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  Subjects -> HEALTH AND SAFETY (Total: 1292 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (524 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (377 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (105 journals)
    - PHYSICAL FITNESS AND HYGIENE (101 journals)
    - WOMEN'S HEALTH (81 journals)

HEALTH AND SAFETY (524 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 23)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 5)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 12)
American Journal of Health Education     Hybrid Journal   (Followers: 29)
American Journal of Health Promotion     Hybrid Journal   (Followers: 23)
American Journal of Health Sciences     Open Access   (Followers: 4)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 22)
American Journal of Public Health     Full-text available via subscription   (Followers: 221)
American Journal of Public Health Research     Open Access   (Followers: 29)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 9)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 1)
Archive of Community Health     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 2)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 6)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 5)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 8)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 17)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 12)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 12)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 20)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 12)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 2)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 5)
ElectronicHealthcare     Full-text available via subscription   (Followers: 4)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 4)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 1)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 6)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 6)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 49)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 13)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Policy     Hybrid Journal   (Followers: 36)
Health Policy and Technology     Hybrid Journal   (Followers: 1)
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 21)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 48)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 40)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 11)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 2)
Health Systems     Hybrid Journal   (Followers: 3)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 12)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthy-Mu Journal     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 10)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 2)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 33)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 16)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 9)
International Journal of Health Geographics     Open Access   (Followers: 6)

        1 2 3 | Last

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  [403 journals]
  • 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: Fri, 13 Oct 2017 09:03:54 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: Fri, 13 Oct 2017 09:03:05 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: Fri, 13 Oct 2017 08:57:06 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: Fri, 13 Oct 2017 08:54:03 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: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 GMT
       
  • Volume 46 Issue 10 - Contraception: LARCs first'
    • Abstract: Samuel, Sophia
      PubDate: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 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: Mon, 9 Oct 2017 23:12:30 GMT
       
  • Volume 46 Issue 10 - Clinical challenge
    • PubDate: Mon, 9 Oct 2017 23:12:30 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: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 GMT
       
  • Volume 46 Issue 9 - Promoting 'quality of life' and 'survivorship' urology
    • Abstract: Katz, Darren J
      PubDate: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 GMT
       
  • Volume 46 Issue 9 - Clinical challenge
    • PubDate: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 GMT
       
  • Volume 46 Issue 9 - Letters
    • PubDate: Mon, 11 Sep 2017 21:03:09 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: Mon, 11 Sep 2017 21:03:09 GMT
       
  • Volume 46 Issue 8 - Clinical challenge
    • PubDate: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 GMT
       
  • Volume 46 Issue 8 - Adolescents with chronic disease
    • Abstract: Mansfield, Sarah
      PubDate: Tue, 8 Aug 2017 15:46:05 GMT
       
  • Volume 46 Issue 8 - Letters
    • PubDate: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 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: Tue, 8 Aug 2017 15:46:05 GMT
       
  • Volume 46 Issue 7 - Clinical challenge
    • PubDate: Thu, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 GMT
       
  • Volume 46 Issue 7 - An update on obesity
    • Abstract: Duns, Glenn
      PubDate: Thu, 6 Jul 2017 20:12:59 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, 6 Jul 2017 20:12:59 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: Tue, 6 Jun 2017 12:05:18 GMT
       
  • Volume 46 Issue 6 - Guidelines and systematic reviews: Sizing up
           guidelines in general practice
    • Abstract: van Driel, Mieke L; Spurling, Geoffrey
      This article is the second in a series on general practice research in Australia. The series explores strategies to strengthen general practice research and further develop the evidence base for primary care.

      PubDate: Tue, 6 Jun 2017 12:02:10 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: Tue, 6 Jun 2017 11:59:19 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: Tue, 6 Jun 2017 11:56:21 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: Tue, 6 Jun 2017 11:54:39 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: Tue, 6 Jun 2017 11:52:14 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: Tue, 6 Jun 2017 09:49:35 GMT
       
  • Volume 46 Issue 6 - Obesity and weight management at menopause
    • Abstract: Proietto, Joseph
      Background: Many women report gaining weight as they transition through menopause. For most, the weight gain is modest and can be reduced with a conscious effort to limit energy intake and increase energy expenditure. However, many women who are already overweight and obese will gain more weight as they approach menopause.

