Management of hypothyroidism: what patients really think

Patients with hypothyroidism often have a low understanding of their condition and the consequences of inadequate thyroid hormone replacement: so found Dew and colleagues in a qualitative study using in-depth interviews. The most commonly experienced symptom was tiredness and people who had obvious pre-diagnosis symptoms had a heightened perception of the threat and they reported excellent adherence to treatment regimes. People who had persistent symptoms despite normal blood TSH concentration often felt that this was a barrier to getting their GPs to address their problems and they lacked the authority to challenge their GPs.

GPs weigh multiple complex factors to reduce risk from NSAIDs

With further evidence emerging on cardiovascular harms McDonald and colleagues explored GPs’ concerns in a qualitative study from New Zealand about managing the significant risks associated with prescribing non-steroidal anti-inflammatory (NSAID) medications. GPs were particularly concerned about long-term use, the risks in children and in older people, and in people with comorbidities. GPs considered gastric, cardiac, and renal risks as well as drug interactions and the need to find strategies to mitigate harms. GPs were also aware of the need to balance patient expectations and the fact NSAIDs are available over-the-counter.

How do GPs recognise sepsis in primary care?

The importance of swift diagnosis and prompt management of sepsis has received much recent attention. This study surveyed a random sample of Dutch GPs and found that decisions around referral to hospital with concerns about sepsis were complex. Decisions involved analysis of vital signs but GPs also use additional aspects of the consultation. These include the history, alteration in mental status, patients who were unable to stand up, response to previous antibiotics, use of immunosuppressives, and gut feeling. This study also suggests GPs may underestimate advanced age, alcohol-related conditions, and psychotic disorders as risk factors for sepsis.