Australian Family Physician March 2004 - Bones
Vol 33, No. 3 (97-192)
Our March issue takes a focus on bones. Includes articles
on the management of upper limb fractures, osteoporosis, pagets disease
and vitamin D - including patient education sheets and the medicolegal
ramifications of fractures.
The ultimate balancing act
Doris Young
General practice is a demanding profession with a high level of patient contact. It also has heavy practice management demands.
Early management of upper limb fractures in general practice
David Spain
Upper limb injuries are very common and patients frequently present to general practitioners for treatment. Circumstances of the injury and varied patient factors are critical to assessment. Outcome of these injuries involves short term pain control and diagnosis; fracture immobilisation, comfort and function in the treatment device medium term; and longer term, the best functional outcome.
Osteoporosis - diagnosis, treatment and management
Patrick Phillips, Jody Braddon
Osteoporosis is common, asymptomatic and usually undetected until a fracture occurs. Fracture, particularly hip fracture, can be associated with significant mortality, morbidity and loss of independence.
Patient education - the forgotten link in managing osteoporosis
Laura L Laslett, Julian D McNeil, Joan Lynch
Osteoporosis and bone fractures are common, yet osteoporosis is under diagnosed in Australian settings. Osteoporosis can now be reliably diagnosed, and safely and effectively treated, but patient education strategies are under utilised.
Physical activity and bone health
Maria A Fiatarone Singh
The optimal use of exercise for bone health is dependent upon the practice of a sustained, adequate dose of the correct modality of exercise/physical activity in the target populations while minimising the risk of side effects. This article provides a brief summary of current recommendations for effective and safe implementation of physical activity in various cohorts.
Paget disease of bone - Diagnosis and indications for treatment
M A Kotowicz
Paget disease was first described in 1877 by Sir James Paget. It is a focal disorder of bone remodelling, involving increased bone resorption and formation.
Vitamin D in Australia - Issues and recommendations
Caryl A Nowson, Terrence H Diamond, Julie A Pasco, Rebecca S Mason, Phillip N Sambrook, John A Eisman
A significant number of Australians and people from specific groups within the community are suffering from vitamin D deficiency. It is no longer acceptable to assume that all people in Australia receive adequate vitamin D from casual exposure to sunlight.
Patient education: Osteoporosis
Patrick Phillips, Jody Braddon
Osteoporosis means bone (osteo) that is porous (porosis) or full of holes. Osteoporosis is characterised by a progressive loss of bone mass. As a result the bones become thin and brittle and liable to break (fracture) more easily. Generally this is a natural part of growing older.
Patient education - Paget disease of bone
M A Kotowicz
Paget disease of bone is a common bone disorder, particularly in the elderly. In Paget disease, the normal regulation of bone remodelling is disrupted.
Shoulder stiffness: diagnosis
Divya Bhargav, George A C Murrell
Pain and stiffness of the shoulder is a common complaint, particularly in the 40-80 years age group. There are several causes of painful, stiff shoulders, but the most common cause in the fifth decade of life is idiopathic capsulitis ('frozen shoulder').
Shoulder stiffness: management
Divya Bhargav, George AC Murrell
There are several causes of painful, stiff shoulders - each with a different method of treatment.
Spider bite - the redback spider and its relatives
B Nimorakiotakis, KD Winkel
Redback spider bite is thought to be the commonest serious spider bite in Australia. The treatment for the envenomation syndrome it causes, termed 'latrodectism', is the most frequently used antivenom in Australia. Several cases of a 'latrodectism-like' illness after cupboard spider bites ('steatodism') have also appeared to respond to redback antivenom.
Eye series - Tennis ball injury
Chris Hodge, Jeff Friedrich
A 27 year old man was playing competition tennis 2 days ago and was struck in the left eye by a quickly returned volley.
Brain teaser - Brown pigmented lesion
Jerzy K Pawlak
A 10 year old girl presents with a brown pigmented lesion, 4 mm in diameter with a slightly elevated and sharply marginated 12 mm white zone associated with a white, sharply marginated oval spot, 11 mm in diameter.
Clinical challenge
Jenni Parsons
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.
Answers to this clinical challenge will be published next month.
Training and supporting GPs in providing palliative care to a Vietnamese-Australian community
B McGrath, B Truong, L Reymond, G Mitchell
The mooted increasing role for general practitioners to provide palliative care for an aging Australian population has raised the need for improved training and support for GPs to provide 'healthcare for dying people that maximises quality of life and assists families and carers during and after death'.
Failure to diagnose - fractures
Sara Bird
This article examines a claim involving a failure to diagnose a fracture and outlines some risk management strategies for general practitioners to minimise the possibility of a claim arising from a failure to diagnose orthopaedic problems.
’Scott, you could have lymphoma’
Scott Smith
These were the words uttered by a radiologist following what I thought would be a straightforward MRI scan of my back showing some type of facet joint degeneration. I discovered later that he had actually rattled off a list of at least six differential diagnoses, but at that time I only remembered hearing the first few words out of his mouth.
Can training reduce the rural workforce shortage?
Richard Lawrance
Commonwealth figures indicate that the number of general practitioners per 100 000 head of population in remote Australia is half the number in metropolitan Australia, while in rural Australia (outside the larger regional centres) the ratio is less than two-thirds.
The challenge of general practice
Ken Nyman
I was distressed to hear recently that there is a shortfall in applications from young doctors to join general practice training programs. If this continues, the already acute shortage of general practitioners Australia wide will become critical.
Barriers and enablers for implementing general practice training
Susan Wearne, Sarah Giles, Alex Hope
The Australian College of Rural and Remote Medicine (ACRRM) curriculum is designed for rural and remote general practice in Australia. We explored the potential for its implementation in the Northern Territory (NT).
Nurses in urban and rural general practice - Who are they and what do they do?
Helen Tolhurst, Irena Madjar, Lorinda Schultz, Allison Schmidt
There is limited information about general practice nurses in Australia and the role they play.
RACGP training registrars' perceptions and practice of prostate cancer screening
Justin Tse, Siaw-Teng Liaw
To examine the perceptions, knowledge and reported intended practice of prostate cancer screening by general practice registrars.
Training GPs in cognitive behaviour therapy for the unemployed
Vanessa Rose, Mary Morrow, Elizabeth Harris, Mark F Harris
Cognitive behavioural therapy (CBT) is effective in improving psychological health and promoting employment for people who are unemployed.