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/index.php/clinical-focus-primary-care/cf-volume-6-n3/itemlist/user/58-editoradmin 2018-01-17T19:06:36+00:00 Joomla! - Open Source Content Management Red Flags in Ophthalmology 2017-04-28T09:04:27+00:00 2017-04-28T09:04:27+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n2/item/268-red-flags-in-ophthalmology Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Eye problems account for 4.5 million GP consultations yearly, in the United Kingdom, and evidence shows that 50% of sight loss could be avoided through improved eye care and early detection. While often it is obvious when an eye condition needs referral (for example the red, painful eye, or sudden loss of vision), there are a number of potentially blinding or even lifethreatening conditions which may present atypically or with subtle signs that may be missed. Such misdiagnoses can have serious implications. </p> <p>This article examines common presentations in ophthalmology and suggest some important ‘red flags’ in each which merit urgent attention. We have placed emphasis on conditions which can be life or sight-threatening, which can present atypically, and whose ‘red flags’ are aspects of history or examination which are easily and quickly elicited in the GP consultation. </p> <p>It is worth noting that while many of the conditions discussed frequently present with eye symptoms (and indeed may be seen in eye casualty), they may in fact reflect other underlying disease processes (e.g. raised intracranial pressure). Having the conviction to refer such patients directly to the medical or neurology team for treatment results in a safer and faster patient journey.</p></div> <div class="K2FeedIntroText"><p>Eye problems account for 4.5 million GP consultations yearly, in the United Kingdom, and evidence shows that 50% of sight loss could be avoided through improved eye care and early detection. While often it is obvious when an eye condition needs referral (for example the red, painful eye, or sudden loss of vision), there are a number of potentially blinding or even lifethreatening conditions which may present atypically or with subtle signs that may be missed. Such misdiagnoses can have serious implications. </p> <p>This article examines common presentations in ophthalmology and suggest some important ‘red flags’ in each which merit urgent attention. We have placed emphasis on conditions which can be life or sight-threatening, which can present atypically, and whose ‘red flags’ are aspects of history or examination which are easily and quickly elicited in the GP consultation. </p> <p>It is worth noting that while many of the conditions discussed frequently present with eye symptoms (and indeed may be seen in eye casualty), they may in fact reflect other underlying disease processes (e.g. raised intracranial pressure). Having the conviction to refer such patients directly to the medical or neurology team for treatment results in a safer and faster patient journey.</p></div> Perianal Dermatoses: a clinical approach to management 2017-04-28T09:00:42+00:00 2017-04-28T09:00:42+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n2/item/267-perianal-dermatoses-a-clinical-approach-to-management Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Perianal dermatoses and pruritus ani are common and socially embarrassing conditions that are often poorly managed. Perianal dermatoses encompass a variety of inflammatory diseases affecting the anal region, of which eczema, of various aetiologies, is the most common. </p> <p>Pruritus ani is a chronic itch of perianal skin without rash and is poorly understood. There is a knowledge gap in understanding the pathophysiology and management of pruritus ani as there has been little research. </p> <p>The aim of this article is to present an overview of perianal dermatoses and their management.</p></div> <div class="K2FeedIntroText"><p>Perianal dermatoses and pruritus ani are common and socially embarrassing conditions that are often poorly managed. Perianal dermatoses encompass a variety of inflammatory diseases affecting the anal region, of which eczema, of various aetiologies, is the most common. </p> <p>Pruritus ani is a chronic itch of perianal skin without rash and is poorly understood. There is a knowledge gap in understanding the pathophysiology and management of pruritus ani as there has been little research. </p> <p>The aim of this article is to present an overview of perianal dermatoses and their management.</p></div> Hip Disorders: When to worry 2017-04-28T08:58:17+00:00 2017-04-28T08:58:17+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n2/item/266-hip-disorders-when-to-worry Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Hip pain is a common presentation in GP practices across the country. It can be caused by a multitude of different pathologies ranging from simple muscle spasms, to fractures. It is vital that health professionals can differentiate between benign causes, which can be treated in the community setting, to symptoms that warrant specialist input.</p></div> <div class="K2FeedIntroText"><p>Hip pain is a common presentation in GP practices across the country. It can be caused by a multitude of different pathologies ranging from simple muscle spasms, to fractures. It is vital that health professionals can differentiate between benign causes, which can be treated in the community setting, to symptoms that warrant specialist input.