Table 1. DSM-IV diagnostic criteria for common eating disorders2 Anorexia nervosa 1. Refusal to maintain body weight at or above a minimally normal weight for age and height (eg. weight loss leading to maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected) 2. Intense fear of gaining weight or becoming fat, even though underweight 3. Disturbance in the way that body weight, size or shape is experienced, undue influence of body shape and weight on self evaluation, or denial of the seriousness of current low body weight 4. In postmenarchal females, amenorrhoea, ie. the absence of at least three consecutive menstrual cycles Types • Restricting type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge eating or purging behaviour (self induced vomiting, misuse of laxatives, diuretics, or enemas) • Binge eating/purging type: during the current episode of anorexia nervosa, the person has regularly engaged in binge eating or purging behaviour (ie. self induced vomiting or the misuse of laxatives, diuretics, or enemas) Bulimia nervosa 1. Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following: • Eating in a discrete period of time (eg. within any 2 hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances • A sense of lack of control over eating during the episode (eg. a feeling that one cannot stop eating or control what, or how much, one is eating) 2. Recurrent inappropriate compensatory behaviour in order to prevent weight gain such as self induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise 3. Binge eating and inappropriate compensatory behaviours both occur on average at least twice a week for 3 months 4. Self evaluation is unduly influenced by body shape and weight 5. The disturbance does not occur exclusively during episodes of anorexia nervosa Types • Purging type: during the current episode of bulimia nervosa, the person has regularly engaged in self induced vomiting or the misuse of laxatives, diuretics, or enemas • Nonpurging type: during the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviours such as fasting or excessive exercise, but has not regularly engaged in self induced vomiting or the misuse of laxatives, diuretics, or enemas Reprinted from Australian Family Physician Vol. 40, No. 3, march 2011 109 FOCUS Eating disorders – early identification in general practice
The Australian Medical Council (AMC) is the national accreditation body for medical education and training in Australia. AMC MCQ Exam: This is a computer-based multiple-choice question (MCQ) AMC Clinical Exam: This exam assesses the clinical skills and knowledge of candidates in a simulated clinical environment. I AMC CAT MCQ Exam: This is a computer adaptive test (CAT) that assesses the clinical knowledge and understanding of candidates.
Tuesday 4 July 2017
Eating Disorders
Table 1. DSM-IV diagnostic criteria for common eating disorders2 Anorexia nervosa 1. Refusal to maintain body weight at or above a minimally normal weight for age and height (eg. weight loss leading to maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected) 2. Intense fear of gaining weight or becoming fat, even though underweight 3. Disturbance in the way that body weight, size or shape is experienced, undue influence of body shape and weight on self evaluation, or denial of the seriousness of current low body weight 4. In postmenarchal females, amenorrhoea, ie. the absence of at least three consecutive menstrual cycles Types • Restricting type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge eating or purging behaviour (self induced vomiting, misuse of laxatives, diuretics, or enemas) • Binge eating/purging type: during the current episode of anorexia nervosa, the person has regularly engaged in binge eating or purging behaviour (ie. self induced vomiting or the misuse of laxatives, diuretics, or enemas) Bulimia nervosa 1. Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following: • Eating in a discrete period of time (eg. within any 2 hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances • A sense of lack of control over eating during the episode (eg. a feeling that one cannot stop eating or control what, or how much, one is eating) 2. Recurrent inappropriate compensatory behaviour in order to prevent weight gain such as self induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise 3. Binge eating and inappropriate compensatory behaviours both occur on average at least twice a week for 3 months 4. Self evaluation is unduly influenced by body shape and weight 5. The disturbance does not occur exclusively during episodes of anorexia nervosa Types • Purging type: during the current episode of bulimia nervosa, the person has regularly engaged in self induced vomiting or the misuse of laxatives, diuretics, or enemas • Nonpurging type: during the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviours such as fasting or excessive exercise, but has not regularly engaged in self induced vomiting or the misuse of laxatives, diuretics, or enemas Reprinted from Australian Family Physician Vol. 40, No. 3, march 2011 109 FOCUS Eating disorders – early identification in general practice
WITH A LOTS OF LATERAL THINKING
Friday 30 June 2017
METABOLIC SYNDROME KEY POINTS
1.Metabolic syndrome is
increasing but often goes
unrecognised.
2.Measuring insulin resistance is
unnecessary – measuring waist
circumference is simpler and
more important.
3.Ethnicity needs to be
considered when cut-off points
for waist measurement are used
to screen for patients at risk of
metabolic syndrome.
4.Risk factors for metabolic
syndrome often cluster together,
and the increase in risk is
multiplied rather than added.
5.Modest weight loss (5kg) and/or
increased physical exercise
reduce the risk of developing
diabetes in patients with metabolic syndrome.
increasing but often goes
unrecognised.
2.Measuring insulin resistance is
unnecessary – measuring waist
circumference is simpler and
more important.
3.Ethnicity needs to be
considered when cut-off points
for waist measurement are used
to screen for patients at risk of
metabolic syndrome.
4.Risk factors for metabolic
syndrome often cluster together,
and the increase in risk is
multiplied rather than added.
5.Modest weight loss (5kg) and/or
increased physical exercise
reduce the risk of developing
diabetes in patients with metabolic syndrome.
WITH A LOTS OF LATERAL THINKING
Waist Target Parameters
Country/ethnic group Waist circumference
Europids Male 94 cm
In the US, the Female 80 cm
ATP III values
(10 cm male;
88cm female)
are likely to
continue to be
used for clinical
purposes.
