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International Primary Care Association

Clinical Focus Volume 1 N3

IPCA Admin

IPCA Admin

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Stress echocardiography today has matured into a robust and reliable technique not only for the diagnosis of suspected coronary artery disease (CAD) but also for the accurate risk stratification of patients with suspected and established CAD. This is mainly because of rapid advances in image acquisition, digital display, and the development of harmonic and contrast imaging. Stress echocardiography today is also utilised in patients with heart failure both for assessing the underlying aetiology of heart failure and determining the extent of hibernating myocardium. With advances in myocardial perfusion imaging, stress echocardiography now allows simultaneous assessment of myocardial function and perfusion. Tissue Doppler imaging allows quantitation of wall motion. Ready availability and reliability makes stress echocardiography a cost effective technique for the assessment of CAD.


Polymyalgia Rheumatica is a benign chronic/relapsing inflammatory condition of unknown aetiology, that affects middle aged people and the elderly. It has a higher prevalence in Caucasian women than in men. There is ongoing discussion regarding the relationship between polymyalgia rheumatica (PMR) giant-cell arteritis (GCA). They are linked conditions, and considered to be different phases of the same disease. Both have acute or insidious presentation and can be referred as an emergency to the newly established medical assessment unit and the acute Physician is likely to see more of these patient because of the rising incidence and the non-specific clinical manifestation of this condition. Both can mimic more serious diseases such as rheumatoid arthritis, polymyositis and occult malignancy. The response to corticosteroids is dramatic within 24 hours and considered to be a diagnostic test in itself.


Practitioners with a special interest in breast diseases will provide effective triage for symptomatic women. After training, by maintaining skills in breast examination they can identify those in need of hospital assessment and reduce the number of unnecessary referrals, particularly for mastalgia, nipple discharge and non-significant family history.


Presenting as anogenital warts, the human papillomavirus (HPV) is the most common viral sexually transmitted infection diagnosed in the United Kingdom (UK). General Practitioners with Special Interests (GPwSIs) that include Sexual Health should be able to manage this common and often frustrating condition. Not routinely requiring partner notification and being diagnosed almost exclusively on clinical appearance, with options for patient selftreatment, genital warts in most cases, lend themselves ideally for management in a primary care setting.

GPwSIs should have knowledge of the homebased treatments and be competent in the use of at least one office-based method. They should be able to advise patients appropriately, perform routine screening tests for sexually transmitted infections and know when to refer to a specialist centre.

Limited resources in the NHS is nothing new, but the recent changes and drives from the Department of Health have had a significant impact on the relationships between doctors in primary and secondary care, as well as the roles and services provided. With great change brings great opportunity. Large egos need to be placed aside as we as a profession take this opportunity to work closely together as a unified team. Most would agree that good teamwork is essential for success, and that respect for all members of the team is paramount. One of us still remember the first clinical attachment at medical school when the Professor of Medicine spoke of the importance of dignity, not only in relation to the patients we treat, but also to those with whom we work. “Do not underestimate anyone in the team”, he said, “not even the cleaners, for without them our workplace would not be safe enough to see patients, and without patients we would be without a job!”

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