Australian Family Physician May 2007 - Travel medicine
Vol 36, (5) 289–384
The theme for the May issue of AFP
is travel medicine. This month's articles include febrile illness in the
returned traveller, travel vaccination, prevention of malaria, the
pre-travel consultation, diagnosing prostate cancer, vitamin D
deficiency in refugees and submassive pulmonary embolism.
An ostrich eye view of avian flu?
Jenni Parsons
Until recently I have had my head in the sand about a potential influenza pandemic. I hadn't fully taken in the implications of numbers of people infected, potential loss of life or the huge disruption to communities and services. I hadn't thought that it is not really a matter of if a pandemic occurs, but when.
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
Management of travel related problems in 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 encounters where travel related problems were managed in BEACH from April 2001 to March 2006. This synopsis provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.
The pre-travel consultation - An overview
Tony Gherardin
Australians are great travellers and the need for travel health advice can be a common presentation in general practice. General practitioners should be an important source of accurate and up-to-date information and provide appropriate travel medicine services.
Travel vaccination
Sonny Lau, Tony Gherardin
Immunisation is very cost effective. It provides high level immunity against a range of general and travel specific pathogens. There are more vaccines available as research and development of vaccines progresses. Some vaccines require multiple doses to induce long lasting protective immunity, and some will only induce protective immunity for a limited period of time.
Fitness to travel - Assessment in the elderly and medically impaired
Peter Fenner
As more people travel, and with an expanding aged population, the number of older travellers, including those with
significant medical or physical impairment will increase significantly.
Prevention of malaria in travellers
Trish Batchelor, Tony Gherardin
Malaria remains endemic in over 100 countries worldwide. Travellers to these countries may be at risk of contracting disease. Assessing risk on an individual basis can be challenging.
The returned traveller with diarrhoea
John M Goldsmid, Peter A Leggat
Traveller's diarrhoea is among the most frequently reported problems for travellers. Prevention remains a challenge in
travellers and the appropriate management of traveller's diarrhoea remains paramount.
Assessment of febrile illness in the returned traveller
Peter A Leggat
Fever is among the most frequently reported problems in returning travellers.
Traveller’s ‘funny tummy’ – Reviewing the evidence for complementary medicine
Marc Cohen
The gastrointestinal system is sensitive to both the place and means of travel and traveller's diarrhoea and motion sickness are among the most prevalent travel related conditions. There is now evidence to suggest that both of these ailments may be treated with safe and inexpensive complementary medicines.
Notification - what's it all about?
Danielle Esler, Emma Just
General practitioners are often unsure of their obligation to notify public health units of infectious disease in their
patients. A measles case study in which contacts missed out on appropriate prophylaxis due to failure to notify by a GP and hospital staff is discussed.
Treating actinic keratoses with imiquimod
Anthony Dixon
Case study: Mr KC, 61 years of age, has extensive actinic damage including squamous cell carcinomas (SCCs) and actinic keratoses (AKs) on his face and forehead. He has had cryotherapy for many years with limited success. Lesions have generally resolved with cryotherapy but he finds the treatment very uncomfortable and can only tolerate a small number of lesions being treated on each visit. He develops lesions faster than lesions are treated.
Diagnosing prostate cancer - What GPs need to know
Mark Frydenberg, Sanjiva Wijesinha
The symptoms and signs of prostate cancer usually manifest after it is too late to 'cure' the condition. General practitioners are ideally suited to diagnose this disease early and need to know the latest information about how best to identify and advise patients.
Travelling with medications - Some lessons learned
Roy G Beran, James Docking
Travelling with medication overseas can require additional care and thought in case the medication is lost or stolen. There are basic steps to follow to ensure medications can be easily replaced while overseas. This article outlines some valuable lessons learned from one patient's experience.
Prevention of progression of kidney disease - CARI guidelines
David W Johnson
The CARI guidelines initiative is an Australia/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 the CARI guidelines on Prevention of progression of kidney disease: diet and miscellaneous factors.
Hiding from the sun - Vitamin D deficiency in refugees
Jill Benson, Sue Skull
It has been well established that women who wear a veil for cultural reasons and dark skinned migrants from Africa have an increased prevalence of vitamin D deficiency. Many refugee patients also come from countries where their skin is covered or they are indoors for most of the day.
Age related macular degeneration - New developments in treatment
Timothy C Smith, Lawrence Lee
Age related macular degeneration (AMD) is a common condition seen in general practice. Over the past few years, new understanding of the condition has seen the rapid development of increasingly effective treatments.
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.
Insurance reports
Sara Bird
General practitioners find their patients requesting that they complete documentation for a myriad of insurance purposes. Often these forms are time consuming to complete, containing seemingly irrelevant questions. This article examines the responsibilities of GPs in providing reports to insurance companies.
ClimateGP - Web based patient education
Gavin Andrews
ClimateGP is an online education suite that combines patient education with feedback to, and guidance from, the doctor. It covers the major chronic diseases and will soon cover the common smoking, nutrition, alcohol and physical activity (SNAP) risk factors. ClimateGP also provides web based continuing medical education approved by The Royal Australian College of General Practitioners.
Do women have a role in early detection of prostate cancer? - Lessons from a qualitative study
Irena Madjar, Jim Denham, Prem Rashid
Prostate cancer is the most common internal cancer in Australian men; more than 3000 men die annually from it. Public awareness of prostate cancer is an important factor in early detection and treatment. Women are known to act as ‘health managers’ for their families and may have a role to play in early detection.
GP workforce participation in Tasmania
Jan Gartlan, Sarah Male, Lawrence Donaldson, Mark Nelson, Tania Winzenberg
Predicting future general practitioner workforce requires information about how demographic factors affect GP workforce participation. Regional differences might not be accounted for in national studies. The authors aimed to determine GP characteristics associated with workforce participation in Tasmania.
Treatment of patients with pulmonary embolism entirely in Hospital in the Home
Benjamin Lui, Anh Tran, Michael Montalto
Low molecular weight heparin (LMWH) has revolutionised the management of venous thromboembolism (VTE). An mportant feature of the use of LMWH is the ability to manage acute VTE in the home. This study examined the outcomes of patients with pulmonary embolism (PE) who were transferred to Hospital in the Home (HIH) within 24 hours of presentation for treatment with LMWH.