Practitioner最新文献_第7页

Rapid diagnosis vital in thunderclap headache. 快速诊断对雷击性头痛至关重要。

Practitioner Pub Date : 2016-04-01

Andrew Barritt, Sarah Miller, Indran Davagnanam, Manjit Matharu

{"title":"Rapid diagnosis vital in thunderclap headache.","authors":"Andrew Barritt, Sarah Miller, Indran Davagnanam, Manjit Matharu","doi":"","DOIUrl":"","url":null,"abstract":"Thunderclap headache is a severe and acute headache that reaches maximum intensity in under one minute and lasts for more than five minutes. Subarachnoid haemorrhage (SAH) accounts for 10-25% of all thunderclap headaches and, despite advances in medical technology, has a 90-day mortality of 30%. Up to a quarter of cases of SAH are misdiagnosed, often through failure to follow guidance. Thunderclap headaches may be associated with symptoms such as photophobia, nausea, vomiting, neck pain, focal neurological symptoms or loss of consciousness. SAH is more likely if there are neurological abnormalities or reduced consciousness. Loss of consciousness at onset is a poor prognostic indicator with a 2.8-fold increase in risk of death. All patients with suspected SAH should undergo a non-contrast CT brain scan as soon as possible after the onset of pain as the sensitivity of CT drops with time. A negative CT is not sensitive enough to exclude SAH and must be followed with lumbar puncture at least 12 hours after onset of the headache. If SAH is excluded then further investigations, in particular MRI brain and vascular imaging with MRI or CT angiography, should be considered to exclude other aetiologies. Headaches, caused by cervical artery dissection are most commonly of gradual onset but up to 20% of patients complain of thunderclap headache.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1792","pages":"23-8, 3"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34604294","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

Keeping yourself on track. 让自己走上正轨。

Practitioner Pub Date : 2016-04-01

David Haslam

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The role of PSA in detection and management of prostate cancer. PSA在前列腺癌的检测和治疗中的作用。

Practitioner Pub Date : 2016-04-01

Roger Kirby

引用次数: 0

DIFFICULT DISLOCATIONS. 困难的混乱。

Practitioner Pub Date : 2016-04-01

W Paulson

引用次数: 0

Managing lower urinary tract symptoms in men. 管理男性下尿路症状。

Practitioner Pub Date : 2016-04-01

Kenneth R MacKenzie, Jonathan J Aning

{"title":"Managing lower urinary tract symptoms in men.","authors":"Kenneth R MacKenzie, Jonathan J Aning","doi":"","DOIUrl":"","url":null,"abstract":"Male lower urinary tract symptoms (LUTS) are common and increase in prevalence with age. Up to 90% of men aged 50 to 80 may suffer from troublesome LUTS. Men may attend expressing direct concern about micturition, describing one or more LUTS and the related impact on their quality of life. Frequently men may present for other medical or urological reasons such as concern regarding their risk of having prostate cancer or erectile dysfunction but on taking a history bothersome LUTS are identified. Men may present late in the community with urinary retention: the inability to pass urine. A thorough urological history is essential to inform management. It is important to determine whether men have storage or voiding LUTS or both. All patients must have a systematic comprehensive examination including genitalia and a digital rectal examination. Investigations performed in primary care should be guided by the history and examination findings, taking into account the impact of the LUTS on the individual's quality of life. Current NICE guidelines recommend the following to be performed at initial assessment: frequency volume chart (FVC); urine dipstick to detect blood, glucose, protein, leucocytes and nitrites; and prostate specific antigen. Men should be referred for urological review if they have: bothersome LUTS which have not responded to conservative management or medical therapy; LUTS in association with recurrent or persistent UTIs; urinary retention; renal impairment suspected to be secondary to lower urinary tract dysfunction; or suspected urological malignancy. All patients not meeting criteria for immediate referral to urology can be managed initially in primary care. Based on history, examination and investigation findings an individualised management plan should be formulated. Basic lifestyle advice should be given regarding reduction or avoidance of caffeinated products and alcohol. The FVC should guide advice regarding fluid intake management and all medications should be reviewed.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1792","pages":"11-6, 2"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34603832","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

