Holding on to Hope podcast
A patient’s potential to suicide haunts most GPs at some stage in their working life. Many patients will endure incredibly stressful periods in their lives, and while you can offer all the support in the world there will always be the question of whether they need more.
In such situations, help offered by a person who can say “I understand – I’ve been there” can be invaluable. That’s where this resource comes into its own.
Hyperkalaemia – harmless artefact or medical emergency?
Elevated potassium is one of the most vexing problems faced by a clinician because of the difficulty knowing whether an elevated level (for example, 7.5mmol/L) is a
harmless artefact or imminently lethal hyperkalaemia.
The clinical background is critical to interpretation.
Correct inhaler technique
Recognise this scenario? You prescribe an inhaler for the patient. You educate the patient on why they need the inhaler. You draw diagrams. You demonstrate the technique on the placebo inhaler. You write the script. And then… you cross your fingers.
Laser ablation works best for varicose veins
Endovenous laser ablation has been rated as the most successful and cost-effective treatment for varicose veins over surgery and sclerotherapy, according to recent research.
In a UK randomised controlled trial involving almost 800 patients, researchers analysed quality of life questionnaires completed by trial participants five years after having their varicose veins treated via one of these methods.
“This large, multicentre trial … showed that in all three groups, quality of life five years after treatment was improved from baseline,” the study authors wrote in The New England Journal of Medicine.
Untangling the Weird, Wired Web of Gaming Disorder and its Classification
Paracetamol – the hidden harm
While the ‘opioid epidemic’ might be grabbing all the headlines at the moment, Australian toxicologists are reminding us that paracetamol is the most common drug used in overdoses in this country.
What’s more the numbers of both paracetamol-related hospital admissions and liver injury have been increasing over the past decade at a rate that far exceeds the rate of population increase.
According to a retrospective study recently published in The Medical Journal of Australia, there has been an average 3.8% annual increase in the number of paracetamol-related hospital admissions since 2007, and a mean 7.7% annual increase in paracetamol-related liver injury cases, whereas the population has been increasing at a rate of only 1.6% annually.
Optimising the value of PSA testing
Screening for prostate cancer with PSA testing has always been a bit controversial. Initially the high rate of false positives, especially in younger men, had most GPs questioning whether overall, we were doing more harm than good. But it would seem we’ve come a long way since those early days.
Not only do we understand a lot more about the PSA test itself, but also, we now are better able to determine what an elevated PSA signifies in a particular patient through tools such as imaging, before subjecting the man to a series of invasive procedures.
Understanding glomerular filtration rate
Glomerular filtration rate (GFR) is the best single measure of kidney function. A subnormal GFR is an important early indicator of possible chronic kidney disease. However, it also does not identify the cause. It is also not a ‘catch all’, for example, in early diabetes mellitus, GFR will typically be normal or even increased, due to ‘hyperfiltration’.
Optimal detection and risk stratification of early kidney disease also requires measurement of urine albumin, rather than just eGFR.
Pre-live vaccine checklist
Any doctor who has done the online yellow fever vaccination training module on the ACRRM website will be aware of this resource.
It’s a straight-forward, one-page pdf that presents a set of questions you need to ask the patient to see whether there are any contraindications to them receiving the yellow fever vaccination or indeed any live vaccine.
The checklist has been derived from information in the Australian Immunisation Handbook, and it is both succinct and comprehensive.
DPP-4 Inhibitors: Similarities and Differences
This article discusses the evidence for the use of DPP-4 inhibitors, in addition to standard care, in the management of type 2 diabetes.
Optimising Management of Type 2 Diabetes in Presence of Renal Impairment
Subclinical hypothyroidism in pregnancy, is it a real risk?
In the ‘largest analysis to date’, researchers have determined that subclinical hypothyroidism is associated with preterm birth but have stopped short of recommending screening.
It is well-known that overt thyroid disease in pregnancy is linked with preterm birth, as defined as delivery before 37 weeks. But whether milder forms of thyroid disease make a difference has been controversial.
