Australian Family Physician May - Childhood emergencies
Vol 39, (4) 257 - 352
The theme for the May issue of AFP is Childhood emergencies.
This month's articles include Croup, Assessment of the unwell child,
Meningococcal sepsis, Croup – assessment and management, Minor
head injuries in children –
an approach to management & Type 1 diabetes in children –
emergency management.
Croup
Janice Charles, Helena Britt, Salma Fahridin
Children aged 1–4 years were significantly more likely to
be managed for croup than children in other age groups.
This was reflected in the age specific rate of 1.9 per 100
encounters for children of that age, compared with a rate
of 1.1 per 100 encounters with infants aged less than 1 year
and children aged 5–9 years.
Assessment of the unwell child
Adriana Yock Corrales, Mike Starr
Children present to general practitioners with a wide range
of problems, but most of the time they are not particularly
unwell.
Meningococcal sepsis
Shabna Rajapaksa, Mike Starr
Meningococcal disease remains a significant illness with
an overall mortality of around 8%. The majority of deaths
occur in the first 24 hours, before the commencement of
specialist care.
Croup – assessment and management
Shabna Rajapaksa, Mike Starr
Croup is a common childhood disease characterised by
sudden onset of a distinctive barking cough that is usually
accompanied by stridor, hoarse voice, and respiratory
distress resulting from upper airway obstruction.
Minor head injuries in children – an approach to management
Carl Luckoff, Mike Starr
Traumatic head injury is a common occurrence in the
paediatric population, with the majority of patients
sustaining only mild head injury.
Type 1 diabetes in children - Emergency management
Aris Siafarikas,
Susan O’Connell
Fifteen to sixty-seven percent of patients with new onset
type 1 diabetes mellitus (T1DM) present in diabetic
ketoacidosis (DKA), of which approximately 79% initially
see their general practitioner.
Aspirin, flu and general practice research
Jenni Parsons
A few weeks ago I received an invitation on
a stiff white card to a morning tea function
at Government House in Melbourne.
General practice research - Training and capacity building
Parker Magin, Marie Pirotta, Emily Farrell, Mieke Van Driel
The Lancet in 1999 suggested that
‘neglect of research has made primary
care one of the most intellectually
underdeveloped disciplines in medicine’1
and later labelled general practice
research ‘a lost cause’.
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
Bacterial cystitis in women
Amanda Chung, Mohan Arianayagam, Prem Rashid
A woman presenting with symptoms suggestive of bacterial cystitis is a frequent
occurrence in the general practice setting. One in three women develop a urinary tract
infection (UTI) during their lifetime (compared to 1 in 20 men).
Erectile dysfunction - When tablets don’t work
Ian A R Smith, Nicholas McLeod, Prem Rashid
Erectile dysfunction (ED) is a common clinical problem managed in the general practice
setting. While the majority of men will find phosphodiesterase-5 (PDE-5) inhibitors
effective, there is a subgroup of men who require second and third line therapies.
Circadian rhythms and depression
Philip Boyce, Erin Barriball
Depression is a common disorder in primary care. Disruptions to the circadian rhythms
associated with depression have received little attention yet offer new and exciting
approaches to treatment.
Epicentre of influenza – the primary care experience in Melbourne, Victoria
Jenny Bocquet, Tania Winzenberg, Kelly A Shaw
General practice in Australia is expected
to play a major role in responding to
an influenza pandemic. This study
investigated the experience of frontline
general practice during the H1N1
influenza pandemic of 2009.
Asthma Cycle of Care attendance - Overcoming therapeutic inertia using an asthma clinic
Patrick Byrnes, Colleen McGoldrick, Margaret Crawford
The prevalence of asthma is high in
Australia. Despite national guidelines
recommending the use of an Asthma
Action Plan only 22.5% of people with
asthma had a plan in 2004–2005.
Patient initiated aggression and violence in Australian general practice
Laura Forrest, Rhian Parker, Kelsey Hegarty, Hagen Tuschke
Aggressive and violent behaviour by
patients, or their relatives or friends,
toward general practice staff is a matter
of national concern. Forms of this
behaviour include verbal and physical
abuse, property damage, theft, stalking,
sexual harassment and sexual abuse.
Two HEADSSS are better than one – a biopsychosocial screening tool for use when treating other doctors
Hilton Koppe
This is the fourth article in a series exploring issues involved in treating
other doctors. The first article discussed potential barriers faced by
doctors when seeking medical care for themselves. The second article
looked at strategies for minimising these barriers before the consultation
takes place, and the third explored strategies for use during a
consultation when the patient is another doctor.
Failure to diagnose: brain tumour
Sara Bird
Victoria Palmer, 5 years of age,
became unwell on 11 January
2008, suffering from nausea and
vomiting. On 18 January 2008 she
was seen by her general practitioner.
The GP recorded a history that
Victoria had woken that morning
with a headache which had
become worse after an episode of
vomiting.
Genomics and general practice: the next 10 years
Lawrence Leung
Genomics is the study of the genetic
information of organisms from their basic
nucleic acid structure (so-called base
pairing) to their polymorphisms and their
variability over time and space.
CareSearch - Online palliative care information for GPs
Christine Sanderson, Jennifer Tieman
General practitioners have always been involved in providing
palliative care. As Australia’s population ages, the number of patients
living with cancer and end stage chronic disease will increase.
Tips from the toolkit: 4 – starting a practice
Neville Steer
Although all general practices will differ
in their achievements and challenges,
one thing is the same: the most important
thing in general practices is the people
working in that practice. Beyond this, the
business structure, systems and processes
will determine the operational efficiency of
the practice, the effectiveness in providing
health care, and financial performance.
AFP in Practice
Carolyn O'Shea
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
Deepa Daniel
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.