Volume 7 Issue 3 - 2013 http://www.ipcauk.org Fri, 15 Dec 2017 09:24:26 +0000 Joomla! - Open Source Content Management en-gb Treatment of Substance Misuse in General practice http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/201-treatment-of-substance-misuse-in-general-practice http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/201-treatment-of-substance-misuse-in-general-practice

Abstract

Many GPs already treat patients with substance misuse problems and are well placed to offer screening, assessment, psychosocial interventions and prescribing to addictions patients. Emphasis in addiction treatment is shifting away from long term maintenance prescribing to recovery focussed services, recovery communities and integration of substance misusers into the world of work, education and training.

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info@ipcauk.org (Editor Admin) Volume 7 Issue 3 - 2013 Mon, 31 Mar 2014 09:01:34 +0000
Managing Overactive Bladder in Primary care http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/200-managing-overactive-bladder-in-primary-care http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/200-managing-overactive-bladder-in-primary-care

Abstract

Overactive Bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Whilst a number of women may be managed based on a clinical diagnosis alone urodynamic studies may be useful in those women with complex or refractory symptoms. In the first instance all women will benefit from a conservative approach using bladder retraining although a number will require antimuscarinic therapy. For those women with persistent symptoms following medical therapy referral to secondary care for alternative treatment modalities such as intravesical Botulinum toxin, neuromodulation or reconstructive surgery may be considered. This review, whilst giving an overview of the syndrome, will focus on a practical clinical approach to managing women with symptoms of OAB in the primary care setting.

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info@ipcauk.org (Editor Admin) Volume 7 Issue 3 - 2013 Mon, 31 Mar 2014 08:59:02 +0000
Back to the Future: The Diagnosis and Management of Back Pain in Primary Care http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/199-back-to-the-future-the-diagnosis-and-management-of-back-pain-in-primary-care http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/199-back-to-the-future-the-diagnosis-and-management-of-back-pain-in-primary-care

Abstract

Back pain remains one of the most common presenting complaints in primary care and often presents both diagnostic and management challenges. Accurate early diagnosis, along with appropriate early specialist intervention is key in managing these conditions, which are often lifelong and associated with significant morbidity.

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info@ipcauk.org (Editor Admin) Volume 7 Issue 3 - 2013 Mon, 31 Mar 2014 08:57:20 +0000
Recognition and management of tuberculosis in primary care http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/198-recognition-and-management-of-tuberculosis-in-primary-care http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/198-recognition-and-management-of-tuberculosis-in-primary-care

Abstract

After many years of declining incidence there has been a resurgence of tuberculosis (TB) in the United Kingdom. Although most cases occur in urban areas TB cases are seen across the country. This paper aims to raise awareness and highlight the pitfalls in diagnosis of an old but not to be forgotten disease.

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info@ipcauk.org (Editor Admin) Volume 7 Issue 3 - 2013 Mon, 31 Mar 2014 08:54:45 +0000
Detecting Dementia; What to do and when. A guide for GPs and community healthcare professionals http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/197-detecting-dementia-what-to-do-and-when-a-guide-for-gps-and-community-healthcare-professionals http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/197-detecting-dementia-what-to-do-and-when-a-guide-for-gps-and-community-healthcare-professionals

Abstract

Recent studies indicate that less than half of those living with a dementia have been diagnosed. This has led to a drive both to develop specialist memory services and educate healthcare professionals in early identification and diagnosis. This article is intended as a guide to the assessment of memory problems prior to referral to specialist services, for those in primary care.

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info@ipcauk.org (Editor Admin) Volume 7 Issue 3 - 2013 Mon, 31 Mar 2014 08:50:37 +0000
Pathological Gambling - A Clinical Overview http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/196-pathological-gambling-a-clinical-overview http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/196-pathological-gambling-a-clinical-overview

Abstract

The nationally representative British Gambling Prevalence Survey of 20101 indicates 0.9% of individuals in Britain meet the criteria for problem gambling, equating to approximately 451,000 adults. However, individuals who are problem gamblers are known to present to their GPs with associated problems without disclosing the underlying condition2 (Sullivan, Arroll, Coster & Abbott, 1998). Pride, shame and denial are factors that non-treatment seeking problem gamblers identify as barriers against them seeking treatment.3, 4 This disorder is therefore hugely challenging for professionals to identify and respond appropriately to. This article will outline the current DSM-IV criteria for Pathological Gambling, describe a simple, easy to administer screening tool, and explain common co-morbidities. Treatment is then discussed in terms of empirically supported approaches and what is currently available in the UK.

