively expensive. All sorts of harrumphing followed in the press as well as the medical press about funding of expensive drugs and QALYs. Personally I think NICE have an important yet unforgiving job to do. I also do get a little cynical at yet another expensive breast cancer drug coming out which, accompanied by a powerful patient interest lobby, is guaranteed to net the drug company a good return. I remember reading the first papers on the initial Herceptin trials which were sponsored by big Pharma & thinking ‘this actually isn’t that great’. The study sample was small, the mortality pretty unchanged though admittedly the disease free interval was extended. I suppose if you have any cancer, these are small positives. My mother is currently in the terminal stages of bowel cancer and I know how awful it can be.
The other side is a drug which may benefit millions of us in the event of a pandemic. This brings us to Tamiflu, or oseltamivir. Not so long ago, a meta-analysis published in the BMJ reported that neuraminidase inhibitors at best had a modest effect (Jefferson et al., 2009). This was something I had always suspected. The patients I treated seemed to have more side effects than benefit in my admittedly small sample. I assumed powerful lobbying by Pharma alongside failure to disclose unpublished trial data had won the day.
It was the other day therefore whilst reading the Torygraph that this article piqued my interest. I won’t go into massive detail as one needs access to full text to assess it. Suffice to say it seems a well constructed systematic review with lots of blobograms (Forest plots) and actually is quite easy to read. The statistics seem sound too. When I see something that is too good to be true, it usually is. Not wanting to be unfair on the authors, there are one or two concerns. Firstly 2 of the 4 authors have been paid by Roche. Secondly, whilst they had no part in the analysis, Roche funded the study under the guise of the MUGAS foundation. The authors acknowledge this and make valid comment. The interesting thing about this study is that it used unpublished data. I don’t know which studies were unpublished but I could probably have a good guess. Of the 9 studies included, a sizeable minority have confidence intervals that cross the line of no effect. This includes the 2nd largest. Clearly when doing a systematic review, one includes all the studies but it is interesting to see all the data.
Probably the biggest issue and the one that that relates to primary care in the UK is the different analyses that were carried out. The intention-to-treat-infected population showed far greater effectiveness than the intention-to-treat population. This is essentially saying that when the nasal swabs were analysed & the results broken down into those who had influenza & those who didn’t, the former group gained far more benefit from oseltamivir. Patients included in the studies presented with symptoms of influenza had their treatment started within 36hr of onset. In other words no time to obtain a lab result to confirm influenza. This means the only population relevant to us in primary care is the intention-to-treat population where the effect is much less. Indeed one of the headlines is reduction of hospital admissions which in the intention-to-treat group was not significant. What we really need is a rapid near test to enable a more accurate diagnosis so the drug is used more effectively.
There are several references to Jefferson’s earlier work and indeed for anyone interested, I would read both studies together. It is a good example of a systematic review and actually one of the easiest to read I have come across in a while. It also will give some justification to the Government for the millions of pounds spent on stockpiling drugs in the event of an influenza pandemic.
DOBSON, J., WHITLEY, R. J., POCOCK, S. & MONTO, A. S. 2015. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. The Lancet.
JEFFERSON, T., JONES, M., DOSHI, P. & DEL MAR, C. 2009. Neuraminidase inhibitors for preventing and treating influenza in healthy adults: systematic review and meta-analysis. Bmj, 339.
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The Familial Risk of Autism
On the way to a leaving lunch the other day, I was tuned into Radio 4 listening to an article on Autistic Spectrum Disorder and the lengths to which some parents will go to help their children. One mother interviewed was spending up to £700 every three months on dietary supplements. Her child had been diagnosed with a variety of imbalances and too much mercury (a part of Thimerosal – useful link here: http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228). She had also been told children with ASD are unable to excrete certain toxins as well as children without it. To a medical professional who is used to Evidence Based Medicine and with a suspicion of some of the ‘quackery’ practised by certain organisations (plus their fees), I found myself getting angry at people being taken for a ride. I also thought that these parents are so desperate for help and so dedicated to their children, they spend thousands of pounds on treatments which are essentially placebo treatments. An expert in the field made valid comment on the paucity of good quality research out there with only £4M being spent annually compared to £650M on cancer and £150M on cardiovascular diseases.
