Aust Fam Physician
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Neck pain is a common presentation in general practice. Nevertheless, recommendations for the investigation and management of neck pain lack a strong evidence base and are predominantly extrapolated from low back pain studies. ⋯ Although sinister causes of neck pain are rare, clinicians must be mindful of red flags that may indicate serious pathology. The medical interview, rather than the physical examination, remains the most critical step in determining the likely cause of cervical spine pain, whereas biochemical tests and imaging are not part of routine assessment. The classification of neck pain into acute or chronic patterns, extrapolated from the low back pain literature, may help stratify the need for intervention and the likely prognosis of neck pain. A more concerted research effort is needed to help better understand and develop evidence-based guidelines for the management of neck pain.
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Review
SGLT2 inhibition with dapagliflozin -- a novel approach for the management of type 2 diabetes.
Because of the progressive nature of the disease, most patients with type 2 diabetes mellitus eventually require multiple treatments to achieve glycaemic targets. The majority of available therapies are insulin dependent, aiming to decrease insulin resistance and increase insulin secretion. Sodium glucose co-transporter 2 (SGLT2) inhibitors, a new class of antidiabetic agents, limit renal glucose reabsorption promoting urinary excretion of glucose, thereby reducing plasma glucose. ⋯ Clinical trials have shown dapagliflozin to be effective in reducing glycosylated haemoglobin, weight and fasting plasma glucose, either as monotherapy or as add-on therapy to metformin, sulphonylurea and insulin. Other SGLT2 inhibitors are currently under investigation.
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The antinuclear antibody (ANA) test is widely used as a serological marker of autoimmune disease. Antinuclear antibodies are immunoglobulins or antibodies that bind to one or more antigens expressed within the nucleus of human cells. Used selectively, the ANA test can be a useful laboratory tool to help confirm or exclude the diagnosis of systemic rheumatic disease. However, the relatively high prevalence of ANAs in other inflammatory conditions, as well as healthy individuals, can make a positive result difficult to interpret.
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Taping can be used to reduce pain in knee osteoarthritis. There are different methods of taping, but the common effect is to exert a medially directed force on the patella to increase the patellofemoral contact area, thereby decreasing joint stress and reducing pain. Taping can be performed by a physiotherapist, but self taping can be taught, which enhances self management. Taping for knee osteoarthritis has National Health and Medical Research Council (NHMRC) Level I evidence of efficacy for pain relief and is associated with negligible adverse effects that generally include minor skin irritation.
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Medical practitioners may have their particular skills called upon outside a direct professional context. The responsibilities of medical practitioners outside their defined scope of clinical practice may not be clear to all clinicians. ⋯ Where an established clinical relationship does not exist, and a doctor does not wish to render aid, three particular scenarios may arise. A doctor may actively deny being a doctor, passively avoid identifying themselves as a doctor or acknowledge being a doctor, but refuse to render assistance. Aside from any ethical issues, how a doctor chooses to act and represent themselves may lead to different legal ramifications. There exists significant variation in state provisions relating to legal obligations to render aid, which may benefit from review and revision at a national level.