Australian Family Physician June 2008 - Challenging children
Vol 37, (6) 385-496
The theme for the June issue of AFP
is challenging children. This month's articles include oppositional
defiant disorder, school refusal, gaining children's confidence, chronic
abdominal pain in children, vertigo management in
general practice, lessons from the TAPS study and pelvic examination of
asymptomatic women.
Challenges for children
Jenni Parsons
This month’s issue of Australian Family Physician focuses on
communication and diagnostic and management challenges for
doctors (and parents) in caring for children.
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.
AD(H)D
Christopher Harrison, Janice Charles, Helena Britt
There were 347 encounters at which AD(H)D was managed
during the almost 8 year period, and four out of five patients were
male.
Gaining children’s confidence - The judicious use of silliness
Michael D Harari
Engaging children in a clinical setting is kind to the
child and their family, and is a useful clinical tool. Each of
us will have our own way of getting through a child’s
fears and defences.
Chronic abdominal pain in children
Leonie Gray
Chronic abdominal pain (CAP) is common in childhood and often
causes significant disruption to daily life. It is most often due to
a nonorganic/functional gastrointestinal disorder.
Oppositional defiant disorder
Anne Fraser, John Wray
Oppositional defiant disorder (ODD) is defined as a repetitive
and persistent pattern of opposition, defiant, disobedient and
disruptive behaviours toward authority figures persisting for at
least 6 months.
School Refusal
Jill Sewell
School refusal occurs in 1–5% of all school children and has
major social, emotional and educational implications for the
child.
Vertigo - Part 2 – management in general practice
Chih-Hung Kuo, Leo Pang, Robert Chang
Vertigo is a common clinical problem managed by general
practitioners.
Patient education - Management of benign positional vertigo
Management of benign positional vertigo
Adults with diabetes - Pharmacological management of hypertension
Leslie Jackowski, Josephine Crockett, Debra Rowett
Cardiovascular and renal disease are leading causes of
morbidity and mortality in patients with diabetes.
Reducing CVD risk - Integration of clinical and laboratory criteria
David P Tognarini, David R Sullivan, David W Thomas, Ken Sikaris
Recent updates to National Heart Foundation of Australia (NHFA)
Lipid management guidelines and Pharmaceutical Benefits Scheme
(PBS) criteria for subsidised lipid lowering therapy have resulted in
greater alignment between the two documents.
Access and limitations of community services for older persons - A guide for the GP
Lee-Fay Low, Henry Brodaty
Increasingly aged care services are shifting from residential to
community care. As a result, systems of access to services for older
persons in Australia have become more complex. It is important for
general practitioners to know how to navigate these systems.
Lessons from the TAPS study - Message handling and appointment systems
Meredith A B Makeham, Chris Cooper, Michael R Kidd
The TAPS study collected error reports from a
representative group of Australian general practitioners and
found that 70% of reported errors were due to process
problems in the delivery of care as opposed to deficiencies in
the knowledge and skills of health professionals.
Women, coronary artery disease and diabetes
Patrick J Phillips
Diabetes is now recognised as a ‘coronary equivalent’. However, both
the diabetes community and health professionals may not recognise
that the presence of diabetes equalises the risk of men and women
for coronary artery disease.
Pelvic examination of asymptomatic women - Attitudes and clinical practice
Rebecca Anne Stewart, Rebecca Anne Stewart, Rebecca Evans
Many women see their general practitioner for 'well woman' checks,
which often include Pap tests and a pelvic examination. A recent
review of the evidence revealed pelvic examination in asymptomatic
women is not a valid screening test, particularly with regard to
ovarian cancer screening.
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.
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.
Teaching psychiatry in general practice
Alistair VickeryClinical psychiatry in Australia has predominantly been taught to
undergraduates through hospital based attachments.
Access to children's medical records
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.
Participatory action research in indigenous health
Danielle M Esler
Participatory action research engenders change not just through
research outcomes but through the research process itself.
Collaboration between researchers and those being researched is
intrinsic to the model.
This sylvan game - creative writing and GP wellbeing
Susan Bradley Smith
Although narrative approaches to medical education have won great
favour in the United Kingdom and elsewhere, the medical humanities
remain a fledgling discipline in Australia.
Practice nurses and research - The Fremantle Primary Prevention study
Julie Young, Wendy Manea-Walley, Noelene Mora
The Primary Health Care Research Evaluation and Development
strategy provides financial support for the development of early
to mid career researchers through its Research Capacity Building
Initiative and Research Development Program. Practice nurses can
provide valuable contributions to research practices undertaking
research projects.
Book reviews
Books reviewed this month are Current Procedures: Pediatrics by Denise M Goodman, Thomas P Green, Sharon M Unti, Elizabeth C Powell and Computing and information management in general practice by Peter Schattner
Does general practice Google?
Moira G Sim, Eric Khong, Moyez Jiwa
Searching websites during consultations with patients has been
anecdotally reported to be useful by some medical practitioners. We
aimed to investigate how and to what extent medical practitioners
use the internet to aid clinical consultations.
Universal telenursing triage in Australia and New Zealand - A new primary health service
Ian St George, Matthew Cullen, Louise Gardiner, Georgia Karabatsos
Most Australian and all New Zealand residents now have 24 hour
access to free telephone advice and symptom triage. Australasia
is following an international trend triggered by a perceived need
for standardised advice, demand management (primary care and
emergency department), and equity of access. A growing literature
describes the impact of this new service on existing primary health
services.
International medical graduates - Challenges faced in the Australian training program
Louise McDonnell, Tim Usherwood
Few studies have examined the challenges faced by international
medical graduate (IMG) registrars and their supervisors in the
Australian General Practice Training Program. This study explored
registrar and supervisor perspectives on these challenges.
Combining vocational and research training
Tim C olde Hartman, Patrick J P Poels, Els Licht-Strunk
The gap between research and clinical practice can be bridged
by strengthening the position of the clinician-researcher with
appropriate research training and protected time for research.
Quality of diabetes care - A comparison of division diabetes registers
Jane Taggart, Qing Wan, Mark F Harris, Gawaine Powell Davies
Several recent government policies aim to narrow the gap between
optimal and current quality of care in the management of type 2
diabetes. This study examines trends in the quality of care and
intermediate outcomes for patients between 1995 and 2004.
Pelvic examination of asymptomatic women - Attitudes and clinical practice
Rebecca Anne Stewart, Jill Thistlethwaite, Rebecca Evans
Many women see their general practitioner for 'well woman' checks,
which often include Pap tests and a pelvic examination. A recent
review of the evidence revealed pelvic examination in asymptomatic
women is not a valid screening test, particularly with regard to
ovarian cancer screening.