Unsafe prescribing of methotrexate

GPs in England continue to breach national guidelines on tablet strength designed to avoid accidental methotrexate overdose, according to research on trends in prescribing of methotrexate. High doses of methotrexate increase the risk of toxicity and 21 deaths have been attributed to methotrexate from 1993 to 2017. Doctors are advised to avoid 10mg tablets and prescribe only 2.5mg tablets. Here, Brian MacKenna, Pharmacist Researcher – University of Oxford, from the Evidence-based DataLab discusses the findings. Also watch videos on Practice and OpenPrescribing at BJGP Life.

National early warning scores

Early warning scores alert clinicians to deterioration in a patient’s condition, with higher scores indicating poorer health. Originally developed for use in hospitals, new research extends the use of National Early Warning Scores (NEWS) to GPs. Scott and colleagues analysed NEWS scores collected for over 13,000 urgent GP referrals to hospital. They found that higher scores are associated with faster travel to hospital by ambulance, and with faster medical review after arriving at hospital. The authors suggest that NEWS could be used by ambulance call handlers and paramedics for triage, and patients and carers could also benefit from education about NEWS to ensure prompt transfer to hospital. Related research by Pullyblank and colleagues examines the use of NEWS scores across a number of settings both in acute trusts and the community. Scores were used by increasing numbers of GPs and, at one centre, 70% of patients had a score recorded on referral. Take up by the ambulance service and GP out of hours service were key to its success.

Video consultations: a guide for GPs

Many practices are using or considering using alternatives to face-to-face consultations because of concerns about COVID-19. Important new information and guidance is now available to support video consultations in the Video Consultation document (pdf), on the RCGP website, and on the BJGP Life blog. Produced by researchers at the University of Oxford, the document covers five key topics: when are video consultations appropriate, how can a practice get ready for them, how can clinicians conduct high-quality video consultations, what can patients do to prepare for and take part in them, and what is the research evidence for their quality and safety? The RCGP has also produced a '10 Top Tips' webpage and '10 Top Tips' PDF guide to telephone consultations. Both documents are packed with extremely useful, practical advice and tips to help doctors, other primary care clinicians, and patients navigate these almost uncharted waters at a time of unprecedented challenge for the health service.

Polycystic ovary syndrome: poorly understood and treated

Polycystic ovary syndrome (PCOS) is very common – the NHS website suggests that up to one in every five women in the UK may be affected. As well as leading to infertility and miscarriages, PCOS is also associated with diabetes, hirsutism, acne, mental health problems, and an increased risk of fatty liver disease and of the potentially pre-cancerous condition endometrial hyperplasia. Hillman and colleagues at the University of Warwick studied over 300 women with PCOS, via questionnaires and interviews, and confirmed that after diagnosis, important issues such as mental health problems and serious associated comorbidities were seldom discussed, and that advice on weight loss was often not provided. Women from ethnic minority groups were even less likely to discuss their mental health problems with their GP. The authors emphasise that PCOS should be better understood as a chronic, multisystem disorder, with significant health implications.