Aust Fam Physician
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This is a relatively specialised technique aimed more at enhancing the skills of doctors regularly performing local anaesthetic blocks. It is a useful device for confirming the location of major nerves and plexuses proximally, but not necessary for most peripheral nerve blocks.
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The prevalence of diabetes in the Aboriginal and Torres Strait Islander population is relatively high. A high proportion of cases are undiagnosed. Diabetes is one of a number of increasingly prevalent chronic diseases which have been described collectively as a noncommunicable disease epidemic. ⋯ There is a strong case for screening for diabetes as part of an opportunistic or planned periodic health examination (PHE). As well as fasting venous plasma glucose, this integrated approach should include assessment of weight, blood pressure, presence of microalbuminuria and hyperlipidaemia. General practitioners need to be sensitive to cultural issues and power relationships, as well as considering 'structural' impediments to good health, such as affordability and availability of nutritious food, rather than focus solely on individual 'lifestyle' issues.
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A cross cultural environment emphasises the challenges for communication between doctor and patient. The following stories share our thoughts and experience. They aim to illustrate issues and provoke reflection.
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Review Case Reports
Parkinson disease and its differentials. Diagnoses made easy.
Parkinson disease is a common neurological disorder that is both underdiagnosed and inaccurately diagnosed. There is no reliable biological marker or test that can differentiate between causes of parkinsonism. Even for experienced clinicians, the clinical diagnostic accuracy compared to post mortem findings is about 80%. ⋯ Although Parkinson disease is a common cause of parkinsonism, other candidates such as drug reactions, benign essential tremor, vascular disease and Lewy body dementia need to be differentiated. Incorrect diagnosis can result in complications related particularly to the use of levodopa and antipsychotic agents. Diagnostic accuracy is important to ensure appropriate management, to avoid complications and to assist patients to have realistic expectations and prognostic information about their condition.