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)
