Australian Family Physician May 2006 - Imaging
Vol 35, (5) 273 - 368
The
theme for the May issue of AFP is imaging. This month's
articles include use of diagnostic imaging in Australian general
practice, radiological tests in investigations of atypical chest pain,
myocardial perfusion imaging, vascular interventional radiology, uterine
artery embolisation and vertebroplasty.
Shades of grey
Steve Trumble, Karda Cavanagh
Ever since Wilhelm Conrad Roentgen startled himself (and, no doubt, his wife) in 1895 by glimpsing the bones of her hand as she passed it in front of a charged cathode tube, radiography has been increasingly put to medical use. That blurry image of Bertha's hand seems a far cry from today's exquisitely detailed magnetic resonance imaging scans, but a clear chain of descent exists.
Letters to the editor
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.
Reforming youth mental health
Patrick McGorry
Across the lifespan, young people aged 12-25 years face the greatest risk of the onset of potentially serious mental and substance abuse disorders, with a peak prevalence between 18-25 years of one in 4 in a 12 month period.
Use of diagnostic imaging in Australian general practice
Graeme Miller, Lisa Valenti, Janice Charles
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of diagnostic imaging ordered by Australian general practitioners. This provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.
Radiological tests in investigations of atypical chest pain
Maxim Kupershmidt, Dinesh Varma
Atypical chest pain (ACP) is a diagnostic challenge that often requires multiple laboratory and radiological investigations.
Myocardial perfusion - a validated and mature cardiac imaging modality
Alex Pitman
Nuclear myocardial perfusion imaging (MPI) involves the use of radiotracers to generate scintigraphic images of the myocardium.
New innovations in vascular interventional radiology? - aortic stent grafting
Barry Leaney
Medical therapies are moving progressively toward 'minimally invasive' techniques resulting in less physiological disruption, smaller 'entry points', reduced intra- and post-operative complications, and earlier discharge.
Uterine artery embolisation - a treatment alternative for women with fibroids
Stuart M Lyon, Karda Cavanagh
Fibroids are a common benign tumour of the female reproductive tract. Uterine artery embolisation is a minimally invasive catheter based technique that compares favourably with surgical treatments.
Vertebroplasty - a new treatment for vertebral compression fractures
Murali Guduguntla, Rathan Subramaniam
The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men. Vertebroplastyn involves the injection of artificial bone cement and an opacifier into the inter-trabecular marrow space of the fractured vertebra.
Metastatic breast cancer
Amanda Stevanovic, Philip Lee, Nicholas Wilcken
This fourteenth article in our series on breast disease gives an overview of what to look for in the patient with a past history of early breast cancer and how to assess and support the patient with metastatic breast cancer in the general practice setting. Information about the latest medical oncology treatments, including new chemotherapies and targeted 'biological' therapies is provided.
Emerging psychosis in young people - Part 1 - key issues for detection and assessment
Gregor Berger, Richard Fraser, Stephen Carbone, Patrick McGorry
A delay in the recognition of first episode psychosis is common and is often associated with psychological distress, social decline, and as recent evidence suggests, lasting brain changes.
Emerging psychosis in young people - Part 2 - key issues for acute management
Richard Fraser, Gregor Berger, Patrick McGorry
To optimise the management of emerging psychotic disorders in young people, close collaboration between the general practitioner and youth friendly specialist mental health services is favourable.
Emerging psychosis in young people - Part 3 - key issues for prolonged recovery
Richard Fraser, Gregor Berger, Eoin Killackey, Patrick McGorry
After 18 months of specialist care only about half of all first episode psychosis patients achieve functional recovery, and about 10-20% patients will not respond to initial treatment and have persistent psychotic symptoms.
Suicide prevention - targeting the patient at risk
Simon Bridge
Suicide is a major cause of death from adolescence upward. While there has been a concentrated effort to educate families and health workers to be aware of warning signs of pending suicide, there has been limited information or practical strategies available for people at risk of suicide or for those who have suicidal thoughts.
Colorectal cancer and CHF - reviewing the evidence for complementary medicine
Luis Vitetta, Avni Sali
This is the third of a series of articles looking at the available evidence for complementary medicine. Physical activity is important in attenuating harmful effects of aging and the onset of chronic disease.
Bone mineral density - frequently asked questions
Patrick J Phillips, George Phillipov
How do you interpret a BMD report (Figure 1a) Measurements of bone mineral density (BMD) are used to diagnose osteoporosis, assess future fracture risk, and monitor treatment. However a busy general practitioner reading a complicated report may find it difficult to interpret.
Painful heel
Jerzy K Pawlak
Case history
Betty B, 57 years of age, presented complaining of pain at the back of her left foot when walking and wearing shoes. On examination she had slight swelling and redness of the posterior heel superficial to the Achilles tendon and was tender to palpation in this area (Figure 1).
Clinical Challenge
Steve Trumble
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.
Loss of chance: what loss?
Sara Bird
A recent New South Wales judgment, Rufo v Hosking, explored the concept of 'loss of a chance' in medical negligence claims.1 'Loss of a chance' claims involve an allegation that the patient lost the chance of a better outcome as a result of the negligence of the medical practitioner.
Professional autonomy - is it the future of general practice?
John Fraser
Internationally, rising financial costs and increasing expectations of health care delivery have increased regulation and decreased the autonomy of general practitioners and other health care professionals.
A teaching ward round in infectious diseases - a pilot module
Sanjaya Senanayake, Francis Bowden, Jan Ironside, Tanya Robertson
The ongoing care of patients requires close communication between general practitioners and hospital specialists.
Reflecting on research
Rachael Boland
Reflecting on my first 4 months as a part time academic general practice registrar demonstrates the highs and lows of pursing the challenges of research - particularly after being involved in full time clinical practice. Exploring research in general practice has proved an interesting and rewarding experience.
Research papers submitted to Australian Family Physician - types and timelines
Rachel Green, Chris Del Mar
Articles published in the research section of Australian Family Physician (AFP) are subject to an editorial process comprising several stages.
Do GPs use electronic mental health resources? - a qualitative study
David Austin, Ciaran Pier, Joanna Mitchell, Peter Schattner, Peter Schattner, Victoria Wade, David Pierce, Britt Klein
The Better Outcomes in Mental Health Care (BOMHC) initiative encourages general practitioners to use electronic mental health resources (EMHRs) during consultation with patients requiring psychological assistance.
Auditory symptoms in whiplash patients - could earwax occlusion be a benign cause?
Robert Ferrari
Excess cerumen (earwax) in the external auditory canal is associated with symptoms of earache, fullness in the ears, and diminished hearing. These symptoms, and tinnitus, are commonly associated with whiplash injury.