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Publisher: RMIT Publishing   (Total: 400 journals)

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Showing 1 - 200 of 400 Journals sorted alphabetically
40 [degrees] South     Full-text available via subscription   (Followers: 2)
Aboriginal and Islander Health Worker J.     Full-text available via subscription   (Followers: 14)
Aboriginal Child at School     Full-text available via subscription   (Followers: 5)
About Performance     Full-text available via subscription   (Followers: 12)
Access     Full-text available via subscription   (Followers: 26)
ACCESS: Critical Perspectives on Communication, Cultural & Policy Studies     Full-text available via subscription   (Followers: 10)
Accounting, Accountability & Performance     Full-text available via subscription   (Followers: 15)
ACORN : The J. of Perioperative Nursing in Australia     Full-text available via subscription   (Followers: 17, SJR: 0.103, h-index: 4)
Adelaide Law Review     Full-text available via subscription   (Followers: 20)
Advocate: Newsletter of the National Tertiary Education Union     Full-text available via subscription   (Followers: 1)
Agenda: A J. of Policy Analysis and Reform     Full-text available via subscription   (Followers: 1)
Agora     Full-text available via subscription   (Followers: 3)
Agricultural Commodities     Full-text available via subscription   (SJR: 0.102, h-index: 8)
Agricultural Science     Full-text available via subscription   (Followers: 5)
AIMA Bulletin     Full-text available via subscription   (Followers: 4)
AJP : The Australian J. of Pharmacy     Full-text available via subscription   (Followers: 10, SJR: 0.102, h-index: 5)
Analysis     Full-text available via subscription   (Followers: 4)
Ancient History : Resources for Teachers     Full-text available via subscription   (Followers: 4)
Anglican Historical Society J.     Full-text available via subscription   (Followers: 3)
Annals of the Royal Australasian College of Dental Surgeons     Full-text available via subscription   (Followers: 4, SJR: 0.101, h-index: 11)
ANZSLA Commentator, The     Full-text available via subscription   (Followers: 4)
Appita J.: J. of the Technical Association of the Australian and New Zealand Pulp and Paper Industry     Full-text available via subscription   (Followers: 12, SJR: 0.18, h-index: 27)
AQ - Australian Quarterly     Full-text available via subscription  
Arena J.     Full-text available via subscription   (Followers: 1)
Around the Globe     Full-text available via subscription   (Followers: 1)
Art + Law     Full-text available via subscription   (Followers: 12)
Art Monthly Australia     Full-text available via subscription   (Followers: 10)
Artefact : the journal of the Archaeological and Anthropological Society of Victoria     Full-text available via subscription   (Followers: 3)
Artlink     Full-text available via subscription   (Followers: 5)
Asia Pacific J. of Clinical Nutrition     Full-text available via subscription   (Followers: 9, SJR: 0.672, h-index: 51)
Asia Pacific J. of Health Management     Full-text available via subscription   (Followers: 3)
Aurora J.     Full-text available via subscription  
Australasian Biotechnology     Full-text available via subscription   (Followers: 1, SJR: 0.1, h-index: 8)
Australasian Catholic Record, The     Full-text available via subscription   (Followers: 6)
Australasian Drama Studies     Full-text available via subscription   (SJR: 0.101, h-index: 2)
Australasian Epidemiologist     Full-text available via subscription  
Australasian Historical Archaeology     Full-text available via subscription   (Followers: 7)
Australasian J. of Early Childhood     Full-text available via subscription   (Followers: 4, SJR: 0.174, h-index: 1)
Australasian J. of Gifted Education     Full-text available via subscription   (Followers: 4, SJR: 0.115, h-index: 3)
Australasian J. of Human Security, The     Full-text available via subscription   (Followers: 3)
Australasian J. of Irish Studies, The     Full-text available via subscription   (Followers: 9)
Australasian J. of Regional Studies, The     Full-text available via subscription   (Followers: 1)
Australasian Law Management J.     Full-text available via subscription   (Followers: 9)
Australasian Leisure Management     Full-text available via subscription   (Followers: 1)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 2)
Australasian Music Research     Full-text available via subscription   (Followers: 3)
Australasian Parks and Leisure     Full-text available via subscription   (Followers: 2)
Australasian Plant Conservation: J. of the Australian Network for Plant Conservation     Full-text available via subscription   (Followers: 4)
Australasian Policing     Full-text available via subscription   (Followers: 5)
Australasian Public Libraries and Information Services     Full-text available via subscription   (Followers: 40)
Australasian Review of African Studies, The     Full-text available via subscription   (Followers: 2)
Australian Aboriginal Studies     Full-text available via subscription   (Followers: 10, SJR: 0.109, h-index: 6)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Ageing Agenda     Full-text available via subscription   (Followers: 5)
Australian and Aotearoa New Zealand Psychodrama Association J.     Full-text available via subscription  
Australian and New Zealand Continence J.     Full-text available via subscription   (Followers: 3)
Australian and New Zealand Sports Law J.     Full-text available via subscription   (Followers: 8)
Australian Art Education     Full-text available via subscription   (Followers: 7)
Australian Bookseller & Publisher     Full-text available via subscription   (Followers: 1)
Australian Bulletin of Labour     Full-text available via subscription   (Followers: 3)
Australian Canegrower     Full-text available via subscription   (Followers: 2)
Australian Coeliac     Full-text available via subscription   (Followers: 2)
Australian Cottongrower, The     Full-text available via subscription   (Followers: 1)
Australian Educational and Developmental Psychologist, The     Full-text available via subscription   (Followers: 7, SJR: 0.143, h-index: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3, SJR: 0.364, h-index: 31)
Australian Field Ornithology     Full-text available via subscription   (Followers: 4, SJR: 0.141, h-index: 6)
Australian Forest Grower     Full-text available via subscription   (Followers: 4)
Australian Forestry     Full-text available via subscription   (Followers: 2, SJR: 0.252, h-index: 24)
Australian Grain     Full-text available via subscription   (Followers: 3)
Australian Holstein J.     Full-text available via subscription   (Followers: 1)
Australian Humanist, The     Full-text available via subscription   (Followers: 3)
Australian Indigenous Law Review     Full-text available via subscription   (Followers: 20)
Australian Intl. Law J.     Full-text available via subscription   (Followers: 27)
Australian J. of Acupuncture and Chinese Medicine     Full-text available via subscription   (Followers: 3, SJR: 0.106, h-index: 3)
Australian J. of Adult Learning     Full-text available via subscription   (Followers: 14, SJR: 0.159, h-index: 7)
Australian J. of Advanced Nursing     Full-text available via subscription   (Followers: 10, SJR: 0.225, h-index: 26)
Australian J. of Asian Law     Full-text available via subscription   (Followers: 6)
Australian J. of Cancer Nursing     Full-text available via subscription   (Followers: 9)
Australian J. of Civil Engineering     Full-text available via subscription   (Followers: 4, SJR: 0.17, h-index: 3)
Australian J. of Dyslexia and Learning Difficulties     Full-text available via subscription   (Followers: 8)
Australian J. of Emergency Management     Full-text available via subscription   (Followers: 8, SJR: 0.401, h-index: 18)
Australian J. of French Studies     Full-text available via subscription   (Followers: 7, SJR: 0.1, h-index: 5)
Australian J. of Herbal Medicine     Full-text available via subscription   (Followers: 3, SJR: 0.109, h-index: 7)
Australian J. of Language and Literacy, The     Full-text available via subscription   (Followers: 4, SJR: 0.399, h-index: 9)
Australian J. of Legal History     Full-text available via subscription   (Followers: 18)
Australian J. of Mechanical Engineering     Full-text available via subscription   (Followers: 3, SJR: 0.129, h-index: 4)
Australian J. of Medical Science     Full-text available via subscription   (Followers: 1, SJR: 0.122, h-index: 5)
Australian J. of Multi-Disciplinary Engineering     Full-text available via subscription   (Followers: 2)
Australian J. of Music Education     Full-text available via subscription   (Followers: 3)
Australian J. of Music Therapy     Full-text available via subscription   (Followers: 6)
Australian J. of Parapsychology     Full-text available via subscription   (Followers: 1)
Australian J. of Social Issues     Full-text available via subscription   (Followers: 6, SJR: 0.178, h-index: 20)
Australian J. of Structural Engineering     Full-text available via subscription   (Followers: 6, SJR: 0.296, h-index: 8)
Australian J. of Water Resources     Full-text available via subscription   (Followers: 6, SJR: 0.226, h-index: 9)
Australian J. on Volunteering     Full-text available via subscription   (Followers: 1)
Australian J.ism Review     Full-text available via subscription   (Followers: 7)
Australian Life Scientist     Full-text available via subscription   (Followers: 2, SJR: 0.1, h-index: 2)
Australian Literary Studies     Full-text available via subscription   (Followers: 5, SJR: 0.1, h-index: 6)
Australian Mathematics Teacher, The     Full-text available via subscription   (Followers: 7)
Australian Nursing J. : ANJ     Full-text available via subscription   (Followers: 6)
Australian Orthoptic J.     Full-text available via subscription  
Australian Primary Mathematics Classroom     Full-text available via subscription   (Followers: 3)
Australian Screen Education Online     Full-text available via subscription   (Followers: 2)
Australian Senior Mathematics J.     Full-text available via subscription   (Followers: 1)
Australian Sugarcane     Full-text available via subscription  
Australian TAFE Teacher     Full-text available via subscription   (Followers: 3)
Australian Tax Forum     Full-text available via subscription   (Followers: 3)
Australian Universities' Review, The     Full-text available via subscription   (Followers: 4)
Australian Voice     Full-text available via subscription   (Followers: 5)
Bar News: The J. of the NSW Bar Association     Full-text available via subscription   (Followers: 6)
Bioethics Research Notes     Full-text available via subscription   (Followers: 14)
BOCSAR NSW Alcohol Studies Bulletins     Full-text available via subscription   (Followers: 5)
Bookseller + Publisher Magazine     Full-text available via subscription   (Followers: 5)
Breastfeeding Review     Full-text available via subscription   (Followers: 18, SJR: 0.31, h-index: 19)
British Review of New Zealand Studies     Full-text available via subscription   (Followers: 3)
Brolga: An Australian J. about Dance     Full-text available via subscription   (Followers: 1)
Cancer Forum     Full-text available via subscription   (SJR: 0.143, h-index: 10)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 6)
Chain Reaction     Full-text available via subscription  
Childrenz Issues: J. of the Children's Issues Centre     Full-text available via subscription  
Chiropractic J. of Australia     Full-text available via subscription   (SJR: 0.107, h-index: 3)
Chisholm Health Ethics Bulletin     Full-text available via subscription   (Followers: 1)
Church Heritage     Full-text available via subscription   (Followers: 8)
Commercial Law Quarterly: The J. of the Commercial Law Association of Australia     Full-text available via subscription   (Followers: 6)
Communicable Diseases Intelligence Quarterly Report     Full-text available via subscription   (Followers: 2, SJR: 0.567, h-index: 27)
Communication, Politics & Culture     Open Access   (Followers: 14)
Communities, Children and Families Australia     Full-text available via subscription   (Followers: 2)
Connect     Full-text available via subscription   (Followers: 2)
Contemporary PNG Studies     Full-text available via subscription  
Context: J. of Music Research     Full-text available via subscription   (Followers: 8)
Corporate Governance Law Review, The     Full-text available via subscription   (Followers: 7)
Creative Approaches to Research     Full-text available via subscription   (Followers: 12)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 16, SJR: 1.737, h-index: 24)
Cultural Studies Review     Full-text available via subscription   (Followers: 16)
Culture Scope     Full-text available via subscription   (Followers: 2)
Current Issues in Criminal Justice     Full-text available via subscription   (Followers: 10)
Dance Forum     Full-text available via subscription   (Followers: 2)
DANZ Quarterly: New Zealand Dance     Full-text available via subscription   (Followers: 3)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Deakin Law Review     Full-text available via subscription   (Followers: 15)
Developing Practice : The Child, Youth and Family Work J.     Full-text available via subscription   (Followers: 20)
Early Days: J. of the Royal Western Australian Historical Society     Full-text available via subscription  
Early Education     Full-text available via subscription   (Followers: 10)
EarthSong J.: Perspectives in Ecology, Spirituality and Education     Full-text available via subscription   (Followers: 1)
East Asian Archives of Psychiatry     Full-text available via subscription   (Followers: 2, SJR: 0.331, h-index: 7)
Educare News: The National Newspaper for All Non-government Schools     Full-text available via subscription  
Educating Young Children: Learning and Teaching in the Early Childhood Years     Full-text available via subscription   (Followers: 17)
Education in Rural Australia     Full-text available via subscription   (Followers: 1)
Education, Research and Perspectives     Full-text available via subscription   (Followers: 12)
Educational Research J.     Full-text available via subscription   (Followers: 18)
Electronic J. of Radical Organisation Theory     Full-text available via subscription   (Followers: 3)
Employment Relations Record     Full-text available via subscription   (Followers: 2)
English in Aotearoa     Full-text available via subscription   (Followers: 1)
English in Australia     Full-text available via subscription   (Followers: 2, SJR: 0.19, h-index: 6)
Essays in French Literature and Culture     Full-text available via subscription   (Followers: 8)
Ethos: Official Publication of the Law Society of the Australian Capital Territory     Full-text available via subscription   (Followers: 5)
Eureka Street     Full-text available via subscription   (Followers: 4)
Extempore     Full-text available via subscription  
Family Matters     Full-text available via subscription   (Followers: 13, SJR: 0.259, h-index: 8)
Federal Law Review     Full-text available via subscription   (Followers: 23)
Fijian Studies: A J. of Contemporary Fiji     Full-text available via subscription  
Focus on Health Professional Education : A Multi-disciplinary J.     Full-text available via subscription   (Followers: 7)
Food New Zealand     Full-text available via subscription   (Followers: 5)
Fourth World J.     Full-text available via subscription  
Frontline     Full-text available via subscription   (Followers: 19)
Future Times     Full-text available via subscription   (Followers: 1)
Gambling Research: J. of the National Association for Gambling Studies (Australia)     Full-text available via subscription   (Followers: 5)
Gay and Lesbian Law J.     Full-text available via subscription   (Followers: 2)
Gender Impact Assessment     Full-text available via subscription  
Geographical Education     Full-text available via subscription   (Followers: 3)
Geriatric Medicine in General Practice     Full-text available via subscription   (Followers: 8)
Gestalt J. of Australia and New Zealand     Full-text available via subscription   (Followers: 2)
Globe, The     Full-text available via subscription   (Followers: 4)
Government News     Full-text available via subscription   (Followers: 2)
Great Circle: J. of the Australian Association for Maritime History, The     Full-text available via subscription   (Followers: 8)
Grief Matters : The Australian J. of Grief and Bereavement     Full-text available via subscription   (Followers: 11)
He Puna Korero: J. of Maori and Pacific Development     Full-text available via subscription   (Followers: 1)
Headmark     Full-text available via subscription   (Followers: 1)
Health Inform     Full-text available via subscription  
Health Issues     Full-text available via subscription   (Followers: 2)
Health Promotion J. of Australia : Official J. of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10, SJR: 0.606, h-index: 19)
Health Voices     Full-text available via subscription  
Heritage Matters : The Magazine for New Zealanders Restoring, Preserving and Enjoying Our Heritage     Full-text available via subscription   (Followers: 3)
High Court Quarterly Review, The     Full-text available via subscription   (Followers: 3)
History of Economics Review     Full-text available via subscription   (Followers: 10)
HIV Australia     Full-text available via subscription   (Followers: 3)
HLA News     Full-text available via subscription   (Followers: 6)
Hong Kong J. of Emergency Medicine     Full-text available via subscription   (Followers: 4, SJR: 0.173, h-index: 7)
Idiom     Full-text available via subscription   (Followers: 1)
Impact     Full-text available via subscription   (Followers: 1)
InCite     Full-text available via subscription   (Followers: 24)
Indigenous Law Bulletin     Full-text available via subscription   (Followers: 17)
InPsych : The Bulletin of the Australian Psychological Society Ltd     Full-text available via subscription   (Followers: 3)
Inside Film: If     Full-text available via subscription   (Followers: 8)
Institute of Public Affairs Review: A Quarterly Review of Politics and Public Affairs, The     Full-text available via subscription   (Followers: 14)
Instyle     Full-text available via subscription   (Followers: 1)
Intellectual Disability Australasia     Full-text available via subscription   (Followers: 8)
Interaction     Full-text available via subscription   (Followers: 3)
Intl. Employment Relations Review     Full-text available via subscription   (Followers: 2)
Intl. J. of Disability Management Research     Full-text available via subscription   (Followers: 2)

