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International Primary Care Association
 
 
 

Clinical Focus Volume 8 N1

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Abstract

This review aims to cover the epidemiology, pathophysiology, symptoms/signs and management options (including when to refer) of common hand conditions presenting to primary care. These include: triggering; ganglions; base of thumb arthritis; carpal tunnel syndrome; Dupuytren’s disease and De Quervain’s tenosynovitis.

Abstract

Antibiotics were one of the most important discoveries last century. As with all drugs, however, they are associated with adverse effects. This article reviews how inappropriate antibiotic prescribing not only fails to cure an infected patient; it may encourage overgrowth of resistant pathogens that ultimately threaten future management of sepsis.

A tumultuous year so far for UK generally and the NHS in particular. Against most of the predictions the EU referendum was a win for the exit camp. This will have major effects on healthcare delivery, both directly and indirectly.  

Abstract

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.

Abstract

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.

 

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