Type 2 diabetes is becoming more common in adolescents. Type 2 diabetes onset generally coincides
with mid to late puberty, during the peak of physiological pubertal insulin resistance. Patients with type 2 diabetes
are usually asymptomatic at presentation, being diagnosed incidentally or on screening after consideration
of risk factors. Diagnosis of type 2 diabetes is by glucosebased tests or glycated haemoglobin (HbA1c). Each
test has its limitations. Treatment of type 2 diabetes is multidisciplinary. Vigilance in follow-up healthcare is
required in adolescents with diabetes as lifestyle and antihyperglycaemic medication interventions are often not
very effective or durable in this patient population.
Over the past two decades, as the prevalence of chronic pain and health care costs have exploded,
an opioid epidemic with adverse consequences has escalated. Efforts to increase opioid use and
a campaign touting the alleged under-treatment of pain continue to be significant factors in the
escalation. Many arguments in favour of opioids are based solely on traditions, expert opinion,
practical experience and uncontrolled anecdotal observations. Opioids should only be used when
benefits are expected to outweigh risks. Ensuring that patients have access to safe, effective
treatment is critical and involves improving the way opioids are prescribed.
Evidence-based lifestyle changes and drug therapies are known to reduce the risk of further cardiovascular
events in patients who have survived an acute coronary syndrome. Secondary prevention strategies should
be implemented before the patient is discharged from hospital and continued by GPs. Establishing a strong
therapeutic alliance with the patient can help GPs promote a lifelong approach to secondary prevention
measures. Patient education about coronary heart disease, personalised interventions and strategies such
as referral to a cardiac rehabilitation program can improve adherence to secondary prevention measures. Increased
use of chronic disease management items might support more systematic care for people living with cardiovascular
disease.
We welcome you to come and read through our latest, October, edition of Modern Medicine.
This month we have a jam packed edition for you. Our features this month include; Ethics, Cardiology, Pain and many more.
We encourage all of our readers to complete the CPD questionnaire for this edition, this can be done on the answer-form included in the magazine, or on ourwebsite CPD system.
Modern Medicine,the journal that’s with you wherever you go.
Multiparametric magnetic resonance imaging (mpMRI)
is proving to be an excellent tool for detecting aggressive prostate
cancers and performing targeted biopsies. Potentially, it will reduce
overdetection and underdetection and optimise active surveillance
and other aspects of cancer assessment and treatment. mpMRI
of the prostate is still evolving and is not without limitations.
Treating chronic musculoskeletal pain and chronic joint pain (osteoarthritis) in particular, is challenging as the
peripheral and central pain mechanisms have not been fully discovered. The pain associated with joint discomfort
is highly variable, often underestimated by clinicians and shows only modest association with crude radiological
scorings. One reason for the disconnect between the extent of structural damage and pain is neuroplastic
changes occurring in the peripheral and central nervous system resulting in pain sensitisation impacting the
patient’s experience of pain.
Heart failure with preserved ejection fraction (HFpEF, diastolic heart failure) is equally as common as heart
failure with reduced ejection fraction (HFrEF, systolic heart failure). HFpEF is an emerging epidemic, due to the
increasing age of the population and increasing incidence of risk factors such as obesity and hypertension.
Recognition of the typical signs and symptoms of heart failure in the setting of specific echocardiographic
features is key to diagnosis. The diagnosis can be confirmed with exercise right heart catheterisation.
Key principles of management are blood pressure control, physical activity, optimisation of comorbidities
and judicious volume management. Few therapies are effective at reducing morbidity or mortality in HFpEF
at present. Active research is under way to develop appropriate diagnostic and management strategies.
Acute myocardial infarction (MI) can be grouped into ST-elevation and non ST-elevation MI. Diagnosis of MI
requires review of the patient’s symptoms and signs, ECG patterns and troponin levels. Some patients do not present
with the chest pain characteristic of MI. In these patients, angina-equivalent criteria need to be considered. Simple
risk scores such as the TIMI and HEART scores can help risk-stratify patients and determine the most appropriate
treatment strategy; these scores may be useful for GPs as well as in the emergency department.
Errors are inherent in medicine due to the imperfectness of human
nature. Healthcare providers may have a difficult time accepting
their fallibility, acknowledging mistakes, and disclosing errors.
Fear of litigation, shame, blame and concern about reputation are
just some of the barriers preventing doctors from being more candid
with their patients, despite the supporting body of evidence that
patients cite poor communication and lack of transparency as primary
drivers to file a lawsuit in the wake of a medical complication. Proper
error disclosure includes a timely explanation of what happened,
who was involved, why the error occurred and how it will be
prevented in the future. Medical mistakes afford the opportunity for
individuals and institutions to be candid about their weaknesses
while improving patient care processes.
We welcome you to come and read through our latest, September, edition of Modern Medicine.
This month we have a jam packed edition for you. Our features this month include; Heamatology Woman’s Health, Neurology and many more.
We encourage all of our readers to complete the CPD questionnaire for this edition, this can be done on the answer-form included in the magazine, or on ourwebsite CPD system.
Modern Medicine,the journal that’s with you wherever you go.