</p></div> Depression in children and adolescents 2017-04-28T08:54:13+00:00 2017-04-28T08:54:13+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n2/item/265-depression-in-children-and-adolescents Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Depression is a common mental health disorder in children and adolescents and presents relatively frequently to primary care. Early recognition, assessment and treatment of depression is important to alleviate distress, improve functioning and later outcome, and manage risks. Primary care and tier 1 professionals may manage mild depression whilst moderate to severe depression is usually managed by specialist mental health services. Treatment of depression is dependent on severity and individual circumstances; interventions include supportive measures, addressing stressors, psychological therapy, and antidepressant edication in selected cases.</p></div> <div class="K2FeedIntroText"><p>Depression is a common mental health disorder in children and adolescents and presents relatively frequently to primary care. Early recognition, assessment and treatment of depression is important to alleviate distress, improve functioning and later outcome, and manage risks. Primary care and tier 1 professionals may manage mild depression whilst moderate to severe depression is usually managed by specialist mental health services. Treatment of depression is dependent on severity and individual circumstances; interventions include supportive measures, addressing stressors, psychological therapy, and antidepressant edication in selected cases.</p></div> Poisoning: an update for primary care professionals 2017-04-28T08:42:05+00:00 2017-04-28T08:42:05+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n2/item/264-poisoning-an-update-for-primary-care-professionals Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Primary care professionals are amongst the most frequent users of the National Poisons Information Service in the United Kingdom. This paper provides an up-to-date review on the management of acute poisoning in this setting.</p></div> <div class="K2FeedIntroText"><p>Primary care professionals are amongst the most frequent users of the National Poisons Information Service in the United Kingdom. This paper provides an up-to-date review on the management of acute poisoning in this setting.</p></div> The diagnosis and management of colorectal cancer 2017-04-28T08:12:58+00:00 2017-04-28T08:12:58+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n2/item/263-the-diagnosis-and-management-of-colorectal-cancer Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide. Incidence strongly increases with age, with the median age at diagnosis being 70 years in developed regions. Although 5-year relative survival exceeds 90% in stage I disease, it only marginally exceeds 10% in stage IV disease. This review aims to guide generalists through the early diagnosis, referral, and treatment of colorectal cancer, and highlight current preventive strategies.</p></div> <div class="K2FeedIntroText"><p>Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide. Incidence strongly increases with age, with the median age at diagnosis being 70 years in developed regions. Although 5-year relative survival exceeds 90% in stage I disease, it only marginally exceeds 10% in stage IV disease. This review aims to guide generalists through the early diagnosis, referral, and treatment of colorectal cancer, and highlight current preventive strategies.</p></div> from the editor... 2017-04-28T07:47:43+00:00 2017-04-28T07:47:43+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-11-n2/item/262-from-the-editor Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p><span style="font-size: 12.16px; line-height: 1.3em;"><span>The deed is done. Brexit is happening. We shall see what it brings to the NHS, a worsening of frontline </span><span>medical and non-medical staff by all accounts. A trickle of exits of EU citizens may turn to a deluge if </span><span>the issue of retaining citizenship is not resolved, early on in the negotiations. The worry is that the UK </span><span>government may be relying on recruiting from outside the EU, such traditional heartlands as India, Nigeria and </span><span>other Commonwealth of Nations. I am not sure if this will be easy as the laws on immigration and rights have so </span><span>parred the advantages that there is unlikely to be a rush of healthcare staff wishing to come to the UK. The double </span><span>whammy for politicians is that increasing numbers of staff, particularly in primary care, are choosing to retire early, </span><span>work part time or simply have a career change. Plugging this gap, with the decision for additional places in medical </span><span>school, will take over a decade for the effect to show. Indeed, the last round of undergraduate medical school places </span><span>were unfilled and had to be offered in clearing. I cannot remember this happening in my working lifetime, 39 years. </span><span>Jam tomorrow then!