Australian Family Physician March 2007 - Gynaecological malignancies
Vol 36, (3) 97-192
The theme for the March issue of AFP
is gynaecological malignancies. This month's articles include HPV
vaccination, ovarian cancer, postmenopausal bleeding, cervical cancer,
health care for refugee women, and GPs, violence and work
performance.
Preventing cervical cancer
Jenni Parsons
Every month in Australian Family Physician, and in every other medical journal in the world, there are discussions of new information; descriptions of innovations; or changes in the way we view health and illness that cumulatively or individually will make a positive impact.
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.
Gynaecological cancer in Australian general practice
Clare Bayram, Ying Pan, Graeme Miller
The BEACH program is a continuous national study of general practice activity in Australia. This article provides an analysis of the encounters where gynaecological cancer was managed from April 1998 to March 2006. This synopsis provides a backdrop against which articles in this issue of the Australian Family Physician can be further considered.
HPV vaccination - A paradigm shift in public health
Jenny May
In 2006, the world's first quadrivalent human papillomavirus (HPV) vaccine (Gardasil) was made available to the Australian public. The quadrivalent HPV vaccine protects against cervical cancer, cervical abnormalities, and genital warts related to HPV types 6, 11, 16 and 18. General practitioners play a vital role in preventive medicine and as such should have a good understanding of the vaccine and its role in the primary prevention of cervical cancer and precancers.
Pap test update
Stella Heley
2006 was an eventful year in the area of screening to prevent cervical cancer. New screening guidelines were introduced nationally in July, and in November the Australian Government agreed to fund one of the human papillomavirus (HPV) vaccines, Gardasil, under the National Immunisation Program.
The woman with postmenopausal bleeding
Alison H Brand
Postmenopausal bleeding is a common complaint from women seen in general practice.
Management of cervical cancer
Penny Blomfield
Australia now has one of the lowest incidence and mortality rates for cervical cancer worldwide. Women who develop the disease frequently have underutilised cervical screening opportunities and commonly present with symptoms such as abnormal vaginal bleeding.
Ovarian cancer screening
Deborah Neesham
Current tests used in the diagnosis of ovarian cancer are the CA-125 blood test and transvaginal ultrasound.
Ovarian cancer - Diagnosis and management
Margaret Davy
Epithelial ovarian cancer presents most often as late stage disease due to a lack of effective screening tests and
vagueness of symptoms.
Integrative medicine in gynaecological cancers
Avni Sali, Luis Vitetta
Gynaecological cancers are the fifth most common cause of cancer death in women in Australia. This article reviews three studies investigating nutritional aspects relating to gynaecological cancers.
Prevention of progression of kidney disease: diabetic nephropathy - CARI guidelines
Kathy Nicholls
The Caring for Australasians with Renal Impairment (CARI) guidelines initiative is an Australian and New Zealand project that aims to provide high quality, evidence based clinical practice guidelines for the management of all stages of kidney disease. This article summarises CARI guidelines on the Prevention of progression of kidney disease: diabetic nephropathy.
Rare skin cancers in general practice
Anthony Dixon
Case study: Mr LA has long been troubled with actinic damage to his skin, especially his face. He has had many squamous cell carcinomas (SCCs) removed and many solar keratoses managed.
Clinical breast examination for asymptomatic women - Exploring the evidence
Jill Thistlethwaite, Rebecca Anne Stewart
Clinical breast examination (CBE) is often offered as a component of the well woman check or carried out at the request of an asymptomatic woman. In these cases the examination is a screening procedure, as opposed to a diagnostic CBE in a symptomatic woman.
Health care of refugee women
Daniela Costa
Women refugees have endured major discrimination and poverty in their countries of origin or countries of displacement. This has had a major impact on their physical and psychological health. The experience of resettlement places a further burden on their health.
Extending care to women lay carers
Pretoria Iris Bilinski
Women represent 71% of the 474 600 primary lay carers in Australia. It is well documented that providing care for family members with a life threatening illness places a strain on the health and emotional wellbeing of the carer. Lay carers are rarely attentive to their own health needs due to lack of time and energy, and owing to feelings of guilt, they are unlikely to seek medial attention for preventive health concerns. This article presents four case studies that illustrate the tragic consequences of delayed review for self detected breast lumps which were proven to be breast cancer.
