Children with eczema: the link to food allergies is not clear cut

By Dr Matthew Ridd, GP and Senior Lecturer in Primary Healthcare, Centre for Academic Primary Care, University of Bristol
and Dr Robert Boyle, Consultant Paediatric Allergist, Imperial College London

Around one in five children have eczema – and even mild cases can have a big impact on both the child and their family. For many, symptoms will come and go before they start primary school, but for others it can indicate the beginning of a genetic tendency to develop allergic conditions such as hay fever or asthma (or both).

We also know that children with eczema are more likely to develop food allergies, especially if the condition starts in the first few months of life and is severe. Often parents will make the allergy diagnosis themselves – at the sudden onset of vomiting, diarrhoea or rash after eating scrambled egg, for example.

This can be frightening, but … Read more

Much we can do and even more to learn about COPD

 

Guest blog by Dr James Dodd
Consultant Senior Lecturer
Academic Respiratory Unit, University of Bristol
and Southmead Hospital, Bristol

What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term which includes ‘chronic bronchitis’ and ‘emphysema’. It causes a progressive decline in lung function and health. It is common, affecting 2% of the adult population, and is projected to become the third leading cause of death in the UK. People with COPD experience breathlessness, cough and wheeze and often suffer with repeated chest infections. These ‘exacerbations’ are the second most common reason for emergency admissions to hospital.

Sadly, around two of the three million people with COPD in the UK remain undiagnosed, meaning that they live with debilitating symptoms for many years before receiving the support and advice they need. These ‘missing millions’ are the driving force behind COPD awareness month and World COPD Day.

It is … Read more

What’s normal in children’s respiratory infections? Bristol parents helped us find out

 

by Dr Emma Anderson
Senior Research Associate
Centre for Academic Primary Care

As any parent knows, children get coughs, colds and ear infections all the time. Symptoms of these respiratory infections – including runny nose, cough and sore throat – can seem never-ending.

In the EEPRIS Study, led by Professor Alastair Hay from the University of Bristol’s Centre for Academic Primary Care, we recruited parents across Bristol to tell us about their children’s respiratory symptoms as they became ill. Gathering information in the community means we are able to find out more about common respiratory illnesses than when we study those who have decided to consult their GP. It also gives us a more accurate picture of how likely parents are to consult for these common illnesses, something which has been surprisingly unclear.

Two of our main findings were that:

  • it takes up to three weeks for most
Read more

Can a programme of supervised exercise improve the quality of life of men with advanced prostate cancer?

Dr Eileen Sutton

 

by By Dr Eileen Sutton
Senior Research Associate, Qualitative Lead on the STAMINA Study
Centre for Academic Primary Care

STAMINA is a five-year study funded by the NIHR’s Programme Grants for Applied Research scheme and is led by researchers from Sheffield Hallam University, with collaborators from Sheffield Teaching Hospitals, University of Leeds, University of Sheffield, Queen Mary University London, University of Bristol, University of York, Cardiff University, University of Edinburgh and Queen’s University, Belfast in partnership with Nuffield Health.

Why are we doing the research?

Prostate cancer is the most common cancer in men in the UK, with around 47,000 cases diagnosed each year. Androgen deprivation therapy (ADT) is a standard treatment for men with advanced prostate cancer but it is associated with significant side-effects which include fatigue, depression, sexual dysfunction, impairment of memory and concentration, increased fat mass and loss of muscle strength. ADT also increases the risk … Read more

Medicines have revolutionised treatment in the NHS – can this progress be sustained?

Dr Rupert Payne

 

by Dr Rupert Payne
Consultant Senior Lecturer in Primary Health Care
Centre for Academic Primary Care

The seventieth anniversary of the NHS has made me reflect on how proud I am to have contributed to its work for over the past twenty-odd years. Founded on 5 July 1948, the service continues to this day to operate to the same three core principles – meeting the needs of everyone, free at the point of delivery, and based on clinical need.

Aside from providing comprehensive, high-quality healthcare services to virtually the entire UK population, the other thing that the NHS is known for is the constant political bickering that carries on in the background, with criticisms about chronic under-funding and stealth privatisation. However, these are not new issues, with medicines an important reason for the challenges the NHS now faces.

