ESC Congress 2010
28 Aug-01 Sep 2010
Stockholm - Sweden
ESC for Primary Care Physicians and Nurses
Saturday 28 August
SEARCH
European Society of Cardiology Congress
June 2010 issue CPD exercise
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Practitioner CPD exercise - June 2010
14 Jul 2010
Chest pain, unstable angina and NSTEMI, GMC (UK) and end of life care guidance, one year mortality after MI and prostate cancer
Symposium
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Cardiovascular medicine:Chest pain of recent onset requires prompt diagnosis
23 Jun 2010
The new NICE guidance on recent onset chest pain urges GPs to assess the nature and timing of acute pain rapidly and arrange urgent admission for suspected acute coronary syndrome (ACS). Key features of the presenting history are: pain in the chest and/or other areas (e.g. the arms, back or jaw) lasting longer than 15 minutes; chest pain associated with nausea and vomiting, marked sweating breathlessness, or a combination of these; chest pain associated with haemodynamic instability;new onset chest pain, or abrupt deterioration in previously stable angina, with recurrent chest pain occurring frequently and with little or no exertion, and with episodes often lasting longer than 15 minutes. If any, or all, of these features are present ACS should be suspected. A 12-lead ECG should be performed and treatment commenced with 300 mg aspirin and GTN spray. Other pain relief such as opiates should be considered. The routine use of oxygen is not advised unless supported by pulse oximetric evidence of desaturation (<94% in those not at risk of hypercapnic respiratory failure).
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Cardiovascular medicine: Managing unstable angina and non-ST elevation MI
22 Jun 2010
Acute coronary syndrome (ACS), encompassing unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI), is often the result of an acute thrombotic occlusion of the coronary vessels, associated with atheromatous plaque rupture or erosion. ACS is associated with a severely impaired prognosis and requires prompt and efficient specialist treatment. The GP plays a major role in ensuring optimal patient management after hospital discharge and secondary prevention of cardiovascular events.
Special report and casebook
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Tackling obesity in adults in primary care
23 Jun 2010
In England in 2008, 66% of men and 57% of women had a BMI >25 kg/m2; within this 24% of men and 25% of women were obese with a BMI >30 kg/m2. The relative risk of diabetes in overweight men is 2.40 and in obese men 6.74 compared with men with a BMI in the normal range. The respective relative risks in women are 3.92 and 12.41.There is a 40% increased risk of death from cardiovascular disease for every 5 kg/m2 increase in BMI above 25 kg/m2. While trying to tackle obesity may seem like very hard work for little gain, having a structured approach to dealing with overweight and obese patients will make it easier to broach the subject and enable evidence-based advice to be given that will be helpful to all patients.
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Passive smoking damages children’s health
29 May 2010
The simplest way to prevent passive exposure of children to tobacco smoke is to encourage and support their parents to quit smoking. For parents and other family members who will not or cannot quit smoking, the next best course of action is to make the home environment in which children live completely smoke-free. Primary care health professionals, in common with all health professionals, therefore need to engage with smoking prevention and cessation initiatives at all levels, but particularly in all contacts with individual patients who smoke, or family members who smoke. As educators, GPs and practice nurses can explore with GP and nursing trainees the importance of smoking cessation in preventing disease and improving health, an element that is barely covered in the traditional organ-based medical school curricula.
Clinical Reviews
Optimal medical therapy boosts one-year survival rates following acute MI
24 Jun 2010
One-year mortality following MI can be significantly improved by giving patients a combination of five drug classes: aspirin, beta-blockers, statins, renin angiotensin system (RAS) blockers and thienopyridines. However, less than half of patients receive this optimal therapy, a study from Germany has shown. 'These findings should further reinforce our efforts to maximise the uptake of these drugs in our post-infarct populations. This should form a key part of cardiac rehabilitation and primary care chronic disease programmes.'
Watchful waiting on the increase for low-grade prostate cancer
23 Jun 2010
More men are receiving conservative management for low-grade prostate cancer, a British study has found. The authors used a longitudinal observational database, the British Association of Urological Surgeons Cancer Registry, to investigate patterns of care for low-risk, localised prostate cancer from 2000 to 2006. The database contains data from approximately 150 institutions and 400 urologists throughout the UK. 'This trend towards increasing conservative management of low-risk disease is in marked contrast to practice in the United States. If the findings of the study represent an accurate picture of patterns of care across the UK, it would indicate a significant shift in clinical practice.'
PHOTOGUIDE
HASLAM
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Myth of the guitar man in a pale blue jumpsuit
14 Jul 2010
Aren't reputations strange things? Frequently based much more on fantasy than fact, they are often completely out of our control, and - whether good or bad - often ludicrously undeserved. These thoughts were triggered by a patient who had just registered with us. He had a wealth of medical problems, and was going to be someone I would get to know well over the coming years. At the end of the consultation he said: ‘I hear you're a pretty ace guitarist too.'
