Treating sexual dysfunction in general practice

A method of training general practitioners in the treatment of sexual dysfunction is described, using fortnightly seminars at which the doctors discussed the continuing care of their patients.Doctors took on patients presenting in their practices and treated couples together, where possible, using a mixture of insight-directed and behavioural techniques similar to those used by Masters and Johnson (1970). Interviews were reported back to the group which gave advice and support. The doctors, all beginners in this type of work, were able to help substantially 72 per cent of 47 couples treated.     

Nephrology in general practice

Hints for the practitioner concerning the management of patients with renal disease are presented. Important facts relating to history, physical, laboratory and radiological findings are stressed and diagnostic assessment is briefly described. Although the general practitioner will refer such patients in most instances to a nephrologist, he should know what kind of further examinations and studies are necessary for correct diagnosis and adequate treatment. The present therapeutic possibilities have greatly improved, but one still disappointing aspect is the treatment of certain forms of glomerulonephritis. The cumulative survival rates in patients undergoing hemodialysis and renal transplantation are assessed and compared with the survival rates in patients suffering from myocardial infarct and carcinoma of the breast, colon and the lung. Essential preventive measures are avoidance of toxic substances like analgesics and consistent antihypertensive therapy even in patients with a renal ailment. The dosage of drugs which are mainly eliminated by the kidneys must be adapted to renal function (serum creatinine or clearance of endogenous creatinine).     

Somatization in general practice

Patients with unexplained physical symptoms are very common in primary care. Some patients attribute these symptoms to physical disease (somatizing patients). Somatization can be a symptom of psychiatric disorder, which is found in 1/4 to 1/3 of the patients in a primary care setting. This form of somatization makes diagnosing difficult and is the main reason why psychiatric disorders are underdiagnosed. Simple techniques for diagnosing and treating somatizing patients are available to general practitioners. However, to improve diagnostic sensitivity and treatment, further teaching and development in primary care settings are necessary.     

Psoriasis in general practice

This report, based on a resource pack for primary care nurses, describes the features of psoriasis and reviews current prevention and treatments. The pack emphasises the important role of nurses in helping people to maintain their confidence and independence in the face of this chronic disease.     

Predictable exodontia in general practice

Exodontia that is carefully and skillfully done by general dentists is a valuable service to patients. The majority of patients would rather have their family dentist perform necessary extractions or other minor surgery procedures than be referred outside the office. Most teeth that need to be extracted could be removed by a generalist if that person has developed the expertise to do not only relatively easy extractions, but also that percentage that is inevitably more difficult--requiring "surgical" removal. To be successful with exodontia, the dentist must have the ability to select cases within his or her level of comfort and ability, have a working knowledge of sound surgical principles, be able to apply a variety of patient management techniques, and then be prepared to handle whatever complications may arise. This article has presented ideas that should be integrated into the operator's own systematic approach to extractions. It is one of many resources to help the general dentist provide a higher level of surgical treatment.     

Lithium follow-up in general practice

Lithium salts have been used in medicine for over a century and are a widely accepted treatment. Clinical practice in the London borough of Barnet led us to suspect that agreed guidelines were not being followed. We checked them against published guidelines and followed up their implementation. A list of patients on lithium was obtained from the local biochemistry laboratory and a representative sample extracted. We looked at the frequency of laboratory testing and compared it with the guidelines. We found that the standards for lithium therapy follow-up were not being met and that while we awaited the outcome of our consultant psychiatrists' committee deliberations, the recommendations were not being implemented. A lithium register or clinic needs to be established in the area, and there is also a need for more reliable and effective implementation of clinical audit recommendations.     

Adrenaline degradation in general practice

The general practitioner's (GP's) doctor's bag is exposed to extreme temperatures that may affect the stability of the drugs it contains. Adrenaline (1:1000 solution) is more stable than previous studies would suggest. GPs carry out-of-date drugs despite stating that they regularly check expiry dates.     

Endometrial sampling in general practice

Unexpected vaginal bleeding is a common problem in general medical practice and likely to increase as more women use hormone replacement therapies (HRT). This study looks at the successful introduction of a technique for endometrial sampling into general practice, allowing earlier diagnosis of endometrial cancer and reassurance for women without serious pathology.     

Consultation frequencies in general practice

Some models of the process by which individuals seek medical care suggest the negative binomial as the underlying distribution of the frequencies of consultations in a given practice. Data from the 1970-71 National Morbidity Survey of General Practice are used to test these competing models. It is shown that the negative binomial distribution successfully fits consultation frequencies in aggregate and in subdivisions according to age, sex, and duration of registration. In this article is is assumed that the consultation process has two components: the patient's decision to visit his doctor for a new illness and the follow-up visits that results from this new problem. Supplementing previous evidence that the distribution of episodes of new illnesses follows a negative binomial distribution, this article shows that consultation frequencies among individuals presenting with one new illness also follow a negative binomial distribution. A unifying model is required to synthesize these findings.