Chantal Simon

Cohort study of informal carers of first-time stroke survivors: profile of health and social changes in the first year of caregiving.

Informal carers underpin community care policies. An initial cohort of 105 informal live-in carers of new stroke patients from the South Coast of England was followed up before discharge, six weeks after discharge and 15 months after stroke with face-to-face interviews assessing physical and psychological health, and social wellbeing. The carer cohort was compared to a cohort of 50 matched non-carers over the same time period. Carer distress was common (37-54%), started early on in the care-giving experience and continued until 15 months after stroke. Carers were 2.5 times as likely as non-carers to have significant psychological distress. Presence of early distress predicted 90% of those significantly distressed 15 months after stroke. Female carers were likely to develop distress earlier than male carers and in anticipation of the care-giving situation. Male carers developed similar levels of distress but only once the care-giving situation became reality. Further research is needed to establish ways to screen for psychological distress early after onset of caregiving, to find ways to tailor proven support interventions to the individual carer, and to evaluate the effect of early detection and support provision on later carer distress.

Formal support of stroke survivors and their informal carers in the community: a cohort study

This cohort study, aims to explore formal care provision to stroke survivors and their informal carers in the community in the UK. An initial cohort of 105 cohabitant carers of first-time stroke patients was recruited while the stroke patient was in hospital. Structured face-to-face interviews were carried out with carers prior to discharge of the stroke patient home, at 6 weeks after discharge, and 15 months after stroke. Questionnaires included measures of psychological health (CIS-R), physical health (self-rated health), social well-being (relationship quality and Sarasons social support questionnaire), handicap of the stroke survivor (Oxford Handicap Scale) and formal community support (amount of formal support and carer satisfaction). Multiple services were involved with most survivor-carer pairs (mean 5.4; range 2-9; SD = 1.7), and 74% of carers were satisfied with formal support provided. Number of services decreased with time (5.5 versus 4.1, t = 4.201, d.f. = 52, P < 0.001, 95% confidence interval: 0.71-2.01) but not time allocated. Using stepwise linear regression, service provision early after discharge was predicted by: level of handicap, recruitment centre, carer self-rated health, number of informal supporters and other care commitments. Satisfaction was predicted by quality of informal support and activity restriction. Fifteen months after stroke, predictors of formal care were: level of handicap, quality of informal support and previous caring experience. Predictors of satisfaction were: quality of the relationship between the stroke survivor and carer, age and mood. Quality of services was good, but carers lacked information, had insufficient help and were not consulted enough. Carer distress is common, yet not currently a factor influencing support provision. Formal care provided adapts with time reflecting the importance of quality of support from friends and family rather than quantity of informal supporters. These factors should be taken into consideration when planning and providing formal support for stroke survivors and their carers.

Resilience: what is it, why do we need it, and can it help us?

General practice is the ‘Jewel in the Crown’ of our NHS, providing universal, free health care for a smaller proportion of gross domestic product than other developed nations. Financial stringency has resulted in systemic changes in UK primary care significantly increasing workload, eroding job satisfaction, and increasing stress. However, one in three GPs have experienced exhaustion and burnout. What are the causes of our distress and how can we work with our patients and colleagues to resolve them?

Child health care: adequate training for all UK GPs is long overdue

General practice has long been viewed as the ‘jewel in the crown’ of the UK health service, with the image of a friendly Dr Finlay or an avuncular Dr Cameron still coming to mind with the phrase ‘family doctor’. But much has changed in the 60 plus years since general practice in the UK was created and the job of the GP is now very different. Here we consider whether general practice has evolved sufficiently to meet the needs of infants, children, and young people. When the NHS was formed in 1948 GPs took on the responsibility of providing front line care for the whole population, and providing a gateway for access to specialist services. Rather than becoming salaried employees, GPs remained independent self-employed practitioners and outside the NHS. The Collings Report in 1950 (the first examination of the quality of GP care) found poor standards and working conditions and isolation from other healthcare professionals. The subsequent years brought better premises, support staff, and a growth in professionalism, cemented by the creation of the College of General Practitioners in 1952, which gained its Royal Charter in 1972. However, it was only in 1976, after much discussion about the adequacy of training, that a mandatory 3-year postgraduate programme was introduced for doctors aiming to become GPs. This initially included only 12 months of actual general practice experience. Although the period of training out of hospital in the community has now increased to 18 months, the UK GP training programme has remained essentially unchanged for 40 years. …

A difficult combination: chronic physical illness, depression, and pain.

At present 41% of adult males and 43% of adult females report a long-term illness, and this figure is increasing as our population ages.1 Long-term conditions have been at the centre of UK health policy since the mid-1990s, and managing increasing numbers of people with increasingly complex long-term conditions within a limited healthcare budget is one of the major challenges currently facing the NHS, and in particular general practice. Overall, depression affects around 20% of patients who have a chronic physical health problem. This is two to three times the prevalence of depression in those with good physical health.2 Severity of depression is influenced by the number and severity of symptoms, as well as the degree of functional impairment. Patients with chronic disease together with depression tend to have poorer outcomes. For example, it has been shown that depression is a risk factor for increased morbidity and mortality in patients with diabetes, and that insulin resistance is more common in patients with diabetes and depression than diabetes alone.3 For …

Disorders of Puberty

Puberty is defined as the time when the onset of sexual maturity occurs and the reproductive organs become functional, and it is therefore the time when a child becomes an adult capable of reproduction. Although the terms puberty and adolescence are commonly used interchangeably, the term puberty tends to be used for the physical, and adolescence for the psychological and social changes.

Physical health and mental illness

People with psychotic illness die on average 25 years earlier than would otherwise be expected. Although some of these early deaths are through suicide and can be related to the patient’s underlying mental health disorder, many are due to physical health problems that in many cases could be prevented. Increased rates of physical disease and premature death are also seen among groups with other mental health problems such as those with chronic depression. This article discusses how GPs can intervene to promote health and wellbeing for patients with ongoing metal health problems with a view to improving long-term physical health outcomes.

Enhanced GP training – goals and aspirations

To produce the case for enhancing and extending GP training, the Royal College of General Practitioners (RCGP) sought evidence and submissions from a wide range of professionals, patients and organizations. This evidence was collated and reviewed by an expert group to identify the priority challenges for future general practice, resulting in the identification of a number of key outcomes where future GP training needs to be improved. These outcomes are based on the core roles of the GP in the modern NHS and form the goals and aspirations of enhanced GP training.

Parkinson’s disease: initial presentation

In 1817, James Parkinson described a ‘shaking palsy’ that subsequently took his name. Parkinson’s disease is a chronic, progressive neurological condition that has a profound impact on a sufferer’s quality of life. It is common condition that will affect around 1 in 40 of us in our lifetimes. Early diagnosis results in treatment to reduce symptoms and preserve quality of life, but also enables planning for the future. Most patients with Parkinson’s disease will initially present to their GP. This article explains why diagnosis can be difficult and provides a guide to possible features that might trigger referral for specialist diagnosis.

Preparing and giving presentations

Doctors commonly receive little or no advice about preparing and giving presentations during their training. However, GPs and GPs in training are often asked to give presentations, whether to patient groups or to other health professionals. As a young GP, I found this very daunting and was always terrified of the prospect of ‘getting it wrong’. Many years and many presentations later, I still hate presenting, but it is an essential part of my role and I have learned ways to make presenting easier. This article summarises the tips and tricks that I have learned and uses case studies to illustrate these points.