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Journal Cover Australian Family Physician
  [SJR: 0.364]   [H-I: 31]   [3 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0300-8495
   Published by RMIT Publishing Homepage  [400 journals]
  • Volume 46 Issue 12 - Acne in adolescents
    • Abstract: Gebauer, Kurt
      Background: Acne vulgaris affects more than 90% of Australian adolescents aged 16-18 years. It may have a significantly deleterious effect on their self-esteem and emotional state. Moderate-to-severe acne can lead to scarring. There are many treatment options available. Most teenagers obtain information from their peers or from the internet.

      Objective: The aim of this article is to inform general practitioners (GPs) of the pathogenesis, physiology and description of acne, as well as therapeutic options, including topical and systemic therapies. Skin care, diet and other factors of importance are also discussed.

      Discussion: The first point of contact with patients is in general practice. GPs effectively manage most patients with acne. Treatment choice is guided by experience, with many clinical acne treatment guidelines available. The most common reason for treatment failure is insufficient duration of therapy. Successful treatments require months of topical agents and, in many cases, additional systemic therapies. Internationally, there is a resurgence in the basic research of acne vulgaris, leading to new topical and systemic treatments.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Ican established by Australian doctors awarded Nobel
           peace prize
    • Abstract: Beavis, Margaret
      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - A mixed-methods feasibility study of routinely
           weighing patients in general practice to aid weight management
    • Abstract: Bonney, Andrew; MacKinnon, Duncan; Barnett, Stephen; Mayne, Darren J; Dijkmans-Hadley, Bridget; Charlton, Karen
      Background and objectives: The optimal role of general practice in population weight management remains unclear. The aim of this mixed-methods study was to test the feasibility of routinely weighing all adult patients attending their general practice as an intervention to aid weight management in clinical practice.

      Methods: Consenting patients in six general practices were weighed at each presentation over a 12-month period. Data were analysed using linear mixed growth models. Participants' interviews at the completion of the study were thematically analysed.

      Results: The overall weight loss in patients who completed the study (n = 217) was 0.51 kg (P = 0.26; not significant); in patients who were obese (n = 106) there was a greater weight loss of 1.79 kg (P = 0.04). Patients were receptive to the intervention; however, there was disruption to clinical workflow.

      Discussion: Routinely weighing adult patients in general practice is feasible, requires resources and may be associated with weight loss in patients who are obese. Further research is required to inform support for implementation within practices.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - You should get that mole checked out: Ethical and
           legal considerations of the unsolicited clinical opinion
    • Abstract: Adler, Nikki R; Mahar, Patrick D; Kelly, John W
      Background: Legal and ethical obligations do not always align when doctors become aware of a clinical situation involving a person with whom they have no pre‑existing therapeutic relationship. Noting a potentially malignant skin lesion, such as a melanoma on a person outside the clinical setting, provides a pertinent example.

      Objectives: The aim of this article is to describe the legal, ethical and professional considerations surrounding proffering a dermatological opinion in the case of suspected melanoma outside the clinical setting.

      Discussion: The application of professional and ethical standards may require the doctor to act in some way to alert the person of their findings in a context whereby there is no defined positive duty to do so in Australian law. The degree to which the doctor is ethically obligated to provide an unsolicited dermatological opinion is affected by numerous and, oftentimes, competing factors.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Afp reviewers 2017
    • PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Eczema management in school-aged children
    • Abstract: Leins, Liz; Orchard, David
      Background: Atopic eczema is a relapsing inflammatory skin condition that can be lifelong. Management of eczema is often focused on infants, with many school-aged children undertreated. Uncontrolled eczema has a significant impact on the quality of life of the child and their family.

      Objective: The objective of this article is to discuss the practical management of eczema in school-aged children.

      Discussion: This article will describe how eczema manifests in school-aged children, focusing on when to suspect triggers and how to manage these from a general practice perspective, and when to refer the child on to specialist services.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Letters
    • PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - What is 'normal' in general practice'
    • Abstract: Mansfield, Sarah
      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Growth disorders in adolescents
    • Abstract: Taylor-Miller, Tashunka; Simm, Peter J
      Background Growth is one of the fundamental processes of adolescent development. Careful history and examination, and relevant targeted investigations, can streamline the referral process, highlighting the important role of primary healthcare clinicians.

      Objective This article will provide a guide for clinicians to categorise growth patterns in adolescents, and recognise patients who may have a growth disorder. It will assist clinicians in considering appropriate investigations, and provide guidance for when to refer the adolescent to appropriate paediatric specialists.

      Discussion Causes of tall and short stature can often be distinguished on history, physical examination, and accurate pubertal staging. The height of the adolescent should always be considered in the context of their genetic potential. Physiological variants remain the most common reason for short stature, but awareness of the features of pathological causes is critical. One of the most common presentations is maturational delay in males, and an approach to this issue is discussed.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Childhood constipation
    • Abstract: Waterham, Michelle; Kaufman, Jonathan; Gibb, Susan
      Background Constipation is best defined as difficulty passing stools that may be infrequent (
      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Depression in children
    • Abstract: Charles, Julian; Fazeli, Mandana
      Background Major depressive disorder (MDD) in children (5-12 years of age) is a confronting and serious psychiatric illness. MDD has significant ramifications for the psychosocial development of the child, yet it remains under-recognised and undertreated. General practice is where these children and their parents will first present.

      Objective The aim of this article is to provide general practitioners (GPs) with a framework for considering MDD in a child and recommendations for treatment.

      Discussion Children with MDD have the same core features as adolescents and adults, taking into account the child's capacities for cognition and language, and developmental stage. Earlier onset of illness is associated with poorer outcomes and greater psychiatric morbidity persisting into adulthood. MDD is more common than anticipated, and should be considered for any child presenting with depressive symptoms and/or impaired psychosocial functioning. Despite limited evidence, numerous interventions exist that will, ideally, significantly affect the child's developmental trajectory. GPs are in an important position to initiate these interventions.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Management of bariatric patients beyond the scalpel
    • Abstract: Yates, Natasha; Liew, Victor; Mouton, Jean-Mari; Turner, Jenne; White, Amanda; Smith, Jack
      Background: Obesity management in general practice sometimes involves referral of patients for bariatric surgery. Integral to the success of long-term weight loss maintenance is supporting the patient's psychological, nutritional and exercise needs. Objectives:This article is written to equip general practitioners (GPs) to manage thecomprehensive needs, before and after bariatric surgery, of patients who are obese. Discussion: The number of patients undergoing bariatric surgery in Australia has increased significantly in the past few years. Pre-operative and postoperative management of this intervention presents a challenge for GPs. In this article we provide guidance around psychological, nutritional and exercise interventions, to equip GPs in managing patients who are obese. Access to allied health providersis not always available for patients, so this article is co-written with allied health colleagues who share their expertise as a resource for GPs.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - The Australian Mid-West coastal marine wound
           infections study
    • Abstract: Foote, Andy; Henderson, Robert; Lindberg, Andrew; Grigg, Carolyn; Greenfield, Charlie; Kirke, Andrew B; Auret, Kirsten
      Background and objective: Marine organism wound infections are common in coastal regions of Western Australia. Local treatment guidelines are based on studies from elsewhere. The objective of this article was to identify the causative organisms in marine wounds sustained in the subtropical and tropical coastal waters of the Indian Ocean, Gascoyne region (north-west), Western Australia.

