Conducting a consultation and clinical assessment of the skin for advanced clinical practitioners

2021 ◽  
Vol 30 (21) ◽  
pp. 1232-1236
Author(s):  
Hazel McPhillips ◽  
Alison F Wood ◽  
Bruce Harper-McDonald
Keyword(s):  
Primary Care ◽  
Adult Population ◽  
Skin Condition ◽  
Acute Hospital ◽  
History Taking ◽  
Ability To Work ◽  
Key Points ◽  
Patient Consultation ◽  
Skin Conditions ◽  
The Uk

Advanced clinical practitioner (ACP) roles require a broad range of knowledge of both medical and surgical areas and the ability to work autonomously in a variety of settings. Despite around half of the UK adult population presenting with a skin condition requiring attention at some point, this is an area many ACPs feel unprepared to manage. However, due to the complexity and large number of potential diagnoses, it is imperative that ACPs develop their knowledge of skin conditions so that they can confidently conduct consultations with patients. This clinical review presents the key elements of patient consultation, history taking and assessment of the skin. This is designed to support novice ACPs, whether working in acute hospital settings or primary care, to develop an understanding of the key points that should be included when consulting with and assessing the skin of patients outwith the dermatology setting.

Critical thinking and diagnostic reasoning when advanced practitioners assess and treat skin conditions

2021 ◽  
Vol 30 (22) ◽  
pp. 1278-1286
Author(s):  
Hazel McPhillips ◽  
Alison F Wood ◽  
Bruce Harper-McDonald
Keyword(s):  
Clinical Review ◽  
Adult Population ◽  
Treatment Options ◽  
Skin Condition ◽  
Acute Hospital ◽  
Main Diagnosis ◽  
History Taking ◽  
Ability To Work ◽  
Skin Conditions ◽  
The Uk

Advanced clinical practitioner (ACP) roles require a broad range of knowledge of both medical and surgical medicine and the ability to work autonomously in a variety of settings. Despite around half of the UK adult population presenting with a skin condition requiring attention, this is something many ACPs feel unprepared to be consulted on. However, due to the complexity and large number of potential diagnoses, it is imperative that ACPs develop their confidence and knowledge to diagnosis, request investigations and initiate treatment for a patient with a skin complaint. In the first part of this clinical review the authors presented the key elements of history taking, consultation and assessment of the skin. This second clinical review discusses the main differential diagnoses, mimics, common investigations and treatments. This article is designed to support novice ACPs from acute hospital settings to primary care to develop a foundation of understanding in the main diagnosis and treatment options that should be considered following a clinical assessment of patients’ skin outside the dermatology setting.

Infective skin conditions in an adult sea-going population

2014 ◽  
Vol 100 (1) ◽  
pp. 49-57
Author(s):  
J Tanzer ◽  
A Macdonald ◽  
S Schofield
Keyword(s):  
Primary Care ◽  
Staphylococcus Aureus ◽  
Military Personnel ◽  
Family Doctor ◽  
Soft Tissue Infections ◽  
Close Proximity ◽  
Skin Conditions ◽  
The Uk ◽  
Panton Valentine Leukocidin ◽  
Valentine Leukocidin

AbstractInfective skin conditions represent a significant element of the caseload for sea-going and shore-side clinicians. They are common within the wider military setting due to the frequent requirement to live in close proximity to others in conditions which favour the spread of skin and soft tissue infections (SSTI) (1, 2). Within the UK civilian population, 24% of individuals see their family doctor for skin conditions each year, accounting for 13 million primary care consultations annually. Of these, almost 900,000 were referred to dermatologists in England in 2009-2010 and resulted in 2.74 million secondary care consultations (3).Several recent articles have highlighted the problem of Panton-Valentine Leukocidin Staphylococcus aureus (PVL-SA) infection and carriage in sailors on submarines, and soldiers deployed to Afghanistan (4, 5). However, the majority of published articles relate to land-based military personnel. This article aims to provide an overview of the most common infective skin conditions presenting among Naval personnel (based on the authors’ experience), illustrated by several case studies, together with an approach to their diagnosis and management.

