Aust Fam Physician
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Modern screening tools have the potential to decrease mortality and morbidity from bowel cancer, the second commonest cause of cancer death. The evaluation of the recent National Bowel Cancer Screening Pilot Program (NBCSPP) in Australia has prompted the commonwealth government to fund the first phase of the National Bowel Cancer Screening Program in May 2006. ⋯ Inexpensive tests are available to detect bleeding from the large bowel, a stronger indicator of early bowel cancer than symptoms, and pilot projects confirm their feasibility and acceptability in Australia. A doctor's recommendation strongly influences individual participation in screening. The medical profession are more likely to support an organised screening program if they are informed on the evidence on which the screening program is based.
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Psychotic symptoms in the elderly arise in mood disorders, schizophrenia, dementia, and delirium. ⋯ Management follows logically from a thorough mental state examination, medical work up and accurate diagnosis. Depression and mania with psychotic symptoms respond best to an antidepressant and mood stabiliser respectively, usually in combination with antipsychotic medication. Severe cases require electroconvulsive therapy. Atypical antipsychotics are now the treatment of choice in late life schizophrenia. Psychotic symptoms are common in dementia but usually fade within 6-12 months. Doses of psychiatric medications should therefore be lowered every 3 months to check that continued treatment is necessary. Most cases of delirium do not require psychiatric medication.
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Febrile convulsions, or febrile seizures, are frequently encountered in paediatrics, and despite often being self limiting, these seizures strike fear in the hearts of patients' carers. ⋯ The initial assessment of a child who convulses with fever should be directed at finding a cause for the fever, rather than the seizure itself, once the seizure has abated. A lumbar puncture should be performed if there is clinical suspicion of meningitis. Electroencephalograms and neuroimaging studies are not routinely indicated. Overall, febrile seizures carry a good prognosis, although one-third of children have recurrent attacks. Febrile seizures are genetic in origin. The risk of later epilepsy is small but increased if the child has a complex febrile seizure, neurological deficit, or a family history of epilepsy. Carers should be counselled in the management of seizures. The effectiveness of prophylactic treatment with medication remains controversial.
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Exposure to air pollution (both indoor and outdoor) has many potential adverse effects on human health. ⋯ Motor vehicle and industrial emissions are the primary contributors to outdoor air pollution in Australia. High levels of ozone and other pollutants can cause respiratory symptoms in susceptible individuals. Air quality advisory systems exist in most states. Clinicians can incorporate the health effects of air pollution, and awareness of advisory systems in the education of their susceptible patients and their carers. Asthma and chronic airways disease management plans should include provision for possible exposure to high pollution events and steps that can be taken to reduce exposure.