Volume 10 Issue 1 - 2016 http://ipcauk.org Wed, 19 Dec 2018 01:16:40 +0000 Joomla! - Open Source Content Management en-gb from the editor... http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/235-from-the-editor http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/235-from-the-editor

We are well into 2016. So much happening in healthcare.


The government managed to extract defeat from the jaws of victory as the junior doctors reinstated their February strike. Perhaps the claim from the employers that 15 of the 16 issues had been agreed prior to the most recent talks was an economy of the truth. It did not augur well that the Prime Minister, in a Radio 4 interview, indicated that ultimately the government will not allow a veto over the contract, implying it could be imposed. Indeed, imposition it will be. Around the world government confrontation with medical professionals has usually ended with a climb down by the former. I think history will repeat in this instance.  


I do recall the heady days of the mid 70s of the last strike. I was still a medical student and remember vividly that in similar circumstances the then Secretary of State for Health, Barbara Castle, managed with her polarizing invective, to produce a 15% exodus to foreign climes of newly qualified doctors from my alma mater, the Middlesex Hospital Medical School. There is a real danger that the present government will display a similar machismo that worsens an already beleaguered medical workforce, who have the option of walking out of the exit door of the NHS.


The link of an increase in birth defects, microcephaly, and the mosquito transmission of the Zika virus, is a tragedy. One can only feel for the families where a child is borne with this anomaly. However, the link has not conclusively been proven so prevention and prophylaxis will have to wait until the research has been undertaken. The positive is that the WHO has mobilized the medical and scientific community, which compared to the sluggish approach to the Ebola outbreak, must be commended. Maybe lessons have been learnt, but it will still be 18 months plus to gather evidence and formulate a possible vaccine.


The Savile inquiry and all the other investigations have highlighted how Child Sexual Exploitation can be easily dismissed, even accepted and is frequently perpetrated by those who are in positions of actually protecting individuals. Weller and her colleagues (p.8) provide a synopsis for GPs to recognise earlier potential cases as they may present in primary care.


Dog bite injuries are most frequently seen in children and Mannion et al (p. 18) suggest why this may be. The potential complications, usually understated, associated with what may be a trivial injury are discussed.


This issue continues its paediatric theme with an overview of paediatric urological disorders by Garrod et al (p. 26) and the timely contribution on sepsis in the younger age group by King and Snelson (p. 35). The latter is apposite given the high prolife medicolegal cases of missed, and eventually fatal respiratory infections in babies. We finish with Diggins et al’s article on Self-Harm (p. 46). There is an increasing incidence of this medical issue, with poor provision for mental health clearly a contributory factor. Despite evidence of this inadequate service, highlighted by voluntary and patient organisations, the government seems to be very much behind the curve of the figures revealed in needs assessment! The decades of underfunding cannot be fixed, as the politicians keeping claiming, by throwing a couple
of billion at it. More is, I am afraid, needed, to plug the massive holes created by successive governments.


Happy reading.


Professor Ram Dhillon

info@ipcauk.org (Editor Admin) Volume 10 Issue 1 - 2016 Wed, 02 Mar 2016 08:48:37 +0000
“Child Sexual Exploitation – A primary care perspective” http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/236-child-sexual-exploitation-a-primary-care-perspective http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/236-child-sexual-exploitation-a-primary-care-perspective


It is important that doctors and health professionals are aware that children and young people who are sexually exploited can present across a range of health settings with a variety of physical and mental health problems, and actively consider the possibility of sexual exploitation in their assessments.

‘GPs are ….in an ideal position to notice early signs of childhood sexual exploitation when children present in their surgeries, if alert to possible indicators.

info@ipcauk.org (Editor Admin) Volume 10 Issue 1 - 2016 Wed, 02 Mar 2016 08:54:37 +0000
Dog Bite Injuries http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/237-dog-bite-injuries http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/237-dog-bite-injuries


There are over 8.5 million dogs in the United Kingdom with approximately 30% of all households owning a domestic dog. However, while there has been an increasing popularity of the domestic dog, so there has been a significant increase in the number of dog bite injuries (DBI) recorded.

info@ipcauk.org (Editor Admin) Volume 10 Issue 1 - 2016 Wed, 02 Mar 2016 09:16:38 +0000
Core Paediatric Urology for Community Physicians http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/238-core-paediatric-urology-for-community-physicians http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/238-core-paediatric-urology-for-community-physicians


Urological conditions can often be a source of considerable anxiety for both parent and child but with an understanding of normal anatomy and basic conditions it is possible to manage many presentations in the community and provide reassurance to families.


info@ipcauk.org (Editor Admin) Volume 10 Issue 1 - 2016 Wed, 02 Mar 2016 09:19:57 +0000
The identification and management of paediatric sepsis in primary care http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/239-the-identification-and-management-of-paediatric-sepsis-in-primary-care http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/239-the-identification-and-management-of-paediatric-sepsis-in-primary-care


Paediatric sepsis is an important cause of morbidity and mortality in children. However, in a primary care setting it remains uncommon. This is a review of the current understanding of paediatric sepsis together with evidence-based advice about its recognition and management in primary care.


info@ipcauk.org (Editor Admin) Volume 10 Issue 1 - 2016 Wed, 02 Mar 2016 09:22:03 +0000
Self-Harm – A Primary Care Perspective http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/240-self-harm-a-primary-care-perspective http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n1/item/240-self-harm-a-primary-care-perspective


The incidence of self-harm is increasing in the UK. It is the single best predictor of completed suicide and is associated with poor outcomes in terms of emotional wellbeing and educational attainment. The majority of patients do not present to medical services after an episode of self-harm and so GPs play an important role in identifying the problem, reducing stigma and providing support.


Self-harm is associated with a broad range of risk factors related to emotional distress rather than severe mental illness. It is commonly associated with misuse of alcohol and other substances. Other important risk factors are adverse life events such as unemployment and relationship difficulties, as well as a history of current or past abuse or institutional care. In young people precipitating factors can include arguments with parents and stressors at school such as exam pressures, bullying or cyber bullying.


Self-harm is stigmatised by the general public and medical professionals, so there is a need to approach the subject with sensitivity, respect and acceptance. Self-harm is a behaviour, rather than a diagnosis in itself. It can be seen as a symptom of an underlying mental or personal difficulty, or serve a function for the patient; exploring these reasons can guide management, which focuses on the underlying difficulties. Actively involve the patient in the management plan, asking about their preferences and previous experiences of treatment. High risk patients with a severe mental illness or active suicidal thoughts should be urgently referred on to mental health services for further assessment. Patients at low risk may be supported in primary care, and those in between can be referred to non-urgent mental health or social services, or a 3rd party organisation.

info@ipcauk.org (Editor Admin) Volume 10 Issue 1 - 2016 Wed, 02 Mar 2016 09:24:47 +0000