In a response to concerns about rising costs, perhaps the first … Read more

Penicillin was discovered 90 years ago – and despite resistance, the future looks good for antibiotics

 

by Professor Alastair Hay
Professor of Primary Care
Centre for Academic Primary Care

When the NHS turned 70 this year, I was reminded of another anniversary which has had an enormous impact on healthcare over many years. Penicillin is 90 this year.

Discovered in September 1928 by Alexander Fleming, it was first used as a cure when George Paine treated eye infections with it in 1930. A method for mass production was devised by Howard Florey and Ernst Chain in 1940, and it was first mass produced in 1942, with half of that total supply used for one patient being treated for streptococcal septicaemia.

In 1944, 2.3m doses were produced in time for the Normandy landings of World War II. And it was then that the miracle of penicillin became clear. Soldiers who had previously died from septicaemia were surviving.

Expectations rose. If penicillin could cure septicaemia, what … Read more

Setting the priorities for advanced heart failure research

by Dr Rachel Johnson
Clinical Research Fellow
Centre for Academic Primary Care
@rjohnsonridd

 

This week sees the launch of the James Lind Alliance Advanced Heart Failure Priority Setting Partnership Survey to gather research ideas from those living or working with advanced heart failure.

The clinical academic’s view

When, alongside clinical academic colleagues, I began to think about setting up a process to establish the top research priorities for heart failure, I was intrigued by the thought that I had no idea what people living with heart failure would choose as their priorities.

As a doctor interested in heart disease, I have worked with many people who have heart failure. I feel I have a good sense of the medical aspects of the condition, and, to some extent, the patient experience. And yet, when I thought about what patients and their families might identify as the main problems that … Read more

Repeat prescriptions are expensive and time consuming – it’s time for an NHS rethink

 

Dr Rupert Payne
Centre for Academic Primary Care
@DrRupertPayne

 

 

Dr Céline Miani
University of Bielefeld
@celine_miani

 

Over a billion NHS prescription medicines are issued by pharmacists in England every year – at a cost of over £9 billion. Many of these are prescribed by GPs to manage long-term health conditions, such as diabetes or cardiovascular disease.

The current “repeat prescription” system allows patients to request a further supply of medicines without the inconvenience of another doctor’s appointment.

The UK Department of Health advises that the frequency of repeat prescriptions should “balance patient convenience with clinical appropriateness, cost-effectiveness and patient safety”.

However, it does not recommend a specific time period. As a result, local health service commissioners have developed their own guidance, with many encouraging GPs to issue short-term supplies of repeat medications, typically 28 days in length. This is supported by the UK’s Pharmaceutical Services Read more

How gut feeling guides clinician treatment decisions and why it’s not always enough

by Sophie Turnbull
PhD Student
Centre for Academic Primary Care

 

Clinician intuition and gut feelings are often talked about in health care but are largely mysterious. Clinicians describe just knowing that there was something wrong with a patient but not exactly how they came to that conclusion.

In a recent study we aimed to unpick how clinicians form their gut feelings, how they use them to influence treatment decisions, and whether their gut feeling was good at predicting whether a child with infectious cough would get sicker in the 30 days after seeing them.

Using gut feeling to predict outcome in children with infectious cough

Infectious cough in children is the most common problem managed by health services internationally.  Although the majority of children get better on their own, a small proportion end up hospital with a serious illness. Clinicians do not always find it easy to establish … Read more

Why doctors need to improve the way we discuss assisted dying

Dr Paul Teed
PhD candidate
Centre for Academic Primary Care 
University of Bristol
@DrPaulTeed

Assisted dying can be a divisive and polarising subject. But there is one aspect on which most people probably agree – the need to improve the conversations people have about death.

At the moment, there is uncertainty in the UK regarding what people – especially health professionals – can and cannot say when the topic of assisted dying comes up. Conversation can become especially stilted when it turns to patients obtaining the medical documentation required for an assisted death abroad.

The situation requires clarification. Currently, if a doctor in the UK writes a specific report to help with an assisted death abroad (three organisations in Switzerland accept UK citizens), the General Medical Council (GMC) may view this as a “fitness to practice” issue.

However, if a doctor provides copies of medical records, even with the … Read more