Management of nocturia: overcoming the challenges of nocturnal polyuria.

Nocturia may be a multifactorial condition and should be regarded as a syndrome rather than a diagnosis, with many factors contributing to the clinical presentation. The effects of sleep deprivation can have a severely detrimental impact on the quality of life and productivity of the working age population, with considerable economic implications. Patients are unlikely to seek an appointment with their GP complaining of nocturia - they are more likely to complain of the effects of the condition, such as chronic tiredness, or injuries resulting from falls. The main criterion in deciding whether a patient should undergo further investigations into suspected nocturia is the degree to which the patient finds the condition bothersome. In some patients, lifestyle modifications may be an effective way to manage nocturia before medication is considered. As the only licensed product for all adults including those over 65 years of age, low dose desmopressin (Noqdirna® (as lyophilisate) Ferring Pharmaceuticals Ltd) is highly effective in the management of idiopathic nocturnal polyuria, producing improvements in clinical symptoms, sleep parameters and quality of life. Care should be administered as a joint enterprise between the patient's GP and colleagues in secondary care. This article outlines the findings of a roundtable discussion into the optimal management of patients with nocturnal polyuria.

Skin cancer excision performance in Scottish primary and secondary care: a retrospective analysis.

BACKGROUND: In contrast with most published evidence, studies from north-east Scotland suggest that GPs may be as good at treating skin cancers in primary care as secondary care specialists. AIM: To compare the quality of skin cancer excisions of GPs and secondary care skin specialists in east and south-east Scotland. DESIGN AND SETTING: A retrospective analysis of reports from GPs in Lothian, Fife, and Tayside regions. METHOD: Skin cancer histopathology reports from GPs in Lothian, Fife, and Tayside regions in 2010 were compared with reports from skin specialists in November 2010. The histopathology reports were rated for completeness and adequacy of excision. RESULTS: A total of 944 histopathology reports were analysed. In 1 year, GPs biopsied or excised 380 skin cancers. In 1 month, dermatologists biopsied or excised 385 skin cancers, and plastic surgeons 179 skin cancers. 'High risk' basal cell carcinomas (BCC) comprised 63.0% of BCC excised by GPs. For all skin cancer types, GPs excised smaller lesions, and had a lower rate of complete excisions compared with skin specialists. A statistical difference was demonstrated for BCC excisions only. CONCLUSION: GPs in east and south-east Scotland excise a number of skin cancers including malignant melanoma (MM), squamous cell carcinoma (SCC) and high-risk BCC. Despite removing smaller lesions, less commonly on difficult surgical sites of the head and neck, GP excision rates are lower for all skin cancers, and statistically inferior for BCC, compared with secondary care, supporting the development of guidelines in Scotland similar to those in other UK regions. Poorer GP excision rates may have serious consequences for patients with high-risk lesions.