      Objectives: The aims of this paper are to explain the reasons for menopausal weight gain and to detail a method for achieving and sustaining a substantial weight loss.

      Discussion: Weight gain during menopause is predominantly due to a reduction in spontaneous activity. For women who are lean, advice about controlling energy intake and increasing physical activity may be all that is required to prevent weight gain. For women who are overweight and obese rapid weight loss is best achieved with the help of a very low energy diet. This must be followed by lifelong behaviour modification with or without the help of hunger-suppressing pharmacotherapy.

      PubDate: Tue, 6 Jun 2017 09:40:32 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: Fri, 2 Jun 2017 21:13:38 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: Fri, 2 Jun 2017 21:13:38 GMT
       
  • Volume 46 Issue 6 - Bilateral vision loss in a child recently diagnosed
           with type 1 diabetes mellitus
    • Abstract: O'Day, Roderick Francis Justin; Rocke, John Ross; Tennakoon, Janaka; Sheth, Shivanand; Raj, Christolyn
      A boy, 12 years of age, was referred to the ophthalmology department in the state capital tertiary-referral paediatric hospital with bilateral vision loss and dull red reflexes. Two weeks earlier, he was diagnosed with type 1 diabetes mellitus (T1DM) after presenting to a regional centre base hospital, 150 km outside the nearest capital city, with a four-day history of lethargy, vomiting, polyuria and polydipsia. He was found to be in diabetic ketoacidosis (DKA), with a pH of 6.8, blood glucose of 37.3 mmol/L and glycated haemoglobin (HbA1c) of 9.2%. He had no significant past medical history, no regular medications and no known allergies, and was discharged after 48 hours on a regimen of insulin aspart 30 units twice daily.

      PubDate: Fri, 2 Jun 2017 21:13:38 GMT
       
  • Volume 46 Issue 6 - Measuring and managing complexity
    • Abstract: Samuel, Sophia
      PubDate: Fri, 2 Jun 2017 21:13:38 GMT
       
  • Volume 46 Issue 6 - Travelling safely to places at high altitude -
           Understanding and preventing altitude illness
    • Abstract: Parise, Ivan
      Background: Greater numbers of people are travelling to places at high altitude each year. Altitude illness is common in places at high altitude and may be life-threatening. General practitioners (GPs) are best placed to provide evidence-based advice to keep travellers well informed of the possible risks they may encounter in places at high altitude.

      Objectives: The aim of this article is to review knowledge on altitude illness in order to help GPs assist patients to travel safely to places at high altitude.

      Discussion: Acclimatisation to high altitude is a complex process and when inadequate leads to the pathological changes of altitude illness, including high-altitude headache, cerebral oedema, pulmonary oedema and acute mountain sickness. Higher ascent, faster rate of ascent and a previous history of altitude illness increase the risk of altitude illness. Acetazolamide and other medications used to prevent altitude illness are discussed in detail, including the finding that inhaled budesonide may prevent altitude illness.

      PubDate: Fri, 2 Jun 2017 21:13:38 GMT
       
  • Volume 46 Issue 6 - Keeping an eye on syphilis
    • Abstract: Ong, Daini; Bhardwaj, Gaurav; Ong, Jason; Chen, Marcus; Lim, Lyndell L
      Background and objective: The objective of this article was to alert general practitioners (GPs) to the increase in ocular syphilis in the context of a worsening epidemic of syphilis among men who have sex with men (MSM).

      Method: This study used a retrospective case review of ocular syphilis cases that presented to the Royal Victorian Eye and Ear Hospital from January 2015 to August 2016.

      Results: Twelve patients (19 eyes) were identified, including 11 males. The mean age was 35 years, and seven men were identified as MSM. Two men were diagnosed with human immunodeficiency virus (HIV) infection at presentation. Blurred vision (n = 10) and/or floaters (n = 9) were the most common presenting symptoms. All patients had uveitis as the manifestation of the ocular involvement; however, redness and pain were not universally reported.

