Management of spasticity in adults

2020 ◽  
Vol 13 (10) ◽  
pp. 574-581
Author(s):  
Asha Mary Thomas ◽  
Alexander P Joseph
Keyword(s):  
Multiple Sclerosis ◽  
Primary Care ◽  
Brain Injury ◽  
Secondary Care ◽  
Late Presentation ◽  
Motor Neurone ◽  
The Common ◽  
Timely Referral

Spasticity is one of the most common and disabling impairments seen in patients with an upper motor neurone disorder such as stroke, brain injury and multiple sclerosis. It is increasingly accepted that spasticity remains an unrecognised and underdiagnosed impairment in primary care. This is worrying, as untreated spasticity leading to permanent contractures can be a late presentation in many conditions. There is an onus on GPs to recognise the common symptoms of spasticity and initiate management. This article will focus on practical aspects in the management of spasticity including timely referral to secondary care.

Otorrhoea

2020 ◽  
Vol 13 (5) ◽  
pp. 281-288
Author(s):  
Mark Newton ◽  
Paraskevi Tsirevelou
Keyword(s):  
Primary Care ◽  
Cerebrospinal Fluid ◽  
Physical Examination ◽  
Hospital Admission ◽  
Secondary Care ◽  
Common Causes ◽  
Management Guidance ◽  
Throat Symptom ◽  
The Common ◽  
Nose And Throat

The discharging ear, also known as otorrhoea, is a common ear, nose and throat symptom and defined as drainage or flow exiting the ear. The discharge can be wax, blood, pus, mucus, or cerebrospinal fluid. The underlying cause can usually be determined from the history and physical examination. Most patients with otorrhoea can be managed within primary care and do not require referral or hospital admission. This article considers the common causes of a discharging ear, appropriate management, guidance for referral of patients to secondary care and some key take home points.

Primary care

2018 ◽  
Author(s):  
Philippa Edwards
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Holistic Approach ◽  
Professional Relationship ◽  
Respiratory Problems ◽  
Diagnostic Skills ◽  
The Family ◽  
The Common ◽  
The Uk ◽  
William Osler

General practitioners (GPs) are the gatekeepers of the National Health Service in the UK, and virtually all referrals to secondary care are made through them. The breadth and depth of the discipline can at times seem overwhelming, although the old adage ‘common things occur commonly’ still holds. GPs need to be confident in the diagnosis and management of conditions from birth to the grave, and to know their boundaries of competence and when to refer to secondary care. The complexity of the GP consultation includes the following two points: 1. Many conditions present in a relatively undifferentiated form to the GP, whose job it is to try to identify whether the condition is normal or abnormal, and whether it is serious or minor. 2. GPs develop a close professional relationship with many of their patients and may also be the point of contact for other members of the family, neighbours, and friends of the patient. This knowledge is an important aspect of their holistic approach to medicine and is much valued by their patients. As the nineteenth-century physician Sir William Osler (1849–1919) said, ‘The good physician treats the disease; the great physician treats the patient who has the disease.’ The commonest presentations to GPs in the UK are for respiratory problems, chronic disease management, musculoskeletal disorders, and psychological problems. Health promotion, in particular smoking cessation and the management of obesity, is also important in preventing chronic illness. Although many presentations are minor and self-limiting, serious illnesses also occur, and GPs need to be able to recognize them, sometimes in the early stages. The questions in this chapter will assess your knowledge in the common areas that present, testing diagnostic skills and reasoning. They also test negotiating skills to ensure patient compliance, teamworking within the primary care setting, and risk management.

Rectal bleeding

2018 ◽  
Vol 11 (3) ◽  
pp. 143-146
Author(s):  
Rodrick Babakhanlou
Keyword(s):  
Primary Care ◽  
Rectal Bleeding ◽  
Secondary Care ◽  
Common Presentation ◽  
Common Causes ◽  
Bleeding Per Rectum ◽  
The Common

Bleeding per rectum is defined as the passage of blood from the anus. It is a common presentation in adults of all ages and the majority of cases can be managed in primary care. This article will focus on the common causes of rectal bleeding, its assessment and management, including guidance for referral pathways to secondary care.

Providing Care of Mild Traumatic Brain Injury by the Family Practice/Primary Care Optometrist

2018 ◽  
pp. 110-119
Keyword(s):  
Primary Care ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Family Practice ◽  
Advanced Training ◽  
Entry Level ◽  
The Family ◽  
Basic Understanding ◽  
The Brain

Primary Objectives: By extending the scope of knowledge of the primary care optometrist, the brain injury population will have expanded access to entry level neurooptometric care by optometric providers who have a basic understanding of their neurovisual problems, be able to provide some treatment and know when to refer to their colleagues who have advanced training in neuro-optometric rehabilitation.

