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Practitioner CPD prompts to action
Immediate CPD prompts
These handy 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: editor@thepractitioner.co.uk
The Practitioner
The Practitioner is a PubMed indexed journal, 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
|Be vigilant for dementia in Parkinson’s disease
23 May 2017
It is estimated that up to 80% of patients with Parkinson’s disease will eventually develop cognitive impairment over the course of their illness. Even at the time of diagnosis, cognitive impairment has been reported in 20-25% of patients. Commonly affected domains are executive function, visuospatial ability and attention control. In addition, patients with Parkinson’s disease dementia may present with deficits in language function and verbal memory.
|Diagnosing and managing mild cognitive impairment
23 May 2017
The prevalence of mild cognitive impairment in adults aged 65 and over is estimated to be 10-20%. It is likely that this figure will increase in line with trends in dementia diagnosis. In some cases, mild cognitive impairment may be a prodrome for dementia, and may be caused by any of the dementia pathology subtypes. It is important to obtain a history of cognitive changes over time, as well as information about the onset and nature of cognitive symptoms, confirmed by a reliable informant, if available.
|Diagnosing testicular lumps in primary care
24 Apr 2017
Although the incidence of testicular cancer has increased over the past few decades, testicular tumours are still rare and many GPs will only see one or two new diagnoses in their career. When examining scrotal swellings, the key question is whether the lump is intra- or extra-testicular, as palpable intra-testicular lesions are highly likely (around 90%) to be malignant, whereas those lying outside the testis are usually benign.
|Diagnosing and managing androgen deficiency in men
24 Apr 2017
Androgens play a crucial role in bone, muscle and fat metabolism, erythropoiesis and cognitive health. In men aged 40-79 years the incidence of biochemical deficiency and symptomatic hypogonadism is 2.1-5.7%. Decreased libido or reduced frequency and quality of erections, fatigue, irritability, infertility or a diminished feeling of wellbeing may be presenting complaints. However, a significant proportion of men with androgen deficiency will be identified when they present for unrelated concerns.
Special reports
|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.
|Improving pain control in diabetic neuropathy
22 Mar 2017
Diabetic neuropathy is thought to affect 1.9% of the world’s population and 50% of patients with a diagnosis of diabetes mellitus which would equate to 2.25 million people in the UK. The term diabetic neuropathy includes multiple distinct clinical entities that have been classified under the broad headings of focal and multifocal neuropathies and symmetrical neuropathies. Peripheral diabetic neuropathy, a chronic distal symmetrical predominantly sensory neuropathy, is the most common form of diabetic neuropathy. The common presentation is of painful symptoms originating in the feet, that then spread to the knees before involving the distal portion of the upper limbs in a ‘glove and stocking’ distribution.
Clinical reviews of research - by GPs with interest
Gestational diabetes is on the increase
23 May 2017
The prevalence of gestational diabetes mellitus (GDM) has been increasing over the past three decades, a large retrospective cohort study from the US has shown.
Heavy drinkers and teetotallers at increased risk of wide range of cardiovascular diseases
23 May 2017
Both high levels of alcohol consumption and abstinence raise the risk of a broad spectrum of cardiovascular disorders, a UK study has shown.
Insulin pumps vs multiple injections in adults with type 1 diabetes
23 May 2017
A randomised controlled trial comparing insulin pump use with multiple daily injections suggests that when patients are engaged with intensive self-management, insulin pump therapy may not add significant extra benefits in adults.
Non-major bleeds less frequent in AF patients on apixaban
23 May 2017
Non-major bleeding was substantially less in patients on apixaban compared with those on warfarin in the Apixaban for Reduction in Stroke and other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial.
Gene variants associated with increased risk of congenital heart defects with SSRI use
24 Apr 2017
Common variants in genes related to folic acid, homocysteine and glutathione/transsulfuration metabolic pathways are associated with an increased risk of congenital heart disease in the offspring of women who take SSRIs in the periconceptual period, a US case control study has found.
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: editor@thepractitioner.co.uk
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.
A hundred years ago
|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.
|Dreams 1:Dreams, insanity and fear
24 Apr 2017
IT MAY SEEM OUT OF PLACE that we should be discussing the realms of dreamland, whilst we are face to face with so grim a reality as a War for our very existence; a War which has so deeply affected the life of every individual in this country as well as within the Empire. But we may claim that the “Bowman” in the early days of the War laid particular emphasis upon dreams — for to these of our brave warriors appeared the “Angel of the Mons,” and the “unconscious mind” has thus been drawn, in literature at any rate, into the tragedies of the War. [Written in 1917 in The Practitioner]
Editorials
|Job strain may precipitate clinical depression
23 May 2017
Job strain, a combination of high demand and low control, is associated with an increased risk of subsequent clinical depression, a meta-analysis has found. Patients who report stress at work are both more likely to be depressed and more likely to become depressed. In the UK in 2015/16, work-related stress accounted for 37% of work-related ill health and 45% of working days lost. When helping patients get back to work it is important to discuss ways of reducing job strain and the demand control support model provides a helpful framework.
|Practice nurses can improve insulin uptake in type 2 diabetes
24 Apr 2017
Achieving and maintaining glycaemic targets early on in type 2 diabetes has been shown to improve long-term outcomes. Delay in stepping up treatment, especially initiating insulin therapy is known to be a problem in primary care. A primary care study from Australia, in which practice nurses were trained to have an enhanced role, has shown improved rates of safe and effective insulin initiation compared with usual care.
HASLAM's view
|If I knew then what I know now…
23 May 2017
Directly in front of me sat a woman whose neck I can picture perfectly even after all these years. It was the suspicious looking lesion just below her hairline that had caught my attention. I felt it could well be a malignant melanoma. What should I do?
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
CPD exercises associated with each issue
|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
|CPD exercise - April 2017
24 Apr 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 testicular lumps in primary care • Diagnosing and managing androgen deficiency in men • Palpitations: when you hear hoof beats don’t forget to think zebras
