South African Family Practice - Volume 56, Issue 6, 2014
Volume 56, Issue 6, 2014
Author Gboyega OgunbanjoSource: South African Family Practice 56 (2014)More Less
It was with deep sadness that we mourned the sudden departure to the great beyond of Dr Douw Greeff, who was the director of Medpharm Publications. Medpharm is a medical and pharmaceutical scholarly journal publishing company, established in 1988, which has since grown to publish prominent scholarly titles. My first contact with Douw was at Elsie Ballot Hospital, Amersfoort, Mpumalanga, as a young energetic community service doctor while I was coordinating the Extended Programme on Immunisation for Mpumalanga province as a specialist family physician. It was later on in 2004 that our paths once again crossed at the Medpharm offices when I was appointed associate editor of the South African Family Practice journal and he was the publisher of the journal.
Source: South African Family Practice 56, pp 6 –8 (2014)More Less
Acute otitis externa (AOE), or diffuse inflammation of the external ear canal, causes a range of symptoms, including otalgia, otorrhoea, hearing loss and itching. Despite AOE being common, with a 12-month prevalence of approximately 1%, there is a paucity of evidence-based treatment guidelines. This contributes to a wide variation in its management, especially in general practice. In particular, there appears to be confusion over the roles of topical and oral antibiotics, as well as concerns about ototoxicity and the emergence of microbial resistance potentially caused by topical preparations. This article reviews the current evidence-based treatment of AOE.
Source: South African Family Practice 56, pp 10 –14 (2014)More Less
Acute non-specific low back pain, usually a result of muscle strains and ligament sprains from lifting, exercising or moving unexpectedly, is commonly encountered in primary care. At any given time, approximately one in five adults will report low back pain. Although non-specific low back pain is usually self-limiting and improves with time, there is an array of treatment options to facilitate this process and to minimise potential suffering, disability and absenteeism from work. This article will provide a review of such treatment options.
Source: South African Family Practice 56, pp 16 –18 (2014)More Less
Acute postoperative pain remains a major problem. Undertreatment can lead to serious consequences including persistent postoperative pain, impaired rehabilitation, and increased length of hospital stay, sympathetic overdrive and immunosuppression. Overtreatment can lead to serious adverse events related to analgesic use such as sedation and respiratory depression. It is therefore imperative to prevent and treat postoperative pain, but at the same time not to cause harm from our treatment.
Source: South African Family Practice 56, pp 19 –23 (2014)More Less
Appendectomy is the removal of the vermiform appendix. The term 'appendectomy' is misleading as it gives no indication of degree of clinical compromise the patient may be suffering leading to the need for this procedure. The patient presenting for appendectomy represents a clinical challenge to the anaesthetist, which requires vigilance in ascertaining the severity of illness in order to allow for good anaesthesia management.
Source: South African Family Practice 56, pp 24 –26 (2014)More Less
A severe burn is arguably the most significant injury that the human body can sustain. No other form of trauma causes the massive physiological changes seen in a patient with a major burn injury. This is true in the first few weeks as well as up to two years postburn, due to the persistence of the hypermetabolic response. Both the profound alterations in physiology as well as numerous anatomical changes make anaesthesia of the severely burned patient complex and challenging.
Source: South African Family Practice 56, pp 28 –31 (2014)More Less
Tuberculosis is a common problem in South Africa, and provides a number of challenges for the anaesthetist. Patients may present in a variety of ways. Constitutional and pulmonary symptoms are the most common. These may impact on fitness for surgery and choice of anaesthesia. Tuberculosis treatment has the potential for a number of significant drug interactions. These are primarily mediated through induction of the cytochrome P450 enzyme system by rifampicin. Guidelines for the prevention of tuberculosis in the theatre environment need to be followed to avoid placing staff and other patients in danger.
Source: South African Family Practice 56, pp 32 –37 (2014)More Less
This is Part 2 of a three-part series on medico-legal documentation. Part 1 addressed the knowledge and skills necessary to complete a legal J88 document. The aim of Part 2 is to give practical guidance on completion of the J88 form in the case of assault. Part 3 will address the sexual assault section of the J88 form. As a legal document, the J88 form must be completed accurately with regard to demographic information, including the time and date of examination, to assist with interpretation of the findings. The full names of the person examined appear on the SAPS 308 form, and must be confirmed by the patient and an identification document, if available. The name of the healthcare provider must be identifiable and contact details must be stated to assist with tracing, if necessary. A complete history is important because a differential diagnosis needs be considered, and the clinical findings must be consistent with the description of the incident in terms of time, mechanism of the injury and the place at which the incident took place, as these all add to the probability that the incident occurred as disclosed. The health worker has a dual responsibility with regard to both the health and medico-legal aspects pertaining to the patient and must record these in the clinical notes. Only medico-legal aspects are recorded on the J88 form. A top-to-toe, back-to-front examination must be performed methodically, since the person may be unaware of certain injuries. The healthcare worker must write a conclusion in the space provided. Support of the history with the clinical picture is the basis for the conclusion.
Author Chris EllisSource: South African Family Practice 56 (2014)More Less
About 20 years ago, I started to encounter a new phenomenon in my consulting room. A mother would come in with two young children and they would systematically start to destroy the place. One child would try and strangle the other with the tubing of my sphygmomanometer, while the other pulled all the forms off my desk. The mother would be in a state of cosmic annihilation. The whirling dervishes had arrived. Every now and then, the mother would register some sign of resistance, but usually she was in a world beyond contact, worn down into a state of submission.