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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

Collaborative care effective in cancer patients with depression

23 Oct 2014Registered users

Integrated collaborative care substantially improves outcomes for cancer patients with major depression, a UK study has found. GPs have an important role in recognising depression in cancer patients and should bear in mind the high prevalence of depression when carrying out QOF cancer reviews. This study suggests that treatment is unlikely to be effective unless it incorporates some form of enhanced care. GPs may not have access to collaborative care but can provide case management and liaise with local oncology teams.

Identifying at-risk drinkers in primary care

23 Sep 2014Registered users

It has been estimated that around 20% of patients attending their GP are at risk from their drinking or have an alcohol use disorder. Without using specific screening tools GPs may typically detect about 40% of cases they see, but miss the majority. The study authors suggest a single or two question approach to initial screening, followed by either the CAGE or AUDIT test for those who are positive, and onward referral for those who test positive on the more in-depth questionnaire.

 

Symposium articles

Have a high index of suspicion for atrial fibrillation

23 Oct 2014Registered users

The lifetime risk of atrial fibrillation (AF) for men and women over the age of 40 is about 25%. The condition affects around 800,000 people in the UK, of which it is estimated that 250,000 are undiagnosed. A rapid heart rate may result in palpitations, dyspnoea or chest tightness, whereas loss of atrial contractility may lead to fatigue and reduced exercise capacity. In patients with a confirmed diagnosis of AF, three areas need to be considered: stroke risk, symptoms, and risk of tachycardia cardiomyopathy.

Diagnosis and management of inherited cardiomyopathies

23 Oct 2014Registered users

Inherited heart conditions are the most common cause of sudden cardiac death in those under the age of 35 and the leading cause of non-traumatic death in young athletes. In many cases the first manifestation of an inherited cardiomyopathy can be a sudden cardiac arrest. Other presentations include chest pain or breathlessness during exertion, palpitations and syncope. Hypertrophic cardiomyopathy is the most common inherited heart disease affecting 1 in 500 of the population. Some patients may exhibit severe left ventricular hypertrophy, others may show nothing more than an abnormal ECG.

 

Clinical Reviews

Lifestyle factors associated with risk of gestational diabetes

23 Oct 2014Paid-up subscribers

Maintaining a healthy lifestyle before pregnancy is associated with a substantially lower risk of developing gestational diabetes mellitus), a large prospective cohort study has found. The Nurses Health Study II recruited 116,671 female nurses aged 24-44 in 1989. After ten years’ follow-up, 20,136 singleton pregnancies had occurred in 14,437 women. There were 823 pregnancies affected by GDM.

Do beta-blockers benefit patients with early CHD?

23 Oct 2014Paid-up subscribers

The use of beta-blockers in patients with new-onset coronary heart disease (CHD) is associated with a lower risk of cardiac events only in those who have had a recent myocardial infarction (MI), a study has shown.

 

Special reports

Improving the management of rosacea in primary care

23 Oct 2014Registered users

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.

Preventing avoidable asthma deaths

23 Sep 2014Paid-up subscribers

Deaths from asthma are frequently avoidable, the National Review of Asthma Deaths has confirmed. Key findings from the report include: Almost half the patients (45%) died without seeking medical help or before help could be provided; 10% died within 28 days of discharge from hospital; 21% had attended A&E with asthma in the previous year; and only 23% had a personal asthma action plan. Over-prescription of short-acting bronchodilators and under-prescription of preventer inhalers was common.

 

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

 

A hundred years ago

Fear of syphilis and suicide

23 Oct 2014Registered users

WRITING A HUNDRED YEARS AGO: “No patients are more suicidal than those who believe themselves impotent or affected by a sexual disorder”

Autotherapy in the prevention and cure of purulent infections

23 Sep 2014Paid-up subscribers

WRITTEN A HUNDRED YEARS AGO: I believe that spontaneous cure of an infectious disease is due to entrance into the blood-stream of the unmodified toxins, developed in the focus of infection. When this occurs the power of the blood-serum is raised, the activity of the leucocytes stimulated, with the resultant development of specific anti-bodies. In all acute infections, in which it is possible to obtain the toxins, a speedy cure may be expected. With few exceptions, all chronic infections are benefited more by the autotherapeutic remedy than by any other curative agent. Autotherapy is being used successfully by hundreds of physicians throughout the United States. A patient may abort infection by simply chewing his own blood dressings twice daily. This is a fact, and we cannot know too many facts.

 

HASLAM's view

A lesson in understanding patients’ health beliefs

23 Oct 2014Registered users

Many years ago, during my first weeks as a GP trainee, I learnt  one of the critical lessons of my general practice life. I was well aware that everyone but my trainer knew that intramuscular penicillin was no longer the treatment of choice. Had I realised that I was totally failing to understand parental expectations, I could have handled these cases in a totally different way – though still avoiding the dreaded injections.

 

Practitioner newsletters

  • Monthly Contents
  • Practitioner CPD News
  • Special Interest
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PHOTOGUIDE

Photoguide: Lower limb problems

23 Oct 2014Registered users

• Cellulitis • Gastrocnemius atrophy • Infected arthritis of the knee • Lymphoedema • Necrobiosis lipoidica • Allergic contact dermatitis

Conditions in children

23 Sep 2014Paid-up subscribers

  • Juvenile plantar dermatosis
  • Molluscum contagiosum
  • Verrucas
  • Impetigo
  • Breast buds
  • Slapped cheek disease
 

CPD exercises associated with each issue

CPD exercise - October 2014

23 Oct 2014Paid-up subscribers

The study pack contains October's CPD exercise plus all relevant articles: • Have a high index of suspicion for atrial fibrillation • Diagnosis and management of inherited cardiomyopathies • Improving the management of rosacea 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 and study pack - September 2014

23 Sep 2014Paid-up subscribers

The study pack contains September's CPD exercise plus all relevant articles: • Improving outcomes for chronic pain in primary care • Migraine is underdiagnosed and undertreated • Preventing avoidable asthma deaths.  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.