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International Primary Care Association

Clinical Focus Primary Care

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Editor Admin

Increasing levels of antimicrobial resistance are currently a big problem in the management of Gram negative infections caused by enterobacteriaceae. This article reviews resistance mechanisms, focusing on a management approach relevant to primary care.

It has been an odd summer, and autumn has already and will usher in further calamities. On the home front, the Brexit debate has moved from the extreme hardline exit to a softer approach now that that the consequences of the simple IN or OUT vote have been gradually unveiled by a much-divided government and a slightly less divided opposition. I note a that May et al have subtly indicated changes in their stance, with a wish to continue membership of Research organisations (UK has awards of ~ 1 billion Euros per annum from the EU), Security organisations, there has been a shift on immigration………the list goes on. Strangely, as far as the NHS is concerned, NHS England are looking to attract 1000s of doctors, from the EU, to fill the deficit in GPs! I am not entirely certain they will be able to fulfil the need, as EU healthcare professionals are leaving the UK, rather than flocking to it. We shall probably have to turn to the Commonwealth, India, Australia, Canada….to fill the gaps left and additionally to make up deficits from poor workforce planning.  

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. 

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. 

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.

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. 

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. 

The aim of this article is to present an overview of perianal dermatoses and their management.

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.


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