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Practitioner CPD prompts to action
Immediate CPD prompts
These templates*, associated with all articles, prompt drafting of personal learning, reflection and planning.
Save your record straight into your personal development folder on your device or cloud storage system.
*Adobe fillable PDFs. Adobe reader needed for iPad
Comment or question
If you, or your peer group, would like to comment on an article or have a question for the authors, write to:
Editor
Case report submissions
Do you have an interesting case that you would like to share with other readers?
Your article would need to be around 1,500 words long, include a brief review of the literature to put the case in context, and be fully referenced in the Vancouver style.
Submissions for consideration for publication should be sent to: [email protected]
The Practitioner
The Practitioner contributes to the formal clinical literature and is primarily aimed at GPs, with subscribers throughout the World. It is also used by doctors preparing for work in the UK. All articles in The Practitioner online include CPD fillable PDF frameworks for personal reflection on learning and drafting of plans that will have an impact on practice. Preset search links to PubMed and NICE Evidence are associated with most major articles.
Symposium
|Chronic pancreatitis may be overlooked and undertreated
15 Sep 2017
Chronic pancreatitis is an irreversible, progressive condition where scarring of the pancreas occurs in response to inflammation from many aetiologies including excessive alcohol consumption, smoking, autoimmune disease and post acute severe pancreatitis. Recognising chronic pancreatitis can be challenging especially in its early stages and patients require multidisciplinary management. GPs, in conjunction with secondary care colleagues, have a crucial role in managing the often complex needs of these individuals. A mismatch exists between reported incidence and prevalence in many secondary care studies suggesting chronic pancreatitis is under recognised, especially with historical post-mortem series reporting prevalence rates up to 13%.
|Be vigilant for non-alcoholic fatty liver disease in primary care
28 Jul 2017
Non-alcoholic fatty liver disease (NAFLD) is now the most common cause of chronic liver disease in the Western world. A quarter of the UK population are obese and the numbers of patients being diagnosed with type 2 diabetes and other medical consequences of metabolic syndrome including NAFLD are high. Between 10 and 30% of NAFLD patients will develop non-alcoholic steatohepatitis (NASH) with a risk of progression to cirrhosis. The prevalence of NAFLD is increasing and now affects approximately 20% of the global population.
Special reports
|Aerobic exercise can improve sleep and pain in fibromyalgia
22 Jun 2017
Fibromyalgia is a chronic condition characterised by regional pain at multiple sites, non-restorative sleep and fatigue. In the UK, it is a common cause of musculoskeletal pain and significant disability, affecting around 2% of the population. It has a female preponderance with a female to male ratio of 7:1. Self-help strategies are important. There is strong evidence of benefit from a slow graded increase in daily aerobic exercise which can increase delta sleep and restore descending pain inhibition mechanisms. Sleep hygiene should also be considered to promote delta sleep.
|Early referral improves long-term outcomes in rheumatoid arthritis
23 May 2017
Rheumatoid arthritis is a common, chronic systemic inflammatory disease of unclear aetiology leading to synovial hypertrophy and joint inflammation. It typically presents with symmetrical polyarthritis of small joints of the hands or feet, but can also involve larger joints, and have associated extra-articular manifestations. Diagnosis is based on duration of symptoms, joint distribution, level of inflammatory markers and autoantibodies. The presence of synovitis or effusion is essential for diagnosis. Early referral of patients with suspected synovitis results in significant improvements in long-term outcomes.
Clinical reviews of research - by GPs with interest
|Risk of suicide in university students double that of graduates
22 Jun 2017
Compared with those who have completed university education, university students are more than twice as likely to commit suicide, a Swedish study has found.
Termination of pregnancy via telemedicine service safe and effective
22 Jun 2017
Women using an online telemedicine service for medical termination of pregnancy (MTOP) reported good outcomes, a study has found.Women using an online telemedicine service for MTOP reported good outcomes, a study has found. The study authors analysed data on all women from the Republic of Ireland and Northern Ireland who contacted the Women on Web telemedicine helpdesk, between January 2010 and December 2012. (In both countries termination is not available through the formal healthcare system except in restricted circumstances).
Case report submission
Do you have an interesting case that you would like to share with readers? Your article would need to be around 1,500 words long, include a brief review of the literature to put the case in context, and be fully referenced in the Vancouver style.Submissions for consideration for publication should be sent to: [email protected]
Case reports
|Palpitations: when you hear hoof beats don’t forget to think zebras
24 Apr 2017
In general practice palpitations are reported in around 8 per 1,000 persons per year. The differential diagnosis includes cardiac and psychiatric causes, as well as numerous others e.g. anaemia, hyperthyroidism, prescribed medication, caffeine and recreational drugs. Factors that point towards a cardiac aetiology are male sex, irregular heartbeat, history of heart disease, event duration > 5 minutes, frequent palpitations, and palpitations that occur at work or disturb sleep.
|Artefact mimicking torsades: treat the patient not the ECG
22 Feb 2017
There has been a marked increase in the availability and use of ECG machines in general practice. In 2008, Day and colleagues reported that 85% of GPs who responded to their survey had an ECG machine and that 91% of them used it at least once a week. We report a case in which artefact was misinterpreted as torsades de pointes, often referred to simply as torsades. Our patient did not suffer any harm and did not have any unnecessary investigations, yet inappropriate treatment was administered making the potential for harm a real possibility. We describe the ECG features which differentiate artefact from torsades and review common sources of ECG artefact, in both hospital and general practice.
|Ulnar nerve injury on removal of a contraceptive implant
15 Dec 2016
The close proximity of contraceptive implant placement to the course of the ulnar nerve can result in injury. Several factors have been implicated in this complication including: low BMI, erroneous placement of the implant, implantation over the brachial groove, and migration of the implant from its original insertion. Clinicians should familiarise themselves with the vulnerable neurovascular structures in the area and refer promptly to a specialist if any neurological symptoms develop during placement or removal of these devices.
