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Gender differences in hospital admissions for cardiovascular events and procedures in people with and without diabetes

An article published in the journal Cardiovascular Diabetology examines gender differences in hospital admissions for major cardiovascular events and procedures in people with and without diabetes.

Secondary prevention of cardiovascular disease (CVD) has improved immensely during the past few decades but controversies persist about the cardiovascular benefits among women with diabetes. We investigated 11-year trends in hospital admission rates for acute myocardial infarction (AMI), stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) in people with and without diabetes by gender in England.

We found that diabetes-related admission rates remained unchanged for AMI, increased for stroke by 2% and for PCI by 3%; and declined for CABG by 3% annually. Trends did not differ significantly by diabetes status. Women with diabetes had significantly lower rates of AMI and stroke compared with men with diabetes. However, gender differences in admission rates f…
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The diagnosis and management of Scarlet Fever in primary care

An article published in the London Journal of Primary Care discusses the diagnosis and management of Scarlet Fever. There has been a recent increase in the incidence of scarlet fever with most cases presenting in General Practice and Emergency Departments. Cases present with a distinctive macro-papular rash, usually in children. In patients who have the typical symptoms, a prescription of a suitable antibiotic such as phenoxymethylpenicillin (Penicillin V) should be made immediately to reduce the risk of complications and the spread of infection.

A typical presentation of scarlet fever
An 8-year-old girl is brought to see you at your practice. She has a sore throat, abdominal pain and has been vomiting. Her health was fine until two days ago. Initially, she noticed pain on swallowing and had a temperature of 38 °C. Her parents decided to seem medical advice once they noticed the ‘sandpaper-like’ rash on her trunk and the inside of her elbows. When you examine her tongue, the enlarged …

Is there still a role for smaller hospitals in the NHS?

A paper published in the British Journal of Hospital Medicine asks the questions "Is there a role for smaller hospitals in the future NHS?"

The NHS is challenged by rising demand as a consequence of a population with more complex conditions and the rising costs of paying for that care. Inefficiencies resulting from fragmented primary, secondary and social care services highlight the need for greater coordination and continuity to improve patient outcomes at lower cost. Financial constraints can drive health system review, providing impetus to modify health service delivery within the NHS to maximize value and better align with the needs of our population.

The Naylor (2017) review calls for urgent rationalization of the NHS estate to meet the mandate of the Five Year Forward View. Smaller acute hospitals could be seen as a potential starting point for reconfiguring health services in England. However, local change is not always welcome and the perceived loss of services is o…

The burden of disease in the World Health Organization's Eastern Mediterranean Region

I contributed to a series of papers on health in the World Health Organization's Eastern Mediterranean Region. Key steps that need to be taken to improve the health and well-being of people in the region must include ending the wars and conflicts in the region, as well as improving education and employment opportunities, particularly among women. Health systems must be strengthened as well, for example, through building up primary care and using health programmes to target the causes of ill-health, such as high-calorie diets, smoking, physical inactivity and obesity. In addition, health workers and governments should aim to improve maternal and child health and ensure that immunisation rates are high, as well as addressing environmental factors such as air pollution. You can read more on the Imperial College Website.

The papers were published in the International Journal of Public Health. Papers in the series include:

Diabetes mellitus and chronic kidney disease in the Eastern Med…

NHS England’s plan to reduce wasteful and ineffective drug prescriptions

I published an article in the British Medical Journal in August 2017 on NHS England’s plan to reduce wasteful and ineffective drug prescriptions. In the article, I explain why national rules on prescribing are a better approach than the variable local policies being implemented by clinical commissioning groups (CCGs, the NHS organisations responsible for funding local health services).

The National Health Service (NHS) in England must produce around £22 billion of efficiency savings by 2020. A key component of the NHS budget in England is primary care prescribing costs, currently around £9.2 billion annually. Inevitably, the NHS has begun to look at the drugs prescribed by general practitioners to identify areas in which savings could be made; ideally without compromising patient care or worsening health inequalities. This process was initially led by CCGs, focusing on drugs that are either of limited clinical value or which patients can buy from retailers without a prescription (ref…

Imperial College joins the UK's effort to tackle global health challenges

The Department of Primary Care and Public Health at Imperial College London has been awarded funding as part of a UK drive to tackle global health challenges. The work is funded by Research Councils UK as part of the Global Challenges Research Fund (GCRF), a £1.5 billion fund launched by the UK government in 2015. The fund aims to support cutting-edge research which addresses the global issues faced by developing countries in areas including agriculture, medicine, well-being and infrastructure.

The GCRF funding will also enable Imperial Professors Azeem Majeed, Toby Prevost and Mala Rao to investigate low cost technologies for screening for diabetic eye disease, a leading cause of blindness in India, in partnership with clinicians from Moorfield’s Eye Hospital in London. Professor Mala Rao, who is leading Imperial’s contribution to the project, said: “This award offers a very exciting opportunity for us to work together to transform the lives of people with diabetes and diabetic eye …

Advice on the management of the transgender patient in primary care

A recent article in the journal BJGP Open provides advice on the management of transgender patients in primary care. With referrals to gender identity clinics rising rapidly, general practitioners (GPs) and primary care physicians are more likely to meet patients who are transgender (whose gender identity, or internal sense of gender, does not match their gender assigned at birth) or diagnosed with gender dysphoria (the severe psychological distress that is experienced by an individual as a result of the conflict between their gender identity and gender assigned at birth).1 Teaching on transgender medicine is lacking in both undergraduate and postgraduate curricula, leading to a perceived lack of expertise in this area. Furthermore, General Medical Council (GMC) guidelines on the GP’s role in prescribing are vague, resulting in some controversy. As waiting times for appointments at specialist clinics are often at least 18 months, GPs and primary care physicians will increasingly be i…

Visit to DeepMind

I was invited Google’s headquarters in London today to discuss the work in healthcare being carried out by DeepMind. We had a very interesting discussion about the scope for the use of artificial intelligence in healthcare to improve clinical outcomes and population health. We also discussed the use of predictive modelling to identify patients with long-term conditions at high risk of death, readmissions and complications.