      Method: This was a prospective study. A single wound swab was taken from 28 consenting patients who presented with a suppurating marine wound to the emergency departments of Carnarvon and Exmouth hospitals.

      Results: The wounds of 27 out of 28 patients returned a positive culture. The two most common organisms were 'Staphylococcus aureus' (n = 18/28; 64.3%) and Vibrio species (n = 9/28; 32.1%). The culture was polymicrobial in 11 patients (39.3%).

      Discussion: 'S. aureus' or 'Vibrio' species were frequently seen in marine wounds, and infections were often polymicrobial. Our results suggest that flucloxacillin (or clindamycin) and doxycycline (or ciprofloxacin) would be a reasonable combination for empirical oral therapy in adults.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Psychological distress and risky sexual behaviours
           among women aged 16-25 years in Victoria, Australia
    • Abstract: Nguyen, Nhuong T; Subasinghe, Asvini K; Wark, John D; Reavley, Nicola; Garland, Suzanne M
      Background and objectives: Identifying factors related to risky sexual behaviour may contribute to preventive and interventional approaches to reduce negative mental health outcomes among young women. The aim of this study was to investigate the association between psychological distress and risky sexual behaviours in females aged 16-25 years in Victoria, Australia.

      Method: Data were extracted from the Young Female Health Initiative (YFHI), a study in which participants were recruited via advertisements on Facebook. Logistic regression was used to assess associations between psychological distress, as measured by the Kessler 10 (K10) Psychological Distress Scale, and risky sexual behaviours.

      Results: Data were available from 200 sexually active participants and 40 non-sexually active participants. We found that the K10 score was independently associated with sex while under the influence of alcohol or drugs (odds ratio: 1.7; 95% confidence intervals: 1.2, 2.7; P = 0.006).

      Discussion: Although data were collected from a small sample of young women, we found that those with underlying psychological distress may adopt risky sexual behaviours, especially if concomitantly drinking alcohol or taking drugs.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Clinical challenge
    • PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Occupational violence and staff safety in general
           practice
    • Abstract: Moylan, Steven
      Background: The recent death of a Victorian surgeon who was assaulted by a member of the public when leaving work has re-highlighted the risk and potential cost of violence experienced by healthcare workers.

      Objectives: The aim of this article is to outline the risk of occupational violence experienced by doctors, and general practitioners in particular, and to discuss practical measures that can be taken to manage this risk.

      Discussion: The majority of doctors have experienced aggression or violence in their workplaces in the past 12 months. Risks for violence include elements of workplace design, policy and procedures, and client factors. A series of practical tools designed to assist the assessment and management of risk of occupational violence are discussed.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 12 - Understanding the decision to commence a dose
           administration aid
    • Abstract: Barton, Elsa; Twining, Lydia; Walters, Lucie
      Background and objectives: The use of dose administration aids (DAAs), such as compartmentalised boxes (eg dosette) or medicine packs (eg Webster-pak), is common, particularly among patients with chronic disease. The aim of this study was to investigate factors influencing patients' decisions to commence using a DAA with a view to summarising implications for practice for general practitioners (GPs).

      Method: Semi-structured interviews were undertaken with participants living in a regional town in South Australia. Analysis of transcripts was facilitated using a qualitative analysis grid.

      Results: Eight participants were interviewed. Four main themes included complexity of managing medications, DAAs as a cultural artefact, taking the lead in decision making, and weight of influence of health professionals.

      Discussion: This study highlights the role of individual autonomy, close relatives and pharmacy staff in decisions to commence using a DAA. Tablets included in DAAs can take priority over inhaled and injected medications. GPs have an important role in ensuring that commencing a DAA helps empower patients to improve their healthcare management and does not inhibit communication between patient, doctor and pharmacist.

      PubDate: Wed, 20 Dec 2017 08:41:37 GMT
       
  • Volume 46 Issue 11 - Patients' attitudes towards chaperone use for
           intimate physical examinations in general practice
    • Abstract: Stanford, Lucie; Bonney, Andrew; Ivers, Rowena; Mullan, Judy; Rich, Warren; Dijkmans-Hadley, Bridget
      Background and objectives: The objective of this article is to investigate patients' attitudes to the use of chaperones for intimate physical examinations (IPEs) in a sample of Australian general practices.

      Method: A cross-sectional survey of adult patients from 13 randomly selected general practices in regional New South Wales was conducted between September and November 2012. Generalised linear mixed models were used for analysis.

      Results: Of 780 surveys distributed, 687 (88%) were returned; the age range was 18-91 years and 356 (52%) were from female patients. Most women had never had a chaperone present for a Papanicolaou (Pap) smear (82.6%). Between 23% and 33% of respondents preferred a chaperone with their usual general practitioner (GP) across IPEs and gender of the respondents. The odds of preference for a chaperone were significantly less with a GP whom the respondents did not know well, compared with their usual GP, for a Pap smear (female) or genital examination (male).

      Discussion: Individualised discussion regarding chaperone use for IPEs is warranted, especially with patients seeing their usual GP.

      PubDate: Tue, 21 Nov 2017 09:47:14 GMT
       
  • Volume 46 Issue 11 - Pericarditis
    • Abstract: Rahman, Atifur; Saraswat, Avadhesh
      Background: Pericarditis is an important diagnosis to consider, along with various other differential diagnoses, in a patient who presents with chest pain.

      Objective: This article describes in detail the common features, management and complications of pericarditis in the general practice setting.

      Discussion: Characteristic clinical findings in pericarditis include pleuritic chest pain and pericardial friction rub on auscultation of the left lower sternal border. Electrocardiography may reveal diffuse PR-segment depressions and diffuse ST-segment elevations with upward concavity. The most common aetiologies of pericarditis are idiopathic and viral, and the most common treatment for these are nonsteroidal anti-inflammatory drugs and colchicine. The complications of pericarditis include pericardial effusion, tamponade and myopericarditis. The presence of effusion, constriction or tamponade can be confirmed on echocardiography. Tamponade is potentially life-threatening and is diagnosed by the clinical findings of decreased blood pressure, elevated jugular venous pressure, muffled heart sounds on auscultation and pulsus paradoxus.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Pulmonary embolism: An update
    • Abstract: Doherty, Steven
      Background: Pulmonary embolism is a common condition and can be the source of significant morbidity and mortality.

      Objective: This article reviews the approach to the diagnostic assessment and management of patients with suspected pulmonary embolism.

      Discussion: Various clinical decision rules and algorithms are available to assist in the diagnosis of pulmonary embolism, and the Wells score and Pulmonary Embolism Rule-out Criteria rule are presented in this article. The utility of D-dimer testing and the role of imaging to confirm the diagnosis are also discussed. Treatment options once pulmonary embolism is confirmed are presented.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - A Bayesian approach to chest pain'
    • Abstract: Margolis, Stephen A
      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Early detection of eating disorders in general
           practice
    • Abstract: Rowe, Elizabeth
      Background: General practitioners (GPs) are often the first health professional consulted in regard to eating disorders and their varied presentations. Given the prognostic significance of early detection of, and intervention for, such conditions, it is important that GPs feel confident to do so.

      Objective: The aim of this article was to heighten awareness of the role of early identification and diagnosis of eating disorders, especially anorexia nervosa and bulimia nervosa, in the primary care setting. The focus will be on their presentations and diagnosis, including changes to the 'Diagnostic and statistical manual of mental disorders', 5th edition (DSM-5), with a brief overview of management recommendations and admission criteria.

      Discussion: Eating disorders are complex, potentially life-threatening illnesses with significant medical and psychosocial consequences. Early detection and intervention can significantly contribute to better outcomes, and GPs are ideally placed to effect this.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - The challenge of liver cancer surveillance in general
           practice: Do recall and reminder systems hold the answer'
    • Abstract: Allard, Nicole; Cabrie, Tracey; Wheeler, Emily; Richmond, Jacqui; MacLachlan, Jennifer; Emery, Jon; Furler, John; Cowie, Benjamin
      Background and objective: Hepatocellular carcinoma (HCC) surveillance reduces mortality in at-risk people living with chronic hepatitis B (CHB), but is difficult to achieve in practice. The objective of this study was to measure participation and adherence to liver cancer HCC surveillance in eligible patients in a community health centre, following support from the Integrated Hepatitis B Service (IHBS).

      Method: A retrospective analysis of the medical records of patients with CHB who met the indications for HCC surveillance over a 4.5- year period of IHBS involvement was conducted. Data collected included the date of ultrasound examinations and HBV DNA viral load tests.

      Results: Sixty-seven patients underwent HCC surveillance, representing 213 person years. The participation rate was 75%. Adherence to surveillance was considered good in 18 (27%) patients, suboptimal in 29 (43%) patients and poor in 20 (30%) patients. A greater proportion of patients were receiving HCC surveillance at the final audit (56%) than at baseline (10%; P < 0.001).

      Discussion: It is difficult to achieve optimal adherence to HCC surveillance, even with additional support.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Clinical challenge
    • PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Diverticular disease practice points
    • Abstract: McSweeney, William; Srinath, Havish
      Background: Diverticular disease and its spectrum of complications are increasingly encountered in the Australian population. Accurate management of patients before and after an acute episode entails extension beyond the acute event to include dietary advice and colonoscopy.

      Objectives: The objectives of this article are to evaluate the literature regarding dietary factors and diverticular disease, routine colonoscopy and antibiotic treatment in acute diverticulitis, to enable primary care physicians to manage patients and provide sound advice after hospital admission.

      Discussion: Diverticulitis can often be managed in the community by general practitioners, but the necessity of antibiotics may not be definitive. When patients do require hospital admission, advice and management of patient lifestyle factors after admission, and investigations to rule out red flags are crucial. These elements of patient management are the subject of debate, as it appears that standard dietary advice does not alter a patient's clinical course, and colonoscopy is not always necessary and should be used judiciously.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Letters
    • PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Troponin testing in the primary care setting
    • Abstract: Mauro, Manuela S; Nelson, Adam J; Stokes, Michael B
      Background: Chest pain is a common presenting complaint in general practice. Serum troponin testing is an important clinical tool to help identify patients who present with suspected acute coronary syndrome (ACS).

      Objective: This article will discuss the role of troponin testing in the diagnosis of ACS, and the role of high-sensitive troponin, which is now in widespread use. The importance of clinical acumen in the interpretation of troponin testing and the pitfalls of troponin testing in the primary care setting will also be explored.

      Discussion: Patients should be promptly referred to the hospital when there is a high clinical suspicion of ACS. This is to ensure early diagnosis, provide specialist care and minimise the risk of complications. For patients who present with suspected ACS, troponin testing in the community should not delay referral to the emergency department. Troponin testing has a limited role in the primary care setting, which will be discussed in this article.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Osteosarcopenia: A new geriatric syndrome
    • Abstract: Hassan, Ebrahim Bani; Duque, Gustavo
      Background: Longevity, the increase in the ageing population and a lifestyle of minimal physical activity come with a hefty price. Consequently, two diseases are increasingly becoming a concern for the welfare of patients and the health industry: osteoporosis and sarcopenia. These conditions are usually interrelated through several mechanisms and metabolic pathways, and comprise a syndrome called osteosarcopenia.