</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; line-height: 1.3em;">Cynicism is rife with most of the government initiatives. STPs, for example, are designed to make the health </span><span style="font-size: 12.16px; line-height: 1.3em;">service more efficient, provide better care and rationalise services. For many it is a euphemism for saving money and </span><span style="font-size: 12.16px; line-height: 1.3em;">cutting costs i.e. reducing services. The government still has not explained where the resource for implementing </span><span style="font-size: 12.16px; line-height: 1.3em;">STPs, worthy they may be, will be coming from. No new money is forthcoming, so the assumption is it will be </span><span style="font-size: 12.16px; line-height: 1.3em;">generated by internal service reduction, as efficiency savings have now gnawed on the bones of the NHS. No waste </span><span style="font-size: 12.16px; line-height: 1.3em;">left to trim. All this may be irrelevant as we could be in the midst of a nuclear war as one testosterone man, Donald </span><span style="font-size: 12.16px; line-height: 1.3em;">Trump, confronts his doppelganger alpha male, Kim Jong-Un, in a demonstration of, “anything you can do I can </span><span style="font-size: 12.16px; line-height: 1.3em;">do better”. Mind you Trump does so many U turns that he is positively spinning i.e. Obamacare, Mexican Wall, </span><span style="font-size: 12.16px; line-height: 1.3em;">Obsolete NATO……….so maybe he will resist the urge to teach the Korean leader a lesson.</span></p> <p>The world keeps turning and people keep falling ill despite the games played by politicians. Healthcare staff, who have little control over most events, can still provide comfort and hope to those with illness. This may have huge non-monetary benefits to the healthcare giver. The death of Emma Morano, who, until earlier this year, was the oldest living person, aged 117, prompted a search for the factors in longevity. One I came across was that selflessness is key to a long life. For Morano it must have been ultruism and the 2 raw eggs eaten each day for the previous 90 years.</p> <p>This issue has a piece on Colorectal cancer (p.74, Thrumurthy et al) and an interesting resume on Poisoning, and the role of primary care (p.89 by Fok et al). We hear a lot about mental health in adults, but little about children suffering the same. Burden, p.101, redresses this imbalance with a focus on Depression in children and adolescents. GPs must see many patients with possible hip symptoms. Ranjit et al, p.110, have provided a useful “What you need to know”, overview. Perianal dermatoses, p.121, by Abu-Asi et al, is not glamorous, but highlights an important clinical area, where diagnoses can be made readily in the community and the patient managed, therefore, appropriately. Finally, Han et al, p.138, have put together a succinct and pictorial piece on Red flags in eye disease.</p> <p>Do remember that for your appraisal and revalidation, verifiable CPD activity is available on line for each of the contributions, which permits you to assess your knowledge base and skills.</p> <p>Please email comments and suggestions to me.</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></div> <div class="K2FeedIntroText"><p><span style="font-size: 12.16px; line-height: 1.3em;"><span>The deed is done. Brexit is happening. We shall see what it brings to the NHS, a worsening of frontline </span><span>medical and non-medical staff by all accounts. A trickle of exits of EU citizens may turn to a deluge if </span><span>the issue of retaining citizenship is not resolved, early on in the negotiations. The worry is that the UK </span><span>government may be relying on recruiting from outside the EU, such traditional heartlands as India, Nigeria and </span><span>other Commonwealth of Nations. I am not sure if this will be easy as the laws on immigration and rights have so </span><span>parred the advantages that there is unlikely to be a rush of healthcare staff wishing to come to the UK. The double </span><span>whammy for politicians is that increasing numbers of staff, particularly in primary care, are choosing to retire early, </span><span>work part time or simply have a career change. Plugging this gap, with the decision for additional places in medical </span><span>school, will take over a decade for the effect to show. Indeed, the last round of undergraduate medical school places </span><span>were unfilled and had to be offered in clearing. I cannot remember this happening in my working lifetime, 39 years. </span><span>Jam tomorrow then!</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; line-height: 1.3em;">Cynicism is rife with most of the government initiatives. STPs, for example, are designed to make the health </span><span style="font-size: 12.16px; line-height: 1.3em;">service more efficient, provide better care and rationalise services. For many it is a euphemism for saving money and </span><span style="font-size: 12.16px; line-height: 1.3em;">cutting costs i.e. reducing services. The government still has not explained where the resource for implementing </span><span style="font-size: 12.16px; line-height: 1.3em;">STPs, worthy they may be, will be coming from. No new money is forthcoming, so the assumption is it will be </span><span style="font-size: 12.16px; line-height: 1.3em;">generated by internal service reduction, as efficiency savings have now gnawed on the bones of the NHS. No waste </span><span style="font-size: 12.16px; line-height: 1.3em;">left to trim. All this may be irrelevant as we could be in the midst of a nuclear war as one testosterone man, Donald </span><span style="font-size: 12.16px; line-height: 1.3em;">Trump, confronts his doppelganger alpha male, Kim Jong-Un, in a demonstration of, “anything you can do I can </span><span style="font-size: 12.16px; line-height: 1.3em;">do better”. Mind you Trump does so many U turns that he is positively spinning i.e. Obamacare, Mexican Wall, </span><span style="font-size: 12.16px; line-height: 1.3em;">Obsolete NATO……….so maybe he will resist the urge to teach the Korean leader a lesson.