      Discussion: GPs should be alert to the possibility of ocular syphilis at the time of syphilis diagnosis, particularly among MSM. Urgent ophthalmic referral is required if the patient is found to have new onset visual symptoms.

      PubDate: Fri, 2 Jun 2017 21:13:38 GMT
       
  • Volume 46 Issue 6 - Clinical challenge
    • PubDate: Fri, 2 Jun 2017 21:13:38 GMT
       
  • Volume 46 Issue 6 - Premature ovarian insufficiency in general practice:
           Meeting the needs of women
    • Abstract: Nguyen, Hanh H; Milat, Frances; Vincent, Amanda
      Background: Premature ovarian insufficiency (POI), defined as amenorrhoea due to the loss of ovarian function before 40 years of age, can occur spontaneously or be secondary to medical therapies. POI is associated with cardiovascular morbidity, osteoporosis and premature mortality. Women with POI present in primary care with menstrual disturbance, menopausal symptoms, infertility and, often, significant psychosocial issues. General practitioners play an important role in the evaluation and long-term management of women with POI.

      Objective: This article examines the diagnostic and management issues when providing care for women with POI in the primary care setting.

      Discussion: Diagnosis of POI requires follicle-stimulating hormone (FSH) levels in the menopausal range on two occasions, at least four to six weeks apart in a woman aged < 40 years, after more than four months of amenorrhoea or menstrual irregularity. The diagnosis is often distressing and women are likely to require psychological support. Hormone replacement therapy, unless contraindicated, is required and should be continued until the age of natural menopause. Contraception is required if pregnancy is not wanted, and multidisciplinary management is necessary.

      PubDate: Fri, 2 Jun 2017 21:13:38 GMT
       
  • Volume 46 Issue 5 - General practitioners and school psychologists: An
           underused collaboration
    • Abstract: Burns, John R; Wong, Kevin
      Background: General Practitioners (GPs) play a vital role in the management of the social, emotional and behavioural health of children and adolescents. Best practice usually requires collaboration with a broad range of other medical and allied health professionals, to bring about optimal outcomes for patients and their family.

      Objectives: This article describes the specific role of a school psychologist and outlines various ways that GPs and school psychologists can collaborate in the assessment and management of school‑aged patients.

      Discussion: Given the importance of school in the social and emotional development of children and adolescents, school psychologists should be considered a valuable partner for GPs when caring for young people.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Clinical challenge
    • PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Measuring general practice activity in Australia: A
           brief history
    • Abstract: Britt, Helena; Miller, Graeme C
      Health services research on general practice that aimed to improve the function of practice and quality of care dates from the seminal ethnographic study of English general practice by Australian general practitioner (GP) Joseph Collings in 1950.1 This remarkable 30-page report published in The Lancet shook British general practice to its foundations and triggered the formation of the Royal College of General Practitioners (RCGP), the world's first general practice college, and subsequently The Royal Australian College of General Practitioners (RACGP).

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - General practitioners' knowledge about use of topical
           corticosteroids in paediatric atopic dermatitis in Australia
    • Abstract: Smith, Saxon D; Harris, Victoria; Lee, Andrew; Blaszczynski, Alex; Fischer, Gayle
      Background and objective: Topical corticosteroids are the standard of care in paediatric atopic dermatitis (pAD). However, messages that overstress possible side effects can have a negative impact on perceptions of safety and contribute to treatment non-adherence. The aim of this study was to assess general practitioners' (GPs') perception of the safety of topical corticosteroids in pAD treatment.

      Methods: Australian GPs participating in continuing professional development programs were assessed before an education session on pAD. Responses were recorded via an electronic survey.

      Results: A total of 257 GPs were surveyed. More than one-third (40.7%) of the GPs instructed parents to apply topical corticosteroids for two weeks or less. Nearly half (47.7%) instructed parents to apply topical corticosteroids sparingly or with the smallest amount possible. Furthermore, nearly one-third (30.2%) reported skin atrophy as the most common side effect of topical corticosteroids.

