Australian Family Physician July 2008 - Acute Care
Vol 37, (7) 497-592
The theme for the July issue of AFP
is Acute Care. This month's articles include referrals to A&E,
ocular emergencies, intitial management of cardiac arrhythmias, lessons
from the TAPS study and emergency drugs in general practice.
Acute care
Kath O’Connor
What is 'acute care' in Australian general practice? It
depends on who you ask. When I use 'acute care' to describe
a proportion of my work at an outer suburban Melbourne
clinic, I am likely to mean something quite different to a
doctor in a regional, rural or remote practice.
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.
Referrals to A&E
Janice Charles, Salma Fahridin, Helena Britt
There were 900 encounters at which patients were referred to
A&E over the 5 year period. There was no difference between male
and female referral rates (0.2 per 100 encounters).
Ocular emergencies
Christopher Hodge, Michael Lawless
General practitioners, especially those located in country areas,
are commonly the first contact for many patients with an ocular
emergency.
Stabilising the newborn for transfer - Basic principles
Kathryn Browning Carmo, Andrew Terrey
Rural general practitioners involved in obstetric service delivery
may have occasion to support the sick or premature newborn
requiring transfer.
Initial management of cardiac arrhythmias
Jaycen Cruickshank
Diagnosis of arrhythmias can be a challenge, in particular
if a patient has no symptoms and a normal electrocardiogram
(ECG) between symptomatic episodes. Ideally, the patient
should be managed in an area with access to ECG monitoring,
oxygen and an external defibrillator.
Management of dyslipidaemia - Evidence and practical recommendations
Paul J Nestel, Richard O’Brien, Mark Nelson
The management of dyslipidaemia is a key aspect of
managing cardiovascular risk. While this article focuses on
lipid management, many patients have multiple risk factors
that also require appropriate treatment. Dyslipidaemia should
not be treated in isolation from other risk factors.
HPV vaccine catch up schedule - An opportunity for chlamydia screening
Miriam Grotowski
The human papillomavirus (HPV) vaccine (Gardasil) catch
up schedule in general practice is available until June 2009 to
females not in school and under the age of 27 years. A course
of three injections is given over 6 months. This provides a
unique opportunity for sexual health screening in an age group
where chlamydia screening is a priority.
STIs and blood borne viruses - Risk factors for individuals with mental illness
Adrienne P Brown, Dan I Lubman, Susan J Paxton
Individuals with mental illness have poorer sexual health compared
to the general population and experience a number of barriers to
accessing health care.
Dental problems in diabetes - Add a dentist to the diabetes team
Patrick J Phillips, Mark Bartold
A healthy tooth in a healthy gum and healthy mouth is fairly
secure. The roots are firmly embedded in bone and the gum firmly
encases the tooth, leaving only the resistant enamel exposed to
any debris and bacteria that saliva has not flushed away.
Emergency drugs in general practice
Andrew Baird
General practitioners need the knowledge, skills, drugs and
equipment for managing medical emergencies. Clinics need
treatment rooms and doctor's bags that enable emergencies to be
managed onsite and offsite respectively.
Lessons from the TAPS study - Management of medical emergencies
Meredith A B Makeham, Deborah C Saltman AM, Michael R Kidd
The Threats to Australian Patient Safety (TAPS) study collected 648
anonymous reports about threats to patient safety by a representative
random sample of Australian general practitioners. These contained
any events the GPs felt should not have happened, and would not
want to happen again, regardless of who was at fault or the outcome
of the event. This series of articles presents clinical lessons resulting
from the TAPS study.
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 40 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.
The RACGP Fellowship examination - 10 tips for answering key feature problems
Susan Wearne
The Royal Australian College of General Practitioners
(RACGP) Fellowship examination is a route to vocational
registration as a general practitioner in Australia.
A road to humanity
Hilton Koppe
Working as a doctor has many rewards, but there are also
many challenges. One of the greatest challenges is being able
to respond appropriately to the human suffering of our patients
without becoming emotionally overwhelmed by it.
Price fixing in general practice
Bella Brushin, Ian Watts
Dr Bev Young has just finished packing up her office. This
is her last day in her Preston practice of 19 years. Bev
enjoys the autonomy of being a solo general practitioner,
but lately she finds managing the practice increasingly
stressful. Teaming up with a fellow GP seemed a good
alternative.
Good Samaritans
Sara Bird
Over the years, medical practitioners have expressed concern about
the possibility of being sued as a result of Good Samaritan acts.
Book reviews
Books reviewed this month are Ferri's Clinical Advisor 2008 Instant diagnosis and treatment by Ferri, Essential Family Medicine by Robert E Rakel and Textbook of Family Medicine by Robert E Rakel
Cardiac rehabilitation - Reducing hospital readmissions through community based programs
Sarah Canyon, Neda Meshgin
Community based cardiac rehabilitation programs have been shown
to reduce cardiovascular disease related mortality and morbidity.
Changing GPs' attitudes to research - Do N of 1 trials hold the key?
Deborah Askew, Philip J Schluter, Alexandra M Clavarino, Chris B Del Mar
Australia is investing in the Primary Health Care
Research, Evaluation and Development (PHCRED) strategy to
redress a lack of quality primary care research.
Association of epilepsy and burns - A case control study
Zahid Ansari, Kaye Brown, Norman Carson, Michael Ackland
General practitioners play a vital role in reducing risk for people with
epilepsy through pharmacological prevention of seizures. Burns are
the most common injury sustained during epileptic seizure. This article
examines the risk of burns among patients with epilepsy in Victoria.
Sexual health care for sex workers
Danielle Esler, Catriona Ooi, Tony Merritt
The Australian STI Prevention Framework identifies sex workers as
a priority group. The Hunter New England Sexual Health Unit, based
at the Royal Newcastle Hospital (New South Wales) provides free
sexual health care to sex industry workers.
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