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12021. Consultation Analysis

? The consultation is described by Pendleton as 'the central act of medicine' which 'deserves to be understood'. It is clearly central to the transaction between doctors and patients and central to the relationship between doctors and patients. [ ] The consultation is the basic tool of general practice and, like general practice, it has changed and evolved over the years. Many factors have contributed to changes in consultation styles, content and length. In the 1950s patients did not usually have booked (...) were ill-prepared for general practice consultations even though such consultations were commonplace in medical practice. There was a need to define and improve skills more appropriate for general practice. Such skills were neither taught nor learned in medical schools or teaching hospitals. The development of general practice as a discipline witnessed analysis of the consultation and the development of a better understanding of the consultation. This in turn helped improve the teaching

2008 Mentor

12022. Consent to Treatment in Children (Mental Capacity and Mental Health Legislation)

to the newsletter? Email address * We'd love to send you our articles and latest news by email, giving you the best opportunity to stay up to date with expert written health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; General Medical Council ; Family Planning Association (...) (FPA), 2009 ; General Medical Council (various dates) ; British Medical Association ; Dept of Health ; British Medical Association (BMA), February 2009 ; Respondent v. West Norfolk and Wisbech Area Health Authority, 1986 ; Gillick or Fraser? A plea for consistency over competence in children. BMJ. 2006 Apr 8332(7545):807 ; General Medical Council ; Public Health England ; Consent to Treatment, Radcliffe Publishing, 2010 RIGHT funny i dont know if its funny or not max ADHD AND DISABLED just had

2008 Mentor

12023. Attention Deficit Hyperactivity Disorder

be referred to a psychiatrist. [ ] Medication should be prescribed for children with severe and persistent symptoms of ADHD, when the diagnosis has been confirmed by a specialist. Children with moderate symptoms of ADHD can be treated with CNS stimulants when psychological interventions have been unsuccessful or are unavailable. Prescribing of CNS stimulants may be continued by general practitioners, under a shared-care arrangement. Treatment of ADHD often needs to be continued into adolescence, and may (...) and imipramine), or combination treatments (including psychological treatments for the parent or carer and the child or young person). Follow-up and monitoring: Drug treatment should be reviewed at least once every six months. Review should include physical review (height, weight, blood pressure and general health), medication review for efficacy, safety and compliance, and a review of the child's functioning at school, at home, socially and psychologically. Monitoring should include regular feedback from

2008 Mentor

12024. Bites - Human and Animal

Bites - Human and Animal Human and Animal Bites. Read about Animal Bites | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Human and Animal Bites Authored by , Reviewed by | Last edited 16 Jun 2014 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European (...) Guidelines. You may find the article more useful, or one of our other . In this article In This Article Human and Animal Bites In this article Epidemiology [ ] Substantially more dog bites occur than cat bites. It has been estimated that dog bites account for 60-90% of bites, cat bites for 5-20% and human bites for 4-23%. One study reported that of an estimated 740 people per 100,000 annually bitten by dogs, only a small proportion seek medical attention. 2.6 in 100,000 require hospital admission. Half

2008 Mentor

12025. Cluster Headache

be changed or supplemented. Acute therapy may be used in addition to prophylactic therapy if breakthrough attacks continue. It is therefore important to: Establish rapport, based on knowledge and understanding of the condition generally and the patient's particular experience. Anticipate that polypharmacy is likely to be required. Be prepared to follow up closely to monitor efficacy of treatments, side-effects, etc. Consider drawing up a programme of measures, perhaps with a patient-held record book (...) Cluster Headache Cluster Headache. CH information. Migrainous Neuraligia | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Cluster Headaches Authored by , Reviewed by | Last edited 2 Jan 2015 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines

2008 Mentor

12026. Chronic Myeloid Leukaemia

Chronic Myeloid Leukaemia Chronic Myeloid Leukaemia. Survival Rate and information | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Chronic Myeloid Leukaemia Authored by , Reviewed by | Last edited 11 Mar 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK (...) and the estimated overall survival of patients who received imatinib as initial therapy was 89% at the same time period. [ ] It has very quickly become standard therapy for CML because of its remarkable efficacy and mild side-effect profile. [ ] Second- and third-generation TKIs : Imatinib seems particularly effective in chronic phase CML. In more advanced disease, patients are less likely to be sensitive and often display a short-lived response to the drug. Failure of imatinib therapy associated

2008 Mentor

12027. Acupuncture

, UK and European Guidelines. You may find one of our more useful. In this article In This Article Complementary and Alternative Medicine In this article Complementary and alternative medicine (CAM) includes a group of diverse medical and healthcare systems, practices and products that are not generally considered part of conventional medicine. Complementary medicine is generally regarded as additional treatment that is used alongside conventional medicine, whereas alternative medicine is regarded (...) Acupuncture Complementary and Alternative Medicine. CAM information. Patient | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Complementary and Alternative Medicine Authored by , Reviewed by | Last edited 11 Feb 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence

