Australian Family Physician April 2008 - Allergy
Vol 37, (4) 193-288
The theme for the April issue of AFP
is allergy. This month's articles include allergic rhinitis, allergy
testing and referral
in children, allergy prevention, food allergy in adults, pathological
hoarding, lessons from the TAPS study, colorectal cancer management,
managing shoulder pain and doctors as patients.
Not allergic to life
Ella Warmington
A lot of things have changed over the 3 years since I first wrote for Australian Family Physician; but one thing remains... without prompt medical assistance I will die if I eat a nut.
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.
Allergic rhinitis
Salma Fahridin, Helena Britt
The BEACH program (Bettering the Evaluation and Care of
Health) shows that allergic rhinitis was managed six times per 1000 encounters between October 2002 to September 2007. This suggests that general practitioners manage allergic rhinitis about 619 000 times nationally each year.
Allergy prevention - Current recommendations and new insights
Mimi L K Tang, Marnie Robinson
The worldwide prevalence of atopic diseases such as asthma, allergic rhinitis, atopic dermatitis and food allergy has increased considerably in recent decades. Australia has one of the highest rates of allergic disease in the world.
Allergy testing and referral in children
Marnie Robinson, Joanne Smart
Allergic diseases – eczema, asthma, rhinoconjunctivitis and food allergy – are the commonest chronic diseases of childhood and Australia has one of the highest prevalence rates of allergic diseases in the world.
Allergic rhinitis - practical management strategies
Wendy Hu, Constance H Katelaris, Andrew S Kemp
'You know how they did those 12 prick tests... what have you, they have the pollen, the bed mites and things like that. I'm a bit blasé when it comes to things like that... I mean, if [my son] sneezes, he sneezes, you know? What can you do? And that's just part of life. And, unless it gives him chronic,
chronic symptoms, I really don't think it's much of a worry. [It] was just general house dust that he was sensitive to - unfortunately you have to live with that. You're never going to
get away from it. We don't live in a sterile environment.'
Food allergy in adults
Jeremy P Wrobel, Robyn E O'Hehir, Jo A Douglass
International and Australian reports indicate a marked increase in the prevalence of food allergies. The occurrence of several well publicised tragic events has also heightened community awareness. Consequently more patients are likely to present to their general practitioner with suspected food allergy.
Patient education - how to use an EpiPen®
Patient education
Management of spinal cord injury in general practice - Part 1
James W Middleton, Grace Leong, Linda Mann
The general practitioner plays a vital role in the primary care of people with spinal cord injury. In a previous article we illustrated how practice structures can accommodate people with disabilities, allowing health surveillance/promotion and disease prevention activities through a comprehensive, systematic approach.
In general practice, 'always expect the unexpected'
Mark Mackinnon
Mr SF had been covering his head with gauze to protect it. Removal of the covering revealed a massive erosive lesion measuring 11x10 cm. It appeared that the lesion had eroded through the skull, soft tissue and down to the meninges of the brain. Careful observation showed a pulsatile area through which was percolating frank blood.
Pathological hoarding
Don Jefferys, Kathleen A Moore
Consumerism drives economies; we acquire and discard possessions without distress. This process is well managed by most with only the occasional glitch. For those who compulsively hoard, this process is impaired; the sufferer is unable to resist the urge to acquire possessions, which are at times of little value, and is unable to discard even at the point of excess leading to cluttered living spaces.
Lessons from the TAPS study - errors relating to medical records
Meredith A B Makeham, Charles Bridges-Webb, Michael R Kidd
Around 20% of all errors reported by general practitioners participating in the TAPS study related to practice and health care systems, and one-quarter of these were due to errors related to patient medical records or practice filing systems.
Is it insulin allergy?
Patrick J Phillips, Warren Weightman
'I'm allergic to that insulin you gave me. The injections sting and leave marks that last more than a week'. When Joe pulls up his shirt you can see the marks.
