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UPDATE_SeptOct14: Editorial Comment - In this issue...


General practitioners manage patients with osteoarthritis on a daily basis, with treatments ranging from non-operative or conservative to orthopaedic referral for surgical intervention. In this article the epidemiology, risk factors, clinical presentation, radiographic findings and management is discussed. The majority of patients with small joint osteoarthritis respond well to non surgical treatments. Those with large joint osteoarthritis often require surgical intervention, particularly those patients with severe osteoarthritis of the hips and knees. The pain relief and improvement in quality of life as a result of these procedures is unquestionable. In the past joint replacements had limited durability. Today, techniques have improved considerably with fewer complications, less failures and increased longevity of the prostheses.

Posted by E-Doc on Tuesday, January 06 @ 10:40:27 SAST (469 reads)
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UPDATE_SeptOct14: Osteoarthritis


Tonia L Vincent

Fiona E Watt


Osteoarthritis (OA) is the most common form of joint disease, and its impact is set to grow as the prevalence of obesity rises and our elderly population increases. Many clinicians regard OA as being simply a disease of ‘wear and tear’, and by implication one in which disease modification is not possible. Such prejudices have led to significant academic apathy in this disease that is reflected not only in our poor understanding of disease pathogenesis, but also in the failure to classify the disease with greater precision, and to develop sensitive tools for diagnosis and prognostic assessment. The recent identification of key degradative enzymes in cartilage and the use of mouse models to study disease pathogenesis have greatly changed our outlook. The next decade is likely to see significant advances in our understanding of, and treatment for, this condition.

Posted by E-Doc on Tuesday, January 06 @ 10:32:46 SAST (554 reads)
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UPDATE_SeptOct14: Eczema


S Richards*

The word `eczema` is used to describe all kinds of red, blistering, oozing, scaly, brownish, thickened and itching skin conditions. Examples include allergic contact eczema; seborrhoeic eczema, characterised by pinky brown, thickened, greasy skin areas most typically on the scalp and central face; and nummular eczema, which consists of round oozing crusting patches.

The most common form of eczema in children is atopic, affecting one child in ten. At some time in their life, perhaps 80 percent of people will have areas of their skin which are eczematous. Cradle cap – a form of infant seborrhoeic eczema – seems to be almost universal and causes considerable parental alarm.

Posted by E-Doc on Tuesday, January 06 @ 10:30:02 SAST (484 reads)
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UPDATE_SeptOct14: Categorising methadone: Addiction and analgesia


Helen Keane

School of Sociology, Research School of Social Sciences, Australian National University, Canberra ACT 0200, Australia


While methadone was first developed as an analgesic, and used for this purpose before it was adopted as a therapy for drug dependence, it is this latter use which has saturated its identity. Most of the literature and commentary on methadone discusses it in the context of methadone maintenance therapy (MMT). But one of the effects of the liberalization of opiate prescription for chronic pain which took place in the 1990s was the re-emergence of methadone as a painkiller. This article examines the relationship between methadone the painkiller and methadone the addiction treatment as it is constituted in recent medical research literature and treatment guidelines. It highlights the way medical discourse separates methadone into two substances with different effects depending on the problem that is being treated. Central to this separation is the classification of patients into addicts and non-addicts; and pain sufferers and non-pain sufferers. The article argues that despite this work of making and maintaining distinctions, the similarities in the way methadone is used and acts in these different medical contexts complicates these categories. The difficulties of keeping the ‘two methadones’ separate becomes most apparent in cases of MMT patients also being treated for chronic pain.

Posted by E-Doc on Tuesday, January 06 @ 10:27:03 SAST (888 reads)
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UPDATE_SeptOct14: Wound dressings: principles and practice


Kathryn Vowden

Peter Vowden



Knowledge of clinically and cost-effective wound management is an obvious requirement for surgeons, yet wound care education rarely features within the medical curriculum. As a result surgical trainees are often poorly placed to join in multidisciplinary wound management and may feel threatened when asked to manage wound complications. A vast range of dressing products exists yet robust evidence of the function and effectiveness of individual products is often lacking. An understanding of wound pathophysiology, a defined treatment goal and regular wound assessment combined with knowledge of basic wound dressing categories will provide guidance on product selection for different clinical situations and wound types.

Posted by E-Doc on Tuesday, January 06 @ 10:24:58 SAST (486 reads)
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UPDATE_SeptOct14: Fake medicines, a real danger for health


A geographical intensification of illegal counterfeit medicines which may be ineffective or even toxic, is now a global problem, largely because of the internet, and is a real danger for patient health. Compounding the problem is the fact that it is no longer just about lifestyle products, like medicines for erectile dysfunction or weight loss, but now includes prescription medicines for treating chronic and serious diseases such as cardiovascular diseases or cancer which are available online.

Posted by E-Doc on Tuesday, January 06 @ 10:22:14 SAST (427 reads)
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