      Discussion: Advice to patients given by Australian GPs may carry unintentional risk messages contributing to treatment non‑adherence. Evidence-based information on the safety of topical corticosteroids is needed to empower GPs to improve treatment outcomes in pAD.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - GPs' perspectives on prescribing intrauterine
           contraceptive devices
    • Abstract: Lodge, Gabrielle; Sanci, Lena; Temple-Smith, Meredith
      Background and objective: Globally, 14% of women use intrauterine contraceptive devices (IUCDs) for prevention of unplanned pregnancy. In Australia, the use of IUCDs is negligible at
      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Actual availability of appointments at general
           practices in regional New South Wales, Australia
    • Abstract: Bradbury, Joanne; Nancarrow, Susan; Avila, Cathy; Pit, Sabrina; Potts, Ruth; Doran, Frances; Freed, Gary
      Background and objective: There is limited data to inform policy about the availability and costs of primary healthcare at the local level. The objective of this article was to determine the appointment availability and out-ofpocket costs for patients presenting with non‑urgent conditions to general practices in a regional setting.

      Method: A cross-sectional, census study included all 184 general practices across 12 local government areas in northern New South Wales. Practices were telephoned in a randomised sequence on weekday mornings by a researcher.

      Results: Twenty-two practices were excluded from the study as these were specialised‑only services; therefore, the sample size was n = 162. The rate of same-day appointment availability was 47.5% (n = 77/162; range: 11-63%), and bulk-billing availability was 21% (range: 0-50%). The mean out-of-pocket cost was $29.98 (range: $12.95-60.30).

      Discussion: Availability of primary healthcare and bulk billing across northern New South Wales is highly variable. Areas with low service availability should be targeted by policy.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Patterns of complementary and alternative medicine use
           and health literacy in general practice patients in urban and regional
           Australia
    • Abstract: von Conrady, Dora M; Bonney, Andrew
      Background and objective: The majority of Australians use complementary and alternative medicine (CAM). Despite concerns about safety, patterns of health literacy and CAM use in Australian general practice are unknown.

      Methods: Pre-existing questionnaires assessing health literacy and CAM use (HLQ and I-CAM-Q) were distributed by eight practices across four Australian states to 800 patients aged 18 years and older for self-completion. Regression modelling and cluster analysis were applied to the data.

      Results: The response rate was 47% (n = 374), the mean age was 53 years and 68% of participants were female. Two-thirds of participants used some form of CAM in the previous 12 months, and 60% believed CAM aided wellbeing. There were significant associations between cluster membership, education, sex and CAM use.

      Discussion: Our findings suggest CAM use is a complex phenomenon, associated with gender and education. We demonstrated a cluster of female patients with high CAM use and lower health literacy warranting further research.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Letters
    • PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Beyond anxiety and agitation: A clinical approach to
           akathisia
    • Abstract: Tachere, Richardson Oghoteru; Modirrousta, Mandana
      Background: When patients suddenly become restless and are unable to sit or stand still, especially in general medical settings, anxiety is often the topmost differential on every clinician's mind. However, the possibility of the very subjectively distressing condition called 'akathisia' should always be considered.

      Objective: The aim of this article is to discuss a clinical approach to the management of akathisia, drawing on the presentation of a patient who was admitted to a general medical ward.

      Discussion: Akathisia, a subjective and very distressing feeling of restlessness, has been found to be caused by a wide range of medications used in general medical settings, such as azithromycin, antiemetics and antipsychotics. Despite its high incidence and association with an increase in suicidal thoughts, it often goes unrecognised. This paper highlights the need for its early recognition, provides a diagnostic guide and an approach to its management.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Ulipristal acetate: An update for Australian GPs
    • Abstract: Mazza, Danielle
      Background: In Australia, use and understanding of emergency contraception among women remains relatively low. This is despite the introduction of levonorgestrel emergency contraceptive pills (ECPs) more than a decade ago. In April 2016, a new ECP with the active ingredient ulipristal acetate became available in Australia.

