Friday, 28 September 2012 10:24

Respiratory Case Book

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Abstract Respiratory diseases account for a large proportion of the primary care workload. This article reviews five cases referred to our chest clinic from primary care highlighting five common clinical problems encountered by general practitioners. The first section begins with a discussion of the options available to prevent recurrent exacerbations of COPD. Palliation of breathlessness in advanced respiratory disease is a difficult clinical problem and the role of anxiolytics, opioids and oxygen therapy are discussed. Chronic cough is one of the most common chronic respiratory problems encountered by GP’s and this case is used to highlight the various steps in investigation and empirical management of this difficult problem. Finally, a lady with recurrent respiratory tract infections and asthma in pregnancy are reviewed and discussed.

Friday, 28 September 2012 10:41

Palliative Care in the Community

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GPs are increasingly at the forefront of providing palliative care in the community. Identifying those patients who should be on the palliative care register, especially those with nonmalignant diseases, managing their symptoms such as pain, addressing difficult questions and anticipating and planning ahead for potential problems can all be challenging but can make a crucial positive impact on these patients and their families.

Friday, 28 September 2012 10:55

Crystal Arthritis – Gout and Pseudogout

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Crystal arthritis presents often as a monoarticular hot swollen joint. Hot swollen joints are a common presentation with a number of differential diagnoses. The most serious of these is septic arthritis, which should always be considered before making an alternative diagnosis. Hot swollen joints commonly have other underlying diagnoses, including crystal arthritis, reactive arthritis, haemarthrosis and a monoarticular presentation of polyarthritis. Here we review the crystal arthropathies Gout and Pseudogout (now termed Calcium pyrophosphate deposition or CPPD).

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Secondary prevention of stroke can make a significant difference to a patient’s outcome. Identifying the aetiology of the stroke and treating the modifiable risk factors must be a priority. Education must continue to reiterate that stroke is a medical emergency.

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This article hopes to update primary care teams about diabetic microvascular complications, to provide an overview of important scientific evidence, and to focus on aspects of screening, diagnosis and prevention with a special emphasis on NICE recommendations

Friday, 28 September 2012 12:13

Bowel Cancer: Focus on Earlier Diagnosis

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Colorectal cancer is an important cause of mortality in the United Kingdom. Many patients with symptoms of colorectal cancer defer presenting for investigation and by the time they are symptomatic often have advanced disease. Early presentation and referral however will allow prompt diagnosis and treatment. A national campaign targeted at people with symptoms suggestive of bowel cancer was launched in January 2012. Both primary and secondary care need to be prepared for an increased demand from patients with gastrointestinal complaints

Thursday, 12 July 2012 08:31

Management of Thyroid Disease

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Abstract

Thyroid disease is common. In a Primary Care group practice of 10,000 patients there are likely to be over 200 with hypothyroidism who require thyroxine replacement therapy and a further 100 who have subclinical disease. Hyperthyroidism is less common but with a prevalence of 0.7% a typical practice is likely to have 50-70 patients with clinical disease, and a further  50-70 with subclinical disease. A clear understanding of the diagnostic issues involving thyroid disease and key management issues are therefore essential. 

Thursday, 12 July 2012 08:22

Primary Age related macular degeneration

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Abstract

Age-related macular degeneration (AMD) is an increasingly common cause of blindness in the UK. Patients commonly present to primary care and the correct diagnosis with rapid referral to access new treatments may save their vision.

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