In My Signals, health and social care staff and service users tell us what research is important to them and why they feel others need to know about it. Join the conversation on Twitter and tell us which Signals have interested, excited or surprised you, using #MySignals. You can find the latest NIHR Signals on the here.
We asked three GPs to tell us which NIHR Signals have most interested them and to explain why they feel the findings are worth sharing.
Charlie works as a sessional GP in Somerset and Bristol and is about to complete Master’s level training in public health. He got to know NIHR Signals through Twitter and set up RSS feeds for topics of interest on the Discover Portal. Charlie works one session per week as a GP Clinical Evidence Fellow with the West of England Academic Health Science Network. This involves supporting local Clinical Commissioning Groups (CCGs) with clinical understanding and research evidence by providing literature reviews to support local decision-making. Charlie maintains a website and curated Twitter list for GPs.
Flushing your nose with salt water may be moderately useful for symptoms of sinusitis
“A big chunk of day-to-day general practice consists of seeing people with problems that are not life- or limb-threatening, but which are debilitating and have a big impact on their lives. Such problems are often difficult to treat. One such issue is chronic or recurrent sinusitis. I see patients with this problem several times a week but I usually feel as if I don’t have completely satisfactory solutions. This Signal summarised a study providing good evidence for the use of nasal flushing with a home-prepared salt and bicarbonate of soda solution. It has helped me to advise my patients with greater confidence.”
Shared decision making in primary care can reduce antibiotic prescribing
“This Signal caught my attention because of my interest in the area of shared decision-making. This approach has been shown to reduce the uptake of surgical options being chosen by patients, especially where the outcomes of surgery are ambiguous. Leonard Kish is credited with the quote ‘if patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it’.
“The sustainability of general practice and health systems as a whole will likely depend on a renewed effort to put patients at the centre of what we do. This Cochrane review found shared decision-making approaches led to a short-term 40% reduction in antibiotic prescribing. Effect sizes of that magnitude are rarely seen from new pharmaceuticals. We should start viewing system interventions like this as the game-changers we’ve been searching for.”
Clinics and activities in primary care can reduce heart disease deaths
“General practice sometimes feels as if it deals with the trivial. However, the study reported in this Signal shows the profound effect that good general practice can have on the health of our population and, again, shows the benefits of health systems thinking. This systematic review found organised activities, such as hypertension and cholesterol clinics and lifestyle advice drop-in-sessions, targeted at patients with coronary heart disease, led to a 20% reduction in all-cause mortality after six years follow-up. Such activity does not look heroic but I suspect that is irrelevant to the people alive as a result of such interventions.”
Francis Campbell is a GP in Swindon and works one session per week with Swindon and Shrivenham CCG to develop their systems for getting research evidence used as part of their service developments. He has a special interest in medicines management.
“When faced with uncertainty during patient consultations, I will usually refer to the NICE CKS website, the BNF and the local prescribing formulary. But NIHR Signals provide an excellent way to update my knowledge across a wide range of conditions and issues. Signals are short, they are written in a standardised form that makes them easy to read and digest, and they are based on the most up to date evidence.”
No clear “best” treatment of mild or severe sickness in pregnancy
“In my practice we have twice the national average birth rate, so we regularly see quite a lot of cases of mothers-to-be struggling with morning sickness. This Signal is useful as it clearly spells out that there is no evidence any of the treatments suggested are harmful to women or their babies, which is always a concern for patients in the early stages of pregnancy. The Signal also emphasises the importance of the simple home remedies, such as ginger and acupressure.”
Nine different drug classes reviewed for type 2 diabetes
“One in 25 of the patients registered with my practice has diabetes so the needs of patients with diabetes take up a substantial proportion of our consultations. Over the last few years there seems to have been an explosion of the number of drug treatments for diabetes and we get a lot of advice about the latest drugs as they become available.
“This Signal echoes other evidence that metformin is definitely good at keeping blood sugar levels under control. The Signal indicates that comparable evidence about the long-term benefits of other drugs is not there and GPs shouldn’t worry if their patients can’t tolerate the newer drugs as metformin is good value, can still be relied upon and remains the drug of first-choice when starting treatment for type 2 diabetes.”
Corticosteroids improve recovery rates after Bell’s palsy
“This Signals very clearly shows that early prescribing of corticosteroids to treat Bell’s Palsy is still good practice. With only 12,000 UK cases per year, most GPs will see a patient with Bell’s Palsy very infrequently. Patients presenting with Bell’s Palsy may have experienced a worrying sudden onset of the condition. It is helpful to be able to offer them a treatment which may reduce inflammation and swelling and limit nerve damage, more helpful still to have the efficacy of this confirmed.”
Farida is the research lead GP at her practice in Bristol and is passionate about clinical evidence. She has particular interests in respiratory medicine, women’s health and medical education. As a clinical evidence fellow with Bristol Clinical Commissioning Group, Farida is exploring the use of evidence in practice for the benefit of patients at a population level.
New evidence for lower blood pressure targets
“This signal caught my eye as in my practice we are currently updating our hypertension protocol and there has been some discussion as to what is the best blood pressure to aim for. Hypertension is something I deal with every day, along with most other GPs. This systematic review of 17 randomised controlled trials concludes that a systolic blood pressure of 130 or less reduces the risk of stroke and myocardial infarction. A similar review of blood pressure targets in diabetics, in the elderly (aged over 80) and the very elderly (aged over 90) would be useful. As always, this guidance should be tailored to the individual patient in front of you.”
Talking therapy given by parents shows promise for childhood anxiety disorders
“I seem to be seeing increasing numbers of children with anxiety related issues. It is good to see some evidence specifically in the 5-12 age group. There is also increasing frustration in primary care as we don’t have access to enough mental health resources, an issue regularly highlighted in the press. This study looks at a small number of children but shows the potential benefits of parent-delivered cognitive behavioural therapy and solution focused therapy. I am struck by how much work it involves for the parent, so it would be restricted to motivated parents who could realistically cope with its demands. However, once the techniques are learnt they may perhaps be used for other children in the family and may form a good foundation as the child goes into adolescence.”
Treatments for reducing menopausal hot flushes are ranked for effectiveness
“We often see patients with menopausal symptoms and we know that many find hot flushes very troublesome. With a variety of Hormone replacement therapy (HRT) preparations available, it is very useful to know that patches seem to be the most effective in helping symptoms compared to oral oestrogen and progestogen preparations.
“The review summarised in the Signal is a reassuringly robust evidence base. Selective serotonin reuptake inhibitors (SSRIs) and Serotonin–norepinephrine reuptake inhibitor (SNRIs) are used primarily in women who can’t take HRT but this review helpfully highlights their ineffectiveness in vasomotor symptoms.”
What can GPs do with Signals?
- Follow up the cited in research in journals or other publications
- Share the evidence with colleagues in your practice or your wider primary care network
- Use the Signal as a way of explaining or discussing a treatment or intervention with a patient
- If you would like other people to know about the Signal and what it covers, share it via Twitter, Facebook or other social media
- If reading the Signal had made you think that there is still an unanswered research question, you can tell NIHR
Produced by the University of Southampton on behalf of NIHR through the NIHR Dissemination Centre