Practitioner最新文献_第9页

Mobile phones have transformed GP care. 移动电话已经改变了全科医生护理。

Practitioner Pub Date : 2016-01-01

David Haslam

引用次数: 0

We need to learn how to stop medication. 我们需要学会如何停止用药。

Practitioner Pub Date : 2015-07-01

David Haslam

引用次数: 0

Sun damage. 阳光的伤害。

Practitioner Pub Date : 2015-07-01

Nigel Stollery

引用次数: 0

Managing the child with a fever. 照顾发烧的孩子。

Practitioner Pub Date : 2015-07-01

Rosie Hague

{"title":"Managing the child with a fever.","authors":"Rosie Hague","doi":"","DOIUrl":"","url":null,"abstract":"Most illnesses associated with fever are self-limiting and children recover with no specific treatment. However, fever can also be the presenting feature of serious illness, which may be life threatening if not diagnosed and treated appropriately. It is important to establish whether the temperature has been measured and, if so, how. The height of the temperature should be recorded, and always enquire what device has been used, as a reading from a forehead thermometer may not be accurate. While many families will use a thermometer the impression of the child being hot to touch without formal measurement should still be taken seriously. Check whether the child is still feeding or taking fluids adequately. Any child may be irritable when their temperature is high, but a constantly irritable or inconsolable child, or one who is extremely lethargic, drowsy or difficult to rouse is a cause for concern. Ask about any skin changes or rashes the parent may have noticed. Find out what measures the parent may already have taken to manage the fever, and in particular, whether, and at what time, antipyretics have been given. Enquire about contact with infectious illnesses, and foreign travel. Other vital signs, including heart rate, respiratory rate and capillary refill time should also be recorded. The child should be examined for focal signs indicating the site of infection, and hydration should be assessed. Posture, tone, fontanelle (if patent), presence of a rash, neck stiffness and level of consciousness should also be assessed. If the diagnosis is unclear, potentially serious, and specific treatment may be needed to prevent deterioration, the child should be referred.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"259 1784","pages":"17-21, 2-3"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34298100","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 detection of non-melanoma skin cancer Non-melanoma skin cancer. 提高非黑色素瘤皮肤癌的检测。

Practitioner Pub Date : 2015-07-01

Nina Natafji, Michael J Tidman

{"title":"Improving detection of non-melanoma skin cancer Non-melanoma skin cancer.","authors":"Nina Natafji, Michael J Tidman","doi":"","DOIUrl":"","url":null,"abstract":"Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are clinically and pathologically distinct and both are locally invasive. However, while BCCs rarely metastasise, SCCs have the potential to do so especially when they arise on the ears or lips. UV radiation is the most important risk factor for non-melanoma skin cancer (NMSC). The tumours most commonly arise in fair-skinned individuals on sun-damaged skin, especially the face. Incidence rises with age. Patients with one NMSC have a higher risk of developing another NMSC and of malignant melanoma. SCCs are frequently more difficult to diagnose than BCCs. Well differentiated lesions have a pronounced keratotic element. Poorly differentiated SCCs tend to be pink or red papules or nodules, lacking keratin, which may ulcerate. Around 5% of SCCs metastasise. High-risk SCCs include those: on the ear, lip, or sites unexposed to the sun and in chronic ulcers, scars or Bowen's disease. SCCs > 20 mm in diameter or > 4 mm in depth are high risk. Patients who are immunosuppressed, have poorly differentiated tumours or recurrent disease are also at increased risk. Patients with a slowly evolving or persistent skin lesion where cancer is a possibility should be referred to a dermatologist. Lesions suspected of being BCC should be referred routinely. Urgent referral should be reserved for cases where there is concern that a delay may have a significant impact because of the size or site of the lesion. Any non-healing lesions >1 cm with marked induration on palpation, showing significant expansion over eight weeks, should be referred urgently as they may be SCCs.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"259 1784","pages":"23-7, 3"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34298095","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

Bullying in adolescence linked to depression in young adults. 青少年恃强凌弱与年轻人抑郁有关。

Practitioner Pub Date : 2015-07-01

Phillip Bland

引用次数: 0

Optimising the management of bronchiolitis in infants. 优化婴儿细支气管炎的管理。

Practitioner Pub Date : 2015-07-01

Benjamiin McNaughten, Thomas W Bourke

{"title":"Optimising the management of bronchiolitis in infants.","authors":"Benjamiin McNaughten, Thomas W Bourke","doi":"","DOIUrl":"","url":null,"abstract":"Bronchiolitis shows a seasonal pattern with peak incidence occurring in the winter. Around 2-3% of children require admission to hospital. Admission rates are highest in infants less than three months old and those with underlying comorbidities. It typically affects children in the first year of life peaking between three and six months of age. Infants will have a coryzal prodrome lasting one to three days before developing a persistent cough. Fever and reduced feeding are common and very young infants may present with apnoeic episodes. Symptoms normally peak between days three to five of the illness. There will be evidence of increased work of breathing such as tachypnoea, in drawing/recession, head bobbing, grunting, nasal flaring or tracheal tug. Auscultation typically reveals wheeze and/or crepitations throughout both lung fields. Most children with bronchiolitis do not need to be referred to secondary care and can be managed safely at home. Immediate referral to hospital should be arranged if there is: apnoea (observed or reported), the child looks seriously unwell, severe respiratory distress, marked chest recession or a respiratory rate >70 breaths/minute, central cyanosis or persistent oxygen saturation < 92% when breathing room air.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"259 1784","pages":"13-5, 2"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34298097","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

Psoriasis. 牛皮癣。

Practitioner Pub Date : 2015-06-01

Nigel Stollery

引用次数: 0

Medical therapy ineffective for aiding passage of ureteric stones. 药物治疗对帮助输尿管结石通过无效。

Practitioner Pub Date : 2015-06-01

Jonathan Rees

引用次数: 0

Diagnosis and treatment of gallstone disease. 胆结石疾病的诊断与治疗。

Practitioner Pub Date : 2015-06-01

Janice Y J Lee, Margaret G Keane, Stephen Pereira

{"title":"Diagnosis and treatment of gallstone disease.","authors":"Janice Y J Lee, Margaret G Keane, Stephen Pereira","doi":"","DOIUrl":"","url":null,"abstract":"Gallstones form when there is an imbalance in the composition of bile resulting in precipitation of one or more of its components. Between 37 and 86% of gallstones are cholesterol-rich stones, 2-27% are pigment stones and 4-16% are mixed. Cholesterol-rich gallstones are more common in Europe and North America. This has been attributed to obesity and diets containing a high proportion of refined carbohydrates and fat. Low-calorie diets and rapid weight loss are also associated with cholesterol-rich gallstones. Gallstone disease increases with age. Women have a higher prevalence of gallstones than men, which is attributed to exposure to oestrogen and progesterone. Of those with gallstones, around 1 to 4% will develop symptoms annually. Most patients (> 80%) will remain asymptomatic throughout their lifetime and the likelihood of developing symptoms diminishes with time. Liver function tests and an abdominal ultrasound should be offered to patients with symptoms suggestive of gallstone disease (e.g. abdominal pain, jaundice, fever). They should also be considered in patients with less typical but chronic abdominal or gastrointestinal symptoms. In patients with acute pancreatitis and evidence of ongoing bile duct obstruction and/or cholangitis, endoscopic retrograde cholangio-pancreatography and biliary sphincterotomy is recommended within 24-72 hours of the onset of symptoms. Patients with acute cholecystitis should be referred for laparoscopic cholecystectomy.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"259 1783","pages":"15-9, 2"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34078210","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