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.



Be vigilant for neonatal abstinence syndrome

21 Oct 2015Registered users

A large population-based study, involving 290,605 pregnant women, identified 1,705 cases of neonatal abstinence syndrome for women who had filled an opioid prescription while pregnant, representing an absolute risk of 5.9 cases per 1,000 deliveries. The risk was greater for long-term prescription opioid users. The majority (88%) took them short term. Babies of women who used prescription opioids during the last trimester had a significantly higher incidence of neonatal abstinence syndrome compared with those who used them in the first two trimesters only.

Androgen deprivation therapy and cardiovascular risk

24 Sep 2015Registered users

An awareness of CVD risk allows GPs to look proactively at modifiable risk factors in these men, to encourage smoking cessation, weight loss and increased exercise – all of which have been independently associated with improved prostate cancer outcomes in their own right – and to consider medical treatment for risk factors such as dyslipidaemia.


Symposium articles

Playing it safe:exercise and cardiovascular health

21 Oct 2015

Regular physical activity controls acquired cardiovascular risk factors such as obesity, diabetes mellitus, hypertension and hyperlipidaemia. Exercise is generally associated with a 50% reduction in adverse events from coronary artery disease. Active individuals are at lower risk of developing certain malignancies including cancer of the prostate and the colon, osteoporosis, depression and dementia. Individuals who exercise regularly extend their life expectancy by three to seven years. Healthy individuals should engage in 150 minutes of moderate-intensity aerobic exercise per week. Even lower volumes of exercise confer health benefits, which is highly relevant to individuals with established cardiac disease including heart failure.

Management of heart failure with preserved ejection fraction

21 Oct 2015

Heart failure affects nearly one million people in the UK. Half of these patients have normal, or near normal, left ventricular ejection fraction and are classified as heart failure with preserved ejection fraction (HFpEF). Newer imaging techniques have confirmed that systolic function in HFpEF patients is not completely normal, with reduced long axis function and extensive but subtle changes on exercise. Patients are likely to be older women with a history of hypertension. Other cardiovascular risk factors, such as diabetes mellitus, atrial fibrillation and coronary artery disease are prevalent in the HFpEF population.


Special reports

Diagnosis directs treatment in fungal infections of the skin

21 Oct 2015Registered users

Dermatophyte fungi are confined to the keratin layer of the epidermis and include three genera: Microsporum, Epidermophyton and Trichophyton. These infections can be transmitted by human contact (anthropophilic), from the soil (geophilic) and by animal (zoophilic) spread. Dermatophyte infections usually present as an erythematous, scaly eruption, which may or may not be itchy. Asymmetry is an important clinical clue to fungal infection, as is annular morphology.

Diagnosing and treating diverticular disease

24 Sep 2015Registered users

It is important to distinguish between diverticulosis, the presence of asymptomatic diverticula, and diverticular disease which refers to symptomatic cases which can present with acute or chronic symptoms. Diverticular disease can be confirmed radiologically or endoscopically. Even in patients with established diverticulosis, a change in the clinical picture with development of red flag symptoms warrants urgent referral to rule out lower gastrointestinal malignancy.


Clinical Reviews

Is high intensity intermittent exercise beneficial in type 2 diabetes?

21 Oct 2015Registered users

Recent research from Newcastle University suggests that high intensity intermittent exercise is associated with improved cardiac structure and reduced liver fat in type 2 diabetes patients.

Moderate exercise lowers risk of atrial fibrillation in older women

21 Oct 2015Registered users

A moderate amount of physical activity appears to reduce the risk of atrial fibrillation significantly in middle-aged and elderly women, according to a study published in Heart. Information about physical activity was obtained from 36,513 women, aged 49-83 (median 60) years in the Swedish Mammography Cohort who had completed a questionnaire at study entry.


HASLAM's view

Helping our patients to understand risk

21 Oct 2015

Every GP develops a profound understanding of risk, and of the sudden changes that can impact on anyone at any time. We see patients who are so unnerved by the risks that face them that life becomes impossible. We see patients who take so little notice of risk, that for instance, they smoke, and they smoke only to stop the moment that cancer is diagnosed. Helping our patients understand risk is a critical part of every doctor’s work.



Photoguide: Pigmentation disorders

21 Oct 2015Registered users

Vitiligo • Melanonychia • Pigmented basal cell carcinoma • Haemosiderin deposition • Blue naevus • Lead pellet

Allergic reactions

24 Sep 2015Registered users

• Fixed drug eruption • Fabric plaster reaction • Latex allergy • Morbilliform drug reaction • Allergic conjunctivitis • Anaphylaxis


CPD exercises associated with each issue

CPD exercise - October 2015

21 Oct 2015Paid-up subscribers

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. The study pack contains this month’s CPD exercise plus all the relevant articles: • Playing it safe: exercise and cardiovascular health • Management of heart failure with preserved ejection fraction • Diagnosis directs treatment in fungal infections of the skin

CPD exercise - September 2015

24 Sep 2015Paid-up subscribers

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. The study pack contains this month’s CPD exercise plus all the relevant articles: •Seizure classification key to epilepsy management •Early accurate diagnosis crucial in multiple sclerosis •Diagnosing and treating diverticular disease


A hundred years ago

Acute gonorrhoea

21 Oct 2015Registered users

The apparatus used for local treatment of acute anterior urethritis is an ordinary douche-can, four feet of indiarubber tubing, a clip, and a glass nozzle, which is fined down to a blunt point, and is flattened. The can is suspended five or six feet above the patient, filled with a pint of water which is a little too hot for the hand to bear with comfort. By the time the fluid has reached the nozzle and one is ready to begin, it will not be too hot.

The tragedy of glycosuria

24 Sep 2015Registered users

A YOUNG woman, pale, thin, and tired, walked into my consulting room, and sat heavily down in the chair opposite me. There, her cheeks hollowed, her chin sharp and pointed, her body thin, and her aspect haunted, she confronted me. Occasionally, she passed her tongue between her lips to moisten them, as if she felt them dry and uncomfortable. There was a slight flush on the prominences of both cheeks, and she looked like an animal which had nearly been starved, and which licked its lips in anticipation of a meal....