Ultrasound, HPV and childhood flu

Too busy to read the latest research? Let Dr Gwen Lewis keep you up to date.

Ultrasound scanning in the community J Fam Plann Reprod Health Care 2008; 34: 115-7
I was especially interested to read this audit of scanning in reproductive health clinics because our practice is considering buying an ultrasound scanner and using it in a practice-based commissioning set-up.

In the clinic studied, ultrasound was used to assess gestation prior to pregnancy termination and for location of IUDs. Sixty-three scans were undertaken in three months.

Scanning in the community was found to reduce unnecessary referrals to hospital services and improve continuity of care. However, concerns were raised about training in scanning and maintenance of skills.

I can certainly see a role for scanning in the surgery for the indications it was used for in the trial but also, for example, in cases of possible ectopic pregnancy and when pelvic masses are found on examination.

The Faculty of Sexual and Reproductive Health Care has recently developed a special skills module in ultrasound and I would certainly be interested in looking into this further as I see a great opportunity here to improve services to patients.

Termination care J Fam Plann Reprod Health Care 2008; 34: 107-10
Debate over pregnancy termination provision looms large in general practice, with talk of medical terminations being made available in polyclinics.

Although this study was based in the US, the situation can be extrapolated to the UK. In the US, it is estimated that almost half of pregnancies are unplanned and about one in three women will have a termination by the age of 45, figures that are certainly similar those in the UK.

Despite the high prevalence of abortion in the US, education for doctors about abortion was lacking in most medical school and family medicine training.

An abortion curriculum was introduced into a family medicine residency, involving three or four half-day training sessions. Residents completed written surveys before and after participating in the curriculum. The post-rotation survey demonstrated improvements in knowledge and self-reported comfort with related skills, as well as favourable attitudes regarding termination training.

Perhaps a similar curriculum should be considered in UK medical training.

Genital warts Sex Transm Infect 2008 doi:10.1136/sti.2007.029512
Vaccination against HPV is due to be administered routinely to girls aged 12-13 starting in September.

As well as HPV types 16 and 18, one of the vaccines used also protects against HPV types 6 and 11, which cause more than 95 per cent of genital warts, as well as cervical cancer.

In my clinical experience, patients are often very upset by a diagnosis of genital warts, presumably because they are very visible, and this study of 18-year-olds with a current diagnosis of genital warts concurs.

Eighty-one young people were interviewed and asked to complete a health-related quality of life questionnaire, which revealed significant detriment to their quality of life.

Not only will vaccination reduce the incidence of cervical cancer, but it will have beneficial effects on quality of life.

Influenza in young children Med J Aust 2008; 188: 510-3
Although this study was undertaken in South Australia, its findings are of significance in the UK because there is interest here in introducing influenza vaccination for young children.

Influenza-related morbidity and mortality in healthy children aged less than five years were studied, with mean admission rates per year and proportion of children without a secondary diagnosis as the main outcome measures.

In the 10-year period from 1996 to 2006, 649 children were admitted to hospital for influenza. Admission rates were highest for children aged less than 12 months and rates decreased with age. Most had no underlying chronic illness.

The authors concluded that more evidence would be needed in order to support the expansion of the influenza immunisation programme to include children of this age.

Blood pressure lowering BMJ 2008; 336: 1,121-3
BP lowering strongly and directly related to relative risk of stroke and heart disease.

As GPs, we have been advised to use the ACD treatment regime, which depends on the age of the patient.

These meta-analyses provide strong support for use of drugs and lifestyle changes to lower BP in older and younger adults, with no strong evidence for the selective use of specific classes of drugs according to age.

Factors such as tolerability and cost are probably reasonable bases for choice of a drug, as long as effective BP reduction is achieved.

It seems the most important thing is to ensure BP is reduced by whatever means necessary.

BP medicine compliance - BMJ 2008; 336: 1,114-7

Most antihypertensive medication can now be prescribed as once-daily formulations, which should be relatively easy to remember to take.

However, this study of the dosing histories of 4,783 hypertensive patients revealed that about half of those prescribed an antihypertensive treatment had stopped the medication within a year.

On any one day, those still taking medication omitted 10 per cent of the daily doses, and 43 per cent of these took 'drug holidays', where the dose was omitted for three or more days.

This should be borne in mind when managing BP.

Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review journals

The quick study

  • Ultrasound scanning in reproductive health clinics was found to reduce unnecessary referrals and to improve continuity of care.
  • Pregnancy termination education for trainee family doctors improves their knowledge and skills.
  • Genital warts significantly reduce a patient's quality of life. The HPV vaccine offers some protection against the wart-causing strains of virus.
  • Influenza admission rates were highest in children younger than 12 months, in a study of children admitted to hospital with influenza.
  • BP may be managed effectively with a variety of drugs and lifestyle changes, and certain drugs are not necessarily more effective in specific age groups.
  • Hypertensive patients often miss doses of medication or stop altogether.

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