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The Practitioner

The Practitioner is a PubMed indexed general medical review monthly journal with subscribers throughout the world. The Practitioner and this website are also used by doctors preparing themselves to work in the UK.

 

Editorials

Medical therapy ineffective for aiding passage of ureteric stones

22 Jun 2015Registered users

The findings from this large, well designed randomised controlled trial which showed no benefit for MET in expectant management, together with the fact that both alpha-blockers and calcium channel blockers have a significant side-effect profile, make a case for changing clinical practice.

 

Symposium articles

Managing irritable bowel syndrome in primary care

22 Jun 2015Registered users

The classic symptoms of irritable bowel syndrome (IBS) are abdominal pain, bloating and some form of bowel dysfunction. The abdomen feels flat in the morning and then gradually becomes more bloated as the day progresses reaching a peak by late afternoon or evening. Rectal bleeding, a family history of malignancy and a short history in IBS should always be treated with suspicion. Both pain and bowel dysfunction are often made worse by eating. It is recommended that a coeliac screening test is undertaken to rule out this condition.

Diagnosis and treatment of gallstone disease

22 Jun 2015Registered users

Gallstone disease increases with age. Women have a higher prevalence of gallstones than men, which is attributed to exposure to oestrogen and progesterone. Liver function tests and an abdominal ultrasound should be offered to patients with symptoms suggestive of gallstone disease (e.g. abdominal pain, jaundice, fever). They should also be considered in patients with less typical but chronic abdominal or gastrointestinal symptoms.

 

Special reports

Early intervention can improve outcomes in acute kidney injury

22 Jun 2015Registered users

The incidence of acute kidney injury (AKI) is rising reflecting an increasingly elderly at-risk population, with multiple comorbidities, coupled with improved detection. AKI is potentially reversible so improvements in its recognition and early interventions could have a major impact on patient outcomes. Potential clues in the history for AKI include reduced fluid intake and/or increased fluid losses, urinary tract symptoms and recent drug ingestion.

Improving outcomes in diabetes in pregnancy

21 May 2015Registered users

One in 250 pregnancies in the UK involves diabetes. The majority of cases (87.5%) are gestational diabetes, 7.5% are type 1 and 5% are type 2 diabetes. Diabetes in pregnancy is associated with a five fold increase in risk of stillbirth and a two-fold increased risk of congenital defects compared with the general maternity population. Women with gestational diabetes have a significant lifetime risk of developing type 2 diabetes, hence diabetes screening must be undertaken on an annual basis in primary care.

 

A hundred years ago

‘Pensionitis’ in a seaman

22 Jun 2015Paid-up subscribers

In reporting him unfit I detailed the circumstances, and ventured to predict that, after receiving his pension, he would be at work within six months…[And] that was the exact period at which he did in fact return to work, with, of course, his pension of twenty-five shillings a week for life!

Cerebrospinal meningitis

21 May 2015Paid-up subscribers

WRITTEN IN 1915: [In acute cerebral meningitis of childhood] I have many times witnessed striking recoveries from full doses of mercury by the skin, after profound coma had almost obliterated all hope of improvement. I believe it to be unjustifiable to abandon the patient to his fate without resorting to vigorous treatment by this drug.

 

Letters to the editor

Education is not the filling of a pail but the lighting of a fire

22 Jan 2015Registered users

Primary and secondary care colleagues meeting to discuss topics, local patient pathways, significant events and altering ways of working can be immensely valuable, and delve deeper than just written words or PowerPoint presentations, argues GP Dr Nicole Howse.

 

HASLAM's view

Trust is the fulcrum of the doctor-patient relationship

22 Jun 2015Registered users

There is a great deal more to knowledge than mere facts, and there is more to caring than curing. For all human beings there remains a deep and continuing need in healthcare for a human relationship based on trust. Trust is hugely important in the doctor-patient relationship.

 

Practitioner newsletters

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PHOTOGUIDE

Psoriasis

22 Jun 2015Registered users

• Facial psoriasis • Guttate psoriasis • Nail psoriasis• Scalp psoriasis • Palmoplantar pustulosis

Conditions in infants

21 May 2015Registered users

• Candida intertrigo • Sticky eyes • Roundworm • Infantile eczema • Lick lip dermatitis • Milk blisters

 

CPD exercises associated with each issue

CPD exercise - June 2015

22 Jun 2015Paid-up subscribers

The study pack contains this month’s CPD exercise plus all the relevant articles: • Diagnosis and treatment of gallstone disease • Managing irritable bowel syndrome in primary care • Early intervention can improve outcomes in acute kidney injury. This CPD study pack can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer.

CPD exercise - May 2015

21 May 2015Paid-up subscribers

The study pack contains this month’s CPD exercise plus all the relevant articles: • Optimising the management of bipolar disorder • Depression in young people often goes undetected • Improving outcomes in diabetes in pregnancy. This CPD study pack can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer.

 

Casebook

A case of recalcitrant bacterial conjunctivitis

05 Dec 2013Paid-up subscribers

It is important to be vigilant for retained foreign bodies as a cause of recalcitrant bacterial conjunctivitis, even in the absence of foreign body sensation. A relapsing-remitting history should prompt referral to an ophthalmology department. All patients presenting with a red eye should be asked specifically about contact lens wear, and causes of conjunctivitis other than those bacterial in nature — such as viral and chlamydial infections or allergy — should be borne in mind.

A case of persistent hemifacial weakness

25 Jul 2013Paid-up subscribers

Bell’s palsy has a typical presentation of sudden onset, mild otalgia, altered facial sensation and/or taste, with no obvious prodrome. It represents over half of hemifacial weakness cases in primary care. However, as a diagnosis of exclusion, there are a number of key clinical features of more sinister diagnoses that must be considered.