Aust Fam Physician
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Traumatic brain injury is a significant cause of disability worldwide. Patients with a traumatic brain injury may have a range of physical, mental, cognitive and social problems involving care from a general practitioner. ⋯ The long term sequelae of traumatic brain injury pose a number of challenges for patients, their families and GPs. Common somatic complaints include seizures, headache, dizziness and sleep disturbance. Common mental health problems include depression, psychosis and anxiety. Cognitive and behavioural or personality changes can be significant and persist for some time following injury. Quality of life is closely predicted by return to the workforce and long term functional status is often linked to the severity of the injury. There is limited evidence for effective treatments of these sequelae and a need for more research. However, there are a number of proven treatments and an emerging understanding of the long term sequelae of traumatic brain injury.
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Intimate partner violence is a common problem among women attending general practice, with around one in 10 women currently experiencing physical, sexual or emotional abuse by a partner. Abused women frequently present with physical and psychosocial issues. Yet intimate partner violence often remains concealed and addressing it poses challenges for the clinician and patient alike. ⋯ Identifying intimate partner violence is important in clinical practice as it underlies many common physical and mental health presentations. Facilitating disclosure and responding effectively requires good communication skills. Safety assessment of women and their families, pinpointing level of readiness to contemplate action, and providing appropriate referral options and ongoing nonjudgmental support are elements of an effective response. General practitioners have the potential to identify women and support them safely on a pathway to recovery, thereby avoiding the long term impacts of intimate partner violence.
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Lower urinary tract symptoms are a common problem in men and the incidence of these symptoms increases with age. ⋯ Lower urinary tract symptoms may be divided into voiding and storage, and men may present with a combination of the two symptom groups. Voiding symptoms include weak stream, hesitancy, and incomplete emptying or straining and are usually due to enlargement of the prostate gland. Storage symptoms include frequency, urgency and nocturia and may be due to detrusor overactivity. In elderly men who present with lower urinary tract symptoms, indications for early referral to a urologist include haematuria, recurrent infections, bladder stones, urinary retention and renal impairment. In uncomplicated cases, medical therapy can be instituted in the primary care setting. Options for medical therapy include alpha blockers to relax the smooth muscle of the prostate, 5 alpha reductase inhibitors to shrink the prostate, and antimuscarinics to relax the bladder. The International Prostate Symptom Score is beneficial in assessing symptoms and response to treatment. If symptoms progress despite medical therapy or the patient is unable to tolerate medical therapy, urological referral is warranted.
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From April 2009 to March 2011 in BEACH, benign prostatic hyperplasia/hypertrophy (BPH) was managed at a rate of six per 1000 general practice encounters with male patients aged 18 years and over, suggesting it was managed by general practitioners about 228 000 times per year nationally.
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Proton pump inhibitors (PPIs) are one of the most popularly prescribed drugs in Australia for conditions such as gastro-oesophageal reflux disease, peptic ulcer disease and functional dyspepsia. Despite their good safety profile, PPIs have potential adverse effects, yet they are often overprescribed and without a clear indication. ⋯ Uncommon adverse effects include rebound acid hypersecretion syndrome, fragility fractures, interstitial nephritis, electrolyte derangements, pneumonia, enteric infection and vitamin B12 deficiency. General practitioners should be aware of these potential adverse effects and ensure that PPIs are used appropriately and where benefit clearly outweighs any harmful effects.