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or high risk polyps to be identified and referred for treatment.


They added that GP practice names should be added to invitations sent by the NHS bowel screening programme. They said: ‘Given the small one-off cost to modify the standard invitation letter, and the overall increase in uptake, we suggest that the bowel cancer screening programme consider adding GP endorsement to the screening invitation letter.’ Br J Cancer 2016, online 7 Jan


Two-thirds of patients on the high dose fell during follow-up, compared with less than half of those on the lower dose.


yourself Test


HRT does not increase cardiovascular risk


when started in women under what age?


40 50 60 65 Answer on p58


The study featured 200 men and women assigned to take either high-dose vitamin D – 60,000IU vitamin D3, or 24,000IU combined with 300 calcifediol – or the low-dose of 24,000IU, once per month. Dr Tony Brzezicki, clinical chair at NHS


Croydon CCG and a GP in the borough, said it was


unlikely many elderly patients


Offer CBT ‘in all cases of depression’


GPs should offer CBT as another option to all patients with depression that has not responded to antidepressants, UK researchers say. A study funded by the NIHR Health


Technology Assessment Programme found CBT reduces anxiety, improves mental health and induces remission in depression when used alongside usual forms of therapy, compared with those who did not have CBT. Patients who had received CBT as an adjunct were found to be less depressed than those who had not, and less likely to use antidepressants for a sustained period.


The researchers evaluated patients


three years after they had received CBT alongside other first-line treatments. They said they believe CBT is cost-


effective and provides ‘benefit in terms of health-related quality of life’ that is ‘sustained over time and therefore achieved at no additional cost’. Lancet Psychiatry, online 6 Jan


Fall risk ‘increased by high-dose vitamin D’


Prescribing vitamin D at guideline- recommended high doses does not offer any benefit to older patients and could even put them at an increased risk of falls, Swiss researchers have warned. They assessed whether giving high doses – including doses recommended by the National Osteoporosis Society guidelines for patients with vitamin D deficiency – would be better at preventing functional decline in people over 70 who had already suffered a fall, compared with a more moderate dose. But they found high-dose vitamin D did not slow decline in function, and those who took them were significantly more likely to suffer another fall.


would be on this high dose, but that it ‘should not be difficult to identify these patients from GP systems’. JAMA Int Med 2016, online 4 Jan


Mindfulness ‘may have role in primary care’


Mindfulness-based therapies could be used in primary care to treat patients with mental health problems and improve quality of life, a new meta- analysis has found. Researchers looked at six randomised trials of mindfulness-based interventions, involving a total of more than 550 patients. They included patients with mood problems, stress, depression and medically unexplained symptoms. The team found the mindfulness approaches were associated with moderate, but significant, improvements in mental health-related outcomes and significant, albeit smaller, improvements in measures of quality of life. While they admitted further research


was needed, they said the results were ‘promising’ for primary care patients. Ann Fam Med 2015;13;573-582


Therapeutics update


• NICE considers gliflozins for type 2 diabetes NICE draft technology appraisal guidance proposes canagliflozin, dapagliflozin and empagliflozin as treatment options in type 2 diabetes where metformin is contraindicated, a DPP-4 inhibitor would have otherwise been given, and where a sulfonylurea or pioglitazone are not appropriate.


• Prescribe antivirals to patients with flu-like symptoms


The DH has advised GPs to prescribe antivirals for flu-like symptoms, whether or not the patient is in an at-risk group.


Clinical casebook Lipid modification p70 1.5 CPD HOURS


Picture quiz Dermatitis p75


Five-minute refresher COPD p66


In this month’s clinical section


Key questions Menopause p58 1.5 CPD HOURS


Obscure diagnosis Sphincter of Oddi dysfunction p63


CPD MONTH


TIP OF THE


Wash out PPIs before testing for H. pylori


When testing patients with symptoms of dyspepsia for Helicobacter pylori, you should ensure that those on a PPI have a two-week washout period before they are tested. The same applies to patients undergoing endoscopy. The stool antigen


test and breath test are significantly


more accurate than serology for H. pylori, and should be first choice.


Dyspepsia 1.5 CPD HOURS


pulse-learning.co.uk Pulse February 2016 15


o’’


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