Australian Family Physician August - Current issues in alcohol
Vol 40, (8) 553-648
The theme for the August issue of AFP is Current issues
in alcohol.
This month's articles include Binge drinking, Problem drinking –
detection and
assessment in general practice, Problem drinking – management in general
practice, Risky drinking among young Australians –
causes, effects and implications for GPs & Alcoholic liver disease –
assessment and
management.
Risks and comedy
Kath O’Connor
The old adage that an alcoholic is
someone who drinks more than their
doctor always brings a smile. It also
reveals a deeper truth. What is ‘normal
drinking’ depends on the environment
you were raised in and your current
social, emotional and employment
context.
Improving clinical decision support tools – challenges and a way forward
Michelle Sweidan, James Reeve, Jonathan Dartnell, Stephen Phillips
Would you prescribe a drug without
regulatory approval, for which the safety
and efficacy are unknown? Unlikely.
Would you use a clinical practice
guideline that is not endorsed by a peak
body, with no accessible evidence for its
recommendations and with its authorship
unknown? Unlikely. Do you currently use
decision support tools in your prescribing
software that have not been evaluated
or accredited, with unknown or variable
quality and reliability? Very likely.
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
Binge drinking
Janice Charles, Lisa Valenti, Graeme Miller
‘Binge’ drinking is defined as episodic excessive drinking,
but there is no worldwide consensus on how many drinks
constitute a ‘binge’. BEACH (Bettering the Evaluation and
Care of Health) used three questions from the World Health
Organization’s Alcohol Use Disorders Identification Test
(AUDIT) to gather information on alcohol consumption of
patients aged 18 years or over from a subsample (40%) of
participants. We defined regular binge drinkers as those
who have six or more standard drinks on one occasion,
either weekly or monthly.
Problem drinking – detection and assessment in general practice
Apo Demirkol, Paul Haber, Katherine Conigrave
Alcohol has long been an integral part of the social life of
many Australians. However, alcohol is associated with
significant harm to drinkers, and also to nondrinkers.
Problem drinking – management in general practice
Apo Demirkol, Katherine Conigrave, Paul Haber
Management of problem drinking presents the general
practitioner with similar challenges and rewards to
those associated with the management of other chronic
conditions.
Risky drinking among young Australians – causes, effects and implications for GPs
Amy Pennay, Dan I Lubman, Sarah MacLean
Rates of risky drinking among young Australians have
increased substantially over the past 2 decades, resulting
in significant community concern.
Alcoholic liver disease – assessment and management
Anne E Duggan, John M Duggan
Alcohol is a major cause of liver disease in Australia and
the incidence of end stage liver disease among young adult
Australians is rising.
Ambulatory electrocardiographic monitoring
Alex McLellan, Uwais Mohamed
This article forms part of our ‘Tests and results’ series for 2011 which aims to provide information
about common tests that general practitioners order regularly. It considers areas such as indications,
what to tell the patient, what the test can and cannot tell you, and interpretation of results.
Patient information – Holter monitors/event recorders
Rachel Lee
A Holter monitor is a portable way of taking an
electrical trace of your heartbeat over a period of
time (usually 24 hours) while you go about your
normal day-to-day activities. The machine records
this trace so that a technician and cardiologist
(heart doctor) can review your heart rhythm and
report back information about your heart to your
general practitioner. The test can help pick up if
your heartbeat is too fast, too slow or irregular.
Asymptomatic hilar nodules
Chih-Chung Shiao, Jsun-Liang Kao, Fong-Fong Tsai,
Hwei-Mei Tai, Kuo-Chin Chiu
Mr Lin, a Chinese man aged 38 years, presented
for review of a recent chest X-ray. The X-ray
was ordered as part of a pre-employment
assessment. He was asymptomatic, a nonsmoker
and had no significant past medical history.
Full blood examination, lipids, glucose and liver
and renal function were normal (also ordered
as part of the pre-employment assessment).
On examination, he looked well, with blood
pressure 134/78 mmHg, heart rate 72/min, and
chest and cardiovascular examinations normal.
Not just another sore throat
Karen Broadbent, Michael Lovegrove
Case study
A man, 26 years of age, presented to a hospital
emergency department complaining of a sudden
onset of a sore throat 6 hours previously while
consuming a carbonated drink at work.
Green concretions on the left axillae
Ricardo Ruiz-Villaverde, Daniel Sánchez-Cano, Manuel Galán-Gutierrez
Case study
A man, 47 years of age, with an
unremarkable past medical history,
attended our dermatology outpatient clinic
having developed changes in the colour
and texture of the hair of his left axillae
2 weeks earlier, causing him moderate
itching. He did not remember any changes
in his lifestyle or recall any changes in
sweating patterns.
Odorous vaginal discharge - A case study for thorough investigation
Geta Cernat, Lawrence Leung
Odorous vaginal discharge is a common presentation to general practitioners, and a
frequent presentation for bacterial infections and sexually transmissible diseases. Busy GPs
may be tempted to make a diagnosis from the clinical history and symptoms, and prescribe
antibiotics as a first line treatment. This case highlights an unusual cause of persistent
odorous vaginal discharge.
The Inverse Care Law - Is Australian primary care research funding headed this way?
Tom Brett
Tudor Hart’s Inverse Care Law classically
described the inequity in medical service
access in South Wales. From his primary
care perspective, the availability of
good medical care varied inversely with
the need and the population served.
Insulin in general practice - Barriers and enablers for timely initiation
John Furler, Ondine Spitzer, Doris Young, James Best
Insulin is effective at lowering blood
glucose, and most people with type 2
diabetes need insulin within 10 years of
diagnosis. However, initiating insulin is
often delayed in general practice. This
study explores barriers and enablers to
insulin initiation in general practice.
Data extraction and feedback - does this lead to change in patient care?
Peter Schattner, Mary Saunders, Leslie Stanger, Michele Speak, Kate Russo
Computers enable general practitioners
to collate clinical data within their
practices. The improvements that this
can make to clinical care remain the
subject of enquiry.
Understanding insurance - the GP's professional and ethical responsibilities
Isaac Seidl
General practitioners will often consult with patients in situations where
professional skill is required to support a decision regarding insurance.
Designing practices - using evidence to do better
Ian Watts, Brendan Jones
The physical layout of general practices has generally been overlooked
in research on safety in the health system. This article provides an
overview of the evidence that is available on physical design, and the
implications of this research for general practice.
Heatwaves and the elderly - The role of the GP in reducing morbidity
Leigh Wilson, Deborah Black, Craig Veitch
Heatwaves are increasing in frequency, intensity and duration, and
are associated with an increase in mortality and morbidity, particularly
in the very young and the very old. Concurrently, the Australian
population is aging, with the prediction that by 2036 approximately
27% of Australians will be aged over 65 years.
Book reviews
Books reviewed this month are Ruminations on Aboriginal health by Jonathan Hunt and Toxicology Handbook, second edition by Lindsay Murray, Frank Daly, Mark Little and Mike Cadogan
Clinical challenge
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 multiple choice questions of the RACGP Fellowship exam. The quiz is endorsed by the RACGP Quality Improvement and Continuing Professional Development Program and has been allocated 4 Category 2 points per issue.