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International Primary Care Association

Clinical Focus Primary Care

With the election over we shall soon see if the victors are able to keep the NHS promises. The electorate must be punch drunk with usual list of platitudes that were wheeled out, and these were not party specific: NHS safe in our hands, we shall do more, we will maintain frontline staff, patient’s are the centre of our policies, shorter waiting lists....blah blah blah. This is boring and mostly inaccurate. Dogma rules and control from the centre is exacting, confining and restrictive. Not too far removed from the command type rule of the ex Soviet Union


It is well known that adult thyrotoxicosis can present in many guises and to different specialists, but childhood thyrotoxicosis, particularly in the pre-pubertal age group, is often overlooked as a possible diagnosis. Many children, who present to a tertiary centre for treatment, have been diagnosed ‘accidentally’. A number have seen their General Practitioner or a Paediatrician in the preceding weeks and, although concern may have been raised about the child’s symptoms, thyrotoxicosis has not been considered, as it is not traditionally thought of as a ‘paediatric’ condition.


As Normal Tension Glaucoma (NTG) comprises a significant proportion of the glaucoma workload, it is essential for general practitioners to have a thorough understanding of the nature of this disease. The diagnosis of NTG is strict and requires careful history-taking and examination to exclude differential diagnoses.


The arrival of the aromatase inhibitors (AIs) has increased the options available for the management of postmenopausal women with hormone sensitive breast cancer. Where and when we should use them is however still controversial with the many trials of their use often having raised more questions than they have answered. There is no doubt that they have a role to play but it will be quite some time before we can confidently answer the questions of whether all post menopausal breast cancer patients should get them and if not all, then which patients should get them and for how long.


Facial palsy is a debilitating condition that has many causes. The commonest cause is Bell’s palsy (idiopathic facial nerve palsy) but there is mounting evidence that it may have been over diagnosed. This article draws closer attention to the alternative causes, appropriate examinations and investigations. A consensus for the treatment of Bell’s palsy has been elusive in lieu of well constructed trials. Recently though, good evidence has emerged for the role of steroids and anti-virals in the treatment of Bell’s palsy.


This article is intended to be a guide and to give an overview into some of the common issues and considerations encountered in everyday clinical practice when diagnosing and managing inherited cardiac conditions.

Medicine changes rapidly and Cardiology is often at the peak of this rate of change. Huge resources, both human and financial, are brought to bear to develop new improvements in care and validate and optimise current treatments. Perhaps, cynically, device and pharmacological companies see cardiac conditions as common, “important” and amenable to intervention above all other illnesses. In addition there is a significant political imperative to develop, standardise and prioritise care for ischaemic heart disease and other cardiac conditions.


Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. It is a progressive condition in which arrhythmia-induced remodeling facilitates evolution from paroxysmal AF to persistent and permanent AF. Rhythm control of atrial fibrillation is receiving a resurgence with the recognition that catheter ablation may offer benefits not achieved with pharmacological therapy. Early detection and appropriate initial management can result in considerable improvements in patient’s quality of life, morbidity and mortality.


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International Primary Care Association
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