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THIS MONTH CLINICAL ROUND-UP Journal digest


E-cigarettes ‘reduce chances of quitting’


E-cigarettes reduce the chances of quitting smoking and ‘should not be recommended as smoking cessation aids’, according to new research in The Lancet.


Guideline of the month


Measuring hypertension before surgery


The guideline A document produced jointly by the Association of Anaesthetists of Great Britain and Ireland and the British Hypertension Society, which aims to prevent a diagnosis of hypertension being the reason for the delay or cancellation of planned surgery.


Key points for GPs • GPs should only refer patients for elective surgery with mean blood pressures in primary care in the past 12 months of less than 160mmHg systolic and 100mmHg diastolic. • Patients who remain hypertensive despite optimal treatment, or who refuse treatment, may still be referred. • GPs should document blood pressure readings in the referral letter. Surgeons are asked to request blood pressure readings from GPs for the past 12 months if they are not documented. • Patients who present to pre-operative assessment clinics without documented readings should proceed to elective surgery if clinic blood pressures are below 180mmHg systolic and 110mmHg diastolic.


14 February 2016 Pulse


Case-by-case: hypertension 1.5 CPD HOURS GPSI in cardiology Dr Chris Arden guides you through five hypertensive patients, with advice on diagnosis and management pulse-learning. co.uk


Practical issues Persuading hospitals they do not need to take a pre-operative reading, as there have been reports of patients being rejected on the basis of a single reading exceeding 160/100mmHg.


Expert comment Co-chair of the guidelines working party, and Whitby GP Dr Terry McCormack said: ‘We wanted to create a commonsense document that everybody can use as a benchmark. Blood pressure readings need to come from primary care, since there is already recognition that this is the best place to have them done.


‘It shouldn’t be too big an ask for GPs to include blood pressure in a referral document – the guidelines are intended to make both GPs’ and patients’ lives easier.’


The guideline Hartle A, McCormack T, Carlisle J et al. The measurement of adult blood pressure and management of hypertension before elective surgery. Anaesthesia 2016, online 17 Jan


The team conducted a meta-analysis of 18 observational studies and two clinical trials, and found the use of e-cigarettes reduced the likelihood of a person quitting smoking by 28%. But, coming just weeks after the


Government issued its first approval for an e-cigarette to be prescribed by GPs in England, the study has been fiercely criticised by Public Health England and smoking cessation experts. Professor Paul


Aveyard, professor of behavioural medicine at the University of


Oxford and a GP in Solihull, said the analysis was flawed by the sample population.


He said: ‘This review collates studies that enrol people who smoke and ask them if they have used e-cigarettes. ‘The problem is that people who were


helped by e-cigarettes have left this population because they gave up smoking and therefore you leave only those who were not helped.’ Lancet 2016, online 14 Jan


GP bowel screening invites ‘boost uptake’


GP practices sending headed letters inviting patients for bowel cancer screening can boost uptake and enhance cancer detection. Research from the British Journal of


Cancer found nearly 40,000 additional people would be screened if practice invites were sent out nationally. The researchers concluded this could enable an additional 61 people with cancer and 165 people with intermediate


SCIENCE PHOTO LIBRARY X4 / ALAMY X3


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