Supporting clinical teachers - A review of the literature
Shane Christensen
Medical student teaching in the community has been shown to produce equivalent learning outcomes compared to teaching based mainly in the hospital setting. In Australia, it has been shown to produce improved learning outcomes when associated with a 12 month community rural term, and is positively associated with recruitment of doctors to general practice in the rural setting.
AFP in Practice
AFP in Practice questions are designed to get you started in a small group learning (SGL) activity in your practice or with colleagues. Requirements to earn 40 Category 1 CPD points for a SGL activity are: minimum of four and a maximum of 10 people, minimum of 8 hours of discussion in a year, and at least two GPs.
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.
Doctors as patients
Sara Bird
A recent Australian survey examined the differences in
psychological morbidity between medical practitioners who
have experienced a medicolegal matter and those who have
not.
Colorectal cancer management - The role of the GP
Heather Hanks, Craig Veitch, Mark Harris
General practitioners play a role in all levels of colorectal
cancer (CRC ) care including screening, referral, management,
follow up and palliative care.
Managing shoulder pain in general practice - Assessment, imaging and referral
Parm Johal, David Martin, Norman Broadhurst
Approximately 10% of consultations with general
practitioners are for musculoskeletal problems. Shoulder
pain represents the third most common reason for
presentation, following back and neck complaints.
Too many of us have gone early - Priorities in heart health education for Aboriginal people
Penny Abbott, Joyce Davison, Louise Moore
Aboriginal people have a higher burden of cardiovascular risk factors
and heart disease and poorer outcomes after heart attacks when
compared with other Australians. Indigenous status is also a risk
factor for delayed response to heart attack symptoms.
Book reviews
Books reviewed this month are How doctors think by Jerome Groopman and Girl Stuff - Your full-on guide to the teen years by Kaz Cooke
Telephone based asthma management - financial and individual benefits
Karen J Donald, Helen McBurney, Harry Teichtahl,
Louis Irving, Colette Browning, Abe Rubinfeld,
Judi Wicking, Sue Casanelia
The telephone has been used successfully to deliver management advice and support to patients in their own homes for a number of chronic diseases including diabetes, heart disease, depression and asthma. Telephone based management can be delivered without the time or financial cost to patients of travelling to appointments, may occur more regularly than similar care at a clinic or hospital, and has reported outcomes equivalent to standard care.
General practice registrars and research - attitudes toward participation
Lieke Franke, Thijs Kommers, Evelyn Van Weel, Peter
Lucasson, Mechtild Beek, Henk Van den Hoogen,
Chris Van Weel
Primary care research is important but there is general concern about the difficulty of linking research to patient care. Research development is even more problematic in primary care than in other disciplines. Policies to enhance general practice research include the creation of research networks, collaborations with research institutes, and early exposure to research during undergraduate teaching and specialty training. Early exposure prompts students to consider research as part of their future career, and better equips future practitioners to deliver evidence based patient care.
Coordinated anticoagulation management in a rural setting
Kathleen Hodge, Edward Janus, Vijaya Sundararajan, Sally Taylor, Wendy Brand, Joseph E Ibrahim, Alan Wolff
The standard measure of anticoagulation control in patients taking warfarin is the international normalised ratio (INR), the ratio of a patient’s prothrombin time and a standardised prothrombin time. Warfarin has a narrow therapeutic range, and patients require regular INR testing to prevent haemorrhage or thromboembolic events. In the 1992 Australian Health Care Study, 10.7% of adverse drug events were anticoagulation related, at an estimated annual cost of $100 million for hospital management alone.
Using computer based templates for chronic disease management
Helen Bolger-Harris, Peter Schattner, Mary Saunders
The chronic disease management (CDM) Medicare Benefits Schedule (MBS) items were introduced into the MBS schedule on 1 July 2005. These items included General Practice Management Plans (GPMPs) and Team Care Arrangements (TCAs) which replaced the original care planning items. Previously, formal care planning had not been widely adopted by GPs,2 so the rationale for the change was to facilitate care planning within the general practice setting (via GPMPs) and to improve the multidisciplinary care coordination process (via TCAs).