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The Practitioner

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

 

Editorials

Smoking cessation improves anxiety and depression

20 Mar 2014Registered users

Smokers with a history of anxiety, mood or alcohol use disorders are significantly more likely to be in remission three years later if they quit smoking, an American study has found. Smoking cessation may increase the likelihood of remission, but equally, those who recover may find it easier to quit smoking.

Identifying which patients are at risk of suicide

24 Feb 2014Registered users

Item 9 of the PHQ-9 can be used to identify patients with suicidal thoughts who are at increased risk of suicide. However, this is just one component of the comprehensive and ongoing risk assessment that should be made for all patients with major depression.

 

Symposium articles

Improving the management of urinary incontinence

20 Mar 2014Registered users

Urinary incontinence is a common condition that is likely to be under-reported. Its frequency increases with age, parity, high BMI, and associated comorbidities. The history should include the circumstances in which the incontinence occurs, the duration and how it affects the patient’s quality of life. The initial assessment should include enquiring for symptoms of urinary tract infection and carrying out a urine dipstick test.

Detecting ovarian disorders in primary care

20 Mar 2014Registered users

Ovarian cysts occur more often in premenopausal than postmenopausal women. Most of these cysts will be benign, with the risk of malignancy increasing with age. Symptoms which may be suggestive of a malignant ovarian cyst, particularly in the over 50 age group, include: weight loss, persistent abdominal distension or bloating, early satiety, pelvic or abdominal pain and increased urinary urgency and frequency.

 

Special reports

Managing prolonged disorders of consciousness

20 Mar 2014Registered users

After acute severe brain damage, many people are rendered unconscious or comatose for more than 24 hours. Although a significant number can still recover fully, some will not and a substantial minority remain unconscious for days, weeks or longer. These patients have a prolonged disorder of consciousness. If recovery of awareness has not occurred by six months after hypoxic or hypoglycaemic brain damage and 12 months after most other causes of brain damage, then the patient is very unlikely to recover any awareness and is described as being in a permanent vegetative state.

Improving the management of seborrhoeic dermatitis

24 Feb 2014Paid-up subscribers

Seborrhoeic dermatitis usually starts at puberty with a peak incidence at 40 years of age and is more common in males. Patients develop symmetrical, well demarcated, dull or yellowish red patches and plaques with overlying adherent, yellowish greasy scales. Seborrhoeic dermatitis has a distinctive distribution in areas rich in sebaceous glands. Patients presenting with sudden onset severe seborrhoeic dermatitis should be screened for risk factors for HIV.

 

Clinical Reviews

 

100 Years ago

A children’s casualty department - Evelina Hospital, London 1914

20 Mar 2014Registered users

'There was one type of scald, a grievous type, caused by the parents (with that modicum of wisdom which is infinitely worse than ignorance)  enveloping their children’s nether extremities in boiling rags, not wrung out dry, the very travesty of a fomentation. I saw many more or less severe cases of this kind; one poor child, a little girl aged about four, was brought up with her thigh literally cooked, and died some few days after admission.'

Nephroptosis and mental disorders

24 Feb 2014Paid-up subscribers

'If toxaemia can cause mental disorders, and movable kidney can cause toxaemia, there is no difficulty in recognizing movable kidney as a cause of mental disorders'

 

Online only

Special Interest - Cancer and palliative care 4 - 2013

14 Jan 2014Paid-up subscribers

This document can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer.

  • Editorial: Are 5-ARIs suitable for prevention of prostate cancer?
  • Editorial: PSA in men in their 40s predicts risk of prostate cancer deaths
  • Improving the detection and treatment of liver cancer
  • GPs have key role in early detection of melanoma
  • Advances in the treatment of metastatic prostate cancer

Special interest: Dermatology 2 - 2013

13 Jan 2014Paid-up subscribers

This document can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer.

  • Alopecia areata:more than skin deep
  • GPs have key role in early detection of melanoma
  • Intense nocturnal itching should raise suspicion of scabies
  • Improving outcomes in patients with psoriasis

 

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.

 

HASLAM's view

Prevention is better than cure

20 Mar 2014Registered users

About ten years ago I remember a senior politician waxing lyrical to me about how fantastic the treatment of heart attacks had become, with rapid insertion of coronary artery stents and similar technical developments. I agreed with him that of course this was impressive, but then I asked him which he would prefer: a speedily fitted stent or not needing a stent in the first place.

 

Practitioner newsletters

  • Monthly Contents
  • Practitioner CPD News
  • Special Interest
  • UK Sessional GPs
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PHOTOGUIDE

Bullous disorders

20 Mar 2014Registered users

  • Pompholyx
  • Primary herpes simplex
  • Epidermolysis bullosa simplex
  • Varicella zoster
  • Cellulitis
  • Herpes labialis

Eye problems 2014

24 Feb 2014Registered users

  • Impetigo
  • Molluscum contagiosum
  • Pterygium
  • Subconjunctival haemorrhage
  • Corneal rust spot
  • Basal cell carcinoma
 

CPD exercises associated with each issue

CPD exercise - March 2014

20 Mar 2014Paid-up subscribers

The Practitioner's CPD exercise this month is based on: • Detecting ovarian disorders in primary care • Improving the management of urinary incontinence • Managing prolonged disorders of consciousness. 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. Alternatively, articles can be downloaded one at a time from this page.

CPD exercise - February 2014

24 Feb 2014Paid-up subscribers

The Practitioner's CPD exercise this month is based on: • Risk factor control is key in diabetic nephropathy • Renal replacement therapy should be tailored to the patient • Improving the management of seborrhoeic dermatitis. 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. Alternatively, articles can be downloaded one at a time from this page.

 

Cancer and palliative care

Major articles on cancer and on palliative care, collected together in a Special Interest section,  now appear with external links.

These enable the reader to access the most current evidence and statements on the websites of the UK's National Institute for Health and Care Excellence and the US National Cancer Institute. Some articles also appear with links to clinical assessment tools for primary care, and recommended online CPD on external websites. Click here 

 

Peer Group subscription

A PEER GROUP subscription gives you The Practitioner journal and full web access
PLUS full web access for five colleagues
- PLUS the option of a private page for the subscriber, customised to the country and interests of the subscriber and the group.

Currently private pages are under development for:

  • A peer review group of GPs in New Zealand
  • A network of GP trainers in Ireland
  •  Students and lecturers on an advanced nurse practitioner programme in England
  • A group of specialist nurses developing nurse-led research in England
  • A group of doctors with an interest in the history of medicine

Extra pages and access for further colleagues can be negotiated after the first month.
Click for all subscription details.

 

Primary Care Urology Society (UK)

Primary Care Urology Society

Call for GPs with an interest in urology/men’s health

 Dr Jon Rees, a GPwSI urology who writes The Practitioner's clinical reviews in this area, is looking at setting up a Primary Care Urology Society. The organisation would develop an educational programme to support GPs in their work in primary care and in other GPwSI roles.

Membership would be open to all GPs who wish to extend their education in this field beyond that of a standard generalist, not just GPwSIs.

There is also the potential of affiliating the group with the British Association of Urological Surgeons which would allow collaboration between primary and secondary care.

To register your interest please email drjonrees@gmail.com