Editor Admin International Primary Care Association(IPCA) is an international membership-based organisation of doctors, nurses and allied healthcare professionals with special interests, or are thinking of developing one for career advancement. http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/itemlist/user/58-editoradmin 2018-12-11T10:32:45+00:00 Joomla! - Open Source Content Management ‘Just a fatty lump?’- Imaging soft tissue tumours and suspected sarcoma 2018-07-27T14:22:50+00:00 2018-07-27T14:22:50+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/291-just-a-fatty-lump-imaging-soft-tissue-tumours-and-suspected-sarcoma Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Soft tissue tumours, in particular lipoma, are relatively common with a very high cure rate and low rate of recurrence following excision. They outnumber malignant soft tissue lesions considerably, making identification of aggressive lesions difficult and potentially leading to diagnostic delays. Soft tissue sarcomas are a relatively uncommon group of malignancies arising in mesenchymal tissues, and hence, can occur almost anywhere in the body. In recent years, the investigation and management of these lesions have been centralised to a number of specialist centres throughout the UK in an effort to aid early identification and streamline management of malignant soft tissue tumours.</p></div> <div class="K2FeedIntroText"><p>Soft tissue tumours, in particular lipoma, are relatively common with a very high cure rate and low rate of recurrence following excision. They outnumber malignant soft tissue lesions considerably, making identification of aggressive lesions difficult and potentially leading to diagnostic delays. Soft tissue sarcomas are a relatively uncommon group of malignancies arising in mesenchymal tissues, and hence, can occur almost anywhere in the body. In recent years, the investigation and management of these lesions have been centralised to a number of specialist centres throughout the UK in an effort to aid early identification and streamline management of malignant soft tissue tumours.</p></div> Intellectual disability – the essentials for General Practitoners 2018-07-27T14:17:19+00:00 2018-07-27T14:17:19+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/290-intellectual-disability-the-essentials-for-general-practitoners Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>In this article we introduce the key features and health considerations associated with intellectual disability. Although roughly 1% of the population has an intellectual disability, their needs are frequently overlooked, both in medical training and in clinical practice. This contributes to worse clinical outcomes and excess mortality. General Practitioners have an important role in the co-ordination and delivery of high-quality care for this group.</p></div> <div class="K2FeedIntroText"><p>In this article we introduce the key features and health considerations associated with intellectual disability. Although roughly 1% of the population has an intellectual disability, their needs are frequently overlooked, both in medical training and in clinical practice. This contributes to worse clinical outcomes and excess mortality. General Practitioners have an important role in the co-ordination and delivery of high-quality care for this group.</p></div> Unwanted Tropical Souvenirs 2018-07-27T14:10:22+00:00 2018-07-27T14:10:22+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/289-unwanted-tropical-souvenirs Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>As global travel becomes more accessible, so is the incidence of diseases in the returning traveller. Secondary to gastrointestinal and fever of unknown origin, dermatological presentations are the most prevalent complaints with which patients present. Dermatoses can be non-infective, such as sunburn or worsening of eczema, or infective, and can be specific to the travelled area, such as Dengue or Zika, or can be also be found at home, such as cellulitis. Dermatological presentations are varied, and result in rashes, blisters, bullae, nodules or plaques, to name a few. This review aims to outline some of the most common conditions seen in the returning traveller; both those with primary and secondary dermatological manifestations, and how to manage them appropriately.</p></div> <div class="K2FeedIntroText"><p>As global travel becomes more accessible, so is the incidence of diseases in the returning traveller. Secondary to gastrointestinal and fever of unknown origin, dermatological presentations are the most prevalent complaints with which patients present. Dermatoses can be non-infective, such as sunburn or worsening of eczema, or infective, and can be specific to the travelled area, such as Dengue or Zika, or can be also be found at home, such as cellulitis. Dermatological presentations are varied, and result in rashes, blisters, bullae, nodules or plaques, to name a few. This review aims to outline some of the most common conditions seen in the returning traveller; both those with primary and secondary dermatological manifestations, and how to manage them appropriately.</p></div> Dementia: A Clinical Guide 2018-07-27T14:06:22+00:00 2018-07-27T14:06:22+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/288-dementia-a-clinical-guide Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Dementia is a common clinical syndrome affecting 1 in 14 adults over the age of 65 and a smaller number of younger people. This article explores presentation, assessment, differential diagnosis and management, providing an overview for the generalist and a more in depth insight for those with a special interest.