Effect and acceptability of AKI education using peer review audit in primary care

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696977
Author(s):  
Mufaza Asrar ◽  
Joanna McKinnell ◽  
Nitin Kolhe ◽  
Lynn Woods ◽  
Sally Bassett ◽  
...  
Keyword(s):  
Primary Care ◽  
Peer Review ◽  
Secondary Care ◽  
Group Discussion ◽  
Risk Groups ◽  
Risk Identification ◽  
Care Staff ◽  
Small Group Teaching ◽  
Post Intervention ◽  
Early Management

BackgroundThis was part of the Southern Derby shire CCG AKI awareness and improved management in primary and secondary care. The programme involved educating the primary care staff (GPs nurses) about AKI, identifying and early management in at risk groups. The secondary care aspect involved protocol development for AKI risk/identification to reduce morbidity.AimAs two-thirds of AKI originates in the community we aimed to increase awareness and knowledge levels of AKI in primary care via a CCG wide education programme. This included nephrology a peer review audit of cases with an evaluation of the programme’s acceptability and impact.MethodOver a 12month period, peer review audit sessions were delivered to GPs and the primary care MDT. These sessions consisted of a short presentation by a consultant nephrologist followed by discussion of cases. Qualitative feedback was collected from all participants. Web-based, CCG-wide questionnaires incorporating factual and clinical questions were used to assess baseline and post-intervention knowledge level.Results93% of participants (94 responses) found the peer review audit sessions useful, particularly the presence of nephrologist. 45% of participants were anxious about group discussion of cases, although 36% thought they were the most useful component of the sessions. Formal presentations were ranked as the most popular format of receiving education. 996 individuals completed the questionnaires. At baseline 61% were GPs, 27% practice nurses and 8% Advanced Practitioners, with similar proportions at 1yr. Exposure to AKI teaching, self-reported awareness and confidence levels were higher in the second questionnaire and there was a significant improvement in test scores.ConclusionPrimary care education can improve knowledge and awareness of AKI. Small group teaching with involvement of a nephrologist was popular. These results suggest that there is a need to tailor education styles to individual preferences, and peer review audit may not be universally acceptable in primary care.

Decrease in Secondary Neck Vessels in Multiple Sclerosis: A 5-year Longitudinal Magnetic Resonance Angiography Study

2019 ◽  
Vol 16 (3) ◽  
pp. 215-223 ◽  
Author(s):  
Dejan Jakimovski ◽  
Matthew Topolski ◽  
Kana Kimura ◽  
Virja Pandya ◽  
Bianca Weinstock-Guttman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Longitudinal Change ◽  
Repeated Measure ◽  
Cross Sectional ◽  
False Discovery ◽  
The Common ◽  
Neck Vessels

Background: Studies have previously shown greater arterial and venous extracranial vascular changes in persons with multiple sclerosis (PwMS) when compared to healthy controls (HCs). Objectives: To determine the change in the number and size of secondary neck vessels in PwMS and HCs over a 5-year follow-up period. Methods: Both at baseline and follow-up, 83 PwMS and 25 HCs underwent magnetic resonance angiography (MRA) imaging and analysis. The number and cross-sectional area (CSA) of all secondary neck vessels (excluding the common/internal carotid, vertebral artery, and internal jugular vein) measured at levels from C2-T1 were determined by semi-automated edge detection/ contouring software. The longitudinal change in the number and CSA of the secondary neck vessels from the PwMS and HCs were analyzed by non-parametric Wilcoxon repeated measure. Benjamini-Hochberg procedure adjusted for false discovery rate (FDR). Results: For over 5 years, PwMS demonstrated a consistent longitudinal decrease in both the number of secondary neck vessels (Z-change between -3.3 and -5.4, q=0.001) and their CSA (Zchange between -2.9 and -5.2, q=0.004). On the contrary, the HCs did not demonstrate a significant longitudinal change in secondary neck vessels over the follow-up period. Due to the longitudinal decrease, the PwMS showed a lower number of secondary neck vessels when compared to HCs measured at follow-up (p<0.029, except for C4 with trending p=0.071). The PwMS changes were also corroborated within each MS phenotype. Conclusion: PwMS demonstrate a significant mid-term decrease in the number and the size of the secondary neck vessels. The clinical relevance of these findings and the effect on intracranial blood flow are currently unknown.

Promoting self-management of multiple sclerosis in primary care

2010 ◽  
Vol 20 (2) ◽  
pp. 32-39 ◽  
Author(s):  
Jenna Litchfield ◽  
Sue Thomas
Keyword(s):  
Multiple Sclerosis ◽  
Primary Care ◽  
Self Management
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