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International Primary Care Association

Clinical Focus Primary Care

The air of spring this year is been pushed back and back, with storms, rain and snow predicted for April/May. This seems to be the mirror image of the Brexit process, pushed back and delayed and delayed. At the time of writing the plan was to exit 20th June, although the EU may well offer a 12 month extension as most EU Heads of State are getting mighty peeved off, understandably so, of having to reconvene in Brussels every week or two to consider yet another extension/proposal from the UK.  

Measurement of lipids is regularly performed in General Practice, most commonly as part of a cardiovascular risk assessment. Hypercholesterolaemia increases the risk of cardiovascular disease and hypertriglyceridaemia is associated with metabolic syndrome and pancreatitis. The majority of hyperlipidaemia is successfully managed by General Practitioners, however, some cases (including monogenic hyperlipidaemia, marked hypertriglyceridaemia and treatment intolerance) may require specialist input. The expansion of dedicated lipid services in secondary care and the licensing of monoclonal antibody therapy for hypercholesterolaemia heralds an exciting new period in lipid management. Lipidologists (who often have a Chemical Pathology background) provide an important interface between the laboratory and General Practice. This article aims to provide hints and tips for interpreting a lipid profile in General Practice, and also gives guidance on identification, management and referral of individuals with hyperlipidaemia.

Doctors are taught very little about nutrition at medical school and what little they know is even harder to translate into practice due to knowledge attrition compounded by mixed messages from the media. We ought to educate ourselves on the basics of nutrition and enquire into our patients’ nutritional status via a simple two question screening tool. This will enable us to appropriately guide our patients who are usually more receptive to advice coming from their family doctors whom they have come to know and trust. In an era of growing waistlines and shrinking NHS pockets, this simple two question screening tool followed by evidence-based nutritional advice offers the biggest bang for our buck when it comes to positively affecting our patients’ lifestyle choices.

Within the UK, tuberculosis remains an important public health issue and although the incidence is reducing, it remains clustered around urban areas and vulnerable groups. Presentation is varied depending on pulmonary or extrapulmonary involvement. Combination antimicrobials are used to treat TB and each has its own side effects and interactions.

Treatment burden is the ‘work of being a patient’. It comprises the time, effort and financial implications of following a treatment regimen in chronic disease, and the consequent impact on patients. Treatment burden may affect adherence, quality-of-life and health outcomes. Patients vary in their capacity to manage treatment demands. The concept of treatment burden is now recognised in national guidance on multimorbidity. GPs have an opportunity to enhance patient-centred care through recognition and optimisation of treatment burden.

This review offers practical tips on how to differentiate different tremor types, and reviews current treatment options.

General Practitioners/Primary Care Physicians are frequently consulted to assess feverish children. Of these presentations, thankfully, most are self-limiting illnesses requiring minimal medical intervention. However, identification of children with potentially serious infections such as meningitis, pneumonia or urinary tract infections, which may lead to sepsis, is imperative in order to prevent avoidable morbidity and mortality in this vulnerable population group. Thus, appropriate diagnosis of infections in children within the primary care setting is challenging, and very important.

A heatwave across the country, and no sign of letting up. British politics also generating plenty of heat, both nationally and internationally.  


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International Primary Care Association
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