Gout is caused by the deposition of monosodium urate crystals in joints and soft tissues. It is the most common cause of inflammatory arthritis worldwide, and a cause of substantial pain and long-term disability. It is associated with several co-morbidities and often under-treated in both primary and secondary care. This article sets out the diagnosis and treatment of gout in primary care, and aims to promote self-management by patients through education of doctors.
D evelopmental delay and global developmental delay are terms used to describe children who take longer to reach their milestones than might be expected. They are very common conditions, and we will all have consultations with carers of children who express concern about an aspect of a child's development. This article will look at when to suspect developmental delay, what to do and when to refer. The GP curriculum and developmental delay Clinical module 3.04: Care of children and young people requires GPs to:. Have a thorough understanding of normal development, and be able to recognise delayed development through childhood and adolescence. Be aware of normal growth and development in children and young people. Ensure that parents or carers, children and young people receive information, advice and support to enable them to: Access appropriate services when necessary Access support groups. To assess both a child's and young person's development (physical and psychological). Adopt a family-centred approach in dealing with patients, their families and their problems The four domains of development A child's developmental skills can be split into four domains: gross motor skills, fine motor skills and vision, personal and social, language, and hearing. Developmental delay in a single domain is very common and affects approximately 5-10% of children (Bellman et al., 2013). The key milestones in each developmental area are listed in Table 1. This article will briefly consider some important features of each particular skill set, discuss global developmental delay (GDD) and then consider the assessment of a child with possible developmental delay. Gross motor skills Caregivers commonly present with concerns about their child's gross motor skills. For example, if a child is not sitting unsupported or walking when expected. Other concerns may arise later when the child is running or walking. Isolated motor delay, such as delayed walking is common and may indicate a pure muscle problem. Therefore, after a thorough history and tailored examination it may be appropriate to refer these children for physiotherapy alone. Many of these children improve their gross motor skills with this single treatment. Paediatric physiotherapists are skilled in the assessment of gross motor
Genetic haemochromatosis (GH) is the UK’s most common genetic condition inherited in an autosomal recessive manner. It is an iron overload disorder, in which increased intestinal absorption of iron leads to deposition of iron in organs and tissues, most commonly the liver, heart, pancreas, and joints. GH often presents in an insidious manner, and as a result is significantly underdiagnosed. It is a multi-system disease, in which patient care involves various specialities, including primary care. This article will outline the inheritance, diagnosis, treatment and implications of GH and aims to raise awareness of the condition in general practice.
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