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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

Identifying and managing men with early prostate cancer

23 Apr 2018Registered users

Prostate cancer is the most common cancer in men in the UK. Men have a 1 in 8 lifetime risk of being diagnosed with the disease. Factors associated with an increased risk of prostate cancer include: age > 50 years, black ethnicity, a first-degree relative with prostate cancer, and obesity. Patients may present with erectile dysfunction or lower urinary tract symptoms such as frequency, hesitancy, nocturia, or haematuria.

Managing acute and chronic urinary retention in men

23 Apr 2018Registered users

Urinary retention is the most common urological emergency and more than 95% of cases occur in men. Acute urinary retention (AUR) is defined as the sudden inability to pass any urine voluntarily associated with a painful, palpable or percussable bladder. In chronic urinary retention (CUR) there is a non-painful bladder, which remains palpable or percussable after the man has passed urine, with a post-void residual volume > 300 ml. In acute on chronic urinary retention no urine can be voluntarily passed but the condition is relatively painless and the residual volume on catheterisation is > 1.5 litres.

 

Special reports

Early treatment vital in pelvic inflammatory disease

23 Apr 2018Registered users

Pelvic inflammatory disease (PID) is caused by infection ascending from the cervix. It can affect the uterus, fallopian tubes, ovaries, and peritoneum. Important sequelae include infertility, ectopic pregnancy and tubo-ovarian abscess. PID is associated with sexually transmitted infections. These are more prevalent in younger women. A diagnosis of PID should be considered in any sexually active woman with recent onset pelvic pain associated with tenderness on bimanual examination where other differentials have been excluded. Delay in commencing treatment for PID has been shown to increase the risk of long-term complications.

 

Clinical reviews of research - by GPs with interest

Temporary quadrupling of inhaled steroids can reduce severe asthma exacerbations

23 Apr 2018Registered users

A temporary four-fold increase in inhaled steroids for deteriorating asthma control reduced the incidence of severe exacerbations, in a UK study.

Exercise in middle age may reduce risk of heart failure

23 Apr 2018Registered users

Two years of high intensity exercise training, in previously sedentary healthy middle-aged adults, improved maximal oxygen uptake (VO2max) and reduced left ventricular (LV) stiffness, in a study from the United States. The investigators conclude that regular exercise training may protect against the future risk of heart failure with a preserved ejection fraction (HFpEF) by preventing the increase in cardiac stiffness caused by sedentary aging.

Marked regional variations identified in primary care opioid prescribing

23 Apr 2018Registered users

Opioid prescribing rates are increasing and show notable geographical variations across England. They are highest in the North and in areas of social deprivation, a study on primary care prescribing has shown. Virtually all the low prescribing areas were in the south of England and nine of the ten highest prescribing areas were northern clinical commissioning groups (CCGs).

Bicarbonate for dystocia improves maternal and fetal outcomes

23 Apr 2018Registered users

Administering a drink of sodium bicarbonate dissolved in water to women with dystocia an hour before oxytocin treatment resulted in better outcomes for both mother and child, compared with standard oxytocin treatment alone, a small trial from Sweden has found.

 

CPD exercises associated with each issue

CPD exercise April 2018

23 Apr 2018Paid-up subscribers

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: • Identifying and managing men with early prostate cancer • Managing acute and chronic urinary retention in men • Early treatment vital in pelvic inflammatory disease

 

A hundred and fifty years ago

Vagal compression for nervous affections

23 Apr 2018Registered users

On expressing my satisfaction at the improvement in her health and the increased range of foods that she was able to use with impunity, I found that she had been in the habit of applying vagal compression herself. Whenever any considerable irritation of the stomach was felt after eating, instead of waiting until the symptoms became severe, she immediately applied slight pressure on the vagus, thus arresting the symptoms at their début, and digestion was completed without further inconvenience.

 

A hundred years ago

Enuresis in childhood

23 Apr 2018Registered users

It is easy to see the ill-effects of circumstances which add new force to the fear of failure or shake the confidence in the control which has been regained.  Thus, a boy, an only child, who had suffered from enuresis till his seventh year, had regained complete control till his eleventh year, when he went to school. In his dormitory at school was a boy who had enuresis, and was being fined and punished by the schoolmaster. The enuresis at once reappeared and continued unchecked while he was at school.

 

Editorials

Intensive weight management can achieve remission in type 2 diabetes

23 Apr 2018Registered users

Almost half the patients in a UK primary care-led weight management programme achieved remission of their type 2 diabetes after a year, a study in the Lancet has shown. Forty nine general practices in Scotland and Tyneside took part in the DiRECT study, an open label, cluster randomised trial.

 

HASLAM's view

GPs must always be vigilant for the rare bird

24 Apr 2018Registered users

Isn’t it frustrating how the most complex and rare conditions can turn up when you are least expecting them? One fact that we must never ever forget is that even the world’s rarest condition will affect a patient who has a GP.

 

Diabetes

Improving pain control in diabetic neuropathy

22 Mar 2017Paid-up subscribers

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.

Frailty predicts adverse outcomes in older people with diabetes

23 Jan 2017Paid-up subscribers

In older people living with diabetes, geriatric syndromes, which indicate frailty, are emerging as a third category of complications in addition to the traditional microvascular and macrovascular sequelae. Frailty is defined by the presence of three or more phenotypes (weight loss, weakness, decreased physical activity, exhaustion and slow gait speed). Patients may progress from a non-frail to pre-frail or frail state. With timely intervention, there is a greater chance for an individual to recover from pre-frail to non-frail than to deteriorate into frailty.

 

Photoguide selection - with PubMed links

Allergic reactions

24 Sep 2015

• Fixed drug eruption • Fabric plaster reaction • Latex allergy • Morbilliform drug reaction • Allergic conjunctivitis • Anaphylaxis

Pruritus

23 Mar 2015

•Cholestatic pruritus •Phytodermatitis •Insect bites •Chickenpox •Urticaria •Hypertrophic lichen planus

Urgent referrals

23 Mar 2011

• Eczema herpeticum • Pemphigus vulgaris • Perinephric abscess • Quinsy [with pre-set links to the evidence base]