Sedentary behaviour associated with type 2 diabetes. 久坐行为与2型糖尿病有关。

Practitioner Pub Date : 2016-04-01

Matthew Lockyer

引用次数: 0

Conditions affecting the hair and scalp. 影响头发和头皮的状况。

Practitioner Pub Date : 2016-04-01

Nigil Stollery

引用次数: 0

Early diagnosis of oesophageal cancer improves outcomes. 早期诊断食管癌可改善预后。

Practitioner Pub Date : 2016-03-01

Andrew D Hopper, Jennifer A Campbell

{"title":"Early diagnosis of oesophageal cancer improves outcomes.","authors":"Andrew D Hopper, Jennifer A Campbell","doi":"","DOIUrl":"","url":null,"abstract":"There are two main types of oesophageal cancer, oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC). They present in the same manner and both carry a five-year survival of only 16%. In the UK there is a 2:1 male to female ratio for oesophageal cancer. Peak incidence at presentation is in the 65-75 age group, with 95% of cases presenting in those over 50. Smoking is a major risk factor for both types and is linked to an estimated 66% of cases in the UK. OSCC is linked to alcohol, smoking, and chewing betel quid. OAC is associated with the presence of GORD, and its duration, and obesity (especially increased waist circumference). Oesophageal cancer commonly presents with dysphagia or odynophagia. This can be associated with weight loss and vomiting. All patients with recent onset dysphagia should be referred for rapid access endoscopy. Referral for urgent endoscopy should still be considered in the presence of dysphagia regardless of previous history or medication. Dysphagia is not always present so all patients with alarm symptoms should be considered for endoscopy. NICE recommends referral for urgent direct access upper GI endoscopy to assess for oesophageal cancer for patients with dysphagia or aged 55 and over with weight loss and any of the following: upper abdominal pain; reflux; dyspepsia.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1791","pages":"23-8, 3"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34511103","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

Women with bipolar disorder at high risk of relapse after childbirth. 患有双相情感障碍的妇女产后复发的风险很高。

Practitioner Pub Date : 2016-03-01

Phillip Bland

引用次数: 0

Underestimating risk in women delays diagnosis of CVD. 低估女性患心血管疾病的风险会延误诊断。

Practitioner Pub Date : 2016-03-01

Tracey Keteepe-Arachi, Sanjay Sharma

{"title":"Underestimating risk in women delays diagnosis of CVD.","authors":"Tracey Keteepe-Arachi, Sanjay Sharma","doi":"","DOIUrl":"","url":null,"abstract":"CVD remains the most common cause of mortality in women. In 2007, the annual mortality in women secondary to CAD was 4.7 times that of breast cancer. Around 2.8 million women are living with CVD in the UK. There has been an increase in the prevalence of MI in women aged 35 to 54, while a decline in prevalence was observed in age-matched men. Difficulty in evaluating symptoms of ischaemic heart disease in women is well documented and remains challenging because of their atypical nature. The main gender difference is that women tend to present less frequently with exertional symptoms of chest pain before an AMI. Although men and women share classic cardiovascular risk factors the relative importance of each risk factor may be gender specific. The impact of smoking is greater in women than men, especially in those under 50. Diabetes is a more potent risk factor for fatal CHD in women than men. Risk factors specific to women include postmenopausal status, hysterectomy and complications during pregnancy. Women who develop gestational diabetes mellitus or pre-eclampsia more than double their risk of CVD later in life. Transition to the menopause is associated with a worsening CHD risk profile. After the menopause women may experience an increase in weight, alteration in fat distribution and an increase in other CVD risk factors such as diabetes and a more adverse lipid profile. Pharmacological stress testing is preferred for diagnosing CAD in females with lower exercise capacity. Stress cardiomyopathy is triggered by intense, unexpected emotional or physical stress and is characterised by transient apical systolic dysfunction or ballooning of the left ventricle. The syndrome predominantly affects postmenopausal women. Women presenting with STEMI have worse outcomes compared with men. However, in those presenting with NSTEMI there were no differences in outcomes.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1791","pages":"11-5, 2"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34509645","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