      Objectives: As patients with osteosarcopenia represent an important subset of frail individuals at higher risk of institutionalisation, falls and fractures, the aim of this review is to further familiarise general practitioners with osteosarcopenia as a new geriatric syndrome that requires early diagnosis and effective therapeutic interventions.

      Discussion: The most important aspects of osteosarcopenia are discussed here. These include pathogenesis, prevalence, diagnostic criteria, management and follow-up. Finally, the role of multidisciplinary clinics for the care of patients with osteosarcopenia is discussed in brief.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Unilateral diffuse lung opacification in an
           asymptomatic woman
    • Abstract: Khajotia, Rumi R; Raman, Sree
      A healthy woman aged 19 years was sent to the general hospital in Malaysia by her family physician for a routine medical check-up, as this was a prerequisite for admission to a university graduate course. She was asymptomatic. She did not complain of cough, breathlessness, fever, night sweats, loss of appetite or loss of weight. On examination, vital signs were normal. Her height was 157 cm and she weighed 54 kg. On local examination of the chest, her trachea was shifted significantly to the left side, and the left hemithorax moved less on inspiration, compared with the right. The apex beat was felt in the fifth left intercostal space at the anterior axillary line. Percussion note was dull over the left hemithorax, and auscultation revealed diminished air entry over the entire left chest, anteriorly and posteriorly, with diminished vocal resonance over the same area. The right side was normal. No surgical scars were seen over the chest wall and there was no past history of surgery. The rest of the clinical examination was normal. A chest radiograph (posterioranterior view) showed a diffuse opacity over the entire left hemithorax with the trachea shifted to the left side.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Painful bilateral lower limb swelling in an elderly
           female
    • Abstract: Chan, Linda; Lee, Kenneth; Cook, David
      A woman aged 78 years was admitted to hospital with gallstone-induced acute pancreatitis. She had a five-hour history of epigastric pain, high lipase 7040 U/L, bilirubin 66 μmol/L, deranged liver function tests and leukocytosis (white cell count of 12.1 x 109/L). Multiple gallstones were visualised on abdominal ultrasound. Her heart rate, blood pressure, temperature and respiratory rate were within normal limits and she was managed conservatively after she declined a cholecystectomy. On day 2, the patient developed redness and pain over both of her anterior shins, but these were worse on the right shin. There was circumferential erythema with a purpuric patch above the right medial malleolus and two 1 x 2 cm erythematous nodules on the left pretibial region. Her medical history included a high body mass index (BMI) and hypothyroidism, which was controlled with maintenance thyroxine 50 μg daily. The patient had a chronic cough and had been diagnosed with eosinophilic pneumonia one month earlier. Since then, she had been on a tapering dose of prednisone and is currently taking 12.5 mg per day.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - A non-healing ulcer in a healthy young woman
    • Abstract: Loftus, Michael J; Gates, Robert J; Crouch, Simon; Sutton, Brett; Johnson, Paul DR
      A previously healthy woman, 22 years of age, presented to her general practitioner (GP) with a small, painless ulcer of 1 cm in diameter on her right ankle, which had developed after she expressed a small pustule at that site a few weeks earlier. She could not recall any preceding trauma or insect bite. She travelled extensively throughout Australia for work, but remained exclusively in urban areas of major cities. Her only other travel of note in the previous year was an overnight holiday on the Mornington peninsula in Victoria four months prior to presentation.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 11 - Pain: The person, the science, the clinical interface
           [Book Review]
    • Abstract: McCoy, Ronald
      Review(s) of: Pain: The person, the science, the clinical interface, Edited by Patricia Armati with Roberta Chow, Research IP Communications, 2015, ISBN: 978-0-9872905-6-4.

      PubDate: Fri, 10 Nov 2017 23:01:18 GMT
       
  • Volume 46 Issue 10 - The management of irregular bleeding in women using
           contraception
    • Abstract: Foran, Terri
      Background: The pattern of menstrual bleeding seen in women during their reproductive years is the result of a finely tuned balance between endogenous oestrogens, which stimulate the endometrial lining, and progesterone, which temporarily maintains that lining in anticipation of a pregnancy. Many women have expectations of a 'normal monthly' cycle, and may be wary of anything that has the potential to disrupt its regularity. From a clinical perspective, any alteration in vaginal bleeding may indicate underlying pathology, and lead to further investigation and management.

      Objective: The aim of this article is to provide a practical approach to the investigation and management of altered vaginal bleeding patterns in women using various methods of contraception.

      Discussion: Around 70% of Australian women of reproductive age use some form of contraception. Any discussion of 'normal bleeding' becomes even more complex given that modern contraceptive methods almost inevitably modify the pattern of bleeding experienced by the user.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - LARCs as first-line contraception: What can general
           practitioners advise young women'
    • Abstract: Temple-Smith, Meredith; Sanci, Lena
      Background: The use of long-acting reversible contraceptives (LARCs) is globally accepted as a strategy that is successful in decreasing rates of unintended pregnancy, especially in very young women. Currently, Australia has very low uptake rates of LARC.

      Objective: The aim of this paper is to explore the latest information on using LARCs as first-line contraception in young women.

      Discussion: Low uptake of LARCs may be related to Australia's prevailing cultural norm of oral contraception, and practitioner and patient misperceptions of the safety and efficacy of LARC, which have been dispelled in recent years. LARCs are widely recommended by professional bodies and the World Health Organization (WHO) as first-line contraception for young women as they are safe, effective and reversible. Young women should be offered the choice of a LARC as part of a fully informed decision for their first form of contraception.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - A young woman with yellow hands and secondary
           amenorrhoea
    • Abstract: Morton, Adam; Morton, Sarah
      A personal trainer, 26 years of age, presented because of a 12-month history of secondary amenorrhoea since ceasing the oral contraceptive pill. In addition, a friend had commented on the yellow pigmentation of her hands, which had been present for an uncertain duration. Menarche occurred at 13 years of age, and menses had been regular prior to commencing the oral contraceptive pill for menorrhagia. The patient did 30-45 minutes of physical exercise five days per week and reported having a balanced diet. There were no other symptoms suggestive of pituitary hormone deficiency or mass effect. On examination, the patient had yellow hands and feet, sclerae were normal and body mass index (BMI) was 24.1 kg/m2. She was clinically eupituitary, visual fields and fundi were normal, and a pregnancy test was negative.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Non-invasive prenatal testing
    • Abstract: Harraway, James
      Background: Non-invasive prenatal testing (NIPT), also known as cell-free DNA testing and non-invasive prenatal screening (NIPS), is an important addition to the range of screening tests for fetal chromosomal abnormalities. For trisomy 21 in particular, NIPT is superior to other screening modalities. However, NIPT has limitations and complexities that requesting clinicians and their patients should understand.

      Objective: This review article will briefly describe the technical basis of NIPT assays and compare the performance characteristics of NIPT with existing screening tests. The clinical use of NIPT will also be discussed.

      Discussion: NIPT is now an established option for antenatal screening for trisomy 21, 18, 13 and other selected chromosomal abnormalities. If used appropriately, it increases the detection rate for fetal chromosomal abnormalities, while decreasing the number of invasive tests required. An understanding of the scientific basis of NIPT, and the appropriate clinical use and limitations, will enable medical practitioners to provide optimal antenatal screening.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Contraception: LARCs first'
    • Abstract: Samuel, Sophia
      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Oral hormonal contraception in special circumstances
    • Abstract: Moore, Patricia; Streeton, Catherine
      Background: Despite the general consensus that long-acting reversible contraceptives (LARCs) are the most appropriate choice of contraception for most women, there are special circumstances when the contraceptive and non-contraceptive needs of the patient are met by oral methods.

      Objective: By using case histories, we seek to demonstrate the medical and practical complexities in managing contraceptive needs that may result in oral contraception being the most appropriate choice. The cases also illustrate the resources available to enable evidence-based management.

      Discussion: Concurrent medical conditions and non-contraceptive benefits of oral contraceptive methods will see the continued use of these medications for a significant minority of women. A comprehensive knowledge of the rapidly developing evidence regarding medical eligibility and indications for usage is required. Reference to the already highly developed and easily accessible evidence bases ensures best practice for the women and families who seek advice.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Emergency contraception: Oral and intrauterine
           options
    • Abstract: Black, Kirsten I; Hussainy, Safeera Y
      Background: Emergency contraception can be used to prevent pregnancy where contraception has not been used, or there has been contraceptive misuse or failure. Australian women have three options for emergency contraception: two types of oral pills (levonorgestrel [LNG]-containing pill and ulipristal acetate [UPA]) and the copper intrauterine device (IUD). Both pills are available from pharmacies without prescription, whereas the copper IUD requires insertion by a trained provider.

      Objective: The objective of this article is to describe the indications, efficacy and contraindications for use of the three emergency contraceptive methods available in Australia.

      Discussion: Emergency contraception can potentially reduce the risk of unplanned pregnancies. The oral methods have similar side effects, but UPA is more effective than LNG and can be used up to five days after intercourse. The copper IUD is the most effective method, and provides ongoing contraception for up to 10 years. Factors to consider when recommending one option over another include time since unprotected sex, body mass index and use of enzyme-inducing medicines.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Lifestyle risk factors and corresponding levels of
           clinical advice and counselling in general practice
    • Abstract: Beattie, Jessica; Binder, Marley; Harrison, Christopher; Miller, Graeme C; Pedler, Daryl
      Background and objective: The objective of this study was to examine prevalence rates of lifestyle risk factors in the Western Victorian Primary Health Network (WV PHN) general practice patient population and the corresponding levels of clinical advice and counselling.

      Method: Analysed data from the Bettering the Evaluation and Care of Health (BEACH) program from April 2011 to March 2015 were examined, providing a comparison of three geographical areas of general practice patients: WV PHN, Victoria and Australia.

      Results: Rates of clinical advice and counselling for diet and exercise provided by general practitioners (GPs) in the WV PHN network were significantly lower than Victorian and Australian rates, despite the region's higher obesity rates. Smoking rates were higher in the WV PHN compared with Australia, but there was no difference in the levels of smoking cessation advice disseminated. Across all regions, one in four patients drank alcohol at hazardous levels.

      Discussion: GPs in rural practice require further support, encouragement and resources to provide diet and exercise advice to their patients more frequently.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Subcutaneous finger nodules
    • Abstract: Charlton, Olivia A; Stewart, Thomas J
      A woman, aged 29 years, presented to her general practitioner (GP) with a 12-month history of multiple skin-coloured nodules on the palmar aspect of her fingers bilaterally. The nodules were painless, but frequently interfered with her work as a florist. On examination, the nodules were 1-2 cm in diameter, firm, mobile and nontender to palpation.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - A suspicious haematoma
    • Abstract: Chan, On Bon
      A man, 75 years of age, presented with an enlarging lump in his left thigh after he fell from the roof six months ago. He saw a general practitioner (GP) several weeks after the initial injury. An ultrasound scan showed a large intramuscular collection of 20 cm x 8 cm x 14 cm. The diagnosis of a large intramuscular haematoma was made. The GP advised him to manage the swelling with a warm compress and simple analgesics.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Barriers to effective conversations regarding
           overweight and obesity in regional Victoria
    • Abstract: Glenister, Kristen M; Malatzky, Christina AR; Wright, Julian
      Background and objectives: General practitioners (GPs) have a crucial role to play in engaging patients in discussions about overweight and obesity. However, such discussions are currently uncommon. The aim of this study was to examine how GPs in rural areas talk about overweight and obesity with their patients, specifically to identify key barriers to effective conversations.

      Method: This study used a qualitative methodology. Semi-structured interviews were conducted with GPs (n = 7) and patients (n = 7) across two rural areas.