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info@ipcauk.org (Editor Admin) Volume 7 Issue 3 - 2013 Mon, 31 Mar 2014 08:47:37 +0000
A flutter in the chest, palpitations and butterflies: Is it the heart? http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/195-a-flutter-in-the-chest-palpitations-and-butterflies-is-it-the-heart http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/195-a-flutter-in-the-chest-palpitations-and-butterflies-is-it-the-heart

Abstract

Palpitations and fluttering are extremely common. A clinician faced with a patient presenting with such symptoms needs to be able to rapidly differentiate between normality, benign arrhythmias and pathological arrhythmias that may be associated with substantial risk, including that of stroke or sudden cardiac death.

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info@ipcauk.org (Editor Admin) Volume 7 Issue 3 - 2013 Mon, 31 Mar 2014 08:44:14 +0000
From the editor... http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/194-from-the-editor http://www.ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-7-n3/item/194-from-the-editor

The chill of winter will have reached all of us with the publication of this issue, made worse by the government’s belligerent stance on public sector pay freeze, including NHS workers, despite the talk of an economic recovery. The comfort of improving economic statistics and numbers are not the same as the experience of rising food, transport and fuel bills, little prospect in acquiring a decent job and a reduction in public services.

Poor planning in medical manpower, and a lack of focused investment has produced the spectre of massive strain on emergency services this winter. The UK simply does not produce enough of home-grown medical or nursing personnel which leads to a clinical brain drain from other countries such as the Philippines, India, Pakistan, Nigeria, Ghana….This problem is coupled with the disruption of frequent NHS re-organisations and a management heavy structure, despite the reforms, culminating in poor or absent decision making, which results in further deterioration of services.We have heard the low rumbling of political stances commence during the party political conference season and this will crescendo to the next election. I am not optimistic that the NHS will fare well but am having a bet on a further restructure within the lifetime of the next government.

 

This issue of Clinical Focus may provide a modicum of relief from the usual doom and gloom. It is stuffed with high quality education. There has been a massive push on identifying and treating patients with arrhythmias, particularly atrial fibrillation. Diana Gorog and Vias Markides have provided an excellent summary of “Palpitations”, (page 152). We have two addiction related topics, “Pathological Gambling”, by Kaspar, Mitter and Bowden-Jones (page 164) and “Treatment of Substance Misuse”, by Critchlow and Lee (page 210). Both of these conditions consume huge resources from the individual concerned and by the NHS more generally. Their increasing incidence may be due to our present economic downturn!

The recent media frenzy of a “Cure for Dementia”, from research performed in Leicester, was ultimately the discovery of a new portion of the degenerative pathway that may be disrupted by new drugs, as yet undiscovered, but providing a potentially fruitful line of investigation. Islam and Carter’s article on “Detecting Dementia” (page 169), pushes us back to the here and now, and leaves the hype to the media.

With primary care expected to delivery many more services, which traditionally were cared for in secondary care, it is timely to read Dedicoat’s article on “The management of TB in primary care”, (page 179) and Hamann and Sengupta’s contribution on addressing the Issue of “Back Pain in primary care”, (page 188). This triplet of articles focusing on managing conditions in the community is completed by Robinson and Dudley’s piece on, “The Overactive bladder in primary care”, (page 198).

As always correspondence on the content and suggestions for future features are most welcome. Please email me at the address shown. Happy educational reading and do try out the “Verifiable CPD” at the end of most articles. This IS a core requirement in revalidation.

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info@ipcauk.org (Editor Admin) Volume 7 Issue 3 - 2013 Mon, 31 Mar 2014 08:22:54 +0000