Using Antibiotics Wisely to Reduce Resistance

Using Antibiotics Wisely to Reduce Resistance

The growing problem of antimicrobial resistance has led to calls for antimicrobial stewardship programmes to
control antibiotic use in healthcare settings. Available estimates indicate that between 30% and 50% of
antibiotic use is inappropriate. Improper utilisation of antimicrobials often leads to increased costs, widespread
antimicrobial resistance and medication errors

Modern Medicine – April 2018

Thunderclap Headache When the risk of doing nothing is too high

Thunderclap Headache When the risk of doing nothing is too high

The cause of thunderclap headache should be considered to be aneurysmal subarachnoid haemorrhage
until proven otherwise. The diagnostic work up involves urgent non-enhanced CT of the brain (with
CT angiography if immediately available), then possibly a lumbar puncture, then cerebral arterial and venous
imaging with either MRI or CT if each preceding investigation has yielded a normal/negative result.
Reversible cerebral vasoconstriction syndrome is usually characterised by recurrent thunderclap headaches
and multifocal, multi-vessel segmental cerebral artery vasoconstriction that usually resolve within 12 weeks.
It can be associated with neurological complications including intracerebral haemorrhage and cerebral
ischaemic infarctions.

Modern Medicine – April 2018

Diagnosing Bacterial Conjunctivitis

Diagnosing Bacterial Conjunctivitis

Although the ocular surface resists bacterial infection through a variety of mechanisms, conjunctival infection
can occur when an organism is able to overcome the host’s resistance. Host resistance can be impaired in
disease states, in immunocompromised patients or following trauma. Most common bacterial pathogens can
cause conjunctivitis. Bacterial conjunctivitis (BC) can be classified as hyperacute, acute and chronic.

Modern Medicine – April 2018

Be True to Yourself if You’re Going to Serve as an Expert Witness

Be True to Yourself if You’re Going to Serve as an Expert Witness

The medico-legal expert witness space appears to have started to
become rather crowded in recent years, with an increasing number of
health professionals believing this to be a desired area of practice,
some virtually immediately postgraduation. As the pool of alleged expertise
grows however, so too do the risks to the reputation of the professional
domain under which an expert is registered and the quality of the
evidence provided if the duties of an expert witness are not properly
respected and understood.

Modern Medicine – April 2018

March 2018 Edition

We welcome you to come and read through our latest, March, edition of Modern Medicine.

This month we have a jam packed edition for you. Our features this month include; Opthalmology, Cardiology, Woundcare, Neurology & CNS 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.

Chronic Pain, Opioids and Dependence A role for every GP

Chronic Pain, Opioids and Dependence A role for every GP

Patients with opioid dependence are a common presentation in
general practice. Stable patients taking medications for pain who
are opioid dependent should ideally be managed in routine
general practice. As well as usual primary care, opioid use or opioid
substitution treatment needs monitoring in these patients.
Shared care with pain and addiction specialists is an effective way for
GPs to provide care to patients with addiction.

Modern Medicine – March 2018

Interferons – Fewer Relapses in Multiple Sclerosis

Interferons – Fewer Relapses in Multiple Sclerosis

The introduction of interferon beta therapies more than 20 years ago marked a milestone in the treatment of
relapsing-remitting multiple sclerosis (RRMS) with a significant impact on the approach to modern multiple
sclerosis (MS) care. The continuous development of interferon’s over the past two decades outlines a journey
with increased understanding of the pharmacodynamics and pharmacokinetic mechanisms of interferons, leading
to innovative formulations with an improved benefit/risk profile.

Modern Medicine – March 2018

Major Depressive Disorder: Diagnosing and Treatment

Major Depressive Disorder: Diagnosing and Treatment

The construct of major depressive disorder makes no etiological
assumptions about populations with diverse symptom clusters.
“Depressed mood” and “loss of interest or pleasure in nearly all
activities” are core features of a major depressive episode, though
a strong case can be made to pay increasing attention to symptoms of
fatigue, sleep disturbance, anxiety and neurocognitive and sexual
dysfunction in the diagnosis. Mood, guilt, work and interest,
as well as psychic anxiety, are consistently identified across
validated subscales of the Hamilton Depression Rating Scale as
prevalent and sensitive to change with existing treatments.

Modern Medicine – March 2018

Cerebral Aneurysms and Subarachnoid Haemorrhage Avoiding the diagnostic pitfalls

Cerebral Aneurysms and Subarachnoid Haemorrhage Avoiding the diagnostic pitfalls

Subarachnoid haemorrhage (SAH) due to a ruptured cerebral aneurysm is a potentially fatal condition that
presents as headache. A raised index of suspicion must exist for all patients with sudden, severe headache with or
without associated symptoms. Initial investigation of suspected SAH should be a
noncontrast CT scan. Management of SAH is increasingly becoming endovascular. The outcome for patients with
no or only a mild global or focal neurological deficit on presentation has improved, but pre-hospital mortality and
disability from the initial haemorrhage remains a problem. Unruptured asymptomatic aneurysms are not an urgent
scenario and can be dealt with in consultative outpatient fashion.

Modern Medicine – March 2018

Cutting Heart Rate Reduces Angina Symptoms

Cutting Heart Rate Reduces Angina Symptoms

Globally, coronary artery disease (CAD) is the leading cause of death
and is predicted to remain so for the foreseeable future. Stable angina
pectoris is defined as chest pain that develops when the heart rate
rises, for example, during intense sports or exciting emotions. In such
situations, the blood supply cannot meet the myocardial metabolism
needs, thus leading to angina.

Modern Medicine – March 2018