</span></p> <p>The world keeps turning and people keep falling ill despite the games played by politicians. Healthcare staff, who have little control over most events, can still provide comfort and hope to those with illness. This may have huge non-monetary benefits to the healthcare giver. The death of Emma Morano, who, until earlier this year, was the oldest living person, aged 117, prompted a search for the factors in longevity. One I came across was that selflessness is key to a long life. For Morano it must have been ultruism and the 2 raw eggs eaten each day for the previous 90 years.</p> <p>This issue has a piece on Colorectal cancer (p.74, Thrumurthy et al) and an interesting resume on Poisoning, and the role of primary care (p.89 by Fok et al). We hear a lot about mental health in adults, but little about children suffering the same. Burden, p.101, redresses this imbalance with a focus on Depression in children and adolescents. GPs must see many patients with possible hip symptoms. Ranjit et al, p.110, have provided a useful “What you need to know”, overview. Perianal dermatoses, p.121, by Abu-Asi et al, is not glamorous, but highlights an important clinical area, where diagnoses can be made readily in the community and the patient managed, therefore, appropriately. Finally, Han et al, p.138, have put together a succinct and pictorial piece on Red flags in eye disease.</p> <p>Do remember that for your appraisal and revalidation, verifiable CPD activity is available on line for each of the contributions, which permits you to assess your knowledge base and skills.</p> <p>Please email comments and suggestions to me.</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></div> Chest pain: Proper history and simple imaging gives the answer 2017-01-25T09:28:20+00:00 2017-01-25T09:28:20+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/261-normal-sleep-a-concise-review Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p>A 65 years old lady with a history of type 2 diabetes mellitus and well controlled hypertension is brought to A&amp;E with central chest discomfort of 2 days duration. Her BP was 143/89 mmHg, Pulse 98 regular. Normal ECG. The A&amp;E doctors arranged CT Aortogram to exclude aortic dissection. What is the diagnosis based on the imaging?</p></div> <div class="K2FeedIntroText"><p>A 65 years old lady with a history of type 2 diabetes mellitus and well controlled hypertension is brought to A&amp;E with central chest discomfort of 2 days duration. Her BP was 143/89 mmHg, Pulse 98 regular. Normal ECG. The A&amp;E doctors arranged CT Aortogram to exclude aortic dissection. What is the diagnosis based on the imaging?</p></div> Normal Sleep: A concise review 2017-01-25T09:26:56+00:00 2017-01-25T09:26:56+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/260-normal-sleep-a-concise-review Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p><span style="font-size: 12.16px;">Sleep medicine is a fairly new subspecialty with many disorders. In order to understand sleep disorders, it is essential to understand normal sleep. In this review, we discuss normal sleep and how investigate suspected sleep disorders.</span></p></div> <div class="K2FeedIntroText"><p><span style="font-size: 12.16px;">Sleep medicine is a fairly new subspecialty with many disorders. In order to understand sleep disorders, it is essential to understand normal sleep. In this review, we discuss normal sleep and how investigate suspected sleep disorders.</span></p></div> The oesophagus and the Lungs 2017-01-25T09:22:16+00:00 2017-01-25T09:22:16+00:00 http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/259-the-oesophagus-and-the-lungs Editor Admin info@ipcauk.org <div class="K2FeedIntroText"><p><span style="font-size: 12.16px;">The oesophagus is a highly specialised muscular tube, whose function is to transport food from the mouth to the stomach, where the process of digestion starts. This requires an efficient and coordinated process. Due to its proximity to the lungs, disorders of the oesophagus may present to the respiratory physician and may be wrongly treated as respiratory disorders. </span></p> <p>Chronic cough is defined as cough that persists for more than 8 weeks. Its exact prevalence has proved difficult to estimate and recurrent cough is reported by 3-40% of the population1-4 It is also a common reason for attendance to a health clinic and can be very difficult to treat. Chronic cough may be due to underlying oesophageal disorders.</p> <p>This review article discusses the oesophageal disorders that can present with respiratory symptoms.</p></div> <div class="K2FeedIntroText"><p><span style="font-size: 12.16px;">The oesophagus is a highly specialised muscular tube, whose function is to transport food from the mouth to the stomach, where the process of digestion starts. This requires an efficient and coordinated process. Due to its proximity to the lungs, disorders of the oesophagus may present to the respiratory physician and may be wrongly treated as respiratory disorders. </span></p> <p>Chronic cough is defined as cough that persists for more than 8 weeks. Its exact prevalence has proved difficult to estimate and recurrent cough is reported by 3-40% of the population1-4 It is also a common reason for attendance to a health clinic and can be very difficult to treat. Chronic cough may be due to underlying oesophageal disorders.</p> <p>This review article discusses the oesophageal disorders that can present with respiratory symptoms.</p></div>