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MALINGERING IN SOLDIERS. 士兵装病。

Practitioner Pub Date : 2016-03-01

Harry Campbell

引用次数: 0

Fungal infections. 真菌感染。

Practitioner Pub Date : 2016-03-01

Nigel Stollery

引用次数: 0

Managing debilitating menopausal symptoms. 管理衰弱的更年期症状。

Practitioner Pub Date : 2016-03-01

Marie O'Sullivan, Caroline Overton

{"title":"Managing debilitating menopausal symptoms.","authors":"Marie O'Sullivan, Caroline Overton","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Severity and duration of menopausal symptoms varies markedly. Eight out of ten women experience symptoms and on average these last four years, with one in ten women experiencing symptoms for up to 12 years. A recent study found that women whose vasomotor symptoms started before the menopause suffered longest, median 11.8 years. Women whose hot flushes and night sweats started after the menopause had symptoms for a median of 3.4 years. Menopausal symptoms can begin years before menstruation ceases. Menopausal status needs to be evaluated based on history and symptoms. Testing for FSH levels should only be considered in women aged 40-45 with menopausal symptoms or those under 40 with suspected early menopause. In general, the benefits of short-term HRT outweigh the risks in the majority of symptomatic women, especially in those under 60. There is no evidence that HRT confers any cardiovascular protection (or harm) or protection against the development of dementia. Cardiovascular risk should be assessed. Women with cardiovascular disease are not necessarily unsuitable for HRT but need their cardiovascular health optimised. In those women with a high risk of venous thromboembolism a thrombophilia screen should be considered (although even if this is negative, it does not absolve risk). If there is a history of arterial disease a lipid profile should be considered. If there is a high risk of breast cancer, counsel the woman with regards to her risk and consider referring for mammography.</p>","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1791","pages":"17-21, 2-3"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34509646","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

Choosing the right words. 选择正确的词语。

Practitioner Pub Date : 2016-03-01

David Haslam

引用次数: 0

AETIOLOGY OF WAR NEUROSES. 战争神经症的病因学。

Practitioner Pub Date : 2016-01-01

Harry Campbell

引用次数: 0

Active and passive smoking linked to infertility and early menopause. 主动和被动吸烟与不孕不育和提前绝经有关。

Practitioner Pub Date : 2016-01-01

Jez Thompson

引用次数: 0

Controlling joint pain in older people. 控制老年人关节疼痛。

Practitioner Pub Date : 2016-01-01

Peter Paisley, Mick Serpell

引用次数: 0

Anxiety in older adults often goes undiagnosed. 老年人的焦虑往往得不到诊断。

Practitioner Pub Date : 2016-01-01

Ivan Koychev, Klaus P Ebmeier

{"title":"Anxiety in older adults often goes undiagnosed.","authors":"Ivan Koychev, Klaus P Ebmeier","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Anxiety disorder in the elderly is twice as common as dementia and four to six times more common than major depression. Anxiety is associated with poorer quality of life, significant distress and contributes to the onset of disability. Mortality risks are also increased, through physical causes, especially cardiovascular disease, and suicide. Diagnosing anxiety disorders in older adults remains a challenge because of the significant overlap in symptoms between physical disorders (shortness of breath; abdominal and chest pain; palpitations) and depression (disturbed sleep; poor attention, concentration and memory; restlessness). Good history taking is crucial in elucidating whether the complaint is of new onset or a recurrence of a previous disorder. The presence of comorbid depression should be clarified. If present, its temporal relationship with the anxiety symptoms will indicate whether there is an independent anxiety disorder. A medication review is warranted, as a number of drugs may be causative (calcium channel blockers, alpha- and beta-blockers, digoxin, L-thyroxine, bronchodilators, steroids, theophylline, antihistamines) or may cause anxiety in withdrawal (e.g. benzodiazepines). Substance and alcohol abuse should be excluded, as withdrawal from either may cause anxiety. A new or exacerbated physical illness may be related to anxiety. Medical investigations will help clarify the extent to which a particular somatic symptom is the result of anxiety.</p>","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1789","pages":"17-20, 2-3"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34549429","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 and management of type 1 diabetes. 改善1型糖尿病的发现和管理。

Practitioner Pub Date : 2016-01-01

Peter Hammond

{"title":"Improving the detection and management of type 1 diabetes.","authors":"Peter Hammond","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Type 1 diabetes affects around 370,000 adults in the UK, about 10% of all those diagnosed with diabetes. In type 1 diabetes there is a lack of beta cell insulin secretion as a result of autoimmune destruction of the beta cells. However, patients are not affected by insulin resistance, and so do not routinely experience the features of metabolic syndrome that occur in type 2 diabetes. NICE recommends considering further investigation with autoantibody testing or measurement of C-peptide when: type 1 diabetes is suspected but the presentation includes atypical features (e.g. age ≥50, BMI ≥ 25 kg/m2, slow evolution of hyperglycaemia or long prodrome); type 1 diabetes has been diagnosed and treatment started but there is a clinical suspicion that the patient may have a monogenic form of diabetes, and C-peptide and/or autoantibody testing may guide the use of genetic testing; classification is uncertain, and confirming type 1 diabetes would have implications for therapy. Structured education is the cornerstone of care providing tools to allow effective self-management. Following a new diagnosis of type 1 diabetes structured education should be offered within 12 months. Newly diagnosed patients should be offered a regimen including a basal (long-acting) insulin with bolus (rapid-acting) insulin given at mealtimes. The optimal regimen, which should be offered from diagnosis, is a combination of twice daily insulin detemir and a rapid-acting analogue given at mealtimes. However, where glycaemic control is already optimised on an alternative insulin regimen this should not be discontinued.</p>","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"260 1789","pages":"21-6, 3"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34484448","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

Skin conditions in children. 儿童皮肤状况。

Practitioner Pub Date : 2016-01-01

Nigel Stollery

引用次数: 0

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