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.



Risks vs benefits of paracetamol

21 May 2015Registered users

Paracetamol and NSAIDs are the most commonly used OTC and prescription painkillers today. They are largely effective with an NNT of 3.8 and 2.5 respectively to achieve a 50% reduction in acute pain. NSAIDs are well tolerated in the main but potential adverse effects include gastrointestinal (GI) ulceration and bleeding, bronchospasm, renal failure and heart failure. Paracetamol is generally considered to have a safer side-effect profile, however this has been called into question in a recent systematic review.


Symposium articles

Optimising the management of bipolar disorder

21 May 2015Registered users

The prevalence of bipolar disorder in primary care patients is estimated to be between 0.5 and 4.3%, with 9.3% having bipolar spectrum illness. As many as 38% of patients are treated exclusively in primary care. Accurate and timely recognition and assessment of often lifelong and disabling symptoms is essential for long-term engagement in treatment and support at primary care level. This can reduce the use of inpatient services and prevent long-term loss of function. This article updates our previous review, in light of the most recent NICE clinical guidance, published in 2014, which reflects advances in the treatment approaches for patients with bipolar disorder.

Depression in young people often goes undetected

21 May 2015Registered users

Major (unipolar) depression is one of the most common mental health disorders in children and adolescents, with an estimated one year prevalence of 4-5% in mid-late adolescence. Despite its pervasiveness, a diagnosis of depression in young people is often missed. Depression is probably the single most important risk factor for teenage suicide, the second to third leading cause of death in this age group. We also know that depression in young people is a forerunner of adult depressive disorder which is strongly linked to poor physical health outcomes, lower income and increased unemployment. Half of those with lifelong recurrent depression started to develop their symptoms before the age of 15 years. Opinion is divided on how depressed adolescents should be managed. The evidence highlights the importance of treating depression as early as possible, as the longer the course of untreated depression the worse the prognosis for that episode of depression and the higher the likelihood of recurrent, lifelong episodes.7 NICE guidelines, published in March 2015, reflect the most up to date evidence in the management of children and adolescents with major depressive disorder.


Special reports

Improving outcomes in diabetes in pregnancy

21 May 2015Registered users

One in 250 pregnancies in the UK involves diabetes. Pregnancy with uncontrolled glucose levels can have serious consequences for the mother and her baby. This is true of women with known diabetes before pregnancy as well as gestational diabetes mellitus (GDM). As a corollary, patient education, glycaemic control and specialist diabetes and obstetric input can ensure excellent outcomes in the majority of these women. In women with pre-existing diabetes there is a critical role for pre-conception management and monitoring. Gestational diabetes rates would be expected to increase in the UK as a result of rising obesity, maternal age and ethnic diversity. In February 2015, NICE published updated guidance on diabetes management in pregnancy, and there are many areas in which primary care plays a crucial role.

Improving the diagnosis and management of GORD in adults

23 Apr 2015Registered users

Gastro-oesophageal reflux disease (GORD) is defined as a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Many patients with GORD complications such as oesophagitis and up to a third of patients with Barrett's oesophagus have no reflux or heartburn symptoms. Conversely, patients can be symptomatic even when normal reflux levels are found and there is an absence of mucosal damage.


A hundred years ago

Cerebrospinal meningitis

21 May 2015Paid-up subscribers

WRITTEN IN 1915:The serum of Flexner has saved many lives in recent epidemics. Thus, in the Belfast epidemic of 1906-1908, Robb reduced the mortality from 74 to 30 per cent after failing to influence the death-rate by the use of the sera of Ruppel, Kolle and Wassermann, or Burroughs and Wellcome. More recently Robb has published a further 117 cases with only 28 deaths, which represents a further reduction of the mortality to 24 per cent.

Underuse of sublingual medication

23 Apr 2015Registered users

He believed the patient was dead, for he had ceased to breathe, and no pulsation could be detected. By way of a last chance, I inserted a strychnia and two apomorphia discs under his tongue, and rolled him over on to his left side. Well within a minute he made a valiant effort, and vomited, and finally recovered.


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

Plan for the unpredictable

21 May 2015Registered users

Many GPs absolutely want to maximise the time they can spend with their patients, but feel as if they are pushing water uphill. I have no obvious answers, other than to say that the one thing that is absolutely predictable about any day in general practice is its unpredictability. If you know that unpredictable things are going to happen, then plan for them.


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23 Apr 2015Registered users

•Late onset acne •Acne agminata •Exogenous acne •Acne rosacea •Acne conglobata •Folliculitis


23 Mar 2015Registered users

•Cholestatic pruritus •Phytodermatitis •Insect bites •Chickenpox •Urticaria •Hypertrophic lichen planus


CPD exercises associated with each issue

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

CPD exercise - April 2015

23 Apr 2015Paid-up subscribers

The study pack contains this month’s CPD exercise plus all the relevant articles: • Careful assessment key in managing prostatitis • New developments in metastatic prostate cancer therapy • Improving the diagnosis and management of GORD in adults. 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