Australian Family Physician January/February 2009 - Summer Salad
Vol 38, (1/2) 1 - 80
The theme for the January/February issue of AFP is summer salad. This
month's articles include controversies in type 2 diabetes, breastfeeding
knowledge, working with patients with intellectual disabilities,
compounded medicines and 'off label' prescribing, management plans for
anaphylaxis, HPV vaccination catch up program, venous thromboembolism
and general practice as a career.
A healthy educational diet
Jenni Parsons
January in Australia conjures up images of lazy summer
days at the beach, long warm evenings, and crisp cool summer
salads, made from a bit of this and a bit of that... the wonderful
whole so much more than the sum of the individual parts.
Changes to general practice
Jill Thistlethwaite, David Topps
In September 2008, the Federal Minister for Health and
Ageing, Nicola Roxon, announced plans to change delivery of
primary health care in Australia.
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.
Multiple chronic problems
Ying Pan, Helena Britt, Janice Charles
Between April 2006 and March 2008, general
practitioners managed at least one chronic problem at
39.5% of patient encounters, and two or more chronic
problems at one in 10 (9.8%) of these encounters.
Overcoming communication barriers - Working with patients with intellectual disabilities
Ka Lip Chew, Teresa Iacono, Jane Tracy
Some medical practitioners may feel uncomfortable seeing
patients with intellectual disabilities. This discomfort often
stems from a lack of experience and training in working with
people who have communication difficulties.
Compounded medicines and ‘off label’ prescribing - A case for more guidance
Romano A Fois, Barry T Mewes, Andrew J McLachlan, Iqbal Ramzan
There has been a recent rise in the prescribing and
dispensing of compounded medicines both in Australia and
overseas.
Controversies in type 2 diabetes - An update
Bu B Yeap
Patients with type 2 diabetes undergo a transition over
time from an initial state of predominant insulin resistance to
progressive impairment of beta cell function.
Breastfeeding knowledge - The experiences of Australian general practice registrars
Wendy Brodribb, Anthony B Fallon, Claire Jackson, Desley Hegney
In Australia, the National Health and Medical Research
Council and The Royal Australian College of General
Practitioners recommend breastfeeding for at least the first 12
months of an infant’s life, based on the known disadvantages
of not breastfeeding for the mother and child.
New action plans for the management of anaphylaxis
Andrew S Kemp, Wendy Hu
The Australasian Society for Clinical Immunology and Allergy has developed new anaphylaxis action plans intended for use across Australasia. These educational tools aim to give patients and carers easily accessible information about key steps in the emergency treatment of acute allergic reactions and anaphylaxis.
Venous thromboembolism – management in general practice
Nicola H Chapman, Timothy Brighton, Mark F Harris, Gideon A Caplan, Jeffrey Braithwaite, Beng H Chong
The diagnosis, treatment and management of venous thromboembolism prophylaxis are increasingly becoming the responsibility of the general practitioner. Effective treatments exist, as do guidelines for management of hospitalised patients. However, very little research has been done into the implementation of anagement strategies in community based patients.
Upper cervical spine injuries in elderly patients
M Sami Walid, Nadezhda V Zaytseva
Elderly patients may sustain upper cervical spine injury without neurological symptoms or radiographic evidence of fracture.
A mass on the palate
Keng Yin Loh, Bee Eng Ong, Sambandam Elango
A university student, 20 years of age, noticed a mass on
her palate one morning while looking in the mirror. She
has not experienced any symptoms such as pain
or discomfort.
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.
Choosing general practice - A review of career choice determinants
Narelle Shadbolt, Jeremy Bunker
This review takes a narrative synthesis approach - a systematic
approach to interpreting complex evidence - to a broad literature
review of the complex issue of medical career decision making.
Miasma revisited - The intellectual history of tropical medicine
Andrew D S Gibson
Tropical medicine arose as an area of medical practice in the last
decade of the 19th century. Patrick Manson dominated its early
history, and it thrived through the height of the colonial era.
Are sickness certificates doing our patients harm
Debra A Dunstan
Over the past 9 years there has been a 70% increase in requests for
sickness certificates in Australia. In this same period, an increasing
number of people have been certified as permanently disabled for
work.
Book Reviews
Books reviewed this month are Therapeutic Guidelines: Toxicology & Wilderness by Victoria: Therapeutic Guidleines, 2008 and Therapeutic Guidelines: Cardiovascular - Version 5 by Victoria: Therapeutic Guidleines, 2008
GPs' concerns about medicolegal issues - How it affects their practice
Louise Nash, Merrilyn Walton, Michele Daly, Maree Johnson, Garry Walter, Elizabeth van Ekert, Simon Willcock, Chris Tennant
General practitioners' concerns about medicolegal issues have been
shown to influence the practice of medicine. This research looks at
GPs' beliefs about medicolegal issues and how medicolegal concerns
affect their practice.
HPV vaccination catch up program - Utilisation by young Australian women
Edith Weisberg; Deborah Bateson; Kirsten McCaffery; S Rachel Skinner
The quadrivalent human papilloma virus (HPV) vaccine provides
protection against HPV types 6 and 11, and 16 and 18. The Australian
Government’s offer of free vaccination to women aged 18-26 years of
age through general practitioners ends 30 June 2009.
General practice registrar teaching roles - Is there a need for shared understanding?
Jenny Dodd; Alistair Vickery, Hilleke van Osch, Jon Emery
There is currently a shortage of general practitioners and an increase
in the number of medical students and general practice trainees. The
expanded involvement of general practice registrars in teaching roles
has been suggested as part of the solution to increasing the number
of teaching roles in general practice.