Family practice, like other fields of medicine involving daily direct contact with patients, is rewarding but can lead to burnout. Ideas about burnout have evolved through time and the concepts and terms used have become more refined, and more commonly agreed. Earlier publications were mostly descriptive but later ones have begun to look into possible interventions to combat burnout. Validated scales are increasingly being used as outcome measures of the intervention strategies, some in randomised control trials which have contributed to the evidence base. This paper is an evidence-based review of the definition, causes, and interventions published in current literature indexed in PUBMED.

A 27 year old patient with ameloblastoma of the mandible underwent anterior mandibulectomy and reconstruction with left fibula osteocutaneous flap. The bone was shaped at the lower limb before cutting the pedicle. Vascularised free fibula flap provides a good alternative to other bone grafts in mandible reconstruction as it is relatively easy to perform, carries a low complication rate, and mandibular shaping with intact pedicle cuts down on ischaemic as well as total operative time.

Evidence-Based Medicine ; Humans ; Mental Disorders ; drug therapy ; Psychiatry ; Psychopharmacology

To highlight the diagnostic challenges in diagnosing a patient with schizoaffective disorder under DSM-IV-TR and to evaluate the effectiveness of changes in DSM-V in addressing these issues. Methods: We present the evolution of the diagnosis from its inception, outline its complex nosology, review the diagnostic difficulties under DSM-IV-TR and critique the proposed changes made in DSM-V. Results: A complex nosology, varied thresholds of diagnosis under DSM-IV-TR, and the inherent difficulty in obtaining a detailed longitudinal history from a patient contribute to the challenge of diagnosing a patient with schizoaffective disorder. Changes in DSM-V attempt to increase the reliability of the diagnosis by specifying and raising temporal thresholds, moving the time of disease observation away from a single episode but towards the lifetime of illness. Conclusion: Changes made in DSM-V only address a small part of the difficulties raised and clinicians will continue to face challenges in diagnosing schizoaffective disorder under DSM-V. However, there might still be value in the proposed changes under DSM-V

The aim of vaccination is immunisation of the child against diseases to prevent mortality and morbidity from specific infections. Adequate immunization coverage is the prerequisite for creating herd immunity. The maintenance of these levels of population immunity requires continuous vigilance and changes to immunisation schedule in response to changing circumstances. Changes have been made over the years to optimise the immunisation of poliomyelitis, measles, mumps, rubella, and varicella. The introduction of hemophilus influenza type B vaccine and pneumococcal vaccine has reduced the incidence of these infections. Vaccination against human papillomavirus infection is being expanded to protect against cervical neoplasia in females and also anal intraepithelial neoplasia in both genders. Childhood exanthems due to viral and bacterial infections, as well as immunological causes continue to be important and the ability to recognise them is necessary.

INTRODUCTIONSplenic abscess is an uncommon clinical problem. Traditionally, the "gold standard" treatment has been splenectomy. However, there is increasing use of non-operative treatments worldwide.

MATERIALS AND METHODSA 10-year (1996-2005) retrospective review of case records from a single centre (an 800-bed general hospital) was performed. Information regarding demographics, clinical presentation, aetiological agents and management was gathered and analysed.

RESULTSThere were 21 cases from 1996 to 2005. Nineteen (90%) had multiple abscesses. Disseminated melioidosis was the most common aetiological agent (15 cases, 71%). Only 3 patients underwent splenectomy. The remainder were treated conservatively with antibiotics. Almost all the patients (19, 90%) also suffered from diabetes mellitus.

CONCLUSIONSThe most common aetiological agent encountered was Burkholderia pseudomallei. Diabetes mellitus may be an important co-factor in the pathogenesis of splenic abscesses. The majority of our patients were managed conservatively and splenectomy was only occasionally required.

Abscess ; drug therapy ; epidemiology ; etiology ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Bacteremia ; complications ; drug therapy ; Female ; Hospitals, General ; statistics & numerical data ; Humans ; Male ; Melioidosis ; complications ; epidemiology ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Splenic Diseases ; drug therapy ; epidemiology ; etiology

Health Knowledge, Attitudes, Practice ; Humans ; Mental Disorders ; diagnosis ; rehabilitation ; therapy ; Psychiatry

Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurilemmoma ; diagnosis ; Rectal Neoplasms ; diagnosis ; Tomography, X-Ray Computed

Depression ; epidemiology ; etiology ; therapy ; Global Health ; Health Promotion ; Humans ; Mental Disorders ; epidemiology ; etiology ; therapy ; Mental Health

Introduction: Acute respiratory tract infections (ARTIs) are a major cause of morbidity and mortality in paediatric patients. Therefore, early detection of the viral aetiologies of ARTIs is essential for patient management and infection control. In this study, we evaluated the performance of a new multiplex polymerase chain reaction (PCR) assay (xTAG Respiratory Viral Panel [RVP] Fast v2) in the detection of respiratory viruses by comparing it with that of viral culture and direct immunofluorescence (IF) staining. Methods: Nasopharyngeal swab and aspirate samples were collected prospectively from 199 patients who presented with ARTIs at the University Malaya Medical Centre (UMMC) in Kuala Lumpur, Malaysia during a 10-month period. The PCR assay was conducted in parallel with conventional culture and direct IF staining methods. Results: The positive rate of the xTAG RVP Fast v2 assay (78.4%) in detecting respiratory viruses was higher than that of the viral isolation (7.5%) and direct IF (23.1%) methods. Using the xTAG RVP Fast v2 assay, human enterovirus/human rhinovirus (HEV/HRV) was the most frequently detected (46.2%). The xTAG RVP Fast v2 assay revealed mixed infection caused by two or three respiratory viruses in 40 specimens, and these were undetected by the viral isolation and direct IF methods. Conclusion: The xTAG RVP Fast v2 assay was superior to conventional methods in the identification of common respiratory viruses, with higher sensitivity and shorter turnaround times for laboratory results.