      Results: Key barriers to effective conversations between GPs and patients about overweight and/or obesity include: uncertainty about appropriate language; lack of time; concerns about compromising mutual trust and rapport; concerns about patient readiness; concerns about patients' mental health and how this may be impacted by discussing a potentially upsetting and stigmatising topic; and lack of effective and individualised treatment and/or referral options.

      Discussion: The findings suggest that responses to overweight and obesity need to be localised and tailored. Structural-level change is required to enable better responses to overweight and obesity, including multidisciplinary team approaches.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Electronic clinical decision support tool for the
           evaluation of cardiovascular risk in general practice: A pilot study
    • Abstract: Chiang, Jason; Furler, John; Boyle, Douglas; Clark, Malcolm; Manski-Nankervis, Jo-Anne
      Background and objectives: Cardiovascular disease (CVD) is a major cause of death in Australia. Electronic medical record (EMR)-based clinical decision support (CDS) tools have the potential to support absolute CVD risk (ACVDR) evaluation and management. The objective of this study was to test the acceptability and feasibility of the Treat to Target CVD (T3CVD), an EMR-based CDS tool, for the evaluation of ACVDR in general practice.

      Method: Five general practitioners (GPs) piloted the T3CVD tool in their clinic. Interviews with the clinicians explored the acceptability and feasibility of the T3CVD tool.

      Results: The T3CVD tool was acceptable and, in the small pilot, was shown to have the capacity to support GPs in ACVDR assessment and management, and to encourage patient participation and motivation. Technical and structural factors important to ensure feasibility of the tool were identified.

      Discussion: With further development, the T3CVD tool has the potential to improve ACVDR assessment and management in primary care.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Growing and retaining general practice research
           leaders in Australia: How can we do better'
    • Abstract: van Driel, Mieke; Deckx, Laura; Cooke, Georga; Pirotta, Marie; Gill, Gerard F; Winzenberg, Tania
      Background and objective: The aim of this study was to explore the experiences of Australian general practitioners (GPs) with a Doctor of Philosophy (PhD) about their choice to abandon or pursue an academic career.

      Method: A qualitative study of 18 GPs (PhD obtained between 2006 and 2016) was conducted. Semi-structured telephone interviews were transcribed and analysed using concurrent thematic analysis.

      Results: General practice researchers faced insecure career pathways. They often work in isolation, there is a lack of critical mass, and research was often described as a hobby (ie unfunded, done from home). Solutions included expanding academic general practice registrar positions to include advanced research training, building professional networks, mentoring, and better marketing of general practice research.

      Discussion: Focused investment in developing clear and sustainable career pathways is essential to nurture and retain general practice researchers and research leaders. The research culture and professional standing of general practice researchers also need to improve. Support from professional bodies and colleagues, and enabling research collaborations, are key.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Practice-based research networks
    • Abstract: Pirotta, Marie; Temple-Smith, Meredith
      Background: Practice-based research networks (PBRNs) are collaborations between clinical practitioners and academics. PBRNs aim to foster research in general practice through opportunities to learn more about how to undertake and participate in research, and assist in translating new knowledge into practice. Critically, PBRNs also offer clinicians the chance to contribute to research by posing questions of importance to quality clinical care.

      Objectives: The objectives of this article are to describe why PRBNs are needed, the current situation regarding PBRNs in Australia, and why Australian general practice and patient outcomes could benefit from further investment in PBRNs.

      Discussion: PBRNs may assist by engaging more general practitioners (GPs) in the research process, thereby increasing the relevance of the research questions posed to the outcomes of the population GPs work within. Unlike similar countries (eg UK and The Netherlands), Australia no longer has any funding to support the activities of primary-care based PBRNs.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Transport on prescription: How can GPs contribute to
           the promotion of active transport'
    • Abstract: Pistoll, Chance; Furler, John
      Background and objectives: Active transport (ie walking, cycling, using public transport) can play a part in reducing non-communicable diseases (NCDs). Very little is known about how general practitioners (GPs) can contribute to promoting active transport. We explored GPs' ideas around active transport, and potential barriers and facilitators to its promotion in the clinical setting.

      Method: Using a maximal variation sample, we conducted 10 semistructured interviews with GPs in Victoria, Australia. The socioecological model informed data collection and analysis.

      Results: The idea of active transport resonated with GPs. Limited awareness around active transport and safety concerns regarding commuter cycling were barriers to clinical promotion. GPs believed patients' health, cultural norms, socioeconomic position and access to supportive environments could facilitate participation.

      Discussion: Future efforts should prioritise awareness of active transport among GPs. The perspectives of GPs would be valuable to policymakers, particularly in designing programs to mitigate inequalities around active transport access and use.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Morphine use in cancer care: A survey of attitudes
           and perceptions in general practice patients
    • Abstract: Grant, Matthew; Ugalde, Anna; Mancuso, Serafino G; Vafiadis, Platon; Philip, Jennifer
      Background and objectives: Morphine is widely prescribed for patients with cancer, although a number of attitudes have been cited as barriers to its use, including fear, addiction and associations with death. The aim of this study was to explore the nature of these beliefs, and assess the extent to which these attitudes exist in a general practice patient population that may require morphine in the future.

      Methods: A 30-item survey was distributed through general practices in Victoria, Australia.

      Results: Of the 379 questionnaires distributed, 290 were collected (76.5%). Participants were predominantly neutral on questions regarding the effect of morphine on the duration of life. Morphine was seen to be prescribed responsibly (73.5%), even while most perceived its potential for addiction (69.7%). Participants with experience of morphine use had more negative perceptions regarding its efficacy.

      Discussion: Conversations regarding morphine use should include a discussion about the beliefs and experiences of the individual, many of which may reinforce the utility of morphine.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 10 - Clinical challenge
    • PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Locating advance care planning facilitators in general
           practice increases consumer participation
    • Abstract: Mann, Jill; Gill, Stephen D; Mitchell, Lisa; Rogers, Margaret J; Martin, Peter; Quirk, Frances; Corke, Charlie
      Background and objective: Advance care planning (ACP) can positively affect end-of-life care experiences. However, uptake of ACP completion is low. The aim of this study was to investigate whether co-locating ACP facilitators in general practice increased participation.

      Method: Barwon Health commenced promoting its ACP program in 2008. Trained ACP facilitators assisted consumers, which usually occurred in the program's community-based consulting rooms. From 2012 onwards, ACP facilitators were co-located with 18 general practices, where they assisted consumers at the point of care.

      Results: Referrals to the program increased from 2008-11 (n = 2520) to 2012-15 (n = 6847). Between 2012 and 2015, 48% of referrals to the program were from the 18 general practices with co-located ACP facilitators, and 93% of these referrals resulted in ACPs completed, compared with 74% from practices without co-located facilitators and 55% from all other sources (P < 0.01).

      Discussion: Co-locating ACP facilitators in general practice increased the number of referrals to the program and produced higher plan completion rates.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - The suspect - SIADH
    • Abstract: Tee, Kristen; Dang, Jerry
      Background: Hyponatraemia is one of the most commonly encountered electrolyte abnormalities in general practice. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an important but under-recognised cause.

      Objectives: This article explores the presentation, investigation, diagnosis and management of SIADH.

      Discussion: SIADH can occur secondary to medications, malignancy, pulmonary disease, or any disorder involving the central nervous system. Diagnosis is made on the basis of clinical euvolaemic state with low serum sodium and osmolality, raised urine sodium and osmolality, and exclusion of pseudohyponatraemia and diuretic use. Fluid restriction of 800-1200 mL/24 hours is the mainstay of treatment. Patients with severe hyponatraemia and symptoms of altered mental state or seizures should be admitted to hospital for monitoring of fluid restriction and consideration of hypertonic saline. A rapid increase in sodium levels can precipitate osmotic demyelination and, as such, the increase in serum sodium should not exceed 10 mmol/L in 24 hours or 18 mmol/L in 48 hours.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Peyronie's disease - watch out for the bend
    • Abstract: Love, Christopher; Katz, Darren J; Chung, Eric; Shoshany, Ohad
      Background: Peyronie's disease is a relatively common condition in urological practice, but is still poorly identified and understood in the wider medical community and by most of the public. Identifying the condition and appropriate referral for expert opinion can significantly lessen the physical and psychological effect on patients.

      Objective: The objective of this article is to provide general practitioners with a concise and updated review of Peyronie's disease, with the aim of helping them to provide appropriate advice to their patients.

      Discussion: Peyronie's disease is an aberrant wound healing process culminating in excess scar formation in the penis, which may cause penile pain, shortening and curvature. It is often accompanied by erectile dysfunction, and can result in progressive and severe impairment of penetrative intercourse. The course of the disorder is divided into active inflammatory and chronic stable phases. Oral therapy is usually of limited efficacy, while penile traction may only be beneficial in motivated patients. Intralesional injections of collagenase were recently introduced as a non-surgical measure to decrease penile curvature. Surgery remains the most effective treatment for Peyronie's disease and is considered the gold standard.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Urolithiasis - ten things every general practitioner
           should know
    • Abstract: Sewell, James; Katz, Darren J; Shoshany, Ohad; Love, Christopher
      Background: Upper urinary tract stones are a common problem in Australia, with an incidence of 0.13% per year, and a lifetime prevalence of up to 15% in males and 8% in females. Many of these patients first present to general practitioners (GPs), so a thorough understanding of the diagnosis, treatment and prevention of stone disease is an important part of any GP's arsenal.

      Objectives: In this article, we present evidence-based guidelines regarding urolithiasis, from diagnosis, through to conservative and operative management, and prevention, as a reference for GPs and other primary care physicians.

      Discussion: The majority of urolithiasis cases can be conservatively managed. However, prior to conservative management, adequate imaging must be obtained and emergent conditions must be excluded. Conservative management should not be initiated without a plan in the event the management fails, and adequate analgesia and medical expulsive therapy should be prescribed. Should surgery be necessary, the majority of operations can be performed as minimally invasive day procedures.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Male infertility - the other side of the equation
    • Abstract: Katz, Darren J; Teloken, Patrick; Shoshany, Ohad
      Background: A male factor contributes to infertility in approximately 50% of couples who fail to conceive, causing significant psychosocial and marital stress.

      Objective: This article reviews the general practitioner's (GP's) evaluation of male infertility and indications for referral to a male infertility specialist, and gives an overview of the specialist management of male infertility.

      Discussion: Male infertility can result from anatomical or genetic abnormalities, systemic or neurological diseases, infections, trauma, iatrogenic injury, gonadotoxins and development of sperm antibodies. When a couple fails to achieve pregnancy after 12 months of regular, unprotected sexual intercourse, a screening evaluation of both partners is essential. For the male partner this includes history, physical examination, endocrine assessment and semen analysis. Several lifestyle and environmental factors can have a negative impact on male fertility, and the GP has a pivotal role in educating patients about modifiable factors.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Much more than prescribing a pill - assessment and
           treatment of erectile dysfunction by the general practitioner
    • Abstract: Shoshany, Ohad; Katz, Darren J; Love, Christopher
      Background: Erectile dysfunction is a common but often neglected condition. Prevalence increases with age, but is not insignificant in younger men.

      Objectives: This article will broadly describe the epidemiology, classification and risk factors of erectile dysfunction. It will also discuss assessment and current treatment modalities, with a particular focus on the unique role of the general practitioner (GP).

