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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

Improving early detection of chronic kidney disease

23 Feb 2015Registered users

Chronic kidney disease (CKD) is defined as either a reduction in measured kidney function (eGFR) or urinary abnormalities (haematuria/proteinuria) or a combination of both, present for more than 3 months. Individuals with newly identified reduced eGFR should have acute kidney injury excluded. All newly identified CKD patients should have blood pressure, dipstick urinalysis, random urine ACR or PCR, glucose, cholesterol and full blood count checked at the earliest opportunity.

Timely diagnosis and treatment essential in glomerulonephritis

23 Feb 2015Registered users

Glomerulonephritis is an important cause of kidney disease and, in the UK, the most common diagnosis in patients receiving chronic dialysis or waiting for kidney transplantation. A key feature is the presence of urinary abnormalities (proteinuria ± haematuria). Timely diagnosis and treatment of glomerulonephritis can help to minimise both the occurrence and severity of complications.

 

Editorials

Antipsychotics still prescribed inappropriately in primary care

23 Feb 2015Registered users

Less than half the patients prescribed antipsychotics have a diagnosis of severe mental illness, a UK primary care study has found. For patients without severe mental illness, the most commonly recorded mental health diagnoses were anxiety, depression, dementia, sleep disorder and personality disorder. Around 1 in 10 patients had no recorded mental health diagnosis.

DRE has vital role in early detection of prostate cancer

22 Jan 2015Registered users

Digital rectal examination is important, not just for reducing concern in men with urinary symptoms, large prostates and borderline PSA levels, but also because it is recognised that a significant number of men have clinically significant prostate cancer despite a normal PSA. [With external links to the evidence base]

 

Special reports

Managing urticaria in primary care

23 Feb 2015Registered users

Urticaria is characterised by transient wheals that consist of a swollen palpable centre often surrounded by an erythematous flare, associated with itching or, less commonly, a burning sensation. Individual wheals usually disappear within 1 to 24 hours leaving normal skin. The prognosis for eventual recovery from spontaneous and inducible urticaria is excellent. However, the time course is unpredictable and may extend to years, often following a relapsing and remitting course.

Managing patients with type 2 diabetes and obesity

22 Jan 2015Registered users

Diabetes risk increases exponentially with increasing BMI particularly if fat accumulates centrally and/or in the skeletal muscle, liver and other organs such as the pancreas. Those with diabetes and co-existing obesity, particularly if it is severe, are also at risk of other obesity-related conditions, such as cardiovascular disease, obstructive sleep apnoea, joint pain, many cancers and depression. Supporting patients to lose weight should be considered a key goal of diabetes care for all overweight and obese patients with type 2 diabetes.

 

A hundred years ago

Medical women and the War

23 Feb 2015Registered users

WRITTEN IN 1915:While there has been a demand for medical women to take the place of medical men in every capacity, the larger proportion of the posts that have been offered to women are for newly-qualified or quite junior practitioners. There are practically none for the older and more experienced women doctors. The majority of members of the profession are willing for women to take their places as hospital residents or other appointments so as to release them for the front, but they will expect the women to give up their positions with smiling faces when they return at the end of the War. However, many will not return, and, consequently, the preservation of the health of the nation will tend to be more in the hands of women than was the case before the War.

Electro-therapeutics in the present War

30 Jan 2015Registered users

Written in 1915: In many cases, there is doubt as to the organic nature of the paralysis. Numerous cases occur to which, in civil practice, the term “hysterical” would be applied. Many of the patients are, however, men who have proved their bravery in the field, and it seems to me that “psychical” is a fairer term to use. The frightful sights and sounds of a battle-field, combined with some amount of actual personal injury, undoubtedly inflict at times a psychical trauma, which in all probability could be shown to have a definite physical basis, had we means fine enough to investigate it. Nothing could be further from the truth than to suggest any trace of malingering in such cases, yet it is undoubtedly true that in many instances that paralysis would vanish under sufficient mental stimulus - such as the classical “house on fire.”

 

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

Whose body is it, anyway?

23 Feb 2015Registered users

‘How do you feel about patients recording their own blood pressure at home?’ I would ask. My recollection is that around 95% of candidates were vigorously opposed to such an idea. They thought it unsafe, unprofessional, and unacceptable. I would ask them to explain the difference between their approach to self-measurement of hypertension and asthma.

 

Practitioner newsletters

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

Eczema

23 Feb 2015Registered users

• Nickel allergy • Tinea incognito • Infected eczema • Varicose eczema • Atrophie blanche • Asteatotic eczema

Scalp conditions

22 Jan 2015Registered users

•Squamous cell carcinoma •Intradermal naevus •Actinic keratosis •Seborrhoeic keratosis •Scalp psoriasis •Sebaceous naevus

 

CPD exercises associated with each issue

Practitioner CPD exercise - February 2015

23 Feb 2015Paid-up subscribers

The study pack contains this month’s CPD exercise plus all the relevant articles: • Improving early detection of chronic kidney disease • Timely diagnosis and treatment essential in glomerulonephritis • Managing urticaria in primary care. 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 - January 2015

22 Jan 2015Paid-up subscribers

The study pack contains this month’s CPD exercise plus all the relevant articles:• Establishing the cause of memory loss in older people • Diagnosis and management of postherpetic neuralgia • Managing patients with type 2 diabetes and obesity. 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.