Monoclonal gammopathy of undetermined significance is a premalignant, plasma cell disorder. Due to the potential risk of progression to multiple myeloma or a plasma cell-related disorder, it is important for GPs to recognise and manage patients in this cohort appropriately. This article aims to improve understanding, recognition and management of these patients in primary care.
Gastro-oesophageal reflux disease is an unpleasant condition, reported to account for about 5% of GP consultations in western Europe ( United European Gastroenterology, 2018 ). Patients often describe a number of symptoms, which can make identifying the underlying cause challenging. The problem is reported to affect 25% of the population and is two to three times more common in men than in women, with 1% of the population suffering daily symptoms ( Ford and Moayyedi, 2009 ). This article will provide non-medical prescribers an overview of treatment and management and aims to give them more confidence in prescribing for their patients with this condition.
Journal of Prescribing PracticeVol. 1, No. Sup3 DiabetesMetformin use and B12 deficiencyMargaret PerryMargaret PerryCorresponding author: E-mail Address: [email protected]Advanced Nurse Practitioner, Linkway Medical Practice, West MidlandsSearch for more papers by this authorMargaret PerryPublished Online:14 Mar 2019https://doi.org/10.12968/jprp.2019.1.Sup3.S10AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleReferencesDeCensi A, Puntoni M, Goodwin P et al., Metformin and Cancer Risk in Diabetic Patients: A Systematic Review and Meta-analysis. Cancer Prevention Research. 2010;3(11):1451–1461 Google ScholarDiabetes.co.uk. Diabetes care. Metformin side effects. 2019. https://www.diabetes.co.uk/diabetes-medication/metformin-side-effects.html (accessed 25 February 2019) Google ScholarMallick S. Metformin induced acute pancreatitis precipitated by renal failure. Postgrad Med J. 2004;80(942):239–40 Google ScholarNational Institute for Health and Care Excellence. Type 2 diabetes in adults: Management. NICE guideline [NG28]. London: NICE; 2017 Google ScholarNational Institute for Health and Care Excellence. Anaemia – Vitamin B12 and folate deficiency. 2018. http://cks.nice.org.uk/anaemia-b12-and-folate-deficiency (accessed 25 February 2019) Google ScholarOh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician. 2003 Mar 1;67(5):979–86 Google ScholarPublic Health England. 3.8 million people in England now have diabetes 2016. https://www.gov.uk/government/news/38-million-people-in-england-now-have-diabetes (accessed 25 February 2019) Google ScholarSchmeltz L, Metzger B. Therapeutic Areas I: Central Nervous System, Pain, Metabolic Syndrome, Urology, Gastrointestinal and Cardiovascular. In: Comprehensive Medicinal Chemistry II. Amsterdam: Elsevier Science; 2007 Google ScholarShipton MJ, Thackhil J. Vitamin B12 deficiency- A 21st century prospective. Clin Med (Lond). 2015;15(2):145–509 Google ScholarWiwanitkit S, Wiwanitkit V. Metformin and sleep disorders. Indian J Endocrinol Metab. 2012;16 Suppl 1:S63–4 Google ScholarZalaket J, Wehbe T, Abou Jaoude E. Vitamin B12 deficiency in diabetic subjects taking metformin: A cross sectional study in a Lebanese cohort. Journal of Nutrition Intermediary Metabolism. 2018; 11(March): 9–13 Google Scholar FiguresReferencesRelatedDetails 1 March 2019Volume 1Issue Sup3ISSN (print): 2631-8385ISSN (online): 2631-8393 Metrics History Published online 14 March 2019 Published in print 1 March 2019 Information© MA Healthcare LimitedPDF download
BackgroundStandardised delivery of patient care remains an essential facet of the NHS. In 2004, the general practice contract for delivering specific primary medical services incorporated a financial payment: Quality Outcomes Framework (QOF). In majority of practices, these reviews are completed by the practice nursing healthcare team.AimTo understand if the combined care (CC) clinic improves the efficiency in delivering patient reviews.MethodThe CC clinic was designed in 2015 inviting patients with diabetes; who may also have other long-term conditions, to be addressed in a ‘one stop’ approach. It is implemented by healthcare assistants (HCAs) supported by apprentices, who perform standard checks such as blood pressures, urine dipstick checks, smoking data, and health promotion that are protocolled. Where there are abnormalities noted, the HCA is able to escalate to the practice nurses who are supported by a GP lead.ResultsQOF diabetes data were reviewed from 2015–2016 (636 patients on register) and 2016–2017 (649 patients on register). Results showed a marked percentage increase between years in the following indicators: DM003 (last blood pressure measurement ≤140/80 mmHg) 7.29%; DM006 (proteinuria/microalbuminuria) 6.20%; and DM009 (foot exam) 3.21%. All other diabetic indicators apart from two showed a percentage increase. The proportion of patients seen between April–October also increased in the subsequent year.ConclusionThe CC clinic provides a method of patient review in an efficient process, without the need for multiple visits, thereby increasing practice capacity to focus on other aspects of patient care and work streams.