South Asians Male 90 cm
Based on a Female 80 cm
Chinese, Malay
and Asian-Indian
population
Chinese Male 90 cm
Female 80 cm
Japanese Male 90 cm
Female 80 cm
Ethnic South and Use South Asian
Central Americans recommendations until
more specific data
are available.
Sub-Saharan Use European data until
Africans more specific data are
available.
Eastern Use European
Mediterranean data until more specific
and Middle East data are available.
Europids Male 94 cm
In the US, the Female 80 cm
ATP III values
(10 cm male;
88cm female)
are likely to
continue to be
used for clinical
purposes.
South Asians Male 90 cm
Based on a Female 80 cm
Chinese, Malay
and Asian-Indian
population
Chinese Male 90 cm
Female 80 cm
Japanese Male 90 cm
Female 80 cm
Ethnic South and Use South Asian
Central Americans recommendations until
more specific data
are available.
Sub-Saharan Use European data until
Africans more specific data are
available.
Eastern Use European
Mediterranean data until more specific
and Middle East data are available.
WITH A LOTS OF LATERAL THINKING
Preventing Recurrent DVT
A patient with successfully treated
DVT remains at increased risk of
DVT or PE for life and will need prophylaxis
at times. Prophylaxis (with,
for example, enoxaparin 40mg daily)
should begin 12 hours before elective
surgery.
In orthopaedic surgery, it should
be continued at this dose for three
weeks after discharge from hospital2.
Early remobilisation and compression
stockings should be used routinely
for all surgery. Intra-operative
calf compression machines are often
used in prolonged elective surgery.
High-risk medical patients (eg,
those likely to be inpatients for more
than five days) should receive routine
prophylaxis whether or not they
have had a prior DVT.
Seek advice if the patient has renal
impairment because LMW heparins
accumulate quickly in patients with
moderate to severe renal failure.
All women with previous DVT or
artificial heart valves should receive
daily heparin prophylaxis during
pregnancy. Haematological review is
recommended in those with diagnosed
thrombophilia (deficiency of
anti-thrombin III, protein C or S,
mutations of factor V or prothrombin
genes), as more intense prophylaxis
may be needed in some.
Patients with a past history of
DVT who are planning air travel for
more than four hours should be
given recommendations in writing:
• Self-inject 40mg enoxaparin before
each separate flight (not including
refuelling stops)
• Ask for a seat with good leg room
• Accept every non-alcoholic
beverage offered
• Minimise alcohol consumption
• Perform in-seat exercises recommended
by the airline.
National guidelines do not recommend
frequent walking around the
cabin because of the risk of turbulence.
Aspirin does more harm than
good in air travellers.
References
Current Diagnosis of Venous Thromboembolism
in Primary Care: A Clinical Practice Guideline,
American Academy of Family Physicians and
the American College of Physicians.
Annals of Internal Medicine: p57- 62: Vol 5:
No 1: January/February 2007
1. Palareti G., Cosmi B., Legnani C., et al. DDimer
Testing to Determine the Duration of
Anticoagulation Therapy. N Engl J Med 2006;
355:1780-1789, Oct 26, 2006.
2. TGA-approved product information for
DVT remains at increased risk of
DVT or PE for life and will need prophylaxis
at times. Prophylaxis (with,
for example, enoxaparin 40mg daily)
should begin 12 hours before elective
surgery.
In orthopaedic surgery, it should
be continued at this dose for three
weeks after discharge from hospital2.
Early remobilisation and compression
stockings should be used routinely
for all surgery. Intra-operative
calf compression machines are often
used in prolonged elective surgery.
High-risk medical patients (eg,
those likely to be inpatients for more
than five days) should receive routine
prophylaxis whether or not they
have had a prior DVT.
Seek advice if the patient has renal
impairment because LMW heparins
accumulate quickly in patients with
moderate to severe renal failure.
All women with previous DVT or
artificial heart valves should receive
daily heparin prophylaxis during
pregnancy. Haematological review is
recommended in those with diagnosed
thrombophilia (deficiency of
anti-thrombin III, protein C or S,
mutations of factor V or prothrombin
genes), as more intense prophylaxis
may be needed in some.
Patients with a past history of
DVT who are planning air travel for
more than four hours should be
given recommendations in writing:
• Self-inject 40mg enoxaparin before
each separate flight (not including
refuelling stops)
• Ask for a seat with good leg room
• Accept every non-alcoholic
beverage offered
• Minimise alcohol consumption
• Perform in-seat exercises recommended
by the airline.
National guidelines do not recommend
frequent walking around the
cabin because of the risk of turbulence.
Aspirin does more harm than
good in air travellers.
References
Current Diagnosis of Venous Thromboembolism
in Primary Care: A Clinical Practice Guideline,
American Academy of Family Physicians and
the American College of Physicians.
Annals of Internal Medicine: p57- 62: Vol 5:
No 1: January/February 2007
1. Palareti G., Cosmi B., Legnani C., et al. DDimer
Testing to Determine the Duration of
Anticoagulation Therapy. N Engl J Med 2006;
355:1780-1789, Oct 26, 2006.
2. TGA-approved product information for
WITH A LOTS OF LATERAL THINKING
HEALTH INSURANCE
HEALTH INSURANCE IS ONE OF THE MOST IMPORTANT THING YOU NEED TO HAVE WHEN YOU ARRIVE IN AUSTRALIA.IT IS A MUST I WOULD SAY.THERE ARE MANY OPTIONS TO SELECT FROM
WITH A LOTS OF LATERAL THINKING
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