Australian Family Physician November 2007 - Stroke
Vol 36, (11) 881–976
The theme for the November issue of AFP
is stroke. This month's articles include acute stroke patients,
community care after stroke, acute stroke management, stroke in
children, occupational violence, impacts of alcohol use in pregnancy,
cancer education and training and prescribing dilemmas of
benzodiazepines.
Reducing The Impact Of Stroke
John Litt
Worldwide, 10% of all deaths in any year are related
to stroke or its sequelae. In Australia, 53000 people
are affected by stroke each year at a cost of $1.3 billion
annually.
Letters To The Editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners
GP Of The Year Awards
The GP of the Year award recognises an individual GP's understanding of, and commitment to, general practice; their service to their community; and their involvement in ongoing training and continuing professional development.
Management Of Stroke In General Practice
Janice Charles, Graeme Miller, Salma Fahridin
Between April 2002 and March 2007, there were 1171
consultations where stroke was managed, occurring
at over 2 per 1000 encounters. This suggests
that general practitioners manage stroke on about
237 000 occasions nationally each year.
Time Is Brain - Acute Stroke Management
Rajinder K Dhamija, Geoffrey A Donnan
In recent years, four specific strategies have emerged which have proven clinical benefit in treating acute stroke.
These are the administration of tissue plasminogen activator (tPA), aspirin, management in a stroke care unit (SCU)
and the use of hemicraniectomy in patients with severe cerebral oedema.
Stroke In Children
Mark T Mackay, Anne Gordon
Stroke is a major cause of disability and death in children. It can have devastating consequences for families and
enormous costs to society.
Acute stroke patients - Early hospital management
Helen M Dewey, Julie Bernhardt
Patients with acute stroke have improved outcomes when managed in a stroke unit providing multidisciplinary care,
including early rehabilitation.
Community care after stroke
Richard R Lindley
The key to life after stroke is to harness the best secondary preventive strategies and maximise functional outcome.
Stroke resources for GPs
The National Stroke
Foundation
The National Stroke Foundation (NSF) is committed
to supporting best practice stroke care, as outlined in
this issue of Australian Family Physician.
Complementary therapies for cerebrovascular disease
Craig Hassed
Although it is estimated that 60-65% of the Australian
population have used complementary therapies (CT)
at some time, the figure with regard to cardiovascular
disease (CVD) is not known.
The prescribing dilemma of benzodiazepines
Moira G Sim, Eric Khong, Toni D Wain
Benzodiazepines are the most commonly prescribed psychoactive drug in western societies. While associated with risk
and harm, they have a legitimate place in therapeutics.
Oral corticosteroids - Their place in the management of adhesive capsulitis
Julia Walters, Faline Howes, Rachelle Buchbinder
The incidence of intrinsic disorders of the shoulder
presenting in general practice has been estimated
to be 14.7/1000 per year with adhesive capsulitis
(also termed frozen shoulder, stiff painful shoulder
or periarthritis) accounting for around 20% of cases
(incidence 2.4/1000 per year), but occurring more
frequently in the middle aged and those with
diabetes.
Diagnostic dilemmas in unusual presentations of gout
Christopher Hoe-Kong Chui, Jonathan Yi-Liang Lee
Gout is known to mimic conditions as diverse as joint and soft tissue infections, skin malignancies, nerve compression
syndromes and soft tissue tumours. Upper limb involvement is unusual.
Impacts of alcohol use in pregnancy - The role of the GP
Elizabeth Peadon, Colleen O'Leary, Carol Bower, Elizabeth Elliott
Alcohol is teratogenic and its ingestion during
pregnancy can result in miscarriage, stillbirth,
prematurity, birth defects, and problems of growth
and development.
Clinical Challenge
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue.
AFP in Practice
AFP in Practice questions are designed to get you started in a small group learning (SGL) activity in your practice or with colleagues. Requirements to earn 30 Category 1 CPD points for a SGL activity are: minimum of four and a maximum of 10 people, minimum of 8 hours of discussion in a year, and at least two GPs.
Failure to follow up CT reports
Sara Bird
Case histories are based on actual medical negligence claims or medicolegal referrals, however certain facts have been
omitted or changed by the author to ensure the anonymity of the parties involved.
A failure to follow up test results is a common underlying cause of medical negligence claims and complaints
involving general practitioners. This article examines a case in which an incidental finding of an aneurysm on cerebral
computerised tomography scan was not followed up with disastrous consequences for the patient.
One family's stroke experience
Jackie Jukes
Eilish Rose Jukes was a healthy 3 1/2 year old. She
contracted chicken pox mid April 2005 and recovered
unremarkably, although her attention span and
behaviour were out of character afterward.
On 1 June 2005, Eilish was watching her father shave
when she fell to the left. He sat her up and when he asked
her to wipe the shaving cream off her hands, he noticed
she took the towel in one hand and only wiped that hand,
completely forgetting the other hand.
The Peugeot led recovery
Stewart Jackel
She was a sexy little number. Diabolo red; just what
the physiotherapist ordered!? I'd driven a Peugeot
206 2 years earlier but it had failed the indicator test.
More exactly, I'd failed to manage her left hand stalk
indicator. Anyway it was silver: old farts colour. At 63
years of age, old fart I'm not.
Occupational violence in general practice
Parker Magin, Jon Adams, Elyssa Joy
The risk of occupational violence is a cause for considerable concern in Australian general practice. Emerging evidence
from Australian general practice is consistent with evidence from the United Kingdom that occupational violence is
common and has important effects on practitioner welfare and delivery of care. This article provides an overview of the
evidence of prevalence and impact of violence directed against GPs as a context for measures to increase the safety of
GPs and their staff.
An audit of INR control in the Australian indigenous setting
Anastasia Pickering, David P Thomas
Warfarin management can be difficult; many factors can impact on INR control with some factors being unique to the
Australian indigenous setting.
Promoting patient centred palliative care through case conferencing
Tania M Shelby-James, David C Currow, Paddy A Phillips, Helena Williams, Amy P Abernethy
Palliative care focuses on optimising function and
comfort for people with progressive life limiting
illness. It incorporates nursing, medical and allied
health staff, therefore making the coordination of
services crucial. When communication between health
care providers is poor, effort may be duplicated.
The psychosocial experience of women with PCOS - A case control study
Danielle M Esler, Cheryl Anne Travers, Kamala Guttikonda, Andrew Dixon, Peter R Lewis
Polycystic ovary syndrome (PCOS) is a common
endocrine disorder affecting 5-10% of women. It is
characterised by androgenisation and anovulation, with
sufferers being at increased risk of metabolic problems
such as noninsulin dependent diabetes mellitus and
dyslipidaemia.
A risk score to diagnose depression in general practice
S Jeyabalan, A Kuruvilla, J Prasad, S Abraham, KS Jacob
Depression is a common mental health problem often seen in primary care. This study sought to determine the accuracy
of five screening questions for diagnosing common mental disorders in a general practice clinic and to develop a risk
score.
Cancer education and training in primary health care - A national audit of training providers
Brian Ramsay McAvoy, Jane M Fletcher, Mark Elwood
Primary care professionals play a critical role in cancer care but relatively little is known about their education and
training. This article presents the results of a national audit of education and training providers in relation to primary
care and cancer.
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