      Discussion: Erectile dysfunction may be classified as vasculogenic, neurogenic, endocrinological, drug-related, psychogenic or mixed. Commonly, erectile dysfunction is a cause of anxiety and even depression. Risk factors, such as smoking and hypertension, and reversible causes, such as hypogonadism or offending medications, should be addressed. At present, oral pharmacotherapy represents the first-line option for most patients with erectile dysfunction. It is of utmost importance to evaluate and treat comorbidities, such as depression, metabolic syndrome and cardiovascular disease, that often accompany erectile dysfunction. Patients will undoubtedly benefit from comprehensive management by a dedicated GP. Occasionally, referral to a urologist, psychologist or sexual health physician may be required.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Promoting 'quality of life' and 'survivorship' urology
    • Abstract: Katz, Darren J
      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Occult syphilitic chancres in the rectum and
           oropharynx
    • Abstract: Ong, Jason J; Towns, Janet M; Chen, Marcus Y; Fairley, Christopher K
      A man aged 44 years, who tested negative for human immunodeficiency virus (HIV) and is on HIV pre-exposure prophylaxis (PrEP), presented with a hard, painless anorectal lump that he noticed during self-examination. He had intermittent bright rectal bleeding for several weeks. He has had two male partners since he was last tested, two months earlier, for sexually transmissible infections (STIs) . He had condomless, receptive anal sex with both partners.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Knowledge and practices of chronic hepatitis B virus
           testing by general practitioners in Victoria, Australia, 2014-15
    • Abstract: van Gemert, Caroline; Howell, Jess; Wang, Julie; Stoove, Mark; Cowie, Benjamin; Allard, Nicole; Enright, Chris; Dunn, Elisabeth; Towell, Vanessa; Hellard, Margaret
      Background and objective: More than one-third of people living with chronic hepatitis B virus (HBV) in Australia have not been diagnosed. The aim of this study was to assess general practitioners' (GPs') knowledge and practices regarding chronic HBV diagnosis, and identify opportunities to improve testing rates.

      Methods: A cross-sectional survey was conducted with GPs working in Victoria, Australia. Statistically significant adjusted odds ratios for high knowledge, and ordering two or more HBV tests per week were calculated.

      Results: Of 1000 GPs who were invited to participate, 232 completed the survey. Chronic HBV knowledge, use of interpreters, and awareness of HBV testing guidelines were low. Chronic HBV knowledge and testing were associated with age and graduation from a medical school outside Australia. Testing was also associated with gender.

      Discussion: This study identified gaps in GPs' knowledge about chronic hepatitis. Several barriers to improving testing rates among at-risk populations were identified. We recommend revision of the guidelines for prevention in general practice, and educational activities to improve knowledge of at-risk populations for chronic HBV in Australia.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Navigating the disparate Australian regulatory
           minefield of cosmetic therapy
    • Abstract: Leow, Liang Joo
      Recently, New South Wales legislation was amended to enforce that any facility undertaking certain cosmetic procedures must be licensed. Further, the Medical Board of Australia (MBA) issued guidelines for cosmetic procedures. These regulations followed an increase in adverse events, risking patient health and safety, exemplified in a report3 about Australia's largest cosmetic surgery provider, The Cosmetic Institute.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Clinical challenge
    • PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Helping mothers with the emotional dysregulation of
           borderline personality disorder and their infants in primary care settings
           
    • Abstract: Williams, Anne Sved; Apter, Gisele
      Background: Six per cent of patients who present to primary care have borderline personality disorder (BPD). Mothers with full or partial features of BPD, often undiagnosed and perhaps previously functioning adequately enough on the surface, may rapidly become emotionally dysregulated by the normal needs of an infant. Family and maternal functioning can rapidly destabilise. Management of patients with BPD in primary care may be challenging.

      Objectives: The objectives of this article are to provide primary care practitioners with relevant information on current knowledge of BPD and its management when mothers with BPD are caregivers to an infant.

      Discussion: Useful guidelines for general practitioners that can help women who are emotionally dysregulated with infants include:
      - keeping the diagnosis in mind
      - openly discussing BPD diagnosis where relevant
      > - providing psychoeducational material and ongoing support to the woman and her family
      - referring to specialised services for BPD
      - referring to standard maternal-child health services and specialised infant mental health services
      - ongoing communication with other services and supervision for the practitioner.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Letters
    • PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 9 - Adult male stress and urge urinary incontinence - a
           review of pathophysiology and treatment strategies for voiding dysfunction
           in men
    • Abstract: Chung, Eric; Katz, Darren J; Love, Christopher
      Background: Male urinary incontinence adversely affects health-related quality of life and is associated with significant psychosexual and financial burden. The two most common forms of male incontinence are stress urinary incontinence (SUI) and overactive bladder (OAB) with concomitant urge urinary incontinence (UUI).

      Objectives: The objectives of this article are to briefly review the current understandings of the pathophysiological mechanisms in SUI and OAB/UUI, and offer a set of practical, action-based recommendations and treatment strategies.

      Discussion: The initial evaluation of male urinary incontinence usually occurs in general practice, and the basic work-up aims to identify reversible causes. First-line treatment is conservative management, such as lifestyle interventions, pelvic floor muscle training with or without biofeedback, and bladder retraining. Treatment options include male slings and artificial urinary sphincter surgery for men with persistent SUI, and medical therapy, intravesical botulinum toxin, sacral neuromodulation or surgery in refractory cases for those with predominant OAB/UUI.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Clinical challenge
    • PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Employment law: A guidance note for general
           practitioners on providing patient information to employers
    • Abstract: Garnett, Adele; Tobin, Andrew
      Background: Medical practitioners are often caught between a patient who is reluctant to provide their employer with personal health information and an employer who is requesting more detailed health information.

      Objectives: This article outlines the rights and responsibilities of employees and employers with regards to the provision of personal health information within employment, and how medical practitioners can assist in advocating for their patient. Topics covered include legal requirements for medical certificates; when certificates can be questioned by an employer; and whether employers can request additional health information from a general practitioner (GP) or independent specialist.

      Discussion: In many cases, employers have the right to seek further health information from their employees (eg for health and safety obligations), and employees can face disciplinary action and even dismissal if they are uncooperative. As GPs are necessarily involved in the provision of this information, it is important that they have a general understanding of employment law as it relates to the provision of a patient's personal health information to employers.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Data linkage
    • Abstract: Emery, Jon; Boyle, Douglas
      Background: Data linkage has been defined as 'the bringing together from two or more different sources, data that relate to the same individual, family, place or event'. Australia is one of few countries that has invested significantly in the creation of data linkage facilities.

      Objectives: This paper provides an overview of data linkage and its relevance to general practice research.

      Discussion: Data linkage enables large-scale studies of whole populations across the healthcare system. Data linkage has been used for studies of health service outcomes and use, epidemiology, and needs analysis. In Australia, there is growing interest in the potential to link data from general practice to other healthcare datasets. This can be achieved through access to Medicare data (Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data) or potentially using data extraction tools to obtain more detailed clinical general practice data. In this article, we discuss issues that relate to privacy and ethical use of data in linkage studies, and provide examples of the types of research performed using this methodological approach nationally and internationally.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Key feature problems: A self-assessment guide for
           family medicine trainees [Book Review]
    • Abstract: Mansfield, Sarah
      Review(s) of: Key feature problems: A self-assessment guide for family medicine trainees, Edited by Cheong Lieng Teng, Stanley Chun Wai Chan, Malaysia, Medical Education Publisher, 2017, ISBN 978-967-14714-0-1.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Managing symptoms and health through self-prescribed
           restrictive diets: What can general practitioners learn from the
           phenomenon of wheat avoidance'
    • Abstract: Golley, Sinead; Corsini, Nadia; Mohr, Philip
      Background and objectives: Seven per cent of Australian adults report avoiding wheat products for the relief of symptoms. The objective of this study was to explore the experiences, symptoms, influences and beliefs that may explain the tendency for this behaviour to occur predominantly in the absence of a reported medical diagnosis or expert dietary supervision.

      Method: Data were collected through preliminary questionnaires and semi-structured interviews with 35 self-identified symptomatic individuals who avoid consumption of wheat-based products without a diagnosis of coeliac disease or wheat allergy.

      Results: Like other contested health phenomena, symptomatic wheat avoidance is characterised by broad symptomatology, perceived benefits, absence of clear biological markers, dissatisfaction with conventional medicine following previous negative test results, and the fact that presumed treatment - elimination of a dietary factor - requires no medical intervention. Discussion: Self-prescribed food avoidance represents a diagnostic and therapeutic challenge for practitioners, central to which is a tension between patient expectations and biomedical standards of evidence in the diagnostic relationship.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Chewing the fat over statins: Consumer concerns about
           lipid-lowering medication
    • Abstract: Deckx, Laura; Kreijkamp-Kaspers, Sanne; McGuire, Treasure; Bedford, Suzanne; van Driel, Mieke
      Background and objective: The objective of this article was to explore the information needs of consumers using statins.

      Method: Calls made to a national medicines call centre in Australia were analysed. Where question narratives were available electronically (n = 1486), the main concerns were identified using a coding scheme. Subsequently, we evaluated whether these concerns were addressed in the medication leaflet.

      Results: The most common concerns were about side effects (36%) and interactions (28%). Concerns about side effects related to musculoskeletal (27%), gastrointestinal (12%) and skin problems (5%). Concerns about interactions included other medicines (49%), complementary and alternative medicines (CAMs; 39%) and grapefruit (6%). Additional questions related to differences between treatments (12%) and dosage (8%). Most topics were mentioned in the medication leaflet, but strategies to manage these concerns were lacking.

      Discussion: When prescribing statins, information about common side effects, when symptoms require action, and interactions with other medicines, especially CAMs, should be addressed and tailored to the patient.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Hidradenitis suppurativa - Management, comorbidities
           and monitoring
    • Abstract: Vekic, Dunja A; Cains, Geoffrey D
      Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease presenting in intertriginous areas. HS is associated with a number of disease-modifying comorbidities, including metabolic syndrome and androgen dysfunction, and smoking.

      Objectives: This review provides a synopsis of the aetiology and diagnosis of HS, and an overview of management for this often devastating disease.

      Discussion: The clinical course and disease severity of HS are variable among patients. HS has profound physical and psychological consequences that affect patients' quality of life. Effective treatment is now a realistic goal, but needs to be combined with treatment of the comorbidities and psyche. Evidence-based management guidelines have been established for the management of this disease. General practitioners play a pivotal role in the holistic treatment of this disease.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Rheumatology and the adolescent patient
    • Abstract: Tiller, Georgina; Allen, Roger
      Background: Adolescence can be a time when rheumatological conditions present to the general practitioner for diagnosis and management. Diagnosis of rheumatic disease during adolescence and earlier childhood often brings additional challenges such as those relating to body image, schooling and recreational activities, friendships and relationships, compliance with medications and independence with healthcare needs.

      Objectives: This article highlights rheumatological conditions that have relevance during adolescence and describes the approach to the history, examination and investigation of young people with rheumatic disease. Some common management issues that may arise when assessing adolescent patients in the primary care setting, including indications for referral to a rheumatologist, are outlined.

      Discussion: The transition from one of dependence to self-management is a complex but important process as many adolescents with rheumatic disease will have persistent disease activity or ongoing sequelae continuing into their adulthood.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Inflammatory bowel disease in adolescents
    • Abstract: Grover, Zubin; de Nardi, Angela; Lewindon, Peter J
      Background: Nearly 20% of all inflammatory bowel disease (IBD) is diagnosed in children and adolescents, where it follows a more complicated and aggressive course than adult-onset IBD. General practitioners (GPs) have a pivotal role in early diagnosis, and monitoring and supporting children and families with IBD.

      Objective: This article will focus on recognising key differences between paediatric-onset IBD and adult-onset IBD, proposed treatment targets, and practical issues in the management of adolescents with IBD.

      Discussion: IBD in children is more aggressive in nature, with additional issues of growth failure, delayed puberty and the consequences of a chronic disease commencing at a vulnerable period of psychosocial development. Traditional treatment targets focus on symptom control, but this is insufficient as long-term, end-organ (bowel) damage results from insufficiently controlled inflammation. In this article, we provide a brief overview of IBD in adolescents and cover key management issues, particularly focusing on newer treatment end-points by aiming for high rates of intestinal mucosal healing and evidence to support this approach.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Engaging young people with a chronic illness
    • Abstract: Wilson, Emily V
      Background: General practitioners (GPs) are uniquely placed to help adolescents take control of managing their chronic illness, and provide continuity of care during the transition to adulthood. This is dependent on a well-established therapeutic relationship with a young person and their family.

