Volume 6 Issue 3 - 2012 http://www.ipcauk.org Wed, 17 Oct 2018 20:50:35 +0000 Joomla! - Open Source Content Management en-gb Editorial http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/172-editorial http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/172-editorial

A week is a long time in politics! Barely had my pen dried on the last editorial, focusing on the Health & Social Care bill entering the statute books and we are suddenly presented with a new array of politicos in Health.

Jeremy Hunt has been passed the political poison of the Department of Health. The Prime Minister probably needed to move aside the rather dour Andrew Lansley, whose mere facial appearance managed to upset all levels of health service, even before he opened his mouth. Hunt seems more approachable and likeable because he has a sniff of fallibility, and therefore humanity, about him. This quality, coupled with some humbleness, will endear him to the public and professionals alike and keep the reforms from totally derailing.

 Politicians must possess the key art of persuasion when pushing through unpalatable legislation to professional groups with vested interests. Lansley had a paucity of such essential skills. Let us hope that Hunt will be better equipped. He will have to get a rapid grip of a brief that is daunting in its complexity if he is to have any credibility as Secretary of State for Health. It’s much too late to unpick the structure that Lansley has created so Hunt’s advisors must provide the tools for him to achieve what was intended; maintaining and improving quality of care and saving money. Both are possible, even within the much maligned structure that he inherits.

The National Stroke strategy (2007) aimed to reduce the 42% incidence of recurrent stroke by 2015. This requires the modification of key risk factors which Howse, Jones and O’Mahoney have cogently highlighted in their contribution on Secondary Prevention of Stroke and the role of primary care. Prevention and anticipation are also key in managing the symptoms of end stage life. Healthcare professionals must, according to Ponnampalampillai and Daniels, have the skills and knowledge to provide a “Dignified death” to terminally ill patients.

Increasingly it will be the complications of chronic diseases to which we shall succumb and diabetes will be a significant player. The macrovascular complications of diabetes are well recognised in the community but microvascular problems of retinopathy, nephropathy and neuropathy may go undiagnosed for too long. Hewapathirana and Page give an insight to the basic physiology of these processes and how occurrences can be potentially minimised and if present, better managed. All general practices will have an existing burden of such disease but which ispredicted to grow rapidly in the next 5-10 years, including amongst a much younger age groups.

Earlier this year, in January, the Bowel Cancer Screening Programme was launched with the target to save 5000 lives a year by 2015, from colorectal cancer. Patel and Thomas-Gibson from St Mark’s hospital have summarised the goals of this initiative. Early diagnosis translates into a hugely improved prognosis. This is very much dependent on the awareness of the early warning symptoms and signs of bowel cancer requiring referral. All GPs need to be conversant with this initiative.

Although symptoms of respiratory disease are an all year round phenomena Wilkie, Chalmers and Schembri have teased out some common presenting features and in an interactive discussion format demystified their management. Read their piece and you will be armed appropriately next time you see a patient with frequent exacerbations of COPD, chronic cough, recurrent chest infections, the vexed problem of asthma and pregnancy and the increasing breathlessness in terminal respiratory disease. The winter months are approaching and these scenarios will multiply too, so be ready!

The hot swollen joint is an urgent medical problem. The differential diagnosis can be anything from the sublime and easy (trauma) to the serious and difficult (acute infection). Rapidity of confirmation of the aetiology is vital and although gout and pseudogout are relatively common the contribution by Price and Robertson provides an excellent resume of a common clinical presentation.

Revalidation is upon us. At my hospital a circular has requested those that may wish to volunteer in being guinea pigs in the first wave of such a process. Continuing Professional Development is a key parameter that will be scrutinised in revalidation so please use the “Assessment activity” associated with each article to assist you in demonstrating participation in CPD.