</p></div> <div class="K2FeedIntroText"><p>Dementia is a common clinical syndrome affecting 1 in 14 adults over the age of 65 and a smaller number of younger people. This article explores presentation, assessment, differential diagnosis and management, providing an overview for the generalist and a more in depth insight for those with a special interest.</p></div> Cannabis and the primary care physician 2018-07-27T14:00:37+00:00 2018-07-27T14:00:37+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/287-cannabis-and-the-primary-care-physician Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Cannabis, in herbal and synthetic forms, is becoming increasingly discussed in and advocated for the management of multiple health conditions. Some of this advocacy comes from both prominent figures and politicians. Alongside this there is significant work being undertaken to bring cannabis and products containing cannabinoids to market. This makes understanding the nature of cannabis, the biological and social pressures associated with its use and the evidence of treatment effectiveness, increasingly important. This paper provides a broad overview of cannabis and its potential uses in medicine.</p></div> <div class="K2FeedIntroText"><p>Cannabis, in herbal and synthetic forms, is becoming increasingly discussed in and advocated for the management of multiple health conditions. Some of this advocacy comes from both prominent figures and politicians. Alongside this there is significant work being undertaken to bring cannabis and products containing cannabinoids to market. This makes understanding the nature of cannabis, the biological and social pressures associated with its use and the evidence of treatment effectiveness, increasingly important. This paper provides a broad overview of cannabis and its potential uses in medicine.</p></div> Identifying and managing acute confusion in older adults; beyond the hospital setting 2018-07-27T13:49:15+00:00 2018-07-27T13:49:15+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/286-identifying-and-managing-acute-confusion-in-older-adults-beyond-the-hospital-setting Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Delirium represents a relatively uncommon, but important, presentation within primary care; particularly amongst at risk populations including those with dementia or living in residential care. Recognising delirium effectively is important to provide prompt and effective management to minimise adverse consequences.</p></div> <div class="K2FeedIntroText"><p>Delirium represents a relatively uncommon, but important, presentation within primary care; particularly amongst at risk populations including those with dementia or living in residential care. Recognising delirium effectively is important to provide prompt and effective management to minimise adverse consequences.</p></div> from the editor... 2018-07-27T13:29:01+00:00 2018-07-27T13:29:01+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/284-from-the-editor Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p><span style="font-size: 12.16px; line-height: 1.3em;"><span><span>A heatwave across the country, and no sign of letting up. British politics also generating plenty of heat, both </span><span>nationally and internationally.</span></span> </span><span style="font-size: 12.16px; line-height: 1.3em;"> </span></p> </div><div class="K2FeedFullText"> <p><span style="font-size: 12.16px;">The NHS is rarely out of the news. A further two poisonings with Novichok, with one fatality. I am certain that </span><span style="font-size: 12.16px;">without the dedicated expert care and high-quality NHS facilities, the outcomes would have been worse. Rightly </span><span style="font-size: 12.16px;">the focus is on the methods of delivery of the poison and the perpetrators, but it would have been morale boosting </span><span style="font-size: 12.16px;">if the medical services had more media time! The PM has indicated a further £20 billion for the NHS, welcome, </span><span style="font-size: 12.16px;">but rapidly there was a realization it was not from the windfall figure painted on the side of the Brexit bus, but will </span><span style="font-size: 12.16px;">require a rise in taxation levels. So much for windfalls.</span></p> <p>Theresa May has been checked by her Chequers Brexit proposal but interestingly an amendment in the Commons did vote for continued collaboration and alignment of the Medicines Agency. It may not prevent the potential paucity of drugs in a “No Deal Brexit”, or other “Fudge” but at least UK will still benefit from the cooperation so vital in health of both medical devices and pharmaceutical products. </p> <p>GDPR, General Data Protection Regulations, came into force at the end of May and the world has not collapsed around us. Remember the Millennium bug worries. Nevertheless, to catch a few bad boys, Internet and Social media companies, every organization has been enmeshed in a net to capture a few. The cost to SMEs, including health organisations, is considerable, in both time and resources. More bureaucrats delivering a blunderbuss policy with an unproven evidence base. Generally, like drug lords, it already known who the main perpetrators are likely to be, so a focused approach would have been less costly.</p> <p>The £20 billion mentioned earlier is hardly going to cope with the demographic changes which will result in an escalation of healthcare costs. One chronic disease, dementia, will be eating away large chunks of the health service cake. Devine (p.92) does not mention costs, that is a fact that all are aware of, but concentrates on the human and patient aspects. Gallagher and Hinchcliffe (p.74) highlight a common presentation in our ageing population.