      Objectives: The aim of this article is to address the preferences of young people with a chronic illness in dealing with doctors. It also covers ways in which GPs might frame chronic illness management to young patients and their families to optimise care.

      Discussion: Young people want their doctors to be honest, trustworthy and friendly. Plain language explanations of confidentiality, the patient's illness, management and transition are likely to foster a good therapeutic relationship. Attention should be paid to the difficult balance between managing an illness and enjoying life.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Adolescents with chronic disease
    • Abstract: Mansfield, Sarah
      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Letters
    • PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - TB or not TB: A case report
    • Abstract: Brown, Cassandra EB; Keighley, Caitlin; Chapman, Scott
      An Indian man, aged 33 years, presented to his general practitioner (GP) with fever, dyspnoea, intermittent, sharp, non-radiating retrosternal chest pain, nausea and night sweats. His skin, joint, lymphatic, cardiorespiratory and gastrointestinal examinations were non‑contributory.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 8 - Hypertrophic cardiomyopathy in the adolescent
    • Abstract: Ellims, Andris H
      Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease, which generally manifests during adolescence. Adolescents may be diagnosed incidentally, following the investigation of symptoms, or during family screening. Early recognition may prevent sudden cardiac death. First-degree relatives of an adolescent with HCM should be screened for the condition.

      Objectives: The objectives of this article are to review the genetic basis for HCM and discuss clinical presentations of HCM in adolescents, so that general practitioners:
      - develop confidence in requesting investigations in adolescents with suspected or proven HCM
      - consider early referral to a paediatric cardiology department for any adolescent with left ventricular hypertrophy
      - understand family screening guidelines for HCM.

      Discussion: HCM is a complex cardiac disease with marked heterogeneity. Management strategies should be individually tailored, including avoidance of competitive sports, but encouragement of lower intensity physical activities. Adolescents with HCM should be regularly reviewed in a paediatric cardiology department; however, general practitioners should understand the diagnostic and treatment principles for this condition.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Clinical challenge
    • PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - General practitioner follow-up in older patients after
           an emergency department admission
    • Abstract: Watson, Belinda; Tam, Chun Wah Michael; Pellizzon, Belinda; Ban, Lucille; Doan, Harry
      Background and objective: New studies have investigated older patients with regards to general practice follow-up after an emergency department (ED) admission. We measured the proportion of older patients given explicit general practice follow-up instructions who sought care by day seven after an ED admission.

      Method: Patients discharged from Fairfield Hospital ED (south-western Sydney) who were 65 years and older were approached for a structured telephone interview. Data from the interview and patients' ED discharge summaries were analysed descriptively. Exploratory statistical analyses were conducted to identify potential explanatory factors.

      Results: Fifty patients participated in the study. Most participants (76%) attended general practice follow-up by day seven. Those with more relatives who could be called on for help were more likely to attend the follow-up appointment (P = 0.003). Participants were who were not married (54% versus 84%) and non-drivers (53% versus 90%) were less likely to attend for follow-up.

      Discussion: Close family support and car transport might influence general practice follow-up in older people. Further exploration of contributing factors may be warranted.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Successfully implementing a diabetic retinopathy
           screening service in general practice: What does the evidence tell us'
           
    • Abstract: Crossland, Lisa; Jackson, Claire
      Background and objective: We previously showed that general-practice based screening for diabetic retinopathy significantly improves recording of screening outcomes and follow-up for Australians with type 2 diabetes. In 2016, two Medicare Benefits Schedule item numbers were launched to support screening in general practice. However, there is little evidence-based information to guide practices in successfully implementing screening models for diabetic retinopathy. The objective of this study was to develop an evidence-based framework to guide successful general-practice based screening for diabetic retinopathy.

      Methods: Thematic analysis was used to identify and classify recurrent themes from qualitative and observational data gathered from general practices and staff undertaking successful screening for diabetic retinopathy.

      Results: Seven themes (a combination of enablers and potential risks) were identified as key components of successful screening for diabetic retinopathy in general practice.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Hepatitis B testing and diagnosis experiences of
           patients and primary care professionals in Australia
    • Abstract: Richmond, Jacqueline; Smith, Elizabeth; Wallace, Jack; Duncan, Duane; Lucke, Jayne
      Background and objective: A significant proportion of Australians with chronic hepatitis B (CHB) remains undiagnosed and unaware of their risk of liver disease and cancer. This study explored the hepatitis B testing and diagnostic experiences of people with CHB, general practitioners (GPs) and primary care nurses.

      Method: Semi-structured interviews were conducted with people who have CHB (n = 19), GPs (n = 14) and nurses (n = 5).

      Results: The majority of patient participants with CHB were not provided with information prior to being tested, and were shocked to receive a diagnosis. Neither GPs nor nurses noted Australia's 'National hepatitis B testing policy' as guiding their practice, and hepatitis B contact tracing was poorly executed.

      Discussion: Patient participants' diagnostic experiences did not correspond with national policy recommendations. GPs and nurses need resources to provide accurate information when testing and diagnosing hepatitis B, and clear guidance about their role in contact tracing.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Chronic lymphocytic leukaemia: An updated approach to
           diagnosis and management in general practice
    • Abstract: Tomlinson, Ross
      Background: Chronic lymphocytic leukaemia (CLL) is the most common lymphoproliferative disease in Australia. Improvements in the understanding of this disease have led to drastic changes in regards to diagnosis, management and prognosis.

      Objectives: The aim of this article is to give an updated approach to the diagnosis, investigation, monitoring and new treatments of CLL.

      Discussion: With the advent of new medications and improved investigations to predict outcomes, CLL has now become a chronic disease that requires long-term monitoring by haematologists and general practitioners (GPs).

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Clinical assessment, diagnosis and management of nasal
           obstruction
    • Abstract: Esmaili, Aaron; Acharya, Aanand
      Background: Nasal obstruction is among the most common complaints to the general practitioner (GP). Causes can be divided into mucosal causes or anatomical abnormalities. Most mucosal pathologies can be managed effectively in the primary care setting, with referral to the otolaryngologist in cases that are resistant to medical therapy and in cases of structural anomaly. In cases of allergy, referral to an immunologist may be beneficial.

      Objective: The aim of this article is to review the clinical assessment and management of nasal obstruction in the primary care setting. We consider the various causes of nasal obstruction, describe their management and define those cases that require specialist referral.

      Discussion: Nasal obstruction may be acute or chronic and is a manifestation of a wide range of disease processes, most of which are managed by the GP. In patients with persistent nasal obstruction and in those with structural abnormalities, specialist referral is warranted.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Fragile X-associated disorders: Don't miss them
    • Abstract: Birch, Rachael C; Cohen, Jonathan; Trollor, Julian N
      Background: Fragile X-associated disorders are a family of inherited disorders caused by expansions in the Fragile X Mental Retardation 1 ('FMR1') gene. Premutation expansions of the 'FMR1' gene confer risk for fragile X-associated primary ovarian insufficiency and fragile X-associated tremor ataxia syndrome, as well as other medical and psychiatric comorbidities. Premutation expansions of the FMR1 gene are common in the general population. However, fragile X-associated disorders are frequently under-recognised and often misdiagnosed.

      Objectives: The aim of this article is to describe fragile X-associated disorders and identify specific considerations for general practitioners (GPs) during identification and management of these disorders.

      Discussion: GPs have a critical role in the identification of fragile X-associated disorders, as well as coordination of complex care needs. Prompt recognition and appropriate management of these disorders and potential medical and psychiatric comorbidities will have important implications not only for the affected patient, but also other family members who may be at risk.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Pharmacotherapy for obesity
    • Abstract: Lee, Phong Ching; Dixon, John
      Background: Obesity is a serious, chronic, relapsing disease of energy regulation, with strong genetic and early-life environmental determinants. Pharmacotherapy can be a useful adjunct to lifestyle intervention in effecting and maintaining clinically meaningful weight loss.

      Objectives: The aim of this article is to discuss the role of pharmacotherapy in obesity management. The efficacy, side effects and contraindications of available weight-loss medications are reviewed.

      Discussion: Long-term pharmacotherapy options, which can be effective in providing moderate weight loss, are available to treat obesity. Pharmacotherapy should be considered an adjunct to lifestyle intervention in those with a body mass index (BMI) >30 kg/m2, or in those with a BMI of 27-30 kg/m2 and obesity-related complications. Safety and efficacy should be monitored closely on commencement, and the medication should be discontinued if there are safety or tolerability issues, or if
      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Obstructive sleep apnoea and obesity
    • Abstract: Hamilton, Garun S; Joosten, Simon A
      Background: Obstructive sleep apnoea (OSA) and obesity are two common conditions affecting the Australian population; obesity is the major risk factor for OSA.

      Objectives: The objectives of this article are to review the interactions between obesity and OSA, including the increased cardiovascular risk, and highlight the importance of using OSA diagnosis as a critical time to address obesity itself and other cardiovascular risk factors.

      Discussion: Snoring and symptoms of OSA frequently worsen during periods of rapid weight gain. Obesity and metabolic factors (eg hypertension, hyperlipidaemia, insulin resistance) are commonly present at the time of OSA diagnosis. Severe OSA is an independent risk factor for cardiovascular disease and stroke. Continuous positive airway pressure (CPAP) treatment is safe and effective, reduces sleepiness, and improves mood and quality of life; however, the cardiovascular benefits of CPAP are uncertain. Weight loss leads to variable improvement in OSA, is most effective in milder OSA, and has a greater benefit on cardiovascular risk than CPAP.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Bariatric-metabolic surgery: A guide for the primary
           care physician
    • Abstract: Lee, Phong Ching; Dixon, John
      Background: Bariatric-metabolic surgery has emerged as an attractive option that offers significant and durable weight loss in the treatment of clinically severe obesity. Given the high prevalence of obesity, and growing numbers of bariatric-metabolic surgeries performed, primary care physicians increasingly encounter patients who have had, or are considering, bariatric-metabolic surgery.

      Objectives: The aim of this article is to provide guidance on common issues pertaining to bariatric-metabolic surgery that general practitioners (GPs) face, including patient selection, pre‑operative work-up, acute and long-term complications following the surgery, and long-term lifestyle and nutritional support.

      Discussion: In properly selected patients with clinically severe obesity, there is clear net benefit in terms of improved health outcomes and reduced mortality following bariatric-metabolic surgery. Similarly to other chronic conditions, GPs play a crucial role in the management of obesity, and in the multidisciplinary, long-term postoperative support and monitoring that is important for optimal outcomes after surgery.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Beneath the tip of the iceberg: Why so many people
           with eating disorders are not referred for treatment
    • Abstract: Mitchison, Deborah; Basten, Christopher; Griffiths, Scott; Murray, Stuart B
      Eating disorders contribute substantially to global disability burden in terms of prevalence (Australian estimate is 17.2%), mental and physical morbidity, duration of illness and early mortality. With figures suggesting that 77% of people with an eating disorder never receive specialised treatment, it is clear that eating disorder clinicians are only treating patients who are on the 'tip of the iceberg'. The broad scope of a general practitioner's (GP's) practice inhibits the detection of each and every underlying condition, yet low referral rates are a part of this issue. People with eating disorders do present to primary care for treatment of associated health conditions; thus, improving detection within this setting represents an opportunity to increase access to evidence-based treatment. We attempt to unravel two prevailing stereotypes that have an impact on how eating disorders are perceived, ultimately influencing detection and referral behaviours.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Using electronic medical records to assess the rate of
           treatment for osteoporosis in Australia
    • Abstract: Elliott-Rudder, Megan; Harding, Catherine; McGirr, Joseph; Seal, Alexa; Pilotto, Louis
      Background and objectives: Despite available Medicare Benefits Schedule subsidies, it has been suggested that screening and treatment for osteoporosisare under-accessed in Australia, particularly in patients >=70years. This study describes the rate of osteoporosis treatment in those aged >=70 years in regional New South Wales as identified in the electronic medical records (EMR) of 11 general practices.

