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International Primary Care Association

Clinical Focus Primary Care


Theories abound and a constant deluge of articles continue in an attempt to give people advice to better health. Many are based on fads. This article provides a summary of the scientifically proven evidence around nutrition, health and exercise for better health, based in fact not in myth.

The chill of winter will have reached all of us with the publication of this issue, made worse by the government’s belligerent stance on public sector pay freeze, including NHS workers, despite the talk of an economic recovery. The comfort of improving economic statistics and numbers are not the same as the experience of rising food, transport and fuel bills, little prospect in acquiring a decent job and a reduction in public services.

Poor planning in medical manpower, and a lack of focused investment has produced the spectre of massive strain on emergency services this winter. The UK simply does not produce enough of home-grown medical or nursing personnel which leads to a clinical brain drain from other countries such as the Philippines, India, Pakistan, Nigeria, Ghana….This problem is coupled with the disruption of frequent NHS re-organisations and a management heavy structure, despite the reforms, culminating in poor or absent decision making, which results in further deterioration of services.We have heard the low rumbling of political stances commence during the party political conference season and this will crescendo to the next election. I am not optimistic that the NHS will fare well but am having a bet on a further restructure within the lifetime of the next government.


Palpitations and fluttering are extremely common. A clinician faced with a patient presenting with such symptoms needs to be able to rapidly differentiate between normality, benign arrhythmias and pathological arrhythmias that may be associated with substantial risk, including that of stroke or sudden cardiac death.


The nationally representative British Gambling Prevalence Survey of 20101 indicates 0.9% of individuals in Britain meet the criteria for problem gambling, equating to approximately 451,000 adults. However, individuals who are problem gamblers are known to present to their GPs with associated problems without disclosing the underlying condition2 (Sullivan, Arroll, Coster & Abbott, 1998). Pride, shame and denial are factors that non-treatment seeking problem gamblers identify as barriers against them seeking treatment.3, 4 This disorder is therefore hugely challenging for professionals to identify and respond appropriately to. This article will outline the current DSM-IV criteria for Pathological Gambling, describe a simple, easy to administer screening tool, and explain common co-morbidities. Treatment is then discussed in terms of empirically supported approaches and what is currently available in the UK.


Recent studies indicate that less than half of those living with a dementia have been diagnosed. This has led to a drive both to develop specialist memory services and educate healthcare professionals in early identification and diagnosis. This article is intended as a guide to the assessment of memory problems prior to referral to specialist services, for those in primary care.


After many years of declining incidence there has been a resurgence of tuberculosis (TB) in the United Kingdom. Although most cases occur in urban areas TB cases are seen across the country. This paper aims to raise awareness and highlight the pitfalls in diagnosis of an old but not to be forgotten disease.


Back pain remains one of the most common presenting complaints in primary care and often presents both diagnostic and management challenges. Accurate early diagnosis, along with appropriate early specialist intervention is key in managing these conditions, which are often lifelong and associated with significant morbidity.


Overactive Bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Whilst a number of women may be managed based on a clinical diagnosis alone urodynamic studies may be useful in those women with complex or refractory symptoms. In the first instance all women will benefit from a conservative approach using bladder retraining although a number will require antimuscarinic therapy. For those women with persistent symptoms following medical therapy referral to secondary care for alternative treatment modalities such as intravesical Botulinum toxin, neuromodulation or reconstructive surgery may be considered. This review, whilst giving an overview of the syndrome, will focus on a practical clinical approach to managing women with symptoms of OAB in the primary care setting.


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International Primary Care Association
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