Coincidentally I received my daily InfoPOEM today which summarised an article about ASD. I talked about how ICT can be used to help improve knowledge and skills ‘whenever and wherever’. I used to subscribe to this when a) it was very expensive (my subscription of $249 pa expired in 2007) and b) when I was writing my assignment & thinking about how I had used learning technologies in the past to assist in my education. From the Essential Evidence Plus website:
‘Daily POEMs (“Patient-Oriented Evidence that Matters”) are synopses of new evidence carefully filtered for relevance to patient care and evaluated for validity. Daily POEMs emerge from continuous review, grading, and critical appraisal of all 3000+ studies published monthly in more than 100 journals. Using Essential Evidence Plus, you will have complete visibility into the archived collection of 3,500+ regularly updated Daily POEMs. Tap into summaries of relevant and essential evidence-based research that are presented in an easy-to-understand format. Quickly identify and understand the information you need and apply the research to your clinical practice’
It is now $85 pa and I have re-subscribed with one of the intentions of blogging about freely available full text articles raised by InfoPOEMs with my own take on them. One of the concerns I have realised immediately is how easy it is to infringe on copyright and inadvertently plagiarise. I have linked to the InfoPOEMs site in the vain hope lenience will be applied by the judge when I am sentenced as a charlatan poaching other people’s hard work.
I have linked to the full text of the article. This is essentially a large cohort study of over 2 million patients which looked how relatedness affected risk of ASD. The most closely related were monozygotic twins with decreasing relative risk with reduced relatedness. There is a lot more to it than that though and with such a large cohort, it carries some weight. The article is worth a read as it is relevant to primary care, is a similar population (Swedish) and is applicable in the context of counselling parents who may visit for advice.
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Resources
I have added a new resources page. This will carry permanent links to downloadable teaching and education tools for all to use.
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Welcome
Welcome to the first blog entry of our PBSGL Blog! I would appreciate it if you can spend a bit of time reading through this as a an invite to participate.
This blog has two purposes. I unashamedly am using you as my Guinea Pigs for my assignment whilst participating in the Learning Technologies in Healthcare Education module of my MMedEd. The purpose in this context is to assess the educational impact of the blog in enhancing learning following our face to face discussions. Secondly I thought it might act as a tool to follow up on our sessions, sharing best practice, discussion of the cases and unanswered questions. I am hoping by participating in this blog, your learning will be enhanced.
The blog will work as a discussion following the small group work. I will summarise what was discussed. I will then post it and link to it via my micro blog (Twitter). What I need you to do is to obtain a Twitter account (free) on whichever platform you want. If you could then follow me (@sppbsgl or @upavondoc), you will receive updates when they are complete. Alternatively you can visit the blog directly at http://salisburyplainpbsgl.wordpress.com.
I hope everyone will participate. It may be a blog is not the best way to do the post meeting discussion but it seems the easiest way to start. Be aware the blog is open to the public so be careful when posting comments about patients. Use general principles not specifics. By all means link to websites and other resources. I hope we can all share our combined knowledge this way.
Each blog entry will be in the format <month> meeting – <subject>. I hope to tag the keywords to allow searching easier at a later date. Once I hope it is established, the plan would be to open up the blog to other administrators to initiate posts.
As e-moderator, I will ensure that comments respect patient confidentiality as well as the copyright of the modules. I don’t expect this to be particularly onerous as we all have a modicum of common sense.
At a later date, probably after two more modules, I will ask your for your feedback. In particular if the on-line discussion has enhanced your learning.
I will e-mail this out via the usual distribution list but if you could spend 2 minutes either registering for a Twitter account & following me or just following me, I would be grateful. Thanks.
