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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.

 

Editorials

Peanut allergy – is it time to change infant feeding practice?

23 Mar 2015Registered users

Early introduction of peanut into the diet of high-risk babies significantly decreases the frequency of peanut allergy at five years of age, a UK open label single-centre study has found. The present study was well designed and showed a strong effect in its primary outcome. The question many will ask is can these findings now be translated into advice for our patients? The answer is no.

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.

 

Symposium articles

GPs have key role in early diagnosis of endometriosis

23 Mar 2015Registered users

Risk factors for endometriosis include early menarche, late menopause, delayed childbearing, vaginal outflow obstruction and a first-degree relative affected. Women commonly present to their GP with pelvic pain, painful intercourse or subfertility. Referral should be considered if pain is not controlled with simple analgesia or the diagnosis is suspected in a woman who is actively trying to conceive. Early referral should be considered in women with abnormal examination findings, or an abnormal ultrasound result.

Be vigilant for perinatal mental health problems

23 Mar 2015Registered users

The postnatal period appears to be associated with higher rates of adjustment disorder, generalised anxiety disorder, and depression. Women who have a history of serious mental illness are at higher risk of developing a postpartum relapse, even if they have been well during pregnancy. Postnatal depression is more severe than baby blues, follows a chronic course and may relapse outside the perinatal period. Bipolar disorder may present as a first depressive episode in pregnancy or the postnatal period. In the postpartum period women have a high risk of severe relapse.

 

Clinical Reviews

Are glitazones associated with increased cancer risk?

23 Mar 2015Registered users

A recent multipopulation pooled cumulative exposure analysis has suggested that the use of pioglitazone is not associated with an increased incidence of bladder cancer. The study used prescription, cancer and mortality data from patients with type 2 diabetes. The raw data were obtained from British Columbia, Finland, Manchester, Rotterdam, Scotland and the UK Clinical Practice Research Datalink. Data were collected on 1.01 million patients over 5.9 million person-years. There were 3,248 cases of incident bladder cancer, 117 in those exposed to pioglitazone, over a median follow-up of 4.0 to 7.4 years.

How do patients with STIs inform their partners?

23 Mar 2015Paid-up subscribers

Most patients with STIs prefer to inform their partners by telephone or face to face, a study from Australia has found. Patients diagnosed with a bacterial STI at the Sydney Sexual Health Centre, over a three-month period in 2010, were studied. Data were extracted on: age, gender, bacterial STI diagnosed, number of sexual partners identified at the treatment visit, number of partners the index case was able to notify, methods used for partner notification and the known outcomes of notification. There were 224 patients diagnosed with one or more of gonorrhoea, chlamydia and infectious syphilis.

 

Special reports

Improving detection and management of drug allergy

23 Mar 2015Registered users

Adverse drug reactions need to be meticulously recorded and the patient kept fully informed. Documentation should include: date of reaction; drug name (chemical and generic); route of administration; time interval between first dose and event; and nature and severity of symptoms. Written guidance should be provided on which other chemically related drugs also need to be avoided. Specialist referral is indicated for: suspected anaphylaxis; severe/life-threatening episodes e.g. Stevens-Johnson syndrome; severe NSAID reactions with ongoing need for NSAID therapy; suspected penicillin allergy (if alternative antibiotics are not available); and problems related to general and local anaesthesia.

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.

 

A hundred years ago

Obstetric mutilations

23 Mar 2015Registered users

WRITTEN IN 1915:A considerable number of women admitted into the London Hospital as obstetric cases have, to an almost inconceivable extent, a lacerated and bruised lower genital tract, cervix, vagina, and perineum. A combination of lack of experience and judgement, lack of adequate time to devote to a midwifery case, and a mistaken sense of pride in refusing to take advantage of skilled advice which is nowhere remote in the London area, still renders some of our metropolitan midwifery a blot on the reputation of modern obstetrics.

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.

 

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

All doctors should have their own GP

23 Mar 2015Registered users

I’m going to ask you a personal question. ‘Have you got a GP?’ It matters. You never know when you might need help. Doctors aren’t always very good at recognising their own healthcare needs. I know how busy you are, but doctors matter too. Please don’t neglect yourself.

 

Medico-legal work

We are looking for general practitioners to undertake medico-legal work at various locations throughout the country, specifically in Kent, Berkshire, Bedfordshire and the South West.

We would undertake to find you instructions and carry out the administration on your behalf, by making the appointments, typing the medical reports etc. Apply with CV to:
Windsor Medico-Legal
PO Box 4529
Windsor SL4 9DN
or email info@windsormedico.co.uk

 

Practitioner newsletters

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

Pruritus

23 Mar 2015Registered users

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

Eczema

23 Feb 2015Registered users

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

 

CPD exercises associated with each issue

Practitioner CPD exercise - March 2015

23 Mar 2015Paid-up subscribers

The study pack contains this month’s CPD exercise plus all the relevant articles: • GPs have key role in early diagnosis of endometriosis • Be vigilant for perinatal mental health problems • Improving detection and management of drug allergy. 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

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.