Respiratory tract infections are the most common reason for prescribing antibacterial agents in developed countries, and represent approximately 75% of all prescriptions in community practice. Of these, upper respiratory tract infections (URTIs) constitute more than half of all general practice attendances, and it is common for antibacterials to be prescribed for 50% or more of these. Furthermore, there has been a trend in some countries to prescribe broader spectrum and more expensive agents. As viruses are the most frequent cause of URTIs, high levels of antibacterial prescribing for URTIs suggest that there is considerable unnecessary prescribing. (author abstract)
The number of people presenting to their general practitioner complaining of stress in their workplace seems to be increasing worldwide. The reasons for this have not been clearly elucidated but are probably complex. (author abstract)
Constipation is reported increasingly with age and is more common in females than in males. A search for potentially treatable causes of constipation should always be undertaken, with particular attention being paid to diet, disability, drug use, metabolic causes and anorectal disorders. The diagnosis can usually be made from the history and physical findings, although a plain x-ray of the abdomen is often helpful. Constipation of recent onset deserves a thorough investigation, particularly when it occurs in association with other lower gut symptoms. Most elderly patients complaining of a recent onset of constipation will respond to advice, attention to diet, fibre supplementation and increased mobility. An increase in fibre intake should be complemented with an adequate fluid intake. An osmotic laxative may be required for long standing refractory constipation, but stimulant and other non-osmotic laxatives should be avoided. (author abstract)
Avoid all drug therapy if possible, especially in the first trimester. Use care when prescribing for women of reproductive age as half of all pregnancies are unplanned. Do not rely upon published pregnancy risk categories as the sole means of gauging drug safety. Use older drugs with a more established safety record. Use the lowest effective dosage for the shortest possible time. (author abstract)
Cardiac disease often presents for the first time in pregnancy. All pregnant women should have a careful cardiac examination. The course of pregnancy can best be predicted by understanding both the underlying cardiac lesion and the normal physiological changes in pregnancy. The best pregnancy outcome is dependent in good communication, team care, careful monitoring during pregnancy and a plan for delivery and postpartum management. The safest pregnancy is a planned pregnancy. (author abstract)
Multiple sclerosis (MS) is the third leading cause of disability in adults between 20 to 50 years of age. The aim of rehabilitation is to maximise a patient's functional independence and facilitate their return home, to their family, and, when possible, to their work place. Rehabilitation intervention does not alter the underlying pathology of disease, but it does maximise functional independence, minimise complications and problems, and facilitate maintenance of a quality of life. In Australia, approximately 12 000 to 15 000 people have MS. MS occurs most commonly in Caucasian females, between the ages of 15 and 50 years, with the peak diagnosis occurring in the early 30s. MS is an autoimmune disorder with an environmental trigger (possibly a virus). (author abstract)
A new definition of myocardial infarction has been promulgated by the European Society of Cardiology and the American College of Cardiology. This has wide implications for patients and clinical practice. The new definition is largely based on elevated troponin levels. If a patient has an elevated troponin level in the absence of clinical evidence of ischaemia, differential diagnoses should be considered and investigated. With the change in the definition of MI, the number of patients receiving this diagnosis will rise and the case fatality rates will fall, thus it will be difficult to compare prevalence trends over time. Troponin testing is now considered the definitive method for diagnosis of MI and should be used as the primary diagnostic test both in general practice and in hospitals. (author abstract)
Effective treatment of bipolar disorder involves prophylaxis and treatment of both mania/hypomania and depression. Lithium is an effective treatment of all phases of bipolar disorder. Certain clinical presentations appear to respond better to valproate. Newer anticonvulsants (eg lamotrigine) have an emerging role in bipolar disorder. Atypical antipsychotics may be useful in the treatment of mania. (author abstract)
Febrile seizures are generalised tonic/clonic seizures provoked by fever in children between the ages of 6 months and 5 years who are otherwise neurologically normal. Febrile seizures are usually of short duration and are associated with a rapid recovery. The seizure is by far the most dramatic aspect of the presentation, once it has stopped or been terminated, assessment of the child to determine the cause of the fever is the most important aspect of management. Children who have had a seizure with fever are as likely as any other febrile child of the same age to have a serious bacterial 'infection, eg meningitis. Once the seizure has ceased and the cause of the fever been established, the most important intervention is counselling the parents. The vogue for prescribing anticonvulsant drugs to prevent recurrences of febrile seizures has passed. Management is with paracetamol and rectal diazepam if required. (author abstract)
All significant eye trauma needs urgent assessment. Chemical burns are the one real ocular emergency, where any delay in appropriate treatment can have dire consequences. A patient with red eyes who also has pain or decreased vision should be referred for prompt (within 24 to 48 hours) assessment. Acute glaucoma is the one serious 'red eye' condition with which doctors of all disciplines should be familiar. (author abstract)
Teenage pregnancy is one of the most significant adolescent health issues in Australia. it has a potentially long-term deleterious impact both on the adolescent and, if the pregnancy is continued, on the offspring. In addition to the high emotional cost, the economic cost is considerable in terms of medical care, loss of educational opportunities, and ongoing social security benefit payments.