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. Answers to this clinical challenge will be published next month, and are available immediately following successful completion online.
An unusual sore throat
Andrew Gunn
Case history: A young homeless man recently presented
to a health clinic located in a youth service. He complained that, over the past day, his throat had become increasingly painful with an obstructed sensation. On examination, his uvula was very swollen and red. He had no other significant symptoms and examination was otherwise normal.
Children and adolescents - Who can give consent?
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.Can children and adolescents consent to their own medical treatment?
From solo practice to partnering - The evolution of the Elmore Model of Primary Health
Adel Asaid, Karen Riley
The Elmore Primary Health Service is located in Elmore, 46 km northeast of Bendigo in central Victoria. The population of the town and surrounding district is approximately 5400. Elmore was formerly a campus of the Rochester and Elmore District Health Service until a service review enabled the development of a new model that brought together the local general practice
and a community health service as partners.
Systems and complexity thinking in general practice - Part 1 - clinical application
Joachim P Sturmberg
Many problems encountered in general practice cannot be sufficiently explained within the Newtonian reductionist paradigm. Systems and complexity thinking - already widely adopted in most nonmedical disciplines - describes and explores the contextual nature of questions posed in medicine, and in general practice in particular. This article briefly describes the framework underpinning systems and complexity sciences. A case study illustrates how systems and complexity thinking can help to better understand the contextual nature of patient presentations, and how different
approaches will lead to different outcomes.
Book review
Darren Russell
The book reviewed this month is Management of Erectile Dysfunction in Primary Care Practice: Medical and Psychological Approaches by Rosie King.
Talking with patients from Howlong to the Himalayas - Do all our patients want us to be patient centred?
Malcolm Moore
Patient centred communication is an important feature of general practice training. It is cited by general practitioners
as one of the defining features of our specialty. However, many doctors are not convinced that this approach is
always suitable. This article highlights the range of expectations that patients have toward communication styles. The experience of researching this topic in Nepal has confirmed this diversity for me. We need to have various communication styles at our disposal so that we can engage as many of our patients as possible.
Is there a GP in the hospital?
Eric Khong, Winston Choy
Modern health care is increasingly complex with a progression to specialisation and super specialisation in the primary and tertiary settings. Traditional models of health such as the biomedical model are often inadequate. The value of a more holistic approach to patients' health problems has been long accepted by the medical profession. As health care becomes more fragmented we are overlooking the potential benefits of a generalist approach in improving the care of patients in our hospitals. This article examines the potential benefits of involving general practitioners in the tertiary care setting.
Children with a regular FP - Do they have better health behaviours and psychosocial health?
Albert Lee, Wing-suen Wong, Wing-yan Fung, Patrick Wing-leung Leung, Carmen Lam
Adults who receive care from family physicians (FPs) are healthier than those who do not, but not much is known about the health behaviours and psychosocial health of children who have FPs.
Cervical screening in general practice - Strategies for improving participation
Patrick Byrnes, Colleen McGoldrick, Margaret Crawford, Marilyn Peers
National cervical screening rates have plateaued at around 60%. Each method of recruitment has an upper limit to uptake and the benefits of multiple strategies are additive. There is debate about reallocating Pap testing to nurses in general practice.
General practice consultations - How well do doctors predict patient satisfaction?
Bianca Cannon, Timothy P Usherwood
While patient satisfaction with the general practice consultation has been extensively researched, there have been relatively few studies of doctors' perception of patient satisfaction. This study sought to measure how accurately doctors are able to predict patient satisfaction with consultations in general practice.
Is your sample cupboard relevant to your practice?
Geoffrey Spurling, Greg Kyle
Sample medications represented 4% (A$3.8 million)
of the Australian general practice promotional budget of pharmaceutical companies in the second quarter
of 2005.
GPs, violence and work performance - 'Just part of the job?'
Jan Coles, Stella Koritsas, Malcolm Boyle, Janet Stanley
This study explored the impact of work related violence on general practitioners' work performance.