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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: Care of the elderly

Anxiety in older adults often goes undiagnosed

25 Jan 2016Registered users

Anxiety disorder in the elderly is twice as common as dementia and four to six times more common than major depression. Anxiety is associated with poorer quality of life, significant distress and contributes to the onset of disability. Mortality risks are also increased, through physical causes, especially cardiovascular disease, and suicide. Diagnosing anxiety disorders in older adults remains a challenge because of the significant overlap in symptoms between physical disorders (shortness of breath; abdominal and chest pain; palpitations) and depression (disturbed sleep; poor attention, concentration and memory; restlessness). 

 

Controlling joint pain in older people

25 Jan 2016Registered users

The prevalence of chronic pain in older people in the community ranges from 25 to 76% and for those in residential care, it is even higher at 83 to 93%. The most common sites affected are the back, hip, or knee, and other joints. There is increased reporting of pain in women (79%) compared with men (53%). Common conditions include osteoarthritis and, to a lesser extent, the inflammatory arthropathies such as rheumatoid arthritis. The differential diagnosis includes non-articular pain such as vascular limb pain and nocturnal cramp, some neuropathic pain conditions (such as compressive neuropathies and postherpetic neuralgia), soft tissue disorders such as fibromyalgia and myofascial pain syndromes. 

 

Special reports

Improving the detection and management of type 1 diabetes

25 Jan 2016Registered users

Type 1 diabetes affects around 370,000 adults in the UK, about 10% of all those diagnosed with diabetes. In type 1 diabetes there is a lack of beta cell insulin secretion as a result of autoimmune destruction of the beta cells. However, patients are not affected by insulin resistance, and so do not routinely experience the features of metabolic syndrome that occur in type 2 diabetes. It is therefore important to classify the type of diabetes correctly and to recognise that type 1 diabetes is a condition with its own management requirements. Structured education is the cornerstone of care providing tools to allow effective self-management.

Early diagnosis improves outcomes in hepatitis C

25 Nov 2015Registered users

Hepatitis C infection (HCV) is curable but if left untreated can progress to end stage liver disease and potentially hepatocellular carcinoma. HCV management options have changed dramatically over the past five years, with improvement in cure rates and tolerability; cure rates of more than 90% can now be achieved.

 

Clinical Reviews

Can NSAIDs reduce the need for antibiotics in UTI in women?

25 Jan 2016Registered users

Although initial treatment of urinary tract infection (UTI) with ibuprofen reduced the use of antibiotics, women had a greater symptom burden and a higher risk of pyelonephritis than those treated with antibiotics from the outset, a primary care study from Germany has found.

Structured care improves mortality in women with type 2 diabetes

25 Jan 2016Registered users

Structured personal diabetes care reduced deaths from diabetes and all causes in women but not men with type 2 diabetes, in a primary care study from Denmark.The Diabetes Care in General Practice project is a Danish multicentre, cluster randomised, controlled trial. The participating practices, involving 474 GPs, were randomised to provide six years of structured personal care (243 GPs) or routine care (231 GPs) for newly diagnosed patients with type 2 diabetes. The intervention included regular follow-up, individualised goal setting and continuing medical education for the GPs in that group.

 

Temporary access selection

Evaluating the patient with low back pain

22 Dec 2015

In the UK, low back pain is the most common cause of disability in young adults and every year 6-9% of adults consult their GP about back pain. A thorough history and examination is required to exclude an alternative diagnosis, such as pain arising from the hip or trochanteric bursa and to categorise patients as having: serious spinal pathology, nerve root/radicular pain or non-specific back pain. [With external links to the evidence base]

Diagnosis and management of osteoporosis

22 Dec 2015

Osteoporosis is a common condition characterised by low bone mineral density and an increased risk of fragility fractures. It affects up to 30% of women and 12% of men at some point in their lives. The diagnosis of osteoporosis can be confirmed by DEXA but this should only be performed in patients who have an increased risk of fracture on the basis of clinical risk factors. DEXA should be considered if the 10-year risk of major osteoporotic fracture is > 10%. [With external links to the evidence base]

 

 

Editorials

Active and passive smoking linked to infertility and early menopause

25 Jan 2016Registered users

Exposure to tobacco smoke through passive as well as active smoking is associated with an increased risk of infertility and menopause occurring before the age of 50, a large observational study has shown. This is the first study to assess the impact of second-hand smoking on infertility and age of menopause.

 

HASLAM's view

Mobile phones have transformed GP care

25 Jan 2016Registered users

When it comes to the world of general practice, I have a strong suspicion that during my professional lifetime the mobile phone is the single item that has had the most effect on GPs’ lives. It has fundamentally changed so much of emergency and out-of-hours care, and the way that it is delivered.

 

PHOTOGUIDE

Skin conditions in children

25 Jan 2016Registered users

 • Classic spitz naevus •  Irritant saliva dermatitis •  Umbilical granuloma •  Cradle cap •  Molluscum contagiosum •  Juvenile plantar dermatosis

 

CPD exercises associated with each issue

CPD exercise - January 2016

25 Jan 2016Paid-up subscribers

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. The study pack contains this month’s CPD exercise plus all relevant articles: • Controlling joint pain in older people • Anxiety in older adults often goes undiagnosed • Improving the detection and management of type 1 diabetes.

 

Case reports

The case of the migrating IUD

22 Dec 2015Registered users

A 30-year-old lady presented to the gynaecologist with persistent vaginal bleeding following insertion of an IUD. A transvaginal ultrasound showed a normal uterus, normal ovaries and no adnexal masses or free fluid. It was assumed that the IUD had fallen out. Around the same time she presented to her GP with a short history of dysuria, intermittent visible haematuria and recurrent UTI. Eventually, she was referred to the urology department for further investigation and underwent flexible cystoscopy, which showed the presence of an IUD within the bladder.