Australian Family Physician October 2006 - Palliative care
Vol 35, (10) 753 - 832
The theme for the October issue of AFP is
palliative care. This month's articles include palliating symptoms other
than pain, suffering, loss and grief in palliative care, palliative care
for specific populations, and training the primary care team.
Whither general practice palliative care?
Geoffrey K Mitchell
Palliative care is one of the most important tasks a
general practitioner can undertake. Most GPs will care for 5-7 deaths per annum, and many of these will
take a palliative course.
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.
Malignant neoplasms - Management in Australian general practice
Janice Charles, Christopher
Harrison, Helena Britt
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of encounters at which malignant neoplasms were managed. This synopsis provides a backdrop against which the articles in this issue of Australian Family Physician can be further considered.
Pain management in palliative care - An update
Kirsten Auret, Sarah Pickstock
Pain is a common and feared problem for those with advanced cancer. The goal of palliative care is to relieve suffering and improve quality of life. A step-by-step approach allows good symptom management and minimisation of drug side effects.
Palliating symptoms other than pain
Jane Fischer
Symptoms other than pain are a heavy burden for patients with either malignant or progressive nonmalignant disease
and significantly reduce quality of life.
Suffering, loss and grief in palliative care
Elizabeth A Lobb, Josephine M Clayton, Melanie A Price
The stress associated with advancing and incurable illness inevitably causes distress for patients, families and
caregivers. A palliative approach to care aims to improve the quality of life for patients with a life limiting illness
by reducing suffering through early identification, assessment and optimal management of pain, physical, cultural,
psychological, social, and spiritual needs.
Palliative care for specific populations
Patsy Yates
Ensuring access for all Australians to high quality palliative care requires an understanding of special considerations for specific populations, including children, older persons, and Indigenous Australians.
The role of physiotherapy in palliative care
Liisa Laakso
Why involve a physiotherapist in caring for a palliative patient dying at home from advanced cancer, or a palliative patient presenting to your practice with
complaints of fatigue and reduced stamina?
Complementary medicine in palliative care
Luis Vitetta, Avni Sali
This is the eighth of a series of articles looking at the available evidence for complementary medicine relating to the theme topic in Australian Family Physician.
Managing skin cancer below the knee
Anthony Dixon
Case study: Mr RR, 74 years of age, developed a nodule on his lower right leg in mid 2005. He was offered the option of excision, skin graft and 10 days bed stay with elevation at a private hospital, but declined due to the cost. He was then referred to a major urban cancer institute for opinion. He was advised that the nodule would most likely fall off and that a 'watch and wait' approach was indicated. Presumably there was a clinical diagnosis of keratoacanthoma.
Localised herpes zoster infection and SIADH
Fintan O'Rourke, Michael Chilov
Localised herpes zoster infection ('shingles') in older patients is a common presentation to primary, and sometimes
secondary, care physicians. However, symptoms of hyponatraemia, caused by the rare complication of 'syndrome of
inappropriate antidiuretic hormone secretion' (SIADH), may be mistaken for constitutional symptoms of the infection
itself. Such patients may require closer monitoring or hospitalisation.
Intimate partner violence in deviant settings - Complex needs of women survivors
Lesley Cooper, Julia Anaf, Margaret Bowden
BACKGROUND
Women experiencing intimate violence within deviant settings, including bikie and other gangs and cults, have recently been the focus of research in South Australia. Domestic violence shelters are seeing increasing numbers of these women who are often involved in high risk behaviour and/or situations that pose significant risk to themselves and any accompanying children.
Men who have sex with men - A management approach for GPs
James Baber, Linda Dayan
At least one in 20 Australian men report sexual contact with another man in their lifetime. Men who have sex with other men have higher rates of sexually transmitted infections, and are more likely to experience mental health problems and use recreational drugs and alcohol.
Bisphosphonates and osteonecrosis of the jaw
Philip Sambrook,
Ian Olver, Alastair Goss
Recently an association between bisphosphonate use and a rare dental condition termed 'osteonecrosis of the jaw'
(ONJ) has been reported. Patients with osteoporosis and Paget disease who take bisphosphonates have a significantly
reduced risk of fracture and other skeletal complications.
Diagnostic challenge - Is this really a stroke?
Ching Luen Ng
Although acute stroke most commonly presents with hemiparesis, facial weakness and dysphasia, these symptoms can
sometimes be the atypical presentations of other conditions which may be difficult to diagnose.
Chronic paronychia - Putting a finger on the evidence
Brett D Montgomery
At first glance it seemed a minor problem, but the look on my new patient's face suggested otherwise. His finger had been painful for months and this week it had become worse. His swollen, erythematous nail fold, absent cuticle, and mildly dystrophic nail painted a typical picture of chronic paronychia.
Endocrinology and the skin
Patrick J Phillips, Warren Weightman
Case study:
'I've got these ugly red blotches
on my legs and they are getting
worse?' Lisa, 32 years of age, is
an accountant who always presents
herself meticulously. You can
understand why she doesn't like
the raised red brown blotches on
her shins.
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. 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, and are available immediately following successful completion online
Advance health directives
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.
Book reviews
Frances Cadden, Ronald McCoy
Books reviewed this month are Fast Facts: Multiple Sclerosis (2nd edition) by George D Perkin and Jerry S Wolinsky and Therapeutic Guidelines: Palliative Care Version 2.
Minor skin excisions in general practice in North Queensland
Clare Heal, Petra Buettner, Beverly Raasch, Sheldon Browning
To describe the demographics of patients presenting with skin cancer to general practitioners in rural North
Queensland, the sites from which skin cancers are removed, and their histology.
Training the primary care team - A successful interprofessional education initiative
Claire Louise Jackson, Caroline Nicholson, Bronwyn Davidson, Treasure McGuire
A multidisciplinary approach to the education of health professionals is being increasingly promoted as a means to cultivate collaborative practice between professions in the health care sector and to enhance patient care.
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