Aust Fam Physician
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Facial pain is a relatively frequent cause of presentation to both general medical and dental practitioners. Although in the vast majority of cases the cause is dental disease or tempero-mandibular joint dysfunction, the remaining patients are often difficult to diagnose and treat. ⋯ A detailed history, clinical examination, imaging and laboratory investigations may be required to establish the cause of atypical facial pain. An assessment of the patient's mental state is mandatory, as depression or psychological overlay is common. In a small number of cases, the diagnosis remains unclear despite detailed investigation. These patients may have their symptoms ameliorated by empirical pharmacological therapy.
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Routine clinical measurements of glycated haemoglobin first became available during the early 1970s and are now accepted as the standard for estimated overall glycaemic exposure and risk of microvascular complications in diabetes. ⋯ Blood glucose gives immediate day-to-day information and A1C usually gives a reliable estimate of the average glycaemic exposure over the past 6-8 weeks. Both are important components of glycaemic monitoring. Discrepancies between these two estimates of glycaemia can usually be resolved by checking blood glucose and A1C techniques. Target A1C is less than 7%, but encouraging patients to aim slightly lower (eg. by 0.5%) on A1C can result in significant reduction in complication risk. There is a clear relationship between glycaemic control reflected by A1C and the progression of microvascular complications in both type 1 and type 2 diabetes.
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Hip fracture is a common "geriatric syndrome", presenting general practitioners with complex challenges in prevention and management. Hip fracture entails a high cost to both the individual and the community. ⋯ General practitioners have a key role in preventing hip fracture and optimising the ongoing care of patients who have suffered a fracture.
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Acute dyspnoea is a distressing symptom that can suddenly affect any age group. ⋯ Successful management includes rapid assessment of the extent of the disease process, with emphasis on maintenance or protection of airway integrity and identification of impending respiratory failure. All general practice surgeries must have the appropriate equipment available, and staff trained in its use, to provide immediate relief to any patient who presents with dyspnoea. Urgent transfer from the general practice setting to a more specialised centre is usually necessary.
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Of all the major diseases, chronic obstructive pulmonary disease (COPD) is the one for which the burden is increasing the fastest. ⋯ Diagnosis is by clinical suspicion in patients with an appropriate clinical history and airflow obstruction is confirmed using spirometry. Although smoking cessation and oxygen in selected individuals are the only interventions known to alter the natural history of COPD, many other treatments can significantly lessen breathlessness, reduce exacerbations, and improve exercise and quality of life.