Rheumatoid feet
The importance of good foot care in diabetes is well established and as I recently found out when counselling a newly-diagnosed patient with type 2 diabetes, there are some excellent practical resources on it from charities like Diabetes UK. Rheumatoid Arthritis (RA) is another long-term condition that can affect feet, with up to 90% of patients reporting associated foot problems. A recent Finnish study explored patients’ with RA and their experiences of foot health.1 They found that factors that hindered their foot health included physical characteristics (such as the progression of RA), personal traits (such as lack of motivation), inequalities in access to professional foot care, and problems with finding suitable shoes. The authors suggest that regular assessments of foot health should be a routine part of RA care, ideally including an evaluation of footwear and education about foot self-care.
Paternal mental health
A number of recent campaigns about perinatal mental health have brought conditions like postnatal depression into the consciousness of the medical community, and I have certainly changed my approach to postnatal health checks as a result. There has been comparatively less focus on paternal mental health, and a research group from Singapore recently completed a systematic review examining fathers’ experiences and needs associated with mental health during the perinatal period.2 Fourteen studies were included in total. They found that fathers reported poor mental health and expressed needs to enhance their mental health across the perinatal period. The authors conclude that theory-guided, family inclusive, technology-based healthcare services that focus on promoting positive mental health at individual, family, and community levels are needed across the perinatal period.
Sciatica
The recent SCOPiC randomised controlled trial tested stratified primary care for sciatica by subgrouping patients into one of three groups based on prognostic and clinical indicators. Patients in one group were ‘fast-tracked’ for a scan (MRI) and spinal specialist opinion. A linked qualitative study explored patients’ and clinicians’ perspectives about this pathway.3 While the ‘fast-track’ pathway achieved a degree of ‘coherence’ (that is, it made sense) to both patients and clinicians, particularly in relation to providing early reassurance based on MRI findings, it was less ‘meaningful’ to some clinicians for managing patients with acute symptoms, reflecting a reluctance to move away from the usual stepped care approach. Both groups felt a key limitation of the pathway was that it did not shorten patient waiting times between their spinal specialist consultation and further treatments.
Good family nurses
High-quality primary health care relies on a whole team of healthcare professionals, but few roles are as central as that of family (or ‘practice’) nurses, who plan and provide nursing care for patients and families, and deliver a range of services from health promotion and disease prevention to diagnostic, therapeutic, and rehabilitation services. In light of the ageing population and increasing move to community-based health care, a Polish study explored what the term ‘good family nurse’ means to older patients.4 The main qualities identified include a caring and supportive attitude to patients, the ability to listen and inform the patient, the appropriate professional and technical skills, a respectful and patient approach to patient care, and the necessary availability to provide regular care. As the Polish healthcare system is likely to need a huge increase in family nurses in the coming decades, the authors suggest policymakers could use these findings to develop a suitable workforce strategy and training pathway.
Podcast of the month
After the recent UK A-level result fiasco, what better time to hear about the scandal in the New York public education system in Nice White Parents.5
- © British Journal of General Practice 2020