The prevalence and patient outcomes of adult primary hypercholesterolaemia and dyslipidaemia in the UK: a longitudinal retrospective study using a primary care dataset from 2008 to 2018

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Bilitou ◽  
A Rabe ◽  
L Inema ◽  
G Alamgir ◽  
K Dunton
Keyword(s):  
Primary Care ◽  
Adult Population ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Funding Source ◽  
Private Company ◽  
Primary Hypercholesterolaemia ◽  
The Uk

Abstract Background Cardiovascular disease (CVD) remains the leading cause of death and morbidity in Europe and United Kingdom (UK). Increased low-density lipoprotein cholesterol (LDL-C), implicated in primary hypercholesterolaemia and mixed dyslipidaemia (PH/MD), is an extensively studied risk factor, with proven direct and linear causality of CVD. Lowering LDL-C remains a primary goal in the treatment and prevention of atherosclerotic CVD. Objectives This study aimed to quantify adult prevalence and incidence of PH/MD in the UK. Methods We used an anonymised dataset covering primary care practices across the UK, accessed through the Clinical Practice Research Datalink (CPRD GOLD). Ethics approval was sought and provided (Protocol 19_238R). Using a validated set of clinical codes as well as pre-treatment lipid profile levels for total cholesterol (TC) (>8 mmol/L), LDL-C (>4.9 mmol/L), we calculated prevalent and new adult cases starting from 2009 to 2018. Our denominator population was the CPRD GOLD GP-registered adult population each calendar year, adjusted for mortality. Results There were 1,514,916 adults in the CPRD GOLD GP register for the period from 2009 to 2018. During that period there were 354,444 patients diagnosed with PH/MD. Males comprised 46.5%, mean age on diagnosis was 58.2 years. Mean follow-up time was 104 months. The annual prevalence of PH/MD increased from 2009 to 2019 (see graph). The overall prevalence across the period was 22.7%. Mean annual incidence across the decade was 1.7%. Mean LDL-C levels were 4.7 mmol/L and mean TC level was 6.8 mmol/L. In this cohort, 15.9% experienced cardiovascular events (see table). Nearly all patients have used lipid lowering therapies. Only 2.2% achieved at least 40% reduction of LDL-C from baseline. Conclusions The prevalence of PH/MD has been increasing despite the availability of interventions. Considering guidelines, only a small proportion of patients have achieved LDL-C goals. Est prevalence of PH/MD in the UK Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Daiichi Sankyo Europe, Health iQ Ltd

scholarly journals Exploration of trends in the incidence and prevalence of childhood maltreatment and domestic abuse recording in UK primary care: a retrospective cohort study using ‘the health improvement network’ database

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036949 ◽  
Author(s):  
Joht Singh Chandan ◽  
Krishna Margadhamane Gokhale ◽  
Caroline Bradbury-Jones ◽  
Krishnarajah Nirantharakumar ◽  
Siddhartha Bandyopadhyay ◽  
...  
Keyword(s):  
Primary Care ◽  
Incidence Rate ◽  
Childhood Maltreatment ◽  
Domestic Abuse ◽  
Adult Population ◽  
Health Improvement ◽  
Minority Community ◽  
The Health Improvement Network ◽  
And Gender ◽  
The Uk

ObjectivesDescribe the epidemiology of childhood maltreatment and domestic abuse (in women).DesignAnalysis of longitudinal records between 1 January 1995 to 31 December 2018.SettingUK primary care database: ‘The Health Improvement Network’ (THIN).Participants11 831 850 eligible patients from 787 contributing practices. Childhood maltreatment and domestic abuse (women only) were defined as the presence of a recorded Read code.Outcome measuresThe incidence rate (IR) and prevalence of childhood maltreatment (in children aged 0–18 years) and domestic abuse (in women aged over 18) between 1996 and 2017. An adjusted incidence rate ratio (aIRR) is given to examine the differences in IRs based on sex, ethnicity and deprivation.ResultsThe age and gender breakdown of THIN has been previously reported to be representative of the UK population, however, there is substantial missing information on deprivation quintiles (<20%) and ethnicity (approximately 50%). The IR (IR 60.1; 95% CI 54.3 to 66.0 per 100 000 child years) and prevalence (416.1; 95% CI 401.3 to 430.9 per 100 000 child population) of childhood maltreatment rose until 2017. The aIRR was greater in patients from the most deprived backgrounds (aIRR 5.14; 95% CI 4.57 to 5.77 compared with least deprived) and from an ethnic minority community (eg, black aIRR 1.25; 1.04 to 1.49 compared with white). When examining domestic abuse in women, in 2017, the IR was 34.5 (31.4 to 37.7) per 100 000 adult years and prevalence 368.7 (358.7 to 378.7) per 100 000 adult population. Similarly, the IR was highest in the lowest socioeconomic class (aIRR 2.30; 2.71 to 3.30) and in ethnic minorities (South Asian aIRR 2.14; 1.92 to 2.39 and black aIRR 1.64; 1.42 to 1.89).ConclusionDespite recent improvements in recording, there is still a substantial under-recording of maltreatment and abuse within UK primary care records, compared with currently existing sources of childhood maltreatment and domestic abuse data. Approaches must be implemented to improve recording and detection of childhood maltreatment and domestic abuse within medical records.

