Prescribing Advice for GPs

MeReC Bulletin - CV Risk

August 5, 2008 on 1:30 pm | In Prescribing Extra - Other |  Print | No Comments

The National Prescribing Centre (NPC) has published a MeReC Bulletin (PDF) that summarises the current recommendations for assessing and communicating the risk of cardiovascular disease (CVD).

The bulletin aids the implementation of the recent Lipid Modification issued by the National Institute for Health and Clinical Excellence (NICE). It covers the following:

• Which CVD risk prediction tool to use
• Identification of individuals appropriate for risk assessment
• How to formally assess CV risk
• How to calculate CV risk for patients with type 2 diabetes
• How to communicate the calculated CV risk to patients

Action: Any clinician involved in calculating and communicating CV risk to patients will find this summary useful. It also contains pointers to resources that will make the risk prediction process and communication of that risk easier.

Drug Safety Update - August 2008

August 4, 2008 on 11:24 am | In Prescribing Extra - Other |  Print | No Comments

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for August 2008 (PDF).

This issue includes the following drug safety advice articles:

• Antiepileptics: suicidal thoughts and behaviour
• Recombinant human erythropoietins: new recommendations for treatment of anaemia in cancer

In addition, this issue contains a hot topic containing information about thalidomide and lenalidomide for multiple myeloma. The stop press section contains several reminders of developments in the last month including the prescribing restrictions imposed for moxifloxacin and using oral metronidazole (not intravenous) to treat Clostridium difficile-associated diarrhoea unless advised otherwise by a specialist.

Action: Clinicians will find this publication to be a useful review of current issues in drug safety.

Dietary advice can prevent diabetes

August 1, 2008 on 2:47 pm | In Prescribing Extra - Other |  Print | No Comments

The Cochrane Library has published a review of the impact of dietary advice in the prevention of type 2 diabetes mellitus.

The review could only identify two randomised controlled studies of 12 months duration or longer. The data included just 358 people. The two studies examined different end points so the data were analysed. In the longer (6 year) study there was a 33% reduced risk of developing diabetes in the intervention group assigned to dietary advice. In the shorter (12 month) study there were significant reductions in several biological markers including body mass index, fasting blood glucose, lipids, mean blood pressure and fasting insulin.

American endocrinologists are recommending more systematic identification of patients with prediabetes so that lifestyle interventions, including diet and exercise, can be started to avoid huge financial costs in the future.

Action: Clinicians must ensure that lifestyle interventions are regularly reinforced and not overlooked in favour of “easier” alternatives.

Sustained weight loss with increased physical activity

July 31, 2008 on 3:03 pm | In Prescribing Extra - Other |  Print | No Comments

The Archives of Internal Medicine has published the results of a two year study that examined the effect of physical activity on maintenance of weight loss.

201 obese women aged 21-45 years with a body mass index of 27 to 40 were randomly assigned to one of four physical activity interventions based on physical activity energy expenditure (1000 vs 2000 kcal/wk) and intensity (moderate vs vigorous) in combination with a calorie controlled diet.

Weight loss at 6 months and 2 years did not differ between any of the groups however a post-hoc analysis showed that individuals who lost more than 10% body weight over 2 years reported higher levels of activity (equivalent to 40 minutes per day) than those who lost less than 10% body weight in the same period.

The authors conclude that, “physical activity, in combination with a reduction in energy intake, is important in allowing overweight women to sustain a weight loss of more than 10%“. They also point out that patients are likely to require assistance to achieve this level of physical activity.

Action: Clinicians should ensure they are aware of local programmes to encourage sustained physical activity. In combination with a healthy diet long-term weight loss is possible.

HPV programme extended

July 28, 2008 on 1:59 pm | In Prescribing Extra - Other |  Print | 1 Comment

The Department of Health has announced (PDF) that the human papillomavirus vaccination programme is to be extended to include young women aged 17-18.

The decision to use Cervarix^® has been criticised but this announcement does start to explain why the programme is using an apparently inferior vaccine.

Action: Clinicians should be aware of the extension to the vaccination programme.