Aust Fam Physician
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Review Case Reports
Lower respiratory tract infections and community acquired pneumonia in adults.
Lower respiratory tract infections--acute bronchitis and community acquired pneumonia (CAP)--are important causes of morbidity in Australia. Acute bronchitis is often treated with antibiotics, although the cause is usually viral. Community acquired pneumonia may be fatal, particularly in the elderly, therefore appropriate assessment and management is essential. ⋯ Clinical assessment is important for acute bronchitis and CAP, with investigations such as C reactive protein, serology, and chest X-ray informing diagnosis and management of the latter. Causative organisms are usually not identified, but are presumed to be viral for acute bronchitis, and Streptococcus pneumoniae for CAP; although 'atypicals' are also important. Antibiotics should generally not be prescribed for acute bronchitis, however, there is some evidence they may provide limited benefits in patients who have chest signs, are very unwell, are older, have comorbidities, or smoke. In patients with CAP, treated outside of hospital, the combination of amoxycillin and doxycycline/roxithromycin is the treatment of choice.
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Opioid based cough mixtures are readily available to the public and are generally used safely. However, like alcohol, their use can sometimes be a significant part of a dependence problem. ⋯ Opioid dependence is generally considered synonymous with heroin dependence or dependence on prescribed opioid analgesics. However, cough mixtures are a readily available source of opioids. People who become dependent on these mixtures commonly do not present for medical assistance until the problem is severe.
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General practice education is rapidly changing. Medical students now have exposure to general practice at most year levels, vocational training has been opened to competition, and continuing professional development is a mandatory requirement for maintenance of Health Insurance Commission recognition, and increasingly for state registration. This article outlines the foundations for, and challenge to, building a framework for quality general practice education in Australia.
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A significant number of Australians and people from specific groups within the community are suffering from vitamin D deficiency. It is no longer acceptable to assume that all people in Australia receive adequate vitamin D from casual exposure to sunlight. ⋯ People at high risk of vitamin D deficiency include the elderly, those with skin conditions where avoidance of sunlight is required, dark skinned people (particularly women during pregnancy or if veiled) and patients with malabsorption, e.g. coeliac disease. For most people, deficiency can be prevented by 5-15 minutes exposure of face and upper limbs to sunlight 4-6 times per week. If this is not possible then a vitamin D supplement of at least 400 IU per day is recommended. In cases of established vitamin D deficiency, supplementation with 3000-5000 IU per day for at least 1 month is required to replete body stores. Increased availability of larger dose preparations of cholecalciferol would be a useful therapy in the case of severe deficiencies.