The Complexities of Pain “Oh pain, is thy name torture?” – MM1606
Pain is a sensation of discomfort, distress or agony as perceived by the human brain and can be acute or chronic. It may be a protective mechanism, causing the sufferer to withdraw or to investigate the source of the pain.
Modern Medicine – June 2016
Understanding and Treating Pain in the Elderly – MM1606
Painful conditions are among the most common reasons for older people to present for medical attention. Pain is not a normal part of ageing; its high prevalence in older people is secondary to the burden of pathology. A person’s response to analgesics is variable, with many being poor or non-responders.
Ineffective or poorly tolerated analgesics should be withdrawn before another medication is trialled. A multidisciplinary approach is recommended when usual approaches have failed as no single therapy has been shown to alleviate persistent pain in most patients.
Modern Medicine – June 2016
Reducing Croup Severity Cuts Hospital Readmission – MM1606
Croup is characterised by the abrupt onset, most commonly at night, of a barking cough, inspiratory stridor, hoarseness and respiratory distress due to upper airway obstruction and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body. Croup affects about 3% of children a year, usually between the ages of six months and three years and 75% of infections are caused by Parainfluenza virus. Symptoms usually resolve within 48 hours. Severe infection rarely leads to pneumonia or to respiratory failure and arrest.
Modern Medicine – June 2016
Practical Use of the Nonvitamin K Antagonist Oral Anticoagulants – MM1606
NOACs (nonvitamin K antagonist oral anticoagulants) are an alternative to vitamin K antagonists such as warfarin for: prevention of stroke in patients with nonvalvular atrial fibrillation and of venous thromboembolism in adults after elective total hip or knee replacement; treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as prevention of recurrent DVT and PE.
The NOACs dabigatran and rivaroxaban differ in their properties, including mode of action and drug interactions; these differences must be taken into account when assessing patient suitability for NOAC therapy. Laboratory monitoring required for NOACs differs significantly from that used for warfarin. Perioperative use of NOACs is common but management differs between drugs, depending on their pharmacokinetic and pharmacodynamic properties.
Modern Medicine – June 2016
Diabetes Management in Aged Care Facilities | Meeting the Challenges – MM1606
Diabetes is a common disease that GPs will encounter in patients in institutional care, particularly residential aged care facilities (RACFs). Elderly patients with diabetes benefit from a team approach to management.
The approach to diabetes management should be tailored to each individual patient. Institutions are not all the same: in-house staffing, supports and services vary and need to be well understood to manage chronic diseases effectively. In elderly people with a short life expectancy, excessively tight diabetes control is not recommended. De-prescribing can be difficult but should be considered for every older person with diabetes in institutional care.
Modern Medicine – June 2016
Ethics in Sports Medicine – MM1606
Central to the issues facing the sports physician is the unusual clinical environment of caring for players within the context of a team whose primary goal is to win. This is in variance with the true goal of sport, which is to compete.
Doctors who are sports specialists face a number of ethical issues and this article will highlight some of these dilemmas. Some of the issues are common to other disciplines but others are unique.
Modern Medicine – June 2016
The May edition of Modern Medicine is online and available now.
In this issue we have a locally written article on pelvic organ prolapse, a common and distressing issue for women everywhere. We also focus on Radiology for the month, with details on x-ray in knee and ankle injuries, as well as a great article on new imaging modalities in coronary artery disease.
The articles above are topped off with a therapeutic overview on adult depression, examining everything from detection to treatment of this chronic disorder.
Modern Medicine, the journal that’s with you wherever you go.
Ivy Leaf Extract Effective for Treating Airway Diseases – MM1605
Preparations from ivy leaves (Hederae helicis folium, Hedera helix) dry extracts are well established in the treatment of different respiratory diseases. Their efficacy and safety have been demonstrated in a variety of controlled clinical and non-interventional studies. The effect of ivy leaves dry extract is based on its secretolytical and broncholytical properties. The main active compounds are saponins and especially α-hederin represents the most important saponin molecule responsible for the therapeutic effect.
It has been shown that α-hederin prevents β2-adrenergic receptors from internalisation and enables a higher number of receptors to be activated by the endogenous ligand adrenaline.6 As a consequence, a higher grade of bronchodilation and surfactant production is achieved, leading to the bronchospasmolytic, secretolytic, expectorant and, in turn, antitussive effect of ivy leaves extract preparations.
Modern Medicine – May 2016
Adult Depression A step-by-step guide to treatment – MM1605
A stepwise approach to the early detection and management of depression, guided by severity of presentation and treatment response, encourages more timely access to evidence-based treatments, including easily accessed and destigmatising e-mental health interventions. Evidence-based treatments range from e-mental health apps, psychological therapy and medication to neurostimulation.
With the overall similarities in efficacy of antidepressants, the most important considerations when initiating pharmacotherapy are tolerability and safety. For patients with difficult-to-treat depression, an algorithmic management approach with steps that include increasing the antidepressant dose, switching antidepressants, augmenting with a non-antidepressant treatment and combining antidepressants improves the chance of patient recovery. Neurostimulatory treatments such as electroconvulsive therapy and repetitive transcranial magnetic stimulation have an expanding role in the evidence based treatment of severe depression.
Modern Medicine – May 2016
First-line HIV Treatment Guidelines – MM1605
Currently, there is no effective vaccine against or efficient method of cure for HIV infection; however, numerous antiretroviral medicines have been devised to combat the progression of HIV infection into AIDS. Because no drug has proven to be exceedingly effective individually and the dynamic HIV genome is capable of rapidly developing drug resistance, the use of multiple drug classes each addressing a different aspect of HIV infection is preferred.
Modern Medicine – May 2016