      Objectives: The aims of this article are to increase understanding of the recently introduced ulipristal acetate ECP, including its safety profile, efficacy and special considerations; dispel common myths and misconceptions about emergency contraception; and to provide guidance on emergency contraceptive management in general practice, considering the recent advances.

      Discussion: Women are more receptive to information about emergency contraception that has been provided by a general practitioner (GP). As such, the availability of the ulipristal acetate ECP in Australia provides an important opportunity for GPs to help women prevent unplanned pregnancies.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Improving blood pressure control in general practice:
           A pilot study of the ImPress intervention
    • Abstract: Zwar, Nicholas; Hermiz, Oshana; Halcomb, Elizabeth; Davidson, Patricia; Bodenheimer, Thomas
      Background and objectives: Patients with hypertension and at high absolute cardiovascular disease risk are a priority group for improved blood pressure control. This study examined the impact of an intervention, primarily delivered by the general practice nurse, to identify, recall and manage patients with uncontrolled hypertension who are at high risk of cardiovascular disease.

      Methods: A before-and-after pilot study with a six-month follow-up period was conducted in eight general practices in Sydney, Australia.

      Results: From 507 patients identified, 82 (16.2%) attended an assessment visit, were eligible and provided baseline data. Of these, 55 (67.1%) completed the six-month follow-up. The mean decrease in blood pressure was 14.5 mmHg systolic and 7 mmHg diastolic. Significant decreases were also found in mean weight (1.3 kg), body mass index (0.5 kg/m2) and waist circumference (1.9 cm). Adherence to blood pressure treatment, as measured by the Hill-Bone scale, significantly improved (P = 0.01)

      Discussion: The results of this study justify further investigation in a randomised trial. If effective, the approach could alter the way hypertension care is organised and delivered in Australian general practice.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Skin biopsy in the diagnosis of neoplastic skin
           disease
    • Abstract: Harvey, Nathan Tobias; Chan, Jonathan; Wood, Benjamin Andrew
      Background: Biopsy for diagnostic and therapeutic purposes is a central component in the management of neoplastic skin conditions. While the technical aspects of performing biopsies are familiar to most clinicians, a number of other aspects of the skin biopsy pathway are equally important.

      Objectives: The objectives of this article are to provide general principles related to the biopsy of neoplastic skin conditions and offer practical advice on the approach to some common skin neoplasms.

      Discussion: Careful attention to the selection of biopsy site and type, and communication of appropriate clinical details will ensure optimal patient care, minimising the chance of diagnostic errors with potentially serious medical and medico-legal consequences.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Cognitive errors in the management of skin conditions:
           Rash decisions and alternative facts
    • Abstract: Duns, Glenn
      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Scabies: A clinical update
    • Abstract: Hardy, Myra; Engelman, Daniel; Steer, Andrew
      Background: Scabies is a common, yet neglected, skin disease. Scabies occurs across Australia, but most frequently in socioeconomically disadvantaged populations in tropical regions, including in remote Aboriginal and Torres Strait Islander communities. In temperate settings, the disease clusters in institutional care facilities.

      Objectives: The objective of this article is to provide updates on the clinical diagnosis and treatment approaches for scabies in Australia.

      Discussion: Clinical examination remains the mainstay of diagnosis, although dermatoscopy is a useful adjunct. Scabies presents with severe itch and a papular rash, with a predilection for the hands, feet and genitalia. The distribution may be more widespread in infants and older people. Secondary bacterial infection is also common in patients with scabies. Crusted scabies is a rare but highly infectious variant. Topical permethrin is highly effective for individual treatment, but less practical for treatment of asymptomatic contacts and control of outbreaks. Oral ivermectin is a safe and effective alternative, and is now listed on the Pharmaceutical Benefits Scheme as a third-line treatment.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Optimising cryosurgery technique
    • Abstract: Cranwell, William C; Sinclair, Rodney
      Background: Cryosurgery is an effective, simple and inexpensive treatment used extensively in general practice and dermatology. It is used most commonly for actinic keratoses and warts; however, a large number of benign, premalignant and malignant skin diseases can also be treated.