scholarly journals Case Study of Ruqyah Therapy On Muslim Patient with Eczema

2021 ◽  
Vol 3 (1) ◽  
pp. 41-43
Author(s):  
Hamidi Abdul Rahman ◽  
Supyan Hussin
Keyword(s):  
East Asian ◽  
Skin Condition ◽  
Asian Countries ◽  
Rapid Improvement ◽  
Remarkable Improvement ◽  
Hospital Beds ◽  
Skin Conditions ◽  
The Uk ◽  
Muslim Patient

A case study on a female Malay living in the UK with serious eczema was presented. Her parents believed that it was a condition called santau, a common cultural belief in South East Asian countries. Santau is believed as the insertion of poisonous materials into the victim’s body with the help of jinn. Santau is normally differentiated from other medical skin conditions by the rapid deterioration of the condition and rapid improvement after successful treatment. Her skin condition was intolerable after a trip to Malaysia. Unable to be admitted to hospital because of the pressure on hospital beds during the Covid-19 pandemic, she resorted to intensive multiple-day ruqyah therapy, a therapy based on the incantation of verses from the Quran. Remarkable improvement was observed after three days. Apart from delivering therapeutic outcome, ruqyah therapy as a Traditional and Complementary Medicine has its role in relieving the pressure on the mainstream health system especially in time of pandemic.

scholarly journals A semi-supervised approach for rapidly creating clinical biomarker phenotypes in the UK Biobank using different primary care EHR and clinical terminology systems

JAMIA Open ◽  
2020 ◽  
Author(s):  
Spiros Denaxas ◽  
Anoop D Shah ◽  
Bilal A Mateen ◽  
Valerie Kuan ◽  
Jennifer K Quint ◽  
...  
Keyword(s):  
Primary Care ◽  
Proportional Hazards ◽  
Biomarker Discovery ◽  
Data Extraction ◽  
Cox Proportional Hazards ◽  
Research Quality ◽  
Uk Biobank ◽  
Expert Review ◽  
Cox Proportional Hazards Models ◽  
The Uk

Abstract Objectives The UK Biobank (UKB) is making primary care electronic health records (EHRs) for 500 000 participants available for COVID-19-related research. Data are extracted from four sources, recorded using five clinical terminologies and stored in different schemas. The aims of our research were to: (a) develop a semi-supervised approach for bootstrapping EHR phenotyping algorithms in UKB EHR, and (b) to evaluate our approach by implementing and evaluating phenotypes for 31 common biomarkers. Materials and Methods We describe an algorithmic approach to phenotyping biomarkers in primary care EHR involving (a) bootstrapping definitions using existing phenotypes, (b) excluding generic, rare, or semantically distant terms, (c) forward-mapping terminology terms, (d) expert review, and (e) data extraction. We evaluated the phenotypes by assessing the ability to reproduce known epidemiological associations with all-cause mortality using Cox proportional hazards models. Results We created and evaluated phenotyping algorithms for 31 biomarkers many of which are directly related to COVID-19 complications, for example diabetes, cardiovascular disease, respiratory disease. Our algorithm identified 1651 Read v2 and Clinical Terms Version 3 terms and automatically excluded 1228 terms. Clinical review excluded 103 terms and included 44 terms, resulting in 364 terms for data extraction (sensitivity 0.89, specificity 0.92). We extracted 38 190 682 events and identified 220 978 participants with at least one biomarker measured. Discussion and conclusion Bootstrapping phenotyping algorithms from similar EHR can potentially address pre-existing methodological concerns that undermine the outputs of biomarker discovery pipelines and provide research-quality phenotyping algorithms.

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