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International Primary Care Association

Clinical Focus Primary Care

Substance misuse is commonplace in general practice patients. Many GPs already see patients with alcohol, heroin and crack cocaine problems. However, the world of drugs is changing due to availability of designer drugs and drugs over the Internet. General Practitioners need to be aware of the importance of drugs and alcohol in producing and exacerbating physical and psychiatric medical symptoms.

Vulval disorders are common complaints that many women will experience at least once in their lifetime. Patients will usually attend their general practitioner. An accurate diagnosis relies on a thorough history and examination. A vulval biopsy may be useful where there is any diagnostic uncertainty. Whilst most cases are straightforward many patients resistant to basic treatment require referral to a vulval service in secondary level care.

The proverbial really has hit the fan. The Francis report on the Mid Staffs Hospitals investigation is damning against the culture of an organisation that seemed to have lost its ethos of “Caring for Patients” as the primary objective. Rather the obsession was to hit the “targets” imposed by regional and national policy. Managers colluded with clinicians to garner favourable scores with the wilful neglect of tending to the sick and needy. How have we travelled so far back so quickly? The recent revelation of a whistleblower, who has broken his £500K payment gagging clause, that his concern over deaths in the Lincolnshire Hospitals were ignored at senior managerial level, begs the question how widespread is this lack of transparency.

The assessment and interpretation of albuminuria is crucial in people with CKD. We will discuss recent developments in the field, the rationale for these changes, and the clinical implications of albuminuria.

Hirsutism is the term used for excessive terminal hair of male pattern distribution seen in women. Hirsutism is different from hypertrichosis which is a generalised excessive hair growth of non sexual distribution. Studies on hirsutism and scoring systems have shown that about 5 percent of women of reproductive age group have hirsutism. There are ethnic differences in normal hair distribution. It is rare for women with mild hirsutism and regular periods to have a serious medical problem but on the other hand rapidly progressive or new onset hirsutism especially if associated with virilising features may point towards a more serious diagnosis.

The fundamental importance of diet in the role of disease and also in its treatment is discussed. It is key for the inclusion of dietary modifications in treatment plan of patients.

Anxiety disorders are common mental disorders that present in primary care services. Anxiety is a common and universal feeling that can manifest as a disorder when associated with a cluster of symptoms and socio-occupational dysfunction. The common childhood anxiety disorders, their presentation in primary care and management are discussed.

Haematuria is a common symptom and in some patients it is the first symptom of urological cancer. It is therefore important to investigate it promptly in such cases. There are, of course, many other causes of haematuria, some urological, some nephrological. This article aims to give clear guidance on how to manage these patients.


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International Primary Care Association
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