100 Years ago
100 years ago: Concerning the preservation of health in the tropics
24 Jun 2010
'A healthy lad with a moderate outfit, good food, personal cleanliness, plenty of work, and a disposition that does not worry will do well in India. When a man begins to worry it is time for him to go home, and that applies if he suffers from the so-called Aden or Burma or Punjaub or Madras head. When a man forgets, calls things by wrong names, gets irritable, broods about his work at night, develops insomnia, and loses his confidence, those are symptoms of neurasthenia and the treatment is to send the case home. The Government gives one year's "leave" in every five and a month in every year, and the Goverment would not do that if it did not find that it was necessary.'
100 years ago: State prevention of tuberculosis
23 Jun 2010
We want to attack tuberculosis before it attacks us. The key is that about the period of adolescence, when business life succeeds that of childhood every youth and maid ought to be taught in a sanatorium, how to live as part of the State education. An education also at this period involving an elementary knowledge of human physiology would reap great benefits, for did the man in the street but know, for instance, the actual amount of waste products that he casts off in twenty-four hours by means of perspiration, then, I submit, that he would become more careful than he is now of personal ablutions, changes of underclothing, and perhaps of linen; with untold advantages to our national matters and morals.... Women, too, might be taught the true principles of house-cleaning, which, they might be astonished to learn, they by no means know.
International features of The Practitioner
The Pracititioner is a Pub Med indexed general medical review monthy journal with subscribers throughout the World. To support readers in different countries, collections of links to their learned societies and local information sources are being built.
The Special Interest sections will be one of the most powerful features of The Practitioner website for primary and secondary care doctors internationally.
- Users will be able to access quickly international and national websites relevant to the special interest.
- There will be showcases of the pre-eminent disease-specific European learned society, displaying links of interest to primary care.
- The web content of The Practitioner on the specific interest will be gathered in the relevant section.
Special interest: Cardiovascular medicine
The flagship Special Interest section is 'Cardiovascular medicine' . This was launched during the Heart Failure Association meeting in Berlin, Germany, 29 May to 1 June 2010.
Editorial
GMC guidance will help GPs improve end of life care
23 Jun 2010
The GMC (UK) has published important guidance on the treatment and care of patients who are likely to die within the next 12 months.1 The guidance takes account of the Mental Capacity Act, case law, the Government's end of life care strategy2 and GMC guidance on consent.3 It provides a framework for making decisions which are often clinically complex and may present ethical dilemmas, and for the first time provides guidance on advance care planning.'So far as is possible, we should try to preserve patient autonomy and minimise the role of paternalism. Advance care planning allows us to identify and respect our patient's wishes, and thereby improve care at the end of life, enhance family satisfaction and reduce the risk of depression in surviving relatives.6'
Helping patients back to work
30 May 2010
In April in the UK the old sick note, which had survived in its current form since 1922, was finally replaced with the new fit note. 'The aim is to encourage patients to return to work sooner, by focussing on capability rather than disability, while at the same time simplifying the system and reducing the number of forms that GPs need to complete.'
United Kingdom
Royal College of GPs
Royal College of Physicians
Royal College of Obstet. and Gynaecol.
Royal College of Psychiatrists
Academy of Medical Royal Colleges
Quality outcome framework
NHS Employers:QOF 9/10
Revalidation
RCGP:Revalidation
AMoRC:Revalidation
Information resources
Kings fund
Department of Health
NHS Choices
Health information resources (NHS Evidence)
NHS Improvement
Guidelines
NICE
SIGN
Drug information
BNF
BNF Children
National Prescribing Centre
Scottish Medicines Commission
Health stats
Nationmaster:UK
Europe
European Forum for Primary Care (EFPC)
European GP Research Network
European Academy of Teachers in GP
European Association for Quality in GP
Wonca Europe
European Union of GPs
European Heart network
Ireland
Irish College of GPs
Royal College of GPs: ROI faculty
College of Psychiatry of Ireland
Irish Hospital Consultants Association
Royal College of Physicians of Ireland
Royal College of Surgeons in Ireland
Irish Medical Organisation
Irish Medical Journal
Medical Council
Information resources
All Ireland Health Library
HSE Library
Department of Health and Children
Health Service Executive
Irish healthcare (BMA link)
HIQA, Health Information and Quality Authority
LENUS, the Irish Health Repository
Drug information
IMF
Irish Medicines Board
IPHA, Irish Pharmaceutical Healthcare Association
Medicines.ie
Health stats
Nationmaster:Ireland
HSE:Healthstat
Central Statistics Office
