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International Primary Care Association

Clinical Focus Primary Care

Many diseases result from a combination of genetic, environmental and lifestyle factors. There is a huge amount of genetic variation between individuals, and genomics allows us to identify variations across whole genomes. Here we describe key concepts in genomics and discuss how it can be used to improve patient care.

Chronic viral hepatitis due to hepatitis B (HBV) and hepatitis C (HCV) is a global health concern with almost 500 million people infected and an estimated 1.46 million deaths per year. Many patients are asymptomatic and general practitioners should have a good working knowledge of risk factors and the appropriate tests to make a diagnosis, particularly as hepatitis B testing can be challenging to interpret. The natural history of disease is variable but both infections can lead to cirrhosis and hepatocellular carcinoma. The epidemiology and virology of HBV and HCV differ and their management can be complicated as there has been a huge increase in the number of drugs approved to treat both infections, particularly HCV, over the last few years. This article will provide a review of HBV and HCV for general practitioners who are often the first providers to encounter patients with viral hepatitis. A working knowledge of these conditions will permit a thorough work up and informed discussion with patients.

Diabetic nephropathy is the major cause of end-stage renal disease. It is characterised by albuminuria and by a progressive relentless decline of the glomerular filtration rate. Current management with optimal blood glucose and blood pressure control prevents and slows disease progression as these factors contribute to disease pathophysiology. There are also new therapies currently being explored, which may have additional benefits.

Concerns about a child’s growth are commonly encountered in primary care. These concerns may be raised by family members, healthcare colleagues or social care professionals. Steady normal weight gain is a commonly seen as a reassuring sign that an infant or child is healthy.

Abnormal growth has a wide range of possible aetiologies and is often multifactorial. A key role of the primary care practitioner is to consider the possibility of underlying systemic disease as well as review wider determinants of child health including socioeconomic situation, maternal mental health, parental and family behaviour and safeguarding issues.

Alongside faltering growth, considering what constitutes excessive growth is increasingly relevant in view of rising rates of childhood obesity and the long-term implications for the child and society.

This article presents an approach to assessing growth concerns. The identification of an abnormal pattern of growth should prompt a detailed assessment, management planning with families and sometimes referral for specialist care.

The puerperium marks the 6-8 week post-partum period, where the body reverts back to its pre-pregnancy state with the resolution of the anatomical, physiological, endocrine and biochemical changes of pregnancy. Effective postnatal care should include provision of support with regard to breast feeding, emotional wellbeing and management of birth -related complications such as perineal tears, and, advice regarding contraception. Timely recognition and management of complications, which may occur during the postnatal period such as secondary haemorrhage, endometritis, wound infections, venous thrombo-embolism and post-partum psychosis is vital to optimise maternal and neonatal outcomes.

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.  

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.

The Female lower urinary tract symptoms (FLUTS) are a collection of symptoms akin to the wellknown lower urinary tract symptoms (LUTS) in male counterparts. It is a common presentation in primary care consultations, particularly in women of middle to late age. Awareness of risk factors and actively looking out for these cases may be worthwhile particularly as patients may not be very forthcoming with this problem. Careful history taking, examination and assessment of its impact on quality of life (QOL) are of paramount importance. There is a need to carry out holistic assessment of these patients prior to offering management plan, which can include self-help measures, behavioural treatment, medications and surgical treatment.

This article illustrates the magnitude of the problem and will assist clinicians in primary care to identify, diagnose and manage patients with FLUTS in an evidence-based manner.


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