As always, letters and suggestions for future features are most welcome. Please email me at the address shown. Happy educational reading.

info@ipcauk.org (Editor Admin) Volume 6 Issue 3 - 2012 Fri, 28 Sep 2012 09:43:13 +0000
Respiratory Case Book http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/173-respiratory-case-book http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/173-respiratory-case-book

Abstract Respiratory diseases account for a large proportion of the primary care workload. This article reviews five cases referred to our chest clinic from primary care highlighting five common clinical problems encountered by general practitioners. The first section begins with a discussion of the options available to prevent recurrent exacerbations of COPD. Palliation of breathlessness in advanced respiratory disease is a difficult clinical problem and the role of anxiolytics, opioids and oxygen therapy are discussed. Chronic cough is one of the most common chronic respiratory problems encountered by GP’s and this case is used to highlight the various steps in investigation and empirical management of this difficult problem. Finally, a lady with recurrent respiratory tract infections and asthma in pregnancy are reviewed and discussed.

info@ipcauk.org (Editor Admin) Volume 6 Issue 3 - 2012 Fri, 28 Sep 2012 10:24:53 +0000
Palliative Care in the Community http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/174-palliative-care-in-the-community http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/174-palliative-care-in-the-community

GPs are increasingly at the forefront of providing palliative care in the community. Identifying those patients who should be on the palliative care register, especially those with nonmalignant diseases, managing their symptoms such as pain, addressing difficult questions and anticipating and planning ahead for potential problems can all be challenging but can make a crucial positive impact on these patients and their families.

info@ipcauk.org (Editor Admin) Volume 6 Issue 3 - 2012 Fri, 28 Sep 2012 10:41:06 +0000
Crystal Arthritis – Gout and Pseudogout http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/175-crystal-arthritis-gout-and-pseudogout http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/175-crystal-arthritis-gout-and-pseudogout

Crystal arthritis presents often as a monoarticular hot swollen joint. Hot swollen joints are a common presentation with a number of differential diagnoses. The most serious of these is septic arthritis, which should always be considered before making an alternative diagnosis. Hot swollen joints commonly have other underlying diagnoses, including crystal arthritis, reactive arthritis, haemarthrosis and a monoarticular presentation of polyarthritis. Here we review the crystal arthropathies Gout and Pseudogout (now termed Calcium pyrophosphate deposition or CPPD).

info@ipcauk.org (Editor Admin) Volume 6 Issue 3 - 2012 Fri, 28 Sep 2012 10:55:57 +0000
Secondary Prevention of Stroke: What a GP needs to know http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/176-secondary-prevention-of-stroke-what-a-gp-needs-to-know http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/176-secondary-prevention-of-stroke-what-a-gp-needs-to-know

Secondary prevention of stroke can make a significant difference to a patient’s outcome. Identifying the aetiology of the stroke and treating the modifiable risk factors must be a priority. Education must continue to reiterate that stroke is a medical emergency.

info@ipcauk.org (Editor Admin) Volume 6 Issue 3 - 2012 Fri, 28 Sep 2012 11:07:22 +0000
Diabetic microvascular complications – screening, diagnosis and prevention http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/177-diabetic-microvascular-complications-screening-diagnosis-and-prevention http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/177-diabetic-microvascular-complications-screening-diagnosis-and-prevention

This article hopes to update primary care teams about diabetic microvascular complications, to provide an overview of important scientific evidence, and to focus on aspects of screening, diagnosis and prevention with a special emphasis on NICE recommendations

info@ipcauk.org (Editor Admin) Volume 6 Issue 3 - 2012 Fri, 28 Sep 2012 12:11:10 +0000
Bowel Cancer: Focus on Earlier Diagnosis http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/178-bowel-cancer-focus-on-earlier-diagnosis http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-6-n3/item/178-bowel-cancer-focus-on-earlier-diagnosis

Colorectal cancer is an important cause of mortality in the United Kingdom. Many patients with symptoms of colorectal cancer defer presenting for investigation and by the time they are symptomatic often have advanced disease. Early presentation and referral however will allow prompt diagnosis and treatment. A national campaign targeted at people with symptoms suggestive of bowel cancer was launched in January 2012. Both primary and secondary care need to be prepared for an increased demand from patients with gastrointestinal complaints

info@ipcauk.org (Editor Admin) Volume 6 Issue 3 - 2012 Fri, 28 Sep 2012 12:13:24 +0000