</p> <p>Lord Hague, ex leader of the Conservative party and Foreign secretary, has added his weight to the debate on legalizing cannabis for recreational use. The debate was ignited by a mother demanding cannabis for her child, for medical purposes. Newton-Howes et al (p.84) provide a medical perspective of this much misunderstood drug.</p> <p>Holidays will be in full flow by the time of publication of this issue and many of us will be reveling in the tropics. Try not to bring back unwanted skin souvenirs (Mounsey et al p.104). I was interested to learn that Intellectual Disability affects ~1% of the UK population, that is a whooping 650K (Sheehan et al p.113) and the vital role that GPs/Primary Care and Community physicians can play in managing patients who suffer. This issue ends with Fatty skin lumps (Bean et al p.124) focusing on investigations on the potential myriads of aetiologies and their radiological features.</p> <p>Enjoy the summer and by the time of the next issue one of several events will have occurred. Boris Johnson may be Prime Minister, UK will have a no deal Brexit, a 2nd Brexit referendum will be called, an early election will be in the offing and the NHS will have a wonderful 70th birthday and will outlive all of us.</p> <p><strong style="font-size: 12.16px;"><span style="line-height: 1.3em;">Professor Ram Dhillon</span></strong></p> <p><em style="font-size: 12.16px; line-height: 1.3em;"><span style="line-height: 1.3em;">Editor</span></em></p> <p><em style="font-size: 12.16px; line-height: 1.3em;"><span style="line-height: 1.3em;">ram.dhillon@rila.co.uk</span></em></p></div> <div class="K2FeedIntroText"><p><span style="font-size: 12.16px; line-height: 1.3em;"><span><span>A heatwave across the country, and no sign of letting up. British politics also generating plenty of heat, both </span><span>nationally and internationally.</span></span> </span><span style="font-size: 12.16px; line-height: 1.3em;"> </span></p> </div><div class="K2FeedFullText"> <p><span style="font-size: 12.16px;">The NHS is rarely out of the news. A further two poisonings with Novichok, with one fatality. I am certain that </span><span style="font-size: 12.16px;">without the dedicated expert care and high-quality NHS facilities, the outcomes would have been worse. Rightly </span><span style="font-size: 12.16px;">the focus is on the methods of delivery of the poison and the perpetrators, but it would have been morale boosting </span><span style="font-size: 12.16px;">if the medical services had more media time! The PM has indicated a further £20 billion for the NHS, welcome, </span><span style="font-size: 12.16px;">but rapidly there was a realization it was not from the windfall figure painted on the side of the Brexit bus, but will </span><span style="font-size: 12.16px;">require a rise in taxation levels. So much for windfalls.</span></p> <p>Theresa May has been checked by her Chequers Brexit proposal but interestingly an amendment in the Commons did vote for continued collaboration and alignment of the Medicines Agency. It may not prevent the potential paucity of drugs in a “No Deal Brexit”, or other “Fudge” but at least UK will still benefit from the cooperation so vital in health of both medical devices and pharmaceutical products. </p> <p>GDPR, General Data Protection Regulations, came into force at the end of May and the world has not collapsed around us. Remember the Millennium bug worries. Nevertheless, to catch a few bad boys, Internet and Social media companies, every organization has been enmeshed in a net to capture a few. The cost to SMEs, including health organisations, is considerable, in both time and resources. More bureaucrats delivering a blunderbuss policy with an unproven evidence base. Generally, like drug lords, it already known who the main perpetrators are likely to be, so a focused approach would have been less costly.</p> <p>The £20 billion mentioned earlier is hardly going to cope with the demographic changes which will result in an escalation of healthcare costs. One chronic disease, dementia, will be eating away large chunks of the health service cake. Devine (p.92) does not mention costs, that is a fact that all are aware of, but concentrates on the human and patient aspects. Gallagher and Hinchcliffe (p.74) highlight a common presentation in our ageing population.</p> <p>Lord Hague, ex leader of the Conservative party and Foreign secretary, has added his weight to the debate on legalizing cannabis for recreational use. The debate was ignited by a mother demanding cannabis for her child, for medical purposes. Newton-Howes et al (p.84) provide a medical perspective of this much misunderstood drug.</p> <p>Holidays will be in full flow by the time of publication of this issue and many of us will be reveling in the tropics. Try not to bring back unwanted skin souvenirs (Mounsey et al p.104). I was interested to learn that Intellectual Disability affects ~1% of the UK population, that is a whooping 650K (Sheehan et al p.113) and the vital role that GPs/Primary Care and Community physicians can play in managing patients who suffer. This issue ends with Fatty skin lumps (Bean et al p.124) focusing on investigations on the potential myriads of aetiologies and their radiological features.</p> <p>Enjoy the summer and by the time of the next issue one of several events will have occurred. Boris Johnson may be Prime Minister, UK will have a no deal Brexit, a 2nd Brexit referendum will be called, an early election will be in the offing and the NHS will have a wonderful 70th birthday and will outlive all of us.