The Practitioner

The Practitioner is a PubMed indexed journal, primarily aimed at GPs, with subscribers throughout the World. It is also used by doctors preparing for work in the UK. All articles in The Practitioner online include CPD fillable PDF frameworks for personal reflection on learning and drafting of plans that will have an impact on practice. Preset search links to PubMed and NICE Evidence are associated with most major articles.



Diagnosis and management of nephrotic syndrome

22 Feb 2017Paid-up subscribers

Nephrotic syndrome is uncommon in general practice. A GP may only see two or three adult cases in their career. Nephrotic syndrome develops following pathological injury to renal glomeruli. This may be a primary problem, with a disease specific to the kidneys, or secondary to a systemic disorder such as diabetes mellitus. The most common cause in children is minimal change glomerulonephritis. In white adults, nephrotic syndrome is most frequently due to membranous nephropathy whereas in populations of African ancestry the most common cause of nephrotic syndrome is focal segmental glomerulosclerosis (FSGS). Diabetic nephropathy is the most common multisystem disease that can cause nephrotic syndrome. 

Pyelonephritis can lead to life-threatening complications

22 Feb 2017Paid-up subscribers

As distinct from cystitis and lower urinary tract infection (UTI), which are much more common, pyelonephritis involves the upper tract with potentially more serious sequelae. It is most commonly caused by bacterial infections, typically ascending from the lower urinary tract; haematological seeding from bacteraemia is less common.


Case reports

Artefact mimicking torsades: treat the patient not the ECG

09 Mar 2017Paid-up subscribers

There has been a marked increase in the availability and use of ECG machines in general practice. In 2008, Day and colleagues reported that 85% of GPs who responded to their survey had an ECG machine and that 91% of them used it at least once a week.  We report a case in which artefact was misinterpreted as torsades de pointes, often referred to simply as torsades. Our patient did not suffer any harm and did not have any unnecessary investigations, yet inappropriate treatment was administered making the potential for harm a real possibility. We describe the ECG features which differentiate artefact from torsades and review common sources of ECG artefact, in both hospital and general practice.

Ulnar nerve injury on removal of a contraceptive implant

15 Dec 2016Registered users

The close proximity of contraceptive implant placement to the course of the ulnar nerve can result in injury. Several factors have been implicated in this complication including: low BMI, erroneous placement of the implant, implantation over the brachial groove, and migration of the implant from its original insertion. Clinicians should familiarise themselves with the vulnerable neurovascular structures in the area and refer promptly to a specialist if any neurological symptoms develop during placement or removal of these devices.


Special reports

Be vigilant for skin manifestations of inherited cancer syndromes

23 Jan 2017Registered users

More than 200 hereditary cancer susceptibility syndromes have been described, and it is thought that they account for 5-10% of all cancers. Many have dermatological manifestations (usually lesions, occasionally rashes) which frequently precede other systemic pathology. Dermatological signs are usually non-specific and often trivial in appearance, making their significance easy to overlook and a clinical diagnosis challenging.

Improving the identification and monitoring of cirrhosis

23 Nov 2016Paid-up subscribers

By 2012, cirrhotic patients admitted to hospital were six times more likely to die compared with patients admitted for any other reason. Nearly half of liver disease admissions were for alcohol-related liver disease and were associated with a 12.3% mortality. Cirrhosis is more common in urban and socially deprived areas. The NHS Atlas of Variation in Healthcare for People with Liver Disease found that the highest rates of hospital admission for end-stage liver disease due to chronic hepatitis C virus were in central London and the North West of England. Admissions for alcohol-related liver disease were also most common in the North West.


Clinical reviews of research - by GPs with interest

Low BP in elderly patients treated for hypertension associated with increased mortality

23 Jan 2017Registered users

Systolic blood pressure (BP) below 135 mmHg was associated with greater mortality in patients, aged 80 and over treated for hypertension, in an observational primary care study.

Blood pressure and risk of cardiovascular events in type 2 diabetes

23 Jan 2017Registered users

A large cohort study has found that lower systolic blood pressure (BP) is associated with reduced cardiovascular risk in type 2 diabetes patients with no previous cardiovascular disease (CVD). However, there was evidence of a J-shaped relationship between systolic BP and heart failure, and also all cause mortality.

Is frequent self-monitoring and on-line reporting of blood glucose worthwhile?

23 Jan 2017Registered users

Frequent self-monitoring of blood glucose had a significant effect on HbA1c only when combined with frequent on-line reporting, in a study from Canada.

Women on hormonal contraception at raised risk of depression

23 Jan 2017Registered users

Women who use hormonal contraception are more likely to become depressed, a large Danish prospective cohort study has found. The cohort comprised all adolescents and women aged between 15 and 34 who were resident in Denmark and without a previous history of depression, antidepressant use, other major psychiatric diagnosis, cancer, venous thrombosis or infertility treatment. Data were obtained from national registers of dispensed prescriptions and secondary care psychiatric diagnoses.



MP-MRI could improve the diagnosis of prostate cancer

22 Feb 2017Paid-up subscribers

Multi-parametric magnetic resonance imaging (MP-MRI) could play an important role in triaging men with a raised PSA for prostate biopsy and improve the detection of clinically significant prostate cancer, findings from a UK study suggest.

Risk of acute STEMI significantly increased in younger smokers

23 Jan 2017Registered users

Smoking is associated with an eight-fold increased risk of acute ST-segment elevation myocardial infarction (STEMI) in those under 50 compared with former and never smokers, a UK study has found. However, the incidence of acute STEMI in former smokers was similar to that in those who had never smoked, adding further evidence to the benefits of quitting smoking.


HASLAM's view

Don’t judge a book by its cover

23 Jan 2017Paid-up subscribers

Our patients can frequently surprise us and those initial assumptions we may make can turn out to be wholly and emphatically inaccurate. It can certainly be a great way of uncovering one’s conscious or unconscious biases.


CPD exercises associated with each issue

CPD exercise - January 2017

23 Jan 2017Paid-up subscribers

All articles in The Practitioner online include fillable PDF frameworks for personal reflection on learning and drafting of plans for CPD. These templates are also included here in our standard study pack containing this month’s CPD exercise plus all relevant articles: • Depression is linked to dementia in older adults  • Frailty predicts adverse outcomes in older people with diabetes  • Be vigilant for skin manifestations of inherited cancer syndromes

CPD exercise - December 2016

15 Dec 2016Paid-up subscribers

All articles in The Practitioner online include fillable PDF frameworks for personal reflection on learning and drafting of plans for CPD. These templates are also included here in our standard study pack containing this month’s CPD exercise plus all relevant articles: • Ulnar nerve injury on removal of a contraceptive implant • Diagnosis and management of polymyalgia rheumatica • Improving joint pain and function in osteoarthritis



Papulosquamous conditions

23 Sep 2016Registered users

• Pityriasis rosea • Discoid lupus erythematosus • Lichen planus • Seborrhoeic dermatitis • Tinea corporis • Plaque psoriasis

Sun damage

23 Jun 2016Registered users

 • Squamous cell carcinoma • Actinic keratosis horn • Bowen’s disease • Solar elastosis • Rosacea • Discoid lupus