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
July/August 2010 issue CPD exercise
|
The Practitioner CPD July/August 2010
29 Aug 2010
Urinary tract infection in children, constipation in children, neuopathic pain, MI and passive smoking. Also the clinical reviews on urine cytology and also prostate cancer.
Symposium
|
Paediatics: GPs should evaluate all children following UTI
21 Jul 2010
Urinary tract infections (UTIs) are common in children in the community. Epidemiological data from the UK and Sweden suggest that 10% of girls and 3% of boys will have had an infection by 16 years of age. The majority are acute, isolated illnesses that resolve quickly, with no long-term implications for the patient. However, UTIs may be associated with underlying congenital abnormalities, and recurrent infections can lead to renal scarring. Failure to consider the diagnosis, or investigate appropriately following a diagnosis, may therefore result in long-term damage.
|
Paediatrics: Education key in tackling childhood constipation
20 Jul 2010
Constipation is the most common childhood gastroenterological problem, affecting 5-30% of children. Up to a third of these children will develop chronic constipation. The signs and symptoms of constipation in children are seldom clear and there is frequently a delay in seeking help in either a primary or secondary care setting. Patients and their parents often express concern that healthcare professionals do not take the problem seriously and the advice given is sometimes contradictory. Chronic constipation and soiling can have a massive impact on all aspects of a child's life, and that of their family, causing social, educational and psychological problems.
Special report and casebook
|
Improving the management of neuropathic pain
21 Jul 2010
Neuropathic pain is relatively common. One large European study found a prevalence of 6%. The diagnosis and treatment of long-term pain has received considerable attention recently. Long-term pain is pervasive and costly. There is an interrelationship with psychosocial problems and there are often difficulties in clarifying the diagnosis. Most treatment for long-term pain, including neuropathic pain, should be provided at the primary care level, with support as necessary from specialist services.
|
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.
Clinical Reviews
Urine cytology no help in assessment of non-visible haematuria
22 Jul 2010
A total of 200 patients attending a haematuria clinic in Quebec, Canada were studied. These patients were considered to be low risk for urothelial cancer as they were non-smokers, with no significant occupational risk factors, history of previous malignancies or radiotherapy or cyclophosphamide exposure. Approximately 15% of patients with atypical cytology were found to have tumours. When atypical cytology was analysed as a positive result, the sensitivity, specificity, positive predictive value and negative predictive value of the test were 50%, 90%, 17% and 98% respectively. 'The use of urine cytology in non-visible haematuria is currently recommended by the American Urological Association guidelines, but the British Association of Urological Surgeons/Renal Association guidelines in the UK do not recommend the routine use of cytology. While this study is small and can only be of limited use in determining the correct management strategy for this condition, it would appear to support the British guidelines. GPs should therefore observe these guidelines, with initial investigation in primary care of MSU to exclude infection plus measurement of renal function, albumin:creatinine ratio and blood pressure, followed by referral to secondary care for further investigation.'
Prostate cancer risk increases with number of affected first degree relatives
21 Jul 2010
The risk of prostate cancer increases with the number of family members with the disease, particularly brothers, and with younger age at diagnosis, a nationwide study has shown. The national Swedish family cancer database was used to estimate age-specific familial risks of being diagnosed with prostate cancer according to the number and type of affected first-degree relatives and according to paternal and fraternal age at diagnosis. The registry includes records of >11.8 million individuals and their cancers over nearly 50 years. The authors also calculated the risk of dying from prostate cancer according to family history. This is the largest family study published with more than 26,000 prostate cancer cases, of which 5,600 were familial. 'The take home message... is that the risk of prostate cancer increases with the number of affected first-degree family members, particularly brothers, and with younger age at diagnosis. Therefore, patients who fall into higher-risk groups can be identified.'
PHOTOGUIDE
HASLAM
|
GPs not working fast enough for local PCT
21 Jul 2010
'If my PCT wants me to deal with my patients any quicker, for the simple sake of some ludicrous concept of efficiency and value, the answer will be a simple one. If somewhat anatomically challenging.'
100 Years ago
A hundred years ago: The teaching of insanity to the medical practitioner
21 Jul 2010
'Hitherto there has been no separate recognition of mental diseases as a subject worthy of diploma by the examining bodies, although the London University may be quoted as conferring the title, Doctor of Medicine, upon those of its medical graduates who specialise and pass an examination in this and other subjects. The Medical-Psychological Association of Great Britain and Ireland, consisting of both medical men and women in this country and abroad, who are especially interested in mental diseases, and numbering over 700 members, grants a certificate to qualified men for proficiency in the subject of psychiatry, and it has recently approached the Royal College of Physicians of London and several of the degree-granting authorities for the purpose of promoting further interest, and, if possible, to inaugurate a diploma similar in the scope to those granted for Public Health and Tropical Medicine, and those which the University of Oxford propose to grant in Business or Journalism. It is also considering the establishment of special post-graduate courses for those who make mental disease their life-work. '
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.'
Editorial
MI admissions fall following smoking ban in England
20 Jul 2010
A study in the BMJ has found a significant reduction in the incidence of myocardial infarction (MI) since smoke-free legislation was introduced in England on 1 July 2007. To assess the effectiveness of the smoking ban the study authors analysed all patients aged 18 or older in England with an emergency admission coded with a primary diagnosis of MI. Admissions between July 2002 and September 2008 were included with the aim of comparing data from five years before the ban and 15 months afterwards. The primary outcome measure was the weekly number of completed hospital admissions. ' it would appear that smoke-free legislation leads to reductions in MI although the authors note that this was a fairly modest reduction compared with studies of smoking legislation in other countries.'
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 '
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.
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
