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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

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.

Urgency urinary incontinence the most bothersome LUTS

25 Jul 2014Registered users

This study, from Finland, compared the impact of different lower urinary tract symptoms (LUTS). A total of 3,727 individuals took part, just over half were women. On an individual level, urgency urinary incontinence was the most likely symptom to be rated as bothersome by both men and women, with 30.7% reporting at least moderate bother. It is not the presence of symptoms but the bother they cause the patient that is vital to understand when assessing and managing LUTS. Storage symptoms, particularly urgency and urgency urinary incontinence, are the most likely to cause significant impairment of quality of life. [With external links to the current evidence base]

 

Symposium articles

Migraine is underdiagnosed and undertreated

23 Sep 2014Registered users

Migraine is a common neurovascular disorder characterised by attacks of head pain that are typically unilateral and often described as severe and throbbing in association with nausea and sensitivity to sensory input, i.e. light, sound and head movement. NICE guidelines recommend adopting the stepped-down approach to management. They suggest a combination of a triptan, NSAID or paracetamol, and an anti-emetic taken as early as possible during the headache. [With external links to the evidence base]

Improving outcomes for chronic pain in primary care

23 Sep 2014Registered users

Although the patient’s goal is often complete pain relief, this is rarely a realistic outcome, so the role of the physician in managing chronic pain involves optimising pain relief as far as possible. A thorough biopsychosocial assessment is essential so that an individualised multidisciplinary approach to management can be developed. The aims of assessment of chronic pain are to rule out any underlying serious pathology, identify the pain mechanism and identify and evaluate risk factors that contribute to chronicity.

 

Clinical Reviews

Does vasectomy increase the risk of prostate cancer?

23 Sep 2014Registered users

Vasectomy may be associated with a small increase in absolute risk of prostate cancer, the findings from a large cohort study in the United States suggest. A cohort of 49,405 men taking part in the Health Professionals Follow-Up Study, run by Harvard University, was followed up from 1986 to 2010. During this period 12,321 men (25%) had vasectomies. [With external links to the current evidence base]

Which eating patterns are most effective for weight reduction in type 2 diabetes?

23 Sep 2014Registered users

Eating two larger meals a day is more effective than consuming the same amount as six smaller meals in patients with type 2 diabetes who are trying to lose weight, the findings of a crossover study suggest. The Prague-based study population comprised 54 patients (29 men) with type 2 diabetes of more than one year’s duration. They had all been treated with oral hypoglycaemic drugs. Participants’ BMI ranged from 27 to 50 kg/m2 and HbA1c 6.0-11.8%, average 7.2%. The mean age was 59.4 years and mean duration of diabetes 8.1 years.

 

Special reports

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.

Improving outcomes for patients with obesity

25 Jul 2014Registered users

In England there has been a sharp increase in the prevalence of overweight and obesity in adults. In 1993 58% of men and 49% of women were classified as overweight or obese compared with 65% and 58% respectively in 2011; 24% of men and 26% of women were classed as obese in 2011. Obesity increases the risk of diabetes, hypertension, coronary heart disease, deep vein thrombosis and pulmonary embolism. It is also associated with an increased risk of certain cancers. Lifestyle weight management programmes should be multicomponent, developed by a multidisciplinary team, and delivered by individuals who have undergone appropriate training. They should focus on long-term weight loss and prevention of weight regain and continue for a minimum of three months.

 

A hundred years ago

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.

Treatment of wounded soldiers

25 Jul 2014Registered users

A HUNDRED YEARS AGO: The results of abdominal wounds are very bad. One school of thought recommends immediate operation; the other advises no operation at all. Consider what it means to operate on the abdomen. There must be an absolutely first-class hospital and a first-class nursing staff at our disposal for at least 1½ hours, whilst for each case three highly-skilled medical men are needed: an expert abdominal surgeon – a man who can really tackle big abdominal work, a first-class anaesthetist, and the surgeon’s assistant. In the end, perhaps one out of three, perhaps one out of five, may recover. It is a terrible thing to have to place a man’s life in the balance, when we think we could save it by a great effort. But when there are 50 or 60 other wounded men lying around, and the labour being expended on one may mean lack of attention to the others, it becomes a very difficult question.

 

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

 

Child health meeting

10+ Topics in Child Health for GPs

Monday 10th November 2014

www.TopicsForGPs.eventbrite.co.uk

 

HASLAM's view

The changing face of general practice

23 Sep 2014Registered users

Just consider the extraordinary differences between general practice at the time of my birth and childhood and general practice as it exists now.

 

Practitioner newsletters

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

Conditions in children

23 Sep 2014Paid-up subscribers

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

Skin malignancy

25 Jul 2014Registered users

• Acanthosis nigricans • Morphoeic basal cell carcinoma • Primary cutaneous anaplastic large cell lymphoma • Amelanotic melanoma • Dermatofibrosarcoma protuberans • Squamous cell carcinoma [With external links to current evidence and summaries]

 

CPD exercises associated with each issue

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.

CPD exercise - July/August 2014

25 Jul 2014Paid-up subscribers

The study pack contains this month’s CPD exercise plus all relevant articles: • Detecting patients with cirrhosis in primary care • Early endoscopy improves survival in gastric cancer • Improving outcomes for patients with 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.

 

Casebook

A case of recalcitrant bacterial conjunctivitis

05 Dec 2013Paid-up subscribers

It is important to be vigilant for retained foreign bodies as a cause of recalcitrant bacterial conjunctivitis, even in the absence of foreign body sensation. A relapsing-remitting history should prompt referral to an ophthalmology department. All patients presenting with a red eye should be asked specifically about contact lens wear, and causes of conjunctivitis other than those bacterial in nature — such as viral and chlamydial infections or allergy — should be borne in mind.

A case of persistent hemifacial weakness

25 Jul 2013Paid-up subscribers

Bell’s palsy has a typical presentation of sudden onset, mild otalgia, altered facial sensation and/or taste, with no obvious prodrome. It represents over half of hemifacial weakness cases in primary care. However, as a diagnosis of exclusion, there are a number of key clinical features of more sinister diagnoses that must be considered.