</p> <p><strong style="font-size: 12.16px;"><span style="line-height: 1.3em;">Professor Ram Dhillon</span></strong></p> <p><em style="font-size: 12.16px; line-height: 1.3em;"><span style="line-height: 1.3em;">Editor</span></em></p> <p><em style="font-size: 12.16px; line-height: 1.3em;"><span style="line-height: 1.3em;">ram.dhillon@rila.co.uk</span></em></p></div> Principles & Practice of Postnatal Care 2018-03-14T17:12:55+00:00 2018-03-14T17:12:55+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/283-principles-practice-of-postnatal-care Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>The puerperium marks the 6-8 week post-partum period, where the body reverts back to its pre-pregnancy state with the resolution of the anatomical, physiological, endocrine and biochemical changes of pregnancy. Effective postnatal care should include provision of support with regard to breast feeding, emotional wellbeing and management of birth -related complications such as perineal tears, and, advice regarding contraception. Timely recognition and management of complications, which may occur during the postnatal period such as secondary haemorrhage, endometritis, wound infections, venous thrombo-embolism and post-partum psychosis is vital to optimise maternal and neonatal outcomes.</p></div> <div class="K2FeedIntroText"><p>The puerperium marks the 6-8 week post-partum period, where the body reverts back to its pre-pregnancy state with the resolution of the anatomical, physiological, endocrine and biochemical changes of pregnancy. Effective postnatal care should include provision of support with regard to breast feeding, emotional wellbeing and management of birth -related complications such as perineal tears, and, advice regarding contraception. Timely recognition and management of complications, which may occur during the postnatal period such as secondary haemorrhage, endometritis, wound infections, venous thrombo-embolism and post-partum psychosis is vital to optimise maternal and neonatal outcomes.</p></div> Growth in Infants and Preschool Children 2018-03-14T17:01:40+00:00 2018-03-14T17:01:40+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/282-growth-in-infants-and-preschool-children Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Concerns about a child’s growth are commonly encountered in primary care. These concerns may be raised by family members, healthcare colleagues or social care professionals. Steady normal weight gain is a commonly seen as a reassuring sign that an infant or child is healthy.</p> <p>Abnormal growth has a wide range of possible aetiologies and is often multifactorial. A key role of the primary care practitioner is to consider the possibility of underlying systemic disease as well as review wider determinants of child health including socioeconomic situation, maternal mental health, parental and family behaviour and safeguarding issues.</p> <p>Alongside faltering growth, considering what constitutes excessive growth is increasingly relevant in view of rising rates of childhood obesity and the long-term implications for the child and society.</p> <p>This article presents an approach to assessing growth concerns. The identification of an abnormal pattern of growth should prompt a detailed assessment, management planning with families and sometimes referral for specialist care.</p></div> <div class="K2FeedIntroText"><p>Concerns about a child’s growth are commonly encountered in primary care. These concerns may be raised by family members, healthcare colleagues or social care professionals. Steady normal weight gain is a commonly seen as a reassuring sign that an infant or child is healthy.</p> <p>Abnormal growth has a wide range of possible aetiologies and is often multifactorial. A key role of the primary care practitioner is to consider the possibility of underlying systemic disease as well as review wider determinants of child health including socioeconomic situation, maternal mental health, parental and family behaviour and safeguarding issues.</p> <p>Alongside faltering growth, considering what constitutes excessive growth is increasingly relevant in view of rising rates of childhood obesity and the long-term implications for the child and society.</p> <p>This article presents an approach to assessing growth concerns. The identification of an abnormal pattern of growth should prompt a detailed assessment, management planning with families and sometimes referral for specialist care.</p></div> Diabetic nephropathy: an overview 2018-03-14T16:58:08+00:00 2018-03-14T16:58:08+00:00 http://ipcauk.org.nmsrv.com/index.php/clinical-focus-primary-care/cf-volume-10-n2/item/281-diabetic-nephropathy-an-overview Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Diabetic nephropathy is the major cause of end-stage renal disease. It is characterised by albuminuria and by a progressive relentless decline of the glomerular filtration rate. Current management with optimal blood glucose and blood pressure control prevents and slows disease progression as these factors contribute to disease pathophysiology. There are also new therapies currently being explored, which may have additional benefits.</p></div> <div class="K2FeedIntroText"><p>Diabetic nephropathy is the major cause of end-stage renal disease. It is characterised by albuminuria and by a progressive relentless decline of the glomerular filtration rate. Current management with optimal blood glucose and blood pressure control prevents and slows disease progression as these factors contribute to disease pathophysiology. There are also new therapies currently being explored, which may have additional benefits.</p></div>