2008 Mentor

12028. Antenatal Care

including: Food hygiene and safe eating in pregnancy. Smoking cessation. Advice about avoidance of alcohol and illicit drugs in pregnancy. Medication advice (review of safety of any current medication in pregnancy and avoidance of over-the-counter (OTC) medication which may not be used in pregnancy). At booking, she should be given: Information about the development of the baby during pregnancy. The choice of attending antenatal classes. Written information about antenatal care - for example, the book (...) advises healthcare professionals, at a woman's first contact with primary care, her booking visit and during the early postnatal period, to: Consider asking questions to screen for depression and anxiety as part of a general discussion about a woman's mental health and well-being. Ask about any past or present severe mental illness. Ask about past or present treatment by a specialist mental health service, including inpatient care Ask about any severe perinatal mental illness in a first-degree

2008 Mentor

12029. Antenatal Mental Health Problems

, women of reproductive age with pre-existing significant mental health problems should be encouraged to discuss pregnancy plans, enabling and medication review. Treatment decisions can be challenging, as risks and benefits need to be considered in terms of the welfare of both mother and fetus. Much research focuses on neonatal outcome, but neglects to consider maternal need. General points National Institute for Health and Care Excellence (NICE) guidelines place emphasis on: [ ] Person-centred care (...) visitors and GPs. Psychopharmacology in pregnancy [ , ] The knee-jerk reaction to avoid all psychopharmacology in pregnancy is clearly wrong since untreated mental health problems may be substantially more risky than the medication itself. Any risk putatively associated with the use of psychoactive drugs should be considered in the context of the relatively high, age-related, background risk for congenital abnormalities and spontaneous abortion in the general population. [ ] The risk/benefit ratio

2008 Mentor

12030. Wrist Fractures

. If there is neurovascular compromise, urgent fracture reduction may be needed. Displacement of fractures, dislocation or subluxation must be reduced. In older people the cosmetic result may be subservient to the need for a good functional result. Reduction Manipulation of broken bones is very painful; some form of anaesthesia is required. General anaesthesia is effective but even a brief anaesthetic has risks, especially in the elderly or those with medical problems. It is also necessary to wait until at least four (...) Wrist Fractures Wrist Fractures. Distal radius, ulna and carpal Fractures | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Wrist Fractures Authored by , Reviewed by | Last edited 23 Sep 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines

2008 Mentor

12031. Homeopathy

and European Guidelines. You may find one of our more useful. In this article In This Article Complementary and Alternative Medicine In this article Complementary and alternative medicine (CAM) includes a group of diverse medical and healthcare systems, practices and products that are not generally considered part of conventional medicine. Complementary medicine is generally regarded as additional treatment that is used alongside conventional medicine, whereas alternative medicine is regarded (...) Homeopathy Complementary and Alternative Medicine. CAM information. Patient | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Complementary and Alternative Medicine Authored by , Reviewed by | Last edited 11 Feb 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK

2008 Mentor

12032. HIV Counselling

incidence and services in populations at high risk for HIV exposure: an equity-focused systematic review. BMJ Open. 2014 Dec 154(12):e006859. doi: 10.1136/bmjopen-2014-006859. ; NICE CKS, March 2010 (UK access only) ; NICE/PHE (December 2016) ; Royal College of General Practitioners and British Association for Sexual Health and HIV (Apr 2013) ; Medical Foundation for HIV and Sexual Health (MEDFASH), 2015 ; British HIV Association (September 2008) ; Public Health England ; HIV testing strategies across (...) HIV Counselling HIV Counselling. When is further counselling available? | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search HIV Counselling Authored by , Reviewed by | Last edited 7 Apr 2015 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines

2008 Mentor

12033. High Altitude Illness

Mar157(1):12-7. ; Altitude Illness - Chapter 2, Travelers' Health, The Yellow Book, Centers for Disease Control and Prevention ; High altitude pulmonary oedema. J R Army Med Corps. 2011 Mar157(1):68-72. ; Pro: pulse oximetry is useful in predicting acute mountain sickness. High Alt Med Biol. 2014 Dec15(4):440-1. doi: 10.1089/ham.2014.1045. ; Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med. 2014 Dec25(4 (...) High Altitude Illness High-altitude Illness. Read about High-altitude Illness | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search High-altitude Illness Authored by , Reviewed by | Last edited 7 Mar 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European

