Patients with dementia and their carers.

Clinical guidelines for general practitioners' care of patients with dementia still living in the community (not in hostels or nursing homes) were used in an educational program for general practitioners. At the same time information was obtained about the current health status, needs, and management of such patients and their carers. Eight general practitioners audited a total of 25 patients. Carer questionnaires were returned from 30 carers recruited by the general practitioners and 77 recruited by Alzheimer's Australia NSW. Many of the audit results are as expected, but some raise important issues. The diagnosis was not fully established for 20% of patients and the MMSE score not known by the general practitioner for 56%. Home safety had not been assessed for 44%. Legal matters such as driving or guardianship had not been considered for more than half. Most carers felt supported by their general practitioner in their role as carer, but services that would have been useful were not available to 23%, and most felt that being a carer had affected their own health. The small number of participants means that the audit results come from too few general practitioners to be reliably representative, but they do provide an indication of likely general results, and indicate priority areas for improved care.

Self directed learning and continuing medical education.

Self directed learning (SDL) for continuing medical education (CME) is the most effective approach for improving physician performance and patient care outcomes. Self directed learning is an essential basis for CME. However, instructor directed programs--particularly on-site conferences--remain the most popular method for acquiring CME. This article briefly examines the evolution of SDL and its importance in lifelong learning for general practice. The challenge for CME providers is to facilitate SDL while taking general practitioners' views and preferences into consideration.

What's in the doctor's bag?

BACKGROUND: A doctor's bag is invaluable when you need to take part of the practice to the patient, or in the case of an emergency. OBJECTIVE: This article aims to help new general practice registrars and experienced general practitioners consider what they may need in their doctor's bag. DISCUSSION: The doctor's bag needs to be personalised to the requirements of each GP and their patient population. Decisions need to be made about the type of bag, stationery, equipment and medications carried. Some possible additions for a rural doctor's bag are included, as well as some general tips.

Itch: a symptom of occult disease.

BACKGROUND: Pruritus, (the Latin word for itch), is defined as the 'desire to scratch'. It is a distressing, subjective symptom that may interfere significantly with the quality of a patient's life. OBJECTIVE: This article summarises the systemic causes of pruritus, describes the assessment of a patient presenting with itch without dermatological cause, and discusses the management of itch in patients with cancer. DISCUSSION: Patients with pruritus that does not respond to conservative therapy should be evaluated for underlying systemic disease. Causes of systemic pruritus include cholestasis, thyroid disease, polycythaemia rubra vera, uraemia, Hodgkin disease, and HIV. A thorough history and a complete physical examination are central to the evaluation of pruritus. In the absence of skin lesions, diagnostic testing is directed by the clinical evaluation and may include a complete blood count, liver function tests, serum creatinine, blood urea nitrogen levels, measurement of thyroid stimulating hormone, and chest X-ray. Removal of the causative agent and appropriate investigation and treatment of the underlying disease are essential first line measures in the treatment of pruritus.

Multicentric reticulohistiocytosis presenting with a rash and arthralgia.

A case of multicentric reticulohistiocytosis in a 53-year-old woman with a history of generalized cutaneous eruptions followed by arthralgia is presented. A thorough malignancy screen was performed with negative results. Treatment was commenced with oral prednisone 20 mg daily, which rapidly resulted in marked improvement of joint symptoms and resolution of self-perceived functional disability. As there was little improvement of her rash, oral azathioprine was added at 100 mg daily. Both drugs were well-tolerated and the patient was discharged from hospital on these medications. Two months later the azathioprine was reduced to 50 mg per day orally, following a small rise in hepatic transaminases. Within 4 months there had been dramatic improvement in the rash and cutaneous nodules with complete remission of the arthralgia and pruritus. During this time the oral prednisone had gradually been decreased to 10 mg daily. To date only the periungual nodules persist.