      Objective: The objective of this article is to help readers improve their cryosurgery technique.

      Discussion: Application of the cryogenic agent (most commonly liquid nitrogen) to the skin induces rapid freezing followed by slow thawing. This produces cell injury, vascular stasis and occlusion, and inflammation. The quantity of cryogen delivered onto the skin (dose), technique, duration of thawing and amount of surrounding tissue frozen are dependent on the body region and type of lesion. If clinical diagnosis is not possible, either a skin biopsy or referral to a dermatologist is recommended. We strongly discourage blind treatment of undiagnosed skin lesions.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Rosacea
    • Abstract: Maor, Danit; Chong, Alvin H
      Background: Rosacea is a chronic and common cutaneous condition characterised by symptoms of facial flushing and a broad spectrum of clinical signs. The clinical presentation for rosacea is varied, and there are four primary subtypes, which may overlap - erythrotelangiectatic, inflammatory, phymatous and ocular. It is important to recognise the different subtypes because of the differences in therapy.

      Objective: The objective of this article is to provide evidence-based clinical updates to clinicians, specifically general practitioners (GPs), to assist with their everyday practice, and effective assessment and treatment of rosacea.

      Discussion: Therapeutic modalities are chosen on the basis of the subtypes and clinical features identified; often a combination of these therapies is required.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 5 - Skin biopsy in the diagnosis of inflammatory skin
           disease
    • Abstract: Harvey, Nathan Tobias; Chan, Jonathan; Wood, Benjamin Andrew
      Background: Most non-neoplastic skin conditions are readily diagnosed by a combination of clinical history and examination, but in a small number of cases, biopsy for histopathology and other laboratory investigations can be invaluable tools. Close attention to communication of appropriate clinical details, selection of biopsy site and biopsy technique have a marked impact on the diagnostic yield of this procedure.

      Objectives: The objectives of this article are to provide general principles related to the biopsy of non-neoplastic skin conditions and offer practical advice on the approach to some common skin conditions.

      Discussion: In this article, we discuss a number of general principles that will ensure maximum benefits can be achieved when a biopsy is performed for the diagnosis of non-neoplastic skin disease.

      PubDate: Mon, 8 May 2017 19:11:53 GMT
       
  • Volume 46 Issue 4 - Cancer and the omics revolution
    • Abstract: Epstein, Richard J; Lin, Frank P
      Background: Internal medicine is in flux because of the 'omics revolution', with cancer medicine being a good example. Molecular technologies that detect alterations in gene-based structure or function are having an impact on diagnosis, prognosis and treatment of cancer.

      Objective: In this article, recent advances in gene-based characterisation of cancer are presented, and illustrated where possible by clinical applications.

      Discussion: The research-based vision of precision medicine is now on its way to becoming a clinical reality. A key limiting factor is the small number of therapeutic options available for customisation, which contrasts with the rising abundance of omics-derived data. However, further translational progress is anticipated over the next decade.

      PubDate: Wed, 12 Apr 2017 22:31:47 GMT
       
  • Volume 46 Issue 4 - How can GPs drive software changes to improve
           healthcare for Aboriginal and Torres Strait Islander peoples?
    • Abstract: Kehoe, Helen
      Background: Changes to the software used in general practice could improve the collection of the Aboriginal and Torres Strait Islander status of all patients, and boost access to healthcare measures specifically for Aboriginal and Torres Strait Islander peoples provided directly or indirectly by general practitioners (GPs).

      Objective: Despite longstanding calls for improvements to general practice software to better support Aboriginal and Torres Strait Islander health, little change has been made. The aim of this article is to promote software improvements by identifying desirable software attributes and encouraging GPs to promote their adoption.

      Discussion: Establishing strong links between collecting Aboriginal and Torres Strait Islander status, clinical decision supports, and uptake of GP-mediated health measures specifically for Aboriginal and Torres Strait Islander peoples - and embedding these links in GP software - is a long overdue reform. In the absence of government initiatives in this area, GPs are best placed to advocate for software changes, using the model described here as a starting point for action.

