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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.

 

Symposium articles

Early treatment of psoriatic arthritis improves prognosis

15 Dec 2014Registered users

Psoriatic arthritis (PsA) is a chronic, autoimmune disease affecting up to 1% of the adult population and up to 40% of those with psoriasis. Around 20% of patients develop PsA before psoriasis, often many years before skin or nail changes. Aggressive treatment of early stage progressive PsA can substantially improve the long-term prognosis.


Patients with gout can be cured in primary care

15 Dec 2014Registered users

Gout is associated with comorbidities such as nephrolithiasis, chronic renal impairment, metabolic syndrome, depression and heart disease. It is also associated with increased mortality. Untreated gout can result in disabling irreversible peripheral joint damage and chronic usage-related pain. However, gout is curable.

 

Editorials

Obesity, metformin and prostate cancer risk

15 Dec 2014Registered users

A total of 104 global studies were reviewed, examining nearly 10 million (9,855,000) men and 191,000 cases of prostate cancer. The analysis concluded that being overweight or obese significantly increases the risk of advanced prostate cancer. The link between obesity and advanced prostate cancer is important for primary care. In order to maximise the benefit from PSA testing of asymptomatic men, we should be trying to target higher-risk men and should now think of adding obesity to that list. [With external links to the evidence base]

Second-hand smoke in the home more harmful than air pollution

24 Nov 2014Registered users

Pollution caused by fine particulate matter (PM2.5) is around ten times higher in homes where people smoke indoors compared with non-smoking homes, a study from Scotland has found. Furthermore, home air pollution from smoking appears to dwarf that from outdoor sources. Approximately 20% of those living in smoking homes in Scotland will inhale a lifetime mass of PM2.5 greater than the median value predicted for a non-smoker living in a heavily polluted urban setting.

 

Clinical Reviews

Could HPV infection be transmitted by the use of vibrators?

15 Dec 2014Registered users

Human papilloma virus (HPV) was detected on vibrators 24 hours after cleaning, in a small study in the United States. This finding suggests that shared use of sex toys could lead to transmission of HPV. Women aged 18 to 29 were recruited as part of a larger study looking into the sexual behaviour of women who have sex with women and men. A total of 28 women were recruited and 20 consented to participate.

Running significantly reduces cardiovascular and all cause mortality risk

15 Dec 2014Registered users

Even modest amounts of running, 5-10 minutes a day, at a relatively gentle pace, < 6 miles an hour, can significantly lower the risk of death from cardiovascular disease and all causes, according to a sizeable observational study in the Journal of the American College of Cardiology.

 

A hundred years ago

The psychic factor in insomnia

15 Dec 2014Registered users

FROM THE PRACTITIONER 1914. In the process of analysing this case of insomnia, I discovered that several years before there had been a great intimacy between the patient and Mademoiselle X. The patient’s husband – the mildest of men – had grown uneasy about it, and refused to allow the friendship to go on. In his desire to do everything to render the proposed visit to Paris attractive, he had suggested staying in the house of Mademoiselle X, although he and his wife had never alluded to her for all these years. Instead of stimulating the patient’s recovery the opposite effect had been produced, because, in point of fact, the attachment had been a Lesbian one, and the whole complex was so painful that the patient shrank from the proposed awakening of the memory.

Outbreak of milk-borne diphtheria

24 Nov 2014Registered users

WRITTEN A HUNDRED YEARS AGO. The incidence of the disease was not upon children and invalids, who are generally speaking the principal milk consumers. The children may have escaped owing to the custom in better class houses of cooking milk that is to be consumed by them, or it may be that they consumed nursery milk, obtained locally, and not from the Sussex infected farm.

 

Special reports

GPs could play key role in prostate cancer survivorship programmes

24 Nov 2014Registered users

More than 80% of men diagnosed with prostate cancer can expect to survive for at least five years. Up to 87% of men with prostate cancer may have unmet supportive care needs. Patients regularly cite psychological and sexual issues as the most significant. Poor functional outcomes after treatment such as incontinence and erectile dysfunction have a major impact on quality of life. The key elements of a survivorship programme are: education, intervention, surveillance and co-ordination of care. Interventions which may improve immediate care include: structured holistic needs assessment and care planning, treatment summaries and cancer care reviews, patient education and support events and advice about, and access to, physical activity schemes. [With external links to the evidence base]

Improving the management of rosacea in primary care

23 Oct 2014Paid-up subscribers

Rosacea is more common in women than men and occurs more frequently in fair-skinned individuals, usually in the middle years of life. It tends to localise to the cheeks, forehead, chin and nose, sometimes showing marked asymmetry. Only very occasionally does it involve areas other than the face. Important distinguishing features from acne are a lack of comedones, absence of involvement of extra-facial areas, and the presence of flushing. Rosacea is a disfiguring condition that can have a major psychosocial impact, and its detrimental effect on emotional health and quality of life is often overlooked.

 

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

 

HASLAM's view

The healing power of the magic sponge

15 Dec 2014Registered users

I ran onto the pitch, took one look at the dreadfully swollen and excruciatingly tender ankle joint, and knew exactly what to do. I shouted at one of the spectators to call for an ambulance, and totally disrupted the game. Everyone was standing around looking more than a little worried, when the trainer came running over with a bucket and a sponge ....

 

Practitioner newsletters

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

End of year photo quiz 2014

15 Dec 2014Registered users

Test your diagnostic skills

Hand conditions

24 Nov 2014Registered users

 • Tophaceous gout  • Heberden’s nodes • Mallet finger • Dupuytren’s contracture • Hand dermatitis • Scleroderma/Raynaud’s disease

 

CPD exercises associated with each issue

CPD exercise - December 2014

15 Dec 2014Paid-up subscribers

The study pack contains this month’s CPD exercise plus all the relevant articles: • Patients with gout can be cured in primary care • Early treatment of psoriatic arthritis improves prognosis • Obesity, metformin and prostate cancer risk. 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 - November 2014

24 Nov 2014Paid-up subscribers

The study pack contains November's CPD exercise plus all relevant articles:• Improving the management of asthma in adults in primary care • Early diagnosis pivotal to survival in lung cancer • GPs could play key role in prostate cancer survivorship programmes. 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.