One of our most popular Guidelines in Practice articles so far this year has been a piece on interpreting abnormal results from liver blood tests, by Dr Jez Thompson. A reader got in touch and suggested a separate article focusing on globulins; lo and behold, this issue includes a similar piece on interpreting abnormal results from plasma protein tests.

Plasma proteins have a range of functions and metabolic roles so abnormalities in their levels can be associated with a variety of morbidities, either as the primary cause or through a secondary effect. Dr Jez Thompson discusses the different constituents of plasma protein (including albumin, globulins, and fibrinogen) and highlights possible causes of abnormalities in albumin/globulin levels from liver panel tests, proteinuria, and C-reactive protein. 

Dr Thompson also describes the extra information that can be obtained from protein electrophoresis, immunofixation electrophoresis, and enzyme immunoassays. After reading the article, test your knowledge using the multiple-choice questions in this issue.

Our top tips articles have proven to be very popular so we have been investigating alternative ways of distilling the key information GPs need to know about new and updated guidance when it is published. Key learning points articles will do just this—starting with a piece from Dr Honor Merriman on updated revalidation guidance. 

Earlier this year, the GMC and RCGP published updated requirements on supporting information for appraisal and revalidation. The updated guidance focuses on the essential supporting information and removes the need for excessive detail, which will mean a welcome reduction in the time spent by GPs recording revalidation activities in detail. Dr Merriman focuses on five key requirements that GPs should be aware of, and highlights the need for GPs to reflect on their own health, especially given the current pressures faced by clinicians working in general practice.

Another new series starting in this issue is Pharmacist focus. These articles will draw attention to issues and clinical topics relevant to clinical pharmacists in general practice. The first article in this series is about how to successfully integrate a pharmacist into the general practice team. Shailen Rao, Managing Director, and Anna Prescott, Clinical Services Manager at Soar Beyond Ltd discuss the benefits of having a clinical pharmacist as part of the primary care team, and provide tips on designing the right service, recruiting the right pharmacist, and inducting and supervising the pharmacist once they are on board. 

Look out next month for our follow-up article on accelerating the pharmacist’s development once they are embedded into the practice.

Shailen Rao

Also in this month’s issue is a top tips article on diagnosing and managing the menopause. In most cases, menopause can be diagnosed based on the woman’s symptoms, without the use of laboratory tests. Symptoms of menopause are many and varied, due to the widespread presence of oestrogen receptors throughout the body, but many of these symptoms can be alleviated through the use of hormone replacement therapy (HRT). Dr Alice Scott and Dr Louise Newson provide advice on when laboratory tests should be used to confirm the diagnosis, as well as highlighting the benefits, risks, and side-effects of different types of HRT.

menopause_as

Top tips: menopause

Dr Alice Scott and Dr Louise Newson

Finally, in this month’s View from the ground, Dr Sarah Merrifield writes about taking a break from GP training to spend time as a Leadership fellow, and the lessons she learned throughout the process.