Modern Medicine

Heart Failure with Preserved Ejection Fraction Improving Diagnosis and Management

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.

Modern Medicine – October 2017

Diagnosis of Acute Myocardial Infarction and Patient Risk Stratification

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.

Modern Medicine – October 2017

How to Tell Patients When Medical Errors Occur

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.

Modern Medicine – October 2017

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 our website CPD system.

Modern Medicine, the journal that’s with you wherever you go.

Treating to Target in Gout Simple steps towards effective long-term control

An acutely inflamed joint usually warrants aspiration. Examination of the synovial fluid is the best way to differentiate
bacterial infection from crystal-induced arthritis and other less common disorders. The treatment of
acute gout is determined by the patient’s comorbidities. Confirmation of the diagnosis of gout by identifying urate
crystals is of great value prior to commencing long-term urate-lowering drug therapy (ULT). When ULT is used,
achieving the target serum urate level is of vital importance. In the early phase there is an increased risk of
flares and the risk is higher if the serum urate falls more rapidly. It is wise to introduce ULT at a low dose and to
use prophylactic drug therapy to avoid flares.

Modern Medicine – September 2017

Acute Otitis Media Following Tympanostomy

Insertion of tympanostomy tubes is one of the most common ambulatory surgeries performed on children; they are most
often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic
therapy. Otorrhea is the most common complication following tube insertion and can occur in up to 17% of intubated ears.

Modern Medicine – September 2017

RAINBOW Study Shows Real Life Outcomes in AMD

Obtaining real life evidence is important for ophthalmologists, as the
outcomes achieved in randomised studies of antivascular endothelial
growth factor (VEGF) agents may not always translate into clinical practices.
Linked to this is a scarcity of real life evidence in treatment naïve patients.

Modern Medicine – September 2017

Ocular Allergy Often Misdiagnosed and Overlooked

Allergic conjunctivitis is one of the most common allergic conditions
worldwide. Its incidence is increasing due to changing climate, pollution,
increased pollen loads, and the subject’s heightened immunological
sensitivity in response to these environmental changes.
The most common clinical presentations of ocular allergy are
conjunctival hyperaemia (redness) and chemosis (swelling), itching and
tearing and vision loss in severe cases.

Modern Medicine – September 2017

Pelvic Inflammatory Disease Management of new-onset low abdominal pain in young women

Pelvic inflammatory disease (PID) is an upper genital tract inflammatory syndrome with highly variable symptoms.
The diagnosis of PID should be considered in all young women who present with new-onset low abdominal
pain. A urine pregnancy test is essential in all women of childbearing age with new-onset low abdominal pain to
exclude ectopic pregnancy. Prompt treatment of women with suspected PID with ceftriaxone, azithromycin, doxycycline
and metronidazole to cover the potential polymicrobial causes is essential to prevent long-term complications.
Transfer to the nearest emergency department is warranted for women with severe symptoms or haemodynamic
instability. Sexual contacts should be tested and treated to prevent recurrence of PID.

Modern Medicine – September 2017

Managing Fertility is More than Taking a Pill

Avoiding pregnancy when it is not desired and achieving a desired
pregnancy are matters of concern throughout the reproductive life
course. Modern contraceptives have contributed to fertility management
in what has been termed the “reproductive revolution.” These are
presumed to enable all women and men to manage fertility optimally.
Subsequent surveys of contraceptive use, pregnancy intention, pregnancy
outcome, and ideas about family formation have found that this has not
been realised.

Modern Medicine – September 2017