2008 Mentor

12034. Hepatitis B Vaccination and Prevention

Hepatitis B Vaccination and Prevention Hepatitis B Vaccination and Prevention. Immunisation info | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Hepatitis B Vaccination and Prevention Authored by , Reviewed by | Last edited 5 Jun 2015 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based (...) to reside in areas of high or intermediate prevalence, particularly travellers with pre-existing medical conditions, who may be at higher risk of requiring medical procedures abroad. Those individuals who change sexual partners frequently, particularly commercial sex workers. Injecting drug users. Also: Partners and children of injecting drug users. Non-injecting drug users who live with injecting drug users. Individuals and staff in residential accommodation for those with learning difficulties. People

2008 Mentor

12035. Helping Patients Avoid Doctor Dependency

in the frequency of GP consultations. Br J Gen Pract. 1999 May49(442):363-7. Eric Berne. Games people play.; Penguin Books 1964 ; Striking variations in consultation rates with general practice reveal family BMC Fam Pract. 2007 Jan 188:4. ; Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study. BMJ. 2004 May 1328(7447):1057. Epub 2004 Mar 31. ; Patients' unvoiced agendas in general practice consultations: qualitative study. BMJ. 2000 May 6320 (...) Helping Patients Avoid Doctor Dependency Helping Patients Avoid Doctor Dependency. Advice and info | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Helping Patients Avoid Doctor Dependency Authored by | Last edited 22 Mar 2010 This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK

2008 Mentor

12036. Gestational Diabetes

Gestational Diabetes Gestational Diabetes information. Diabetes in pregnancy | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Gestational Diabetes Authored by , Reviewed by | Last edited 2 Dec 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European (...) [ ] . Diagnosis Screening GDM is usually asymptomatic but has serious consequences that can be reduced by treatment. NICE guidance suggests that screening should be offered at booking to women with the following risk factors for developing GDM [ ] : BMI >30 kg/m 2 . Previous macrosomic baby ≥4.5 kg or above. Previous GDM. First-degree relative with diabetes. Family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern). NICE recommends [ ] : Fasting plasma glucose, random

2008 Mentor

12037. Ethnic Matters

by the ministers of religion (surgical training is part of their theological studies). Some parents ask for a medical practitioner to perform the operation. (The NHS does not generally fund circumcision, other than when it is needed for medical reasons.) [ ] Female genital mutilation (FGM) This is a procedure often involving clitoridectomy together with varying degrees of excision of the labia. It is often performed by practitioners with no degree of precision or surgical skill. The World Health Organization (...) Ethnic Matters Ethnic Matters. Definitions and discussions of Ethnic Matters | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Ethnicity and Health Authored by , Reviewed by | Last edited 3 Dec 2015 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European

2008 Mentor

12038. Forster-Fuchs' Retinal Spot

Forster-Fuchs' Retinal Spot Förster-Fuchs Retinal Spot; Fuchs Retinal Spot. Patient | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Förster-Fuchs Retinal Spot Authored by , Reviewed by | Last edited 21 Mar 2014 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK (...) lesion develops after the macular haemorrhage has been absorbed. Other changes in high myopics include a tilted disc with associated atrophy, early age posterior vitreous detachment, zonular dehiscence (ie the zonules holding taut the capsular bag containing the crystalline lens) and pigment dispersion syndrome. Epidemiology The prevalence of progressive myopia shows geographical variation (eg, it is high in Spain and in Japan). However, generally it is thought to occur in 1-10% of myopic eyes. Up

2008 Mentor

12039. Nystagmus

Nystagmus Nystagmus | Doctor | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Nystagmus Authored by , Reviewed by | Last edited 1 Feb 2017 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our more useful (...) . Differential diagnosis Nystagmus should be distinguished from inappropriate saccades that prevent steady fixation (eg, ocular flutter). Saccades are fast movements, so that the smeared retinal signal because of these movements is largely unperceived. However, patients in whom abnormal saccades repeatedly misdirect the fovea often complain of difficulty in reading [ ] . Symptoms In general, late-acquired nystagmus and saccadic oscillations cause oscillopsia, nausea and vertigo; in contrast, most nystagmus

2008 Mentor

12040. Parvovirus Infection

Parvovirus Infection Parvovirus Infection. Slapped cheek disease, information | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Parvovirus Infection Authored by , Reviewed by | Last edited 28 Sep 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European (...) and fetal hydrops. Permanent congenital abnormality and/or congenital anaemia have also been identified as rare consequences of intrauterine infection. Maternal asymptomatic parvovirus B19 infection is at least as likely to infect and damage the fetus as symptomatic infection. Diagnosis is important, as intrauterine transfusion of the fetus improves the outcome. Investigation and management in pregnancy [ ] General principles All pregnant women who have a non-vesicular rash, or contact with someone who

2008 Mentor

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