Australian Family Physician October 2008 - Outbreaks
Vol 37, (10) 785 - 896
The theme for the October issue of AFP
is outbreaks. This month's articles include influenza, plan your
pandemic - a guide for GPs, searching for salmonella, could it be
legionella, bugs and the big bang, age determination
in refugee children, and survivorship care after breast cancer.
Bugs and the big bang
Jenni Parsons
Now that's a cheery thought! Somewhere more than 100 km
below the Geneva countryside two parallel beams of subatomic
particles are whizzing around a 27 km circuit in opposite
directions at about 99% of the speed of light, doing over 11 000
laps per second.
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.
Influenza
Janice Charles, Christopher Harrison, Helena Britt
Influenza, or the 'flu', is a highly infectious respiratory
viral disease, most common during the winter months. BEACH
data confirm the peak period for influenza vaccination in
general practice is April to June.
Plan your pandemic - A guide for GPs
Nick Collins, John Litt, Tania Winzenberg, Kelly Shaw, Michael Moore
Influenza A virus has a range of subtypes characterised by the
display of particular surface structures and is associated with
significant symptoms and a tendency to cause epidemics and
pandemics.
Searching for Salmonella
Jonathan Darby, Harsha Sheorey
Salmonella species are responsible for two distinct syndromes.
Nontyphoidal Salmonella are common causes of food borne
gastroenteritis. Typhoidal Salmonella cause enteric fever; an
important differential diagnosis in any traveller returning from a
tropical country with fever.
Could it be Legionella?
Jonathan Darby, Kirsty Buising
Community acquired pneumonia is a common condition
presenting to general practitioners and emergency departments
across Australia. Legionella is one of many pathogens
responsible for community acquired pneumonia. Cases of
Legionella may occur sporadically or as part of an outbreak.
Lessons from the TAPS study - Warfarin: a major cause of threats to patient safety
Meredith A B Makeham, Deborah C Saltman, Michael R Kidd
The Threats to Australian Patient Safety (TAPS) study collected
648 anonymous reports about threats to patient safety from 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.
Age determination in refugee children
Jill Benson, Jan Williams
For many refugees, an accurate age is not known and the age on
their visa does not reflect their true age. This has implications for
medical care, education, socialisation, and for legal reasons.
Survivorship care after breast cancer
Meagan Brennan, Phyllis Butow, Andrew Spillane, Frances Boyle
Due to early detection and improving treatment, the number of breast
cancer survivors is increasing. It is estimated that there are now over
113 000 women living in Australia who have had a diagnosis of breast
cancer in the past 20 years.
Red flags in scleroderma
Qiang Li, Joanne Sahhar, Geoffrey Littlejohn
Scleroderma (systemic sclerosis) is an uncommon connective
tissue disease characterised by vascular, inflammatory and fibrotic
dysfunction of multiple organ systems. Systemic sclerosis is often
recognised late in the course of the disease.
A 'wellness check' for every adult in Australia
Leanne Rowe, Michael R Kidd
All people in Australia require concise information about health
risk factors, screening and preventive health care. National expert
guidelines recommend simple screening tests to prevent or detect
serious illness.
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.
Trapped in the net? - What to look for in a web based CPD program
Susan Wearne
Increasing numbers of general practitioners access web based
education programs for continuing professional development (CPD).
Web based programs vary in style, content, relevance, reliability,
authorship and sponsorship, and hence educational quality.
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.
Violence in the consulting room - A multifactorial strategy for prevention and harm minimisation
Ross Mills
Workplace violence in the medical setting should be approached in
the same manner as any other occupational health and safety issue.
The hazards need to be identified, the risk quantified and appropriate
steps to minimise the risk taken.
Navigating general practice - The use of geographic information systems
Paul Grinzi, Andrew Bazemore, Robert L Phillips Jr
Geographic information systems (GIS) are powerful tools for
managing, analysing and mapping geographical and associated
data. In the health care setting, GIS can be used to map and graph
health care provider and social and environmental data.
ABLE - assessment based learning
J P Sturmberg, D O'Halloran, E A Farmer, C W Lee, F Barbagallo
Over the past decade the Australian health care system has
moved rapidly toward a greater emphasis on medical care
being provided within the community.
Book reviews
Books reviewed this month are Contraception Today by John Guillebaud and Menopause for Dummies: Understanding the changes in your body, mind, spirit by Lily Stojanovska, Marcia L Jones and Teresa Eichenwald.
Metaphor in clinical practice
Stephen Rosenman
Clinical thinking is deeply metaphoric, and metaphor is in
the foundations of all aspects of medicine. Understanding
the role of metaphors in medical concepts allows a more
imaginative borrowing of human creativity and makes
practice more flexible, adaptive and rewarding.
How to conduct effective skill building workshops
Ellen McIntyre, Tracy Reibel, Paul Aylward, Phyllis Lau, Jacque Schroeder, Denise Schultz
Skill building workshops need to be successful learning events that
provide value for money. The strategies in this article are based on
a review of the literature and evaluations received from workshop
participants who have attended the many workshops conducted
as part of the Primary Health Care Research Evaluation and
Development (PHCRED) strategy.
The desire for research in general practice
Kathryn M Dwan, Parker J Magin
If you have considered participating in general practice research, the
chances are that a combination of inherent interest and potential
satisfaction drew you toward it.
GP management of osteoarthritic pain in Hong Kong
Albert Lee, Clement K K Tsang, Hon-kei Siu, William Chi-wai Wong, Samuel Yeung-shan Wong
Limited information is available about general practitioners'
knowledge, attitude and practice in treating osteoarthritis. This study
sought to better understand GPs' management of mild to moderate
osteoarthritis in Hong Kong.
Evaluation of e-textbooks - DynaMed, MD Consult and UpToDate
Felicity Goodyear-Smith, Ngaire Kerse, Jim Warren, Bruce Arroll
To evaluate the acceptability and utilisation of three electronic
textbooks: DynaMed, MD Consult (including FirstConsult) and
UpToDate.
Improving glycaemic and BP control in type 2 diabetes - The effectiveness of tai chi
Paul Lam, Sarah M Dennis, Terry H Diamond, Nicholas Zwar
This study assessed the effect of tai chi on glycosylated haemoglobin
(HbA1c), blood pressure and health status (SF-36) in adults with type
2 diabetes.
Allied mental health referral - Trends in the Adelaide Hills Division of General Practice
Christopher A Barton, Melissa Opolski, Elizabeth Cleland, Amy Cotton, Nancy Briggs, Michael Taylor, Cate Howell
Referrals to allied health professionals as part of Access To Allied
Psychological Services (ATAPS) and More Allied Health Services
(MAHS) at the Adelaide Hills Division of General Practice were
examined to gain insight into the characteristics of referred patients
and the characteristics of referring general practitioners.
Improving vaccination cold chain in the general practice setting
Sue L Page, Arul Earnest, Hudson Birden, Rachelle Deaker, Chris Clark
This study compared temperature control in different types of vaccine
storing refrigerators in general practice and tested knowledge of
general practice staff in vaccine storage requirements.
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