Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. It is a complex, long-term condition caused by an endocrine abnormality resulting from insulin resistance, and is often linked to weight gain. The effects are metabolic, reproductive, and psychological, so a holistic approach to management is crucial.

In the absence of any clear guidelines for management of PCOS, this month’s Hot topic article describes the best practice management of PCOS in primary care. Dr Anne Connolly makes recommendations on the holistic management of short- and long-term consequences of PCOS, including the importance of weight reduction in those who are overweight. Risk factors for PCOS, clinical features to look out for, and diagnosing PCOS using the Rotterdam criteria are also discussed.

Continuing with the theme of endocrine disorders, Dr Kevin Fernando describes eight co-morbidities that are common in patients with type 2 diabetes, and how the co-existing conditions should be managed. Multimorbidity is becoming increasingly common in people with chronic disease—around 25% of patients seen in primary care have multimorbidities, and diabetes is often one of their co-morbidities.

Among other areas, Dr Fernando discusses: assessing risk of and preventing cardiovascular disease (CVD); the psychological impact of diabetes and the concept of diabetes distress; and how glycaemic, blood pressure, and lipid targets should be adapted in frailty. This is the first in a new ‘Co-morbidities in …’ series.

On the topic of managing co-existing conditions, this month’s Top tips article is on cardiotoxicity and cancer. Many cancer treatments infer an increased risk of CVD. As improvements in cancer treatment and earlier diagnosis have contributed to increased survival, more people are living longer beyond cancer and developing other co-morbidities that exacerbate this CVD risk. Dr Sinead Clarke and Dr Nicola Harker provide tips on: limiting the effects of cancer treatments on cardiovascular health, using Read Codes to accurately document a patient’s previous cancer treatments and current cardiac risks, and when cardiac symptoms should be investigated further.

Heart puzzle_AS

Top tips: cardiotoxicity and cancer

Dr Sinead Clarke and Dr Nicola Harker

As well as keeping you up to date on clinical guidance and best practice, we are also committed to supporting you with appraisal and revalidation. 

Dr Honor Merriman offers practical advice for GPs and practices on learning from complaints, including typical complaints procedures, how to respond, and how to record personal learnings and reflections. This is particularly relevant as, on 11 June 2018, a report was published following Professor Sir Norman Williams’ review of gross negligence manslaughter in healthcare. The report supports a culture where healthcare professionals are able to raise concerns and reflect openly on their mistakes, while ensuring that those who are responsible for providing unacceptable standards of care are held to account. The GMC has already flagged concerns that the report missed an opportunity to make recommendations about giving doctors’ reflections legal protection in the criminal courts.