Evolution of general practice

Latest Issue: 2016

Podcasts

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December

Breast cancer diagnosis

Dr Andrew Beattie is a GP in Coffs Harbour who decided to look back at the diagnosis of breast cancer over 20 years in his practice. He discusses why he did this and what he found

Duration: 14 minutes 21 seconds
File size: 3MB

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The laparoscopic adjustable gastric band (LAGB) for obesity

Wendy Brown discusses the LAGB procedure and the importance of follow up and a multidisciplinary approach to achieve sustained weight loss and manage problems and complications. Sustained weight loss and improved quality of life following a LAGB procedure depends on a multidisciplinary team (including surgeon, GP, nurse, dietician and psychologist) to meet patient needs of band adjustments, ongoing education about food choices and exercise, monitoring for nutritional and device complications and coping with psychological issues. Roles for the GP in the team include monitoring for ‘alert symptoms’ of volume reflux, nocturnal aspiration, regular regurgitation or vomiting which may indicate a complication; reinforce healthy eating and exercise messages; and adjusting the doses of antihypertensive and diabetic medications as weight loss occurs. When the amount of fluid in the band is optimal the patient feels satisfied with 2-3 small meals per day of solid food with weight loss of about 0.5-1kg per week and does not experience adverse symptoms.

Duration: 23 minutes 38 seconds
File size: 5MB

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IBS or intolerance?

Prof Terry Bolin talks about the relationship between food and irritable bowel symptoms. Prof Bolin highlights that many of the symptoms of IBS are exacerbated by foods and that dietary review has an important role in managing IBS. Prof Bolin describes the effects of different carbohydrates such as lactose and fructose and emphasizes that symptoms are more common with excessive consumption. This podcast and the article provide information to the GP about how to assess and treat dietary components to IBS.

Duration: 9 minutes 37 seconds
File size: 2MB

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PAP testing in the post HPV vaccine era

Dr Stella Heley talks about the ongoing need for routine PAP screeing in young women, despite the good overall takeup of the quadrivalent HPV vaccine in this cohort. The free 'catch up' HPV vaccination program for women under 27 in Australian ended on 31/12/2009. Despite the good uptake of this vaccination program, this cohort of women will continue to require PAP test screening as per the routine schedule and we will continue to see a substantial number of these women with both high and low grade changes on their PAP smears. Many of these women will have been already sexually active prior to vaccination and therefore been exposