The Practitioner

The Practitioner is a PubMed indexed general medical review monthy journal with subscribers throughout the world. The Practitioner and this website are also used by doctors preparing themselves to work in the UK.



Women with diabetes at greater risk of CHD than men

23 Jun 2014Registered users

A recent large meta-analysis has confirmed that women with diabetes have more than a 40% higher risk of incident coronary heart disease (CHD) than men. For GPs this is a timely reminder to consider CHD as a high risk in women with diabetes, and to treat risk factors vigorously. This is especially important because routine screening in the healthy population accustoms us to women being generally at lower risk than men using the current CHD risk tools.

Weighing up the risks and benefits of androgen deprivation therapy

22 May 2014Registered users

The cardiovascular risks of androgen deprivation therapy (ADT) mean that a definite decision should be made regarding risk versus benefit for all men receiving this treatment. For men with high-risk prostate cancer, however, the oncological benefits of ADT are likely to outweigh the cardiovascular risks. Men receiving ADT should be 'medically optimised' in terms of cardiovascular risk and advice from their GP on exercise and diet is essential.


Symposium articles:Paediatrics -June issue

Be vigilant for invasive meningococcal disease

23 Jun 2014Registered users

Neisseria meningitidis is an encapsulated Gram-negative diplococcus which colonises the upper respiratory tract without causing symptoms in up to 25% of the population. In the UK serogroup B causes more than 80% of cases of invasive meningococcal disease (IMD). Petechiae which start to spread, become purpuric, occur in association with signs of shock or meningitis, or in any child who appears ill should always be treated as IMD until proven otherwise. Any child with symptoms and signs suggestive of IMD and a non-blanching rash should be transferred to hospital as an emergency immediately. IM (or IV) benzylpenicillin (or ceftriaxone) should be given at the earliest opportunity, but treatment should not delay transfer.

Diagnosing and managing peanut allergy in children

23 Jun 2014Registered users

The prevalence of peanut allergy is thought to be rising with 1 in 70 children affected in the UK. Accidental exposures are frequent and nut allergies are the leading cause of fatal food allergic reactions. Peanut allergy most commonly presents in the first five years of life. More than 90% of nut allergic children will have a history of eczema, asthma, rhinitis or another food allergy. The clinical diagnosis of peanut allergy is made from a typical history in combination with clinical evidence of sensitisation i.e. the presence of peanut-specific IgE or positive skin prick tests.


Special reports

Identifying the causes of contact dermatitis

23 Jun 2014Registered users

Contact dermatitis results from skin contact with an exogenous substance. It can be caused by direct contact, airborne particles, vapours or light. Individuals of any age can be affected. The two most common variants are irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). ICD is more common and has a worse prognosis. ICD is a form of eczema and is induced by direct inflammatory pathways without prior sensitisation. If eczema is recurrent/persistent, or occurs in an individual with no previous history of eczema, contact dermatitis should be considered. If ACD is suspected the patient should be referred to secondary care for patch testing.

Diagnosis and management of miscarriage

22 May 2014Registered users

Miscarriage is the most common complication of pregnancy. It is defined as a pregnancy failure occurring before the completion of 24 weeks of gestation. It has been estimated that 10 to 15% of all pregnancies end in early spontaneous first trimester miscarriage i.e. before the end of the completed twelfth week of pregnancy. The risk of miscarriage decreases with increasing gestational age, and late miscarriages, from 12 to 24 weeks’ gestation, occur in only 1-4% of cases. While miscarriage is rarely associated with significant health problems, it can cause significant psychological distress to the woman and her partner. [With external links to the current evidence base]


Clinical Reviews

Newer drug therapies lower morbidity and mortality in acute coronary syndrome

23 Jun 2014Paid-up subscribers

The new ADP receptor antagonists significantly reduce deaths and cardiovascular morbidity compared with clopidogrel in patients with stable angina or acute coronary syndrome managed invasively, a meta-analysis has shown. These benefits were achieved without a significant increase in bleeding complications. The researchers identified eight randomised clinical trials comparing the new ADP receptor antagonists (prasugrel, ticagrelor and cangrelor) with clopidogrel in a total of 67,851 patients with stable angina or acute coronary syndrome.

Case finding for hepatitis C in general practice

23 Jun 2014Paid-up subscribers

Identifying, and testing, patients at risk of hepatitis C (HCV) infection by GPs mainly focuses on people who inject drugs (PWID) but migrants from medium- or high-prevalence countries are often overlooked, a UK study has found. Six GP practices in Bristol, serving a total population of 73,814 patients, took part in the study. Three had a high prevalence of PWID and three a low prevalence.



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.


100 Years ago

Psychological aspects of food idiosyncrasies in infants

23 Jun 2014Paid-up subscribers

In older individuals, in whom the powers of reason have become developed, the direct influence of suggestion may be counteracted by innumerable inhibitions, but in babies, animals and hypnotized individuals the call of suggestion is imperative, and the exact form the response takes is determined by the nature of the previous responses, in other words by habit.

X-rays for severe menstrual pain and excessive bleeding

22 May 2014Paid-up subscribers

When I saw her, at the beginning of 1912, she was very pallid and weak, and was obliged to spend ten days out of every month in bed. Even during the intervening time, she was by no means altogether free from haemorrhage. Her doctor informed me that there was absolutely nothing to be made out by physical examination. Six months later, on enquiry, I learned that she continued in perfect health, despite the fact that she had plunged into a whirl of social excitements; joys which had been altogether forbidden to her for more than a year previous to her treatment. Applied in the precise manner I do it, X-rays, should they fail to do good cannot possibly do harm.


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


HASLAM's view

Compassion should not be an optional extra

23 Jun 2014Registered users

If I ever did need to see him again, I would like to be under a general anaesthetic before the consultation started. Surely talking to patients with compassion shouldn’t be an optional extra. What do you think, doctor?


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Lumps and bumps

23 Jun 2014Registered users

  • Haematoma
  • Furuncle
  • Prayer nodule
  • Pilomatrixoma
  • Umbilical granuloma
  • Neurofibroma

Pigmented lesions

22 May 2014Registered users

  • Malignant melanoma
  • Pigmented basal cell carcinoma
  • Seborrhoeic keratosis
  • Lichen planus
  • Dermatofibroma

CPD exercises associated with each issue

CPD exercise - June 2014

23 Jun 2014Paid-up subscribers

The Practitioner's CPD exercise this month is based on: • Be vigilant for invasive meningococcal disease • Diagnosing and managing peanut allergy in children • Identifying the causes of contact dermatitis. 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 - May 2014

22 May 2014Paid-up subscribers

The Practitioner's CPD exercise this month is based on: • Improving the detection and treatment of schizophrenia • Depression in older people is underdiagnosed • Diagnosis and management of miscarriage. 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. Alternatively, articles can be downloaded one at a time from this page.


Primary Care Urology Society (UK)

Primary Care Urology Society

Call for GPs with an interest in urology/men’s health

 Dr Jon Rees, a GPwSI urology who writes The Practitioner's clinical reviews in this area, is looking at setting up a Primary Care Urology Society. The organisation would develop an educational programme to support GPs in their work in primary care and in other GPwSI roles.

Membership would be open to all GPs who wish to extend their education in this field beyond that of a standard generalist, not just GPwSIs.

There is also the potential of affiliating the group with the British Association of Urological Surgeons which would allow collaboration between primary and secondary care.

To register your interest please email drjonrees@gmail.com