Australian Family Physician June - The bottom line
Vol 39, (6) 353- 448
The theme for the June issue of AFP is the bottom line.
This month's articles include pilonidal sinus, anorectal pain, bleeding
and lumps, pruritus ani, postsplenectomy infection, treating primary
insomnia and musculoskeletal pain.
Perianal problems
Janice Charles, Graeme Miller, Salma Fahridin
Between January 2008 and December 2009 in the BEACH
(Bettering the Evaluation and Care of Health) program,
perianal problems were managed in general practice at a
rate of 0.7 per 100 encounters, about 800 000 times per year
nationally. Here we present an overview of perianal problems
and discuss haemorrhoids in particular.
Pruritus ani
Joanne MacLean, Darren Russell
Anal pruritus affects up to 5% of the population. It is
often persistent and the constant urge to scratch the area
can cause great distress. Although usually caused by a
combination of irritants, particularly faecal soiling and
dietary factors, it can be a symptom of serious dermatosis,
skin or generalised malignancy or systemic illness.
Pilonidal sinus – management in the primary care setting
Paul Kitchen
Postanal pilonidal sinus is a skin condition in the midline of
the natal cleft. A primary pit forms in the midline, caused
by a hair follicle that has become infected, into which loose
hairs enter to create a track or abscess.
Anorectal pain, bleeding and lumps
W John Daniel
The patient presenting with anal pain, anal lump or rectal
bleeding is a common occurrence in the general practice
setting and the combination of symptoms usually gives an
indication of the most likely diagnosis. However, careful
examination including digital rectal examination is always
required.
A healthy bottom line
Jenni Parsons
There has been a lot of talk in 2010 about
the bottom line of health care expenditure
in Australia, and how we as a community
manage, control and allocate the available
health care dollar.
Family medicine in the USA – an Australian perspective
Nicholas Zwar
For the most part, Australian general
practitioners do not have a clear idea of
how the health care system works and
how family medicine is practised in the
United States of America.
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.
Postsplenectomy infection – strategies for prevention in general practice
Penelope Jones, Karin Leder, Ian Woolley, Paul Cameron, Allen Cheng, Denis Spelman
The spleen plays a crucial role in human defence against infection. Patients who are
asplenic or hyposplenic are at increased risk of severe sepsis due to specific organisms.
Overwhelming postsplenectomy infection (OPSI) has a mortality rate of up to 50%.
Japanese encephalitis – prevention in travellers
Cora A Mayer, Amy A Neilson
This article is the fourth in a series providing a summary of prevention strategies and
vaccination for infections that may be acquired by travellers. The series aims to provide
practical strategies to assist general practitioners in giving travel advice, as a synthesis
of multiple information sources which must otherwise be consulted.
A patient presenting with 'stiff hands'
Patrick J Phillips, Simon Burnet
Christie, 42 years of age, has a 30 year history of type 1 diabetes. She presents complaining
of stiff hands.
Hypoglycaemia in nondiabetic patients – an evidence
Ching Luen Ng
Hypoglycaemia can have serious consequences for patients. Hypoglycaemia in nondiabetic
patients is not a common condition, and is often a diagnostic challenge for general
practitioners.
Overweight and obesity – use of portion control in management
Amanda Clark, Janet Franklin, Iain Pratt, Melanie McGrice
Overweight and obesity was responsible for 7.5% of the total burden of disease and
injury in Australia in 2003, and was estimated in 2008 to cost the community $58.2
billion. More than half of the adult, and up to a third of the child, population in
Australia is now classified as overweight or obese.
Quality use of medicines in residential aged care
Michael Somers, Ella Rose, Dasha Simmonds, Claire Whitelaw,
Janine Calver, Christopher Beer
Older people are more likely to be
exposed to polypharmacy. People
with dementia, especially those living
in residential aged care facilities
(RACFs), are at particularly high risk of
medication harm. We sought to describe
medications prescribed for a sample of
people with dementia living in RACFs.
General practice registrars – attitudes of older patients
Andrew Bonney, Sandra C Jones, Lyn Phillipson, Don Iverson
Previous research indicates that older
patients may be less willing to consult
general practice registrars (GPRs),
reducing training opportunities in
chronic/complex care. This survey
explores older patients’ attitudes in
order to inform models of interaction
that would be acceptable to patients.
Musculoskeletal pain – presentations to general practice
Scott Masters, Rachel Lind
In order to understand more about
pain presentations in primary care, the
authors undertook a descriptive study on
musculoskeletal pain presentations to a
general practice with a special interest in
musculoskeletal medicine.
Failure to vaccinate
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.
Treating primary insomnia – the efficacy of valerian and hops
Shanah Salter, Sonya Brownie
Sleep disorders are common in the general population and may be associated with considerable economic costs as well as psychological and social disruption, and reduced wellbeing. The conventional definition of a sleep disorder and the one this article will adopt, is any disturbance of a person’s normal pattern of sleep that affects their ability to function.
Project management – tips from the toolkit: 5
Neville Steer
Starting a practice is a complex undertaking requiring planning,
resourcing, and management skills that lead to an ‘up and running’
medical business. Project management methods can be used to phase
activities in a logical and coordinated sequence. This month, we use
some examples of project management methods that can be used in
setting up a practice or other complex projects. Like previous articles in
this series, this article draws on The Royal Australian College of General
Practitioners’ ‘General practice management toolkit’.
Book reviews
Books reviewed this month are Practical Child and Adolescent Psychiatry for Pediatrics and Primary Care by Harsh K. Trivedi and Jeryl D. Kershner and When to Really Worry by Michael Carr-Gregg.
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. Groups may include anyone else who has an interest (ie. practice nurses, community health workers, allied health professionals).
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.