      Methods: EMR data were extracted using a Canning Tool adaptation. The prevalence of osteoporosis, fracture and bone-active medication prescriptions were described, and associations examined.

      Results: Osteoporosis was identified in 728 patients (20.9%) - 28.6%females and 9.4% males - with 70.6% of these patients prescribed active medication. Diagnosis increased with fracture history (odds ratio [OR]: 6.65; 95% confidence interval [CI]: 5.22,8.47), female gender (OR: 3.38; 95% CI: 2.73, 4.16) and each year older (OR: 1.04; 95% CI: 1.02, 1.05). Treatment was negatively associated with patients aged >=90 years versus patients aged70-79 years (OR: 0.5; 95% CI: 0.3, 0.9).

      Discussion: This study suggests that treatment for osteoporosis is suboptimal. The use of EMR data could be used for audit or monitoring of interventions in general practice.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Genitourinary syndrome of menopause
    • Abstract: Farrell, Elizabeth
      Background: Genitourinary syndrome of menopause (GSM) is the new term for vulvovaginal atrophy (VVA). Oestrogen deficiency symptoms in the genitourinary tract are bothersome in more than 50% of women, having an adverse impact on quality of life, social activity and sexual relationships. GSM is a chronic and progressive syndrome that is underdiagnosed and undertreated.

      Objective: The aim of this article is to increase knowledge and understanding of GSM, improving the ability of healthcare professionals to discuss and obtain an appropriate history sensitively, and treat accordingly.

      Discussion: GSM includes conditions of the vagina, vulva, pelvic floor tissues, urinary tract, and sexual dysfunction and loss of libido. Many women are reluctant to report these symptoms to their healthcare professional for many reasons.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - An update on obesity
    • Abstract: Duns, Glenn
      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 7 - Genetics of obesity
    • Abstract: Campbell, Lesley V
      Background: The prevalence and cost of overweight and obesity are projected to continue to rise in our current sedentary, energy-rich environment. The heritability of obesity is reported to be 40-80%.

      Objectives: The objectives of this article are to review recent genetic discoveries about the basis of human obesity; describe familial or syndromic obesity, which is rare but presents early and should, if suspected, be referred for full specialist diagnosis of the underlying genetic disorder; and summarise immediate implications for general practice.

      Discussion: Increasingly, specialised genetic studies are helping to unravel the complex physiology underlying the regulation and control of body fatness. Rare but serious syndromic obesity can now be identified early in life. Possible targets for future drug treatment are currently being found and tested, offering hope for the future. Understanding the heritable nature of obesity should also help to relieve the blame and guilt from the professional's approach to current weight management.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 6 - Can research that is not intended or unlikely to be
           published be considered ethical'
    • Abstract: Barton, Christopher; Tam, Chun Wah Michael; Abbott, Penelope; Hall, Sally; Liaw, Siaw-Teng
      Background: For research to be ethically acceptable, the potential benefits must justify any risks involved for participants. Dissemination of research findings through publication is one way of creating benefit, but not all researchers intend to publish their research. Other factors, such as lack of size or representativeness, generalisability or innovativeness, or negative findings mean the research is unlikely to be published in a peer-reviewed medical journal.

      Objectives: This paper discusses ethical considerations in research where peer-reviewed publication is not intended or unlikely.

      Discussion: Proposing research that is not intended or unlikely to be published in a peer-reviewed journal does not preclude it from being considered ethical. Additional benefits of such projects may include professional development of investigators, pilot data collection leading to more definitive studies, or developing collaborations with research users that increase relevance and improve utility of findings.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 6 - Procedural skills of Australian general practice
           registrars: A cross-sectional analysis
    • Abstract: Aghajafari, Fariba; Tapley, Amanda; Sylvester, Steve; Davey, Andrew R; Morgan, Simon; Henderson, Kim M; van Driel, Mieke L; Spike, Neil A; Kerr, Rohan H; Catzikiris, Nigel F; Mulquiney, Katie J; Magin, Parker J
      Background and objectives: Procedural skills are an essential component of general practice vocational training. The aim of this study was to investigate the type, frequency and rural or urban associations of procedures performed by general practice registrars, and to establish levels of concordance of procedures performed with a core list of recommended procedural skills in general practice training.

      Methods: A cross-sectional analysis of a cohort study of registrars' consultations between 2010 and 2016 was undertaken. Registrars record 60 consecutive consultations during each six-month training term. The outcome was any procedure performed.

      Results: In 182,782 consultations, 19,411 procedures were performed. Procedures (except Papanicolaou [Pap] tests) were performed more often in rural than urban areas. Registrars commonly sought help from supervisors for more complex procedures. The majority of procedures recommended as essential in registrar training were infrequently performed.

      Discussion: Registrars have low exposure to many relevant clinical procedures. There may be a need for greater use of laboratory-based training and/or to review the expectations of the scope of procedural skills in general practice.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 6 - Who do Australian general practitioners refer to
           physiotherapy'
    • Abstract: Dennis, Sarah; Watts, Ian; Pan, Ying; Britt, Helena
      Background and objectives: Physiotherapy plays an important role in the health of many Australians. The aims of this study were to assess changes in the rate of general practitioner (GP) referral to physiotherapists in Australia from 1998 to 2014, and to determine patient characteristics associated with increased likelihood of such referral.

      Method: Secondary analysis was undertaken of data from the Bettering the Evaluation and Care of Health program using weighted encounter data years 1998-99 to 2014-15 inclusive.

      Results: The rate of GP referral to physiotherapists remained steady until 2010, when referrals increased. Patients were more likely to be referred to physiotherapy if they had a Department of Veterans' Affairs card; did not have a Health Care Card; were female aged 45-64 years; or male aged 25-44 years. Musculoskeletal problems accounted for 80% of referrals, but only 6.8% of all musculoskeletal problems managed were referred.

      Discussion: Allied health Medicare Benefits Schedule item numbers have increased referrals to physiotherapy. However, there are some population groups who are not referred but might benefit from physiotherapy.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 6 - Up, up and away: The growth of after-hours MBS claims
    • Abstract: de Graaff, Barbara; Nelson, Mark; Neil, Amanda
      Background and objective: Media reports suggest that growth in urgent, after-hours Medicare Benefits Schedule (MBS) claims has coincided with an increasing number of after-hours medical deputising services (AHMDSs). This article assesses these claims in the context of an increasing presence of AHMDSs.

      Method: Retrospective analysis of MBS claims data for general practitioner (GP) after-hours items from 2010-11 to 2015-16 was conducted. The Tasmanian experience is presented as a case study.

      Results: The number of claims was greatest for MBS item number 597 (urgent, sociable after-hours consultations), increasing by 170% over the study period. For jurisdictions with dates identified for the introduction of AHMDSs, dramatic growth in per capita claims were observed: 1270% for the Australian Capital Territory, 485% for Tasmania and 150% for the Northern Territory. For Tasmania, no decrease in emergency department presentations was observed.

      Discussion: Rapid increases in after-hours claims for MBS item number 597 have coincided with the introduction of AHMDSs in three jurisdictions. The impact on patient outcomes and equitable resource distribution requires attention.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 6 - Assessment and management of asthma and chronic
           obstructive pulmonary disease in Australian general practice
    • Abstract: Reddel, Helen K; Valenti, Lisa; Easton, Kylie L; Gordon, Julie; Bayram, Clare; Miller, Graeme C
      Background: Dispensing data suggest potential issues with the quality use of medicines for airways disease.

      Objective: The objective of this article was to describe the management of asthma and chronic obstructive pulmonary disease (COPD) in general practice, and investigate the appropriateness of prescribing.

      Method: The method used for this study consisted of a national cross‑sectional survey of 91 Australian general practitioners (GPs) participating in the Bettering the Evaluation and Care of Health (BEACH) program.

      Results: Data were available for 2589 patients (288 asthma; 135 COPD). For the patients with asthma, GPs classified asthma as well controlled in 76.4%; 54.3% were prescribed inhaled corticosteroids (ICS), mostly (84.9%) as combination therapy, and mostly at moderate-high dose; only 26.3% had a written action plan. GPs classified COPD as mild for 42.9%. Most patients with COPD (60.9%) were prescribed combination ICS therapy and 36.7% were prescribed triple therapy.

      Discussion: There were substantial differences between guideline-based and GP-recorded assessment and prescription for asthma and COPD. Further research is needed to improve care and optimise patient outcomes with scarce health resources.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 6 - Painful pustular dactylitis in an elderly patient
    • Abstract: Teixeira, Jose Tiago; Afonso, Carina; Machado, Maria Bernardete; Morais, Paulo
      A man, 74 years of age, presented with dactylitis on the first, second and fourth digits of his left hand, characterised by glossy erythema, oedema, pustules and yellowish scales. Additionally, there was onychodystrophy, subungual hyperkeratosis, almost complete onycholysis and pustules on the nail bed. The lesions first appeared two months ago and have been progressively worsening since, spreading proximally. There were no similar lesions and no evidence of psoriasis on full‑skin examination. The patient also noted functional incapacity of the affected digits, along with pain to the touch, but denied hand trauma prior to the appearance of the lesions.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 6 - Perimenopausal contraception: A practice-based
           approach
    • Abstract: Bateson, Deborah; McNamee, Kathleen
      Background: Women who are perimenopausal are at risk of unintended pregnancy despite relatively low fertility at this stage. Contraceptive choice can be limited by increased comorbidities, but the UK Medical Eligibility Criteria (UKMEC) system provides a framework for safe prescribing.

      Objectives: This article provides evidence-based guidance on contraceptive options, and information to support decision-making about stopping contraception at menopause.

      Discussion: Contraceptive choice is determined by several factors, including medical eligibility, side effects and risks, non-contraceptive benefits, cost and personal preference. Long-acting reversible contraceptives (LARCs) are an effective, acceptable and safe choice for many women. For women aged > =50 years who are using a non-hormonal method, contraception is recommended until after 12 months of amenorrhoea, or 24 months if they are aged < 50 years. Switching from a combined hormonal contraceptive or depot injection to an alternative progestogen‑only or non-hormonal method is advised in women aged > 50 years; serial follicle-stimulating hormone (FSH) levels can guide method cessation given amenorrhoea is not a reliable indicator of menopause in this context.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
  • Volume 46 Issue 6 - Incidental adrenal masses - a primary care approach
    • Abstract: Gendy, Rasha; Rashid, Prem
      Background: The common use of cross-sectional imaging for the investigation of abdominal and thoracic illness has resulted in the rise of the incidentally identified adrenal mass, or incidentaloma, which presents a diagnostic and management dilemma for the primary care physician.

      Objective: This article provides a framework for the investigation and management of incidental adrenal masses.

      Discussion: Adrenal incidentalomas are found in approximately 3-4% of abdominal computed tomography (CT) scans. It is important to evaluate these incidental adrenal lesions to determine what treatment, if any, is needed and when specialist referral may be necessary. In particular, incidentalomas must be evaluated in regard to their functional status and malignant potential, as lesions can range from being indolent, benign and non-functioning tumours that can simply be observed, to aggressive and hormonally active malignant lesions that require urgent surgical intervention.

      PubDate: Thu, 2 Nov 2017 11:47:20 GMT
       
 
 
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