      PubDate: Wed, 12 Apr 2017 22:31:47 GMT
       
  • Volume 46 Issue 4 - A survey of hepatitis C management by Victorian GPs
           after PBS-listing of direct-acting antiviral therapy
    • Abstract: Wade, Amanda; Draper, Bridget; Doyle, Joseph; Allard, Nicole; Grinzi, Paul; Thompson, Alexander; Hellard, Margaret
      Background and objective: To increase access to hepatitis C virus (HCV) treatment, the Pharmaceutical Benefits Scheme (PBS) enabled general practitioners (GPs) to prescribe directacting antiviral (DAA) therapy. We conducted a survey to identify GPs' knowledge and management of HCV.

      Methods: A questionnaire consisting of 20 items about HCV knowledge and management was sent to 1000 GPs.

      Results: One hundred and ninety-one GPs (19.1%) responded; 74% answered correctly that antibody and RNA positivity is diagnostic of HCV. Only 12% could directly request transient elastography. Although 53% of respondents reported interest in prescribing DAAs, 72% continued to refer all patients to specialists. Fifty-five per cent were unsure if people who currently inject drugs were eligible for treatment.

      Discussion: Most respondents were interested in prescribing DAAs, but education, access to transient elastography and clear consultation pathways are required to translate this interest into increased treatment availability. PBS eligibility of current injectors needs promotion.

      PubDate: Wed, 12 Apr 2017 22:31:47 GMT
       
  • Volume 46 Issue 4 - A sugary problem
    • Abstract: Foster, Emma; Gao, Phoebe; Zavala, Jorge
      Sarah, 20 years of age, is a student who presented to her family doctor with a one-day history of vertigo and occipital headache. She denied photophobia, neck stiffness, or altered vision or hearing. Sarah had been admitted to a general hospital ward one week earlier with a diagnosis of viral gastroenteritis complicated by diabetic ketoacidosis (DKA). At her presentation one week earlier, her initial pH was 7.28, bicarbonate was 13 mmol/L and ketones were 4.4 mmol/L. She had an uncomplicated recovery with standard care, including fluid rehydration and an insulin infusion. Sarah's medical history included type 1 diabetes mellitus, diagnosed at 8 years of age, with no previous DKA episodes or vascular complications. A recent glycated haemoglobin (HbA1c) measurement was 62 mmol/mol (7.8%). She selfadministered insulin detemir twice daily and insulin aspart with meals. Sarah was not on any other regular medication, and there was no other significant personal or family medical history. She denied smoking cigarettes, use of alcohol or recreational drugs, including no cocaine or amphetamine use.

      PubDate: Wed, 12 Apr 2017 22:31:47 GMT
       
  • Volume 46 Issue 4 - Paradigm shifts
    • PubDate: Wed, 12 Apr 2017 22:31:47 GMT
       
  • Volume 46 Issue 4 - Conservation surgery and radiation therapy in early
           breast cancer - an update
    • Abstract: Tailby, Ellen; Boyages, John
      Background: Multiple randomised trials and meta-analyses have supported the use of conservative surgery (CS) and radiation therapy (RT) for the treatment of early-stage breast cancer. Following lumpectomy, RT has been shown to decrease the chance of local recurrence and improve overall survival when compared with lumpectomy alone.

      Objectives: This update outlines the rationale and outcomes for CS and RT, whether a subgroup exists in which RT may be safely omitted, the process of RT, common side effects and their management, and the latest techniques in the field.

      Discussion: Breast conservation remains an effective treatment for breast cancer without a survival disadvantage to a mastectomy. The combination of advanced imaging and fast three-dimensional (3D) radiotherapy planning computer systems have allowed new techniques that deliver RT more accurately, with better tumour control, fewer side effects and improved survival.

      PubDate: Wed, 12 Apr 2017 22:31:47 GMT
       
  • Volume 46 Issue 4 - Letters
    • PubDate: Wed, 12 Apr 2017 22:31:47 GMT
       
 
 
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