Venoms are usually toxic substances, actively produced by animals and administered by an envenomating apparatus. There are a wide variety of venom components and activities, and some venom components may have multiple actions. Antivenom should never be given to a patient who does not exhibit major local/regional or systemic envenoming. The speed of envenoming will determine the route of antivenom administration. The dose of antivenom required will be determined by the type and quantity of venom injected - the size of the patient is irrelevant and children require the same dose as adults. (author abstract)
The physiological function of magnesium in human body and magnesium - deficiency symptom are described. The supplementary way of magnesium in human body, and the application of medical magnesium mixture in human health are presented.
Primary herpes gingivostomatitis is often misdiagnosed as 'teething'. Eczema predisposes patients to severe primary herpes simplex virus disease. Chickenpox is now a 'vaccine-preventable' disease. Infectiousness has passed by the time the parvovirus rash appears. (author abstract)
Women with chronic disabling conditions face significant barriers that limit access to healthcare and affect their quality of life. Rehabilitation emphasis is on improving health status, managing disability and enhancing functional independence. Minimisation of disability and maintenance of physical function in these women prevents or reduces debilitating physical and mental health conditions later in life. Increased awareness of issues faced by these women can help with: policy making at all levels; equity to, and availability of, health services; and clinical intervention for special healthcare needs and improved quality of life. (author abstract)
There is no fundamental difference between the function of an Occupational Health Service in the health industry, in particular, and in industry, generally. The only difference in a health-industry-based service is the nature of the occupational hazards and the fact that health professionals constitute a large proportion of the workforce. Traditional hazards are still important and include back injuries, infectious disease, blood-borne pathogens, respiratory sensitisers, waste gases and teratogenic agents. More recently recognised problems include stress and violence in the workplace. (author abstract)
Benzodiazepine ('benzo') abuse is by far the largest drug abuse problem facing Australian GPs and pharmacists. it is mostly a hidden epidemic.
Stroke places a considerable financial and social burden on the community and this burden will increase as the population ages. The incidence of stroke can be decreased through suitable public health measures, eg screening and education (primary prevention), but the management of stroke and prevention of recurrence (secondary prevention) also needs to be efficient and cost effective. Rehabilitation following stroke is increasingly efficacious and cost effective. A range of factors predict outcomes following stroke. Rehabilitation physicians can use a number of clinical-prognostic markers to select patients suitable for rehabilitation, and to improve their functional outcome by providing cost effective rehabilitation in the most appropriate setting. (author abstract)
Long QT Syndrome is a genetically determined disease of protein structures in the heart called ionic channels that control the flow of ions such as sodium, potassium and calcium, which produce the electrical activity of heart, depolarisation and repolarisation. Measurement of the QT interval on the electrocardiogram (ECG) can be quite difficult. Treatment of TdP due to ALQTS entails withdrawal of any precipitating agent, administration of MgSO4 and potassium supplements. Correction of bradycardia is very important and temporary pacing may be necessary. If an antiarrhythmic agent is required after all the above, then lignocaine can be used.
