CME : Your SA Journal of CPD - Volume 21, Issue 9, 2003
Volume 21, Issue 9, 2003
Source: CME : Your SA Journal of CPD 21, pp 508 –510 (2003)More Less
Sore throat and URTI are common presenting problems in general practice, and antibiotics are commonly used. <br>Antibiotic resistance is a major cost of widespread antibiotic use. The main impact of antibiotics for people with the common cold is financial cost and adverse clinical effects. <br>In one-half of patients with sore throat, symptoms have improved by day 3 of the illness, with or without the use of antibiotics. <br>For sore throat, antibiotics shorten the average duration of symptoms by hours only, and analgesics are an effective alternative for pain. <br>A throat swab culture is a poor test for active streptococcal infection. <br>There is little reliable evidence regarding the accuracy of clinical signs for diagnosing 'strep throat'. <br>Antibiotic treatment for sore throat reduces the risk of rheumatic fever. <br>Antibiotic treatment to reduce the risk of rheumatic fever is pointless in people with a very low risk, e.g. children under 3 years and perhaps people in good socio-economic circumstances.
Evidence-based treatments for the asymptomatic HIV-positive patient in general practice : main topicAuthor P. MatchabaSource: CME : Your SA Journal of CPD 21, pp 512 –515 (2003)More Less
The asymtomatic HIV-positive patient represents a significant percentage of patients seen in general practice today in South Africa. <br>It is important and beneficial to know a patient's HIV status in order to prevent HIV-related morbidity and mortality. <br>Anti-TB drugs given prophylactically to HIV-positive and tuberculin skin-positive patients reduce their risk of active TB by as much as 70% in the short term (2 - 3 years). <br>Trimethoprim/sulfamethoxazole (TMP-SMX) - co-trimoxazole - is more effective than pentamidine or placebo and can reduce the risk of PCP or toxoplasmosis in patients who are HIV-positive by as much as 60%. <br>Women taking weekly fluconazole have a 58% decrease in the incidence of candidiasis compared with a 44% decrease in those taking placebo.
Reducing chronic diseases of lifestyle and managing HIV using an evidence-based approach - what every clinician should know : main topicSource: CME : Your SA Journal of CPD 21, pp 516 –522 (2003)More Less
Prevention/treatment of overweight should be a priority, particularly in high-risk patients, in order to reduce the risk of type 2 diabetes and CVD. <br>Patients should decrease their total consumption of fat, particularly saturated fat, trans fatty acids, as well as myristic and palmitic acids. <br>About 5 - 6 servings of fruit and vegetables per day are recommended to reduce CVD risk. <br>Regular fish consumption (1 - 2 servings per week) is protective against CHD. <br>Salt intake should be restricted to less than 1 teaspoon per day from all dietary sources. <br>At least 30 minutes of moderateintensity exercise, e.g. brisk walking on most days of the week, is considered sufficient to reduce CVD risk. <br>Dietary counselling is an effective method to encourage PLWHA to restore their energy and nutrient intake, especially during early disease. <br>It is likely that PLWHA will require micronutrient supplementation to reverse underlying deficiencies. <br>Early treatment for infections is an effective way of conserving the nutritional status of PLWHA. Aerobic exercise appears to be safe for PLWHA who are medically s table.
Author Dan Lamla MkizeSource: CME : Your SA Journal of CPD 21, pp 524 –528 (2003)More Less
Dementia is a progressive failure of most cerebral functions. It is a syndrome which may be caused by a number of different illnesses. It is not a part of normal ageing. It is rare in people under 60 years and increases in prevalence at later ages. <br>General practitioners have a central role in the diagnosis and management of dementia. Despite this, they receive little training in the undergraduate curriculum in the management of dementia. Therefore, they sometimes face difficulties in the management of some patients. <br>Non-pharmacological intervention strategies for dementia in general practice are important. <br>Behavioural disturbances such as depression, agitation, aggression, wandering about and sleep disturbances affect most if not all patients at some point in the course of the disease. <br>Empirical data from clinical trials indicate that behavioural problems in dementia can be effectively managed with non-pharmacological treatment. <br>Family caregivers are often 'hidden patients', with health care needs that are neglected or ignored because the patient's needs are so overwhelming. <br>Caregivers are at significant risk for both psychiatric and physical morbidity. <br>The majority of the studies report improvements in disruptive behaviours as a result of practical, clinical and educative interventions which can be undertaken by general practitioners.
Source: CME : Your SA Journal of CPD 21, pp 529 –534 (2003)More Less
Atopic eczema (AE) is a common chronic condition characterised by a dry, itchy skin, associated with flares and remissions. <br>The exact cause of AE is unkown, but a combination of genetic and environmental factors probably interacts. The importance of the latter is emphasised by the observation of an increased incidence in relatives who have moved from a rural to an urban environment. <br>The clinical presentation varies according to the age of the patient. Many remedies are usually tried by both the patient and the doctor, but we only consider treatments based on evidence from randomised controlled trials (RCTs). <br>Practical management consists of the correct diagnosis, moisturising the skin with aqueous cream or petroleum jelly, topical steroids and wet wraps in acute flare-ups, and the use of the newer macrolide treatments in patients with moderate to severe AE. However, use of the latter is limited by cost and availability. <br>Breast-feeding by a mother with a history of atopy may go some way towards preventing a child from developing eczema later in life. <br>The usefulness of antihis tamines to prevent itch has not been proved beyond doubt, nor has that of evening primrose oil.
The Medicines and Related Substances Control Act : essential facts about dispensing licensing, scheduling and generic substitution : GP affairsAuthor Elsabe KlinckSource: CME : Your SA Journal of CPD 21 (2003)More Less