A hundred years ago
|Dreams 3: Dreams and crime
22 Jun 2017
WHAT IS THE ASSOCIATION of dreams with crime? I have questioned insane criminals about their dreams in connection with specific crimes, and although there is always some reserve about admitting revelations in connection with criminal acts, I find that they dream much as do other people. In this class, there is a considerable difficulty in proving their hidden personal secrets, and in overcoming the resistance of the so-called “censor”.
|Dreams 2: Prophetic dreams
23 May 2017
MANY PERSONS have endeavoured to read into dreams some hidden meaning whilst others consider them to be only a confused and jumbled record of sleep-memories unworthy of serious reflection. Possibly the truth in regard to dreams lies between these two extremes of undue scepticism and a too facile credence.
PHOTOGUIDE
|Papulosquamous conditions
23 Sep 2016
• Pityriasis rosea • Discoid lupus erythematosus • Lichen planus • Seborrhoeic dermatitis • Tinea corporis • Plaque psoriasis
|Sun damage
23 Jun 2016
• Squamous cell carcinoma • Actinic keratosis horn • Bowen’s disease • Solar elastosis • Rosacea • Discoid lupus
|Conditions affecting the hair and scalp
25 Apr 2016
• Dermatitis artefacta • Alopecia mucinosa • Lichen planopilaris • Discoid lupus erythematosus • Sebaceous naevus • Basal cell carcinoma
|Fungal infections
21 Mar 2016
• Lingua villosa nigra • Onychomycosis • Tinea corporis • Tinea pedis • Id reaction • Tinea incognito
Editorials
|PPIs with aspirin in older patients lowers risk of major bleeds
28 Jul 2017
The current recommendation for patients suffering ischaemic vascular events is for lifelong antiplatelet treatment based on trial data mainly in patients under the age of 75. A UK prospective population-based cohort study assessed the risk, time course, and outcomes of bleeding on antiplatelet treatment for the secondary prevention of cardiovascular disease in patients of all ages. The Oxford Vascular Study (OXVASC) covers 92,728 patients registered with 100 GPs from nine practices in Oxfordshire.
Temporary access
|Preventing stroke and assessing risk in women
22 Mar 2017
Ischaemic stroke is rare in premenopausal women but risk increases with advancing age and doubles in the ten years following the menopause. Up to the age of 75 years men have a 25% higher risk of suffering a stroke compared with women. However, the increased life expectancy of women ultimately results in a higher overall incidence. Twice as many women die from stroke compared with breast cancer. Women with cerebrovascular disease are more likely to present with atypical symptoms than men. Atrial fibrillation and hypertension, although less common than in men, are more potent risk factors for stroke in women.
|Early recognition vital in acute coronary syndrome
24 Oct 2016
Acute coronary syndrome (ACS) includes both ST (STEMI) and non ST elevation (NSTEMI) MI, and unstable angina. Patients with ACS typically present with chest pain; classically central chest pain that radiates to the left arm. Additional symptoms include dyspnoea, nausea, sweating and syncope. However, patients can present atypically with gastric symptoms. These are often more common in patients with diabetes, women and the elderly. A 12-lead ECG should be performed if possible within 10 minutes of presentation or ideally at first contact with the emergency services.
HASLAM's view
|Do surgeons or GPs take the greatest risks?
22 Jun 2017
Ask ten thousand people which they think is the riskiest – surgery or general practice – and the only ones who will answer general practice will be surgeons or GPs. To the vast majority of the population, the drama of surgery looks horrifically risky. The drama of general practice may not be as great as it is for those who skilfully wield a scalpel while working medical and surgical miracles. However, a life that is saved by early diagnosis is just as much a life as one that is rescued from a life-threatening event.
CPD exercises associated with each issue
|CPD exercise - June 2017
22 Jun 2017
All articles in The Practitioner online include fillable PDF frameworks for personal reflection on learning and drafting of plans for CPD. These templates are also included here in our standard study pack containing this month’s CPD exercise plus all relevant articles: • Diagnosing heart disease in children and adolescents • Early referral key to better outcomes in eating disorders • Aerobic exercise can improve sleep and pain in fibromyalgia
|CPD exercise - May 2017
23 May 2017
All articles in The Practitioner online include fillable PDF frameworks for personal reflection on learning and drafting of plans for CPD. These templates are also included here in our standard study pack containing this month’s CPD exercise plus all relevant articles: • Be vigilant for dementia in Parkinson’s disease • Diagnosing and managing mild cognitive impairment • Early referral improves long-term outcomes in rheumatoid arthritis
