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

Establishing the cause of memory loss in older people

22 Jan 2015Registered users

Common causes of memory loss in older people are mild cognitive impairment (MCI), the various types of dementia, and psychiatric illness, mainly depression. The prevalence of MCI is estimated to be 3-30% of those above 65, while about 20% will experience symptoms of depression. Approximately 36 million people worldwide suffer from dementia, 850,000 in the UK.6 Around 10% of patients with MCI progress to dementia each year.

Diagnosis and management of postherpetic neuralgia

22 Jan 2015Registered users

Reactivation of the latent herpes zoster virus occurs in 50% of those who reach the age of 85. The reduction in cell- mediated immunity that accompanies ageing is thought to be accountable for this viral recrudescence which, in turn, leads to an acute, often painful rash commonly referred to as shingles or acute herpetic neuralgia.Pain usually subsides within three to five weeks, but a significant number of patients develop persistent pain classified as sub-acute herpetic neuralgia, 30-120 days following rash onset, and postherpetic neuralgia (PHN), 120 days following rash onset.



DRE has vital role in early detection of prostate cancer

22 Jan 2015Registered users

One of the many controversies that surround the use of PSA testing to screen for prostate cancer in asymptomatic men, is the question of whether the man who wishes to be screened should have a PSA test alone, or requires a digital rectal examination (DRE) as well. In 2014, a group of leading urologists produced the Melbourne Consensus Statement that advised that PSA testing should ‘not be considered on its own but in conjunction with other variables’. There is no doubt that adding other parameters such as family history, urinary symptoms, age and ethnicity add to the predictive value and the evidence suggests that DRE also increases the predictive value of the screening process. DRE 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.

Obesity, metformin and prostate cancer risk

15 Dec 2014Registered users

A total of 104 global studies were reviewed, examining nearly 10 million (9,855,000) men and 191,000 cases of prostate cancer. The analysis concluded that being overweight or obese significantly increases the risk of advanced prostate cancer. The link between obesity and advanced prostate cancer is important for primary care. In order to maximise the benefit from PSA testing of asymptomatic men, we should be trying to target higher-risk men and should now think of adding obesity to that list. [With external links to the evidence base]


Clinical Reviews

Could HPV infection be transmitted by the use of vibrators?

15 Dec 2014Registered users

Human papilloma virus (HPV) was detected on vibrators 24 hours after cleaning, in a small study in the United States. This finding suggests that shared use of sex toys could lead to transmission of HPV. Women aged 18 to 29 were recruited as part of a larger study looking into the sexual behaviour of women who have sex with women and men. A total of 28 women were recruited and 20 consented to participate.

Running significantly reduces cardiovascular and all cause mortality risk

15 Dec 2014Registered users

Even modest amounts of running, 5-10 minutes a day, at a relatively gentle pace, < 6 miles an hour, can significantly lower the risk of death from cardiovascular disease and all causes, according to a sizeable observational study in the Journal of the American College of Cardiology.


Special reports

Managing patients with type 2 diabetes and obesity

22 Jan 2015Registered users

Type 2 diabetes is fundamentally an obesity-related disease. Risk increases exponentially with increasing body mass index (BMI) particularly if fat accumulates centrally, in the abdominal region, and/or in the skeletal muscle, liver and other organs such as the pancreas. Some individuals are susceptible to developing diabetes at a lower BMI and this may be partly genetic. People of Asian ethnicity are particularly prone to developing diabetes at a lower BMI than Caucasians.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.

GPs could play key role in prostate cancer survivorship programmes

24 Nov 2014Registered users

More than 80% of men diagnosed with prostate cancer can expect to survive for at least five years. Up to 87% of men with prostate cancer may have unmet supportive care needs. Patients regularly cite psychological and sexual issues as the most significant. Poor functional outcomes after treatment such as incontinence and erectile dysfunction have a major impact on quality of life. The key elements of a survivorship programme are: education, intervention, surveillance and co-ordination of care. Interventions which may improve immediate care include: structured holistic needs assessment and care planning, treatment summaries and cancer care reviews, patient education and support events and advice about, and access to, physical activity schemes. [With external links to the evidence base]


A hundred years ago

The psychic factor in insomnia

15 Dec 2014Registered users

FROM THE PRACTITIONER 1914. In the process of analysing this case of insomnia, I discovered that several years before there had been a great intimacy between the patient and Mademoiselle X. The patient’s husband – the mildest of men – had grown uneasy about it, and refused to allow the friendship to go on. In his desire to do everything to render the proposed visit to Paris attractive, he had suggested staying in the house of Mademoiselle X, although he and his wife had never alluded to her for all these years. Instead of stimulating the patient’s recovery the opposite effect had been produced, because, in point of fact, the attachment had been a Lesbian one, and the whole complex was so painful that the patient shrank from the proposed awakening of the memory.

Outbreak of milk-borne diphtheria

24 Nov 2014Registered users

WRITTEN A HUNDRED YEARS AGO. The incidence of the disease was not upon children and invalids, who are generally speaking the principal milk consumers. The children may have escaped owing to the custom in better class houses of cooking milk that is to be consumed by them, or it may be that they consumed nursery milk, obtained locally, and not from the Sussex infected farm.


HASLAM's view

Do you always reveal what you do for a living?

22 Jan 2015Registered users

‘What do you do?’ It’s a question that we all get asked  when we meet people socially for the first time. Your answer, of course, will depend on where you are, and what you are doing. I have certainly had times when I somehow managed to omit any mention that I was a doctor. ...


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End of year photo quiz 2014

15 Dec 2014Registered users

Test your diagnostic skills

Hand conditions

24 Nov 2014Registered users

 • Tophaceous gout  • Heberden’s nodes • Mallet finger • Dupuytren’s contracture • Hand dermatitis • Scleroderma/Raynaud’s disease


CPD exercises associated with each issue

CPD exercise - December 2014

15 Dec 2014Paid-up subscribers

The study pack contains this month’s CPD exercise plus all the relevant articles: • Patients with gout can be cured in primary care • Early treatment of psoriatic arthritis improves prognosis • Obesity, metformin and prostate cancer risk. 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 - November 2014

24 Nov 2014Paid-up subscribers

The study pack contains November's CPD exercise plus all relevant articles:• Improving the management of asthma in adults in primary care • Early diagnosis pivotal to survival in lung cancer • GPs could play key role in prostate cancer survivorship programmes. 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.