Can Punishment Modify Behaviour?

Prof Pierre Joubert Previously, I explained the concepts of cognitive behaviour therapy (CBT) and positive reinforcement (reward). Before moving on to other important topics, it is important for one to understand punishment. Punishment is not really punishment Punishment, as used in learning theory, has nothing to do with morality, judgement, retribution or restitution. It also […]

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Anaesthesia Risk Factors in Major Orthopaedic Surgery Patients

Dr D Lipinska Patients presenting for spine surgery or other orthopaedic procedures may be suffering from rheumatoid arthritis (RA), ankylosing spondylitis and other rheumatological disorders. Difficulty in intubating patients with RA may result from temporomandibular joint arthritis, a hypoplostic mandible and effects of RA on the cervical spine. The prone position is associated with alteration […]

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Compound Analgesics – So Much Inappropriate Medicine in SA

Dr Eric Hodgson South Africa has the dubious distinction of having the largest number of compound analgesics available in the world. These combinations are supposed to improve compliance by providing adequate analgesia with the minimum number of analgesic tablets/capsules. Unfortunately, this is far from the truth. There is a large number of compound analgesics that […]

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Managing Anaesthesia and Hypertension – How to Deal with Borderline BP

Dr D Lipinska Nearly 50 million Americans have hypertension with three-quarters of hypertensive individuals being older than 50 years. Almost a third of adults presenting for non-cardiac surgery and some two-thirds presenting for coronary bypass surgery report a history of hypertension. The clinical consequences of chronic hypertension have been documented as being highly associated with […]

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Non-opioid Painkillers in the ER

Dr Luc Evenepoel This article focuses on the treatment of pain in the emergency room with non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol. NSAIDs: These include aspirin; non-selective (cyclo-oxygenase) COX-1 and COX-2 inhibitors such as diclofenac (Voltaren), ibuprofen (Brufen), naproxen (Naprosyn) and ketorolac (Tora-Do); and COX-2 selective inhibitors including mefloxicam (Mobic), celecoxib (Celebrex) and valdecoxib (Rayzon). […]

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The Choice of an Appropriate Analgesic Should no Longer Be Painful

Dr Luc Evenepoel Pain relief is a human right. Trauma patients, and especially the severely injured, pose an extra challenge to the treating doctor, since there is a risk for significant, deleterious side effects from inappropriate analgesic administration. The pain treatment of the trauma victim has to be individualised: excellent pain relief is, of course, […]

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Perilous Myths and Concrete Truths Associated with Paediatric Surgery

Dr D Lipinska The issue of preoperative fasting is quite controversial and was the subject of practice guidelines published in 1999 by the American Society of Anesthesiologists. The guidelines indicate that the minimal fasting period after consuming clear liquids is two hours, breast milk is four hours, non-human milk is six hours, infant formula is […]

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ARV Treatment Failure – When to Switch Therapy

Dr Xolile Dlamini There are various possible reasons for antiretroviral (ARV) treatment failure. These include: • Inadequate drug delivery: Non-adherence, malabsorbtion, vomiting. • Sub-optimal highly active antiretroviral therapy (HAART): Examples include incorrect dosing or drug interactions such as combining lopinavir and ritonavir combo (Aluvia) and Rifampicin. Rifampicin activates the enzyme which increases the metabolism of […]

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Engaging Serodiscordant Couples in HIV Campaigns is Important

Dr Allison Glass HIV prevention campaigns traditionally focus on preventing high-risk sexual behaviour. However, it is often forgotten that a large proportion of infections occur in stable relationships. Serodiscordant couples should be an important focus in our efforts to decrease HIV transmission. A study conducted in eastern and southern Africa indicated that the prevalence of […]

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Likelihood of Normal Life Expectancies Improving for HIV Patients

Dr Steven Miller Two studies presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI), held in San Francisco during 2010, have shown that that some groups of patients, i.e. those diagnosed recently or those starting treatment with high CD4 counts, will have normal or near-normal life expectancies. Although these are not the first […]

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