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Tailor treatment to the patient with neuropathic pain. 为神经性疼痛患者量身定制治疗方案。

Practitioner Pub Date : 2016-09-01

Peter Paisley, Mick Serpell

{"title":"Tailor treatment to the patient with neuropathic pain.","authors":"Peter Paisley, Mick Serpell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Neuropathic pain can be considered to be a clinical syndrome with multiple causes ranging from damage to peripheral nerve pathways as the level of peripheral nociceptors to abnormalities in the cortical neurons in the brain. It is defined as pain that is caused by a lesion or disease of the somatosensory nervous system and is estimated to affect 6-8% of the general population. A low threshold of suspicion in conditions associates with neuropathic pain can aid diagnosis. Data from the past decade suggest that it is found in 16-26% of patients with diabetes, 8% of patients suffering from shingles in the past three months (increasing to 40% and 75% in patients aged over 50 and 75 respectively), and 10-50% of patients following surgery. Typical neuropathic descriptors include burning, shooting electric shock pain with numbness, pins and needles or itching. After general and neurological examination the focus should turn to the affected pain area using an unaffected body part as a control. Sensory response to cotton wool, pinprick, temperature and vibration should all be assessed. This will identify the positive and negative signs found in neuropathic pain. Tinel's sign and Phalen's sign, although classically taught, have such poor sensitivity and specificity that GPs are no longer encouraged to rely on them, and they should not be used. Neuropathic pain is often poorly responsive to conventional analgesia with the mainstay of treatment being anticonvulsant and antidepressant medication. Multidisciplinary assessment and management in the specialist setting of the pain clinic is often requires.</p>","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1796","pages":"11-5"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35534800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving the detection of coeliac disease. 提高乳糜泻的检出率。

Practitioner Pub Date : 2016-07-01

Michelle S Y Lau, Andrew D Hopper, David S Sanders

引用次数: 0

Diagnosis and treatment of inflammatory bowel disease. 炎症性肠病的诊断和治疗。

Practitioner Pub Date : 2016-07-01

Sarah Taylor, Alan J Lobo

{"title":"Diagnosis and treatment of inflammatory bowel disease.","authors":"Sarah Taylor, Alan J Lobo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients with inflammatory bowel disease (IBD) may previously have received a diagnosis of irritable bowel syndrome and there may be a delay in making the correct diagnosis. This is particularly the case in patients with ileal Crohn's disease and those under 40. Diagnosis of IBD involves endoscopy and biopsy. Histology may not be available – for example in small bowel Crohn's disease – and in this situation, typical radiological appearances help make the diagnosis. Crohn's disease can affect any part of the gastrointestinal tract – most commonly the terminal ileum or colon. Perianal involvement is also common. Intestinal inflammation in Crohn's disease can extend transmurally. Ulcerative colitis almost always affects the rectum with a variable proximal extent and continuous distribution. Inflammation affects the mucosa only. Approximately 25% of people with IBD will have extra-intestinal manifestations of the disease, involving skin, eyes, joints or the liver. There is an increased risk of colorectal cancer in patients with ulcerative colitis estimated at 2% at 10 years, 8% at 20 years and 18% at 30 years. It is important to be aware of infection risk in IBD both due to the disease itself and the impact of treatment. Flu vaccination should be offered to patients with IBD.</p>","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1795","pages":"19-23"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35491108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying patients with complex PTSD. 识别复杂创伤后应激障碍患者。

Practitioner Pub Date : 2016-07-01

Alastair M Hull, Frank M Corrigan, Stephen A Curran

引用次数: 0

Have a high index of suspicion for meningitis in adults. 对成人脑膜炎有很高的怀疑指数。

Practitioner Pub Date : 2016-07-01

Olivier Gaillemin, Fiona McGill

引用次数: 0

Chlamydia infection raises long-term risk of reproductive complications. 衣原体感染增加了生殖并发症的长期风险。

Practitioner Pub Date : 2016-07-01

Richard Ma

引用次数: 0

Sun damage. 阳光的伤害。

Practitioner Pub Date : 2016-06-01

Nigel Stollery

引用次数: 0

Optimising the management of wheeze in preschool children. 优化学龄前儿童喘息的管理。

Practitioner Pub Date : 2016-06-01

Steven McVea, Thomas Bourke

{"title":"Optimising the management of wheeze in preschool children.","authors":"Steven McVea, Thomas Bourke","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>One third of all preschool children will have an episode of wheeze and many of these present to primary care. Most will fall within a spectrum of diagnosis ranging from episodic viral wheeze to multiple trigger wheeze or early onset asthma. A small proportion will have other rare, but important, diagnoses such as foreign body aspiration, anaphylaxis, gastro-oesophageal reflux, congenital anatomical abnormalities or other chronic lung diseases. Clinical assessment should try to classify children into either episodic viral wheeze or multiple trigger wheeze phenotypes. In clinical practice children rarely fit neatly into either category and the phenotype may change overtime. Clinical examination may well be normal in a child presenting with chronic symptoms. Urgent outpatient review should be considered for symptoms present from early infancy, chronic wet cough, failure to thrive or systemic involvement. The child should be referred to hospital immediately if you suspect an inhaled foreign body or anaphylaxis (after administering IM adrenaline). NICE recommends immediate referral for children with wheeze and high-risk features and also those with intermediate-risk features failing to respond to bronchodilator therapy. Children with high-risk features on assessment should be treated immediately with inhaled bronchodilator therapy. Those with intermediate risk should be treated immediately with bronchodilator therapy and reassessed 15-30 minutes later. Intermediate-risk children who respond and low-risk children can be managed at home with bronchodilator therapy via a spacer device.</p>","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1794","pages":"11-4, 2"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34384518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does early introduction of foods protect against allergy? 早期食用食物能预防过敏吗?

Practitioner Pub Date : 2016-06-01

Chris Barclay

引用次数: 0

Early intervention crucial in anxiety disorders in children. 早期干预对儿童焦虑症至关重要。

Practitioner Pub Date : 2016-06-01

Helen Griffiths, Mina Fazel

{"title":"Early intervention crucial in anxiety disorders in children.","authors":"Helen Griffiths, Mina Fazel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Anxiety disorders are among the most common mental health disorders of childhood. Three quarters of anxiety disorders have their origins in childhood, with presentation often chronic in nature. Children with an anxiety disorder are 3.5 times more likely to experience depression or anxiety in adulthood, highlighting the importance of early diagnosis and appropriate treatment. Making a diagnosis can often prove difficult. It is important for clinicians to distinguish between normal anxiety and anxiety disorders. In the latter, symptoms may impair function and/or cause marked avoidance behaviour and significant distress. Younger children, who are less able to verbalise their anxiety, may show symptoms of regression of physical abilities (e.g. toileting, requiring carrying); increased attachment seeking behaviours (e.g. becoming more clingy); or increased physical symptoms (e.g. stomach aches). NICE quality standards recommend the need for an accurate assessment of which specific anxiety disorder the individual is experiencing, its severity, and the impact on functioning. NICE guidance for assessment of social anxiety disorder may be extrapolated to the assessment of other anxiety disorders: e.g. giving the child the opportunity to provide information on their own, and conducting a risk assessment. Where the child is experiencing significant distress or functional impairment (e.g. missing school, not taking part in age-appropriate activity), then specialist input is likely to be needed.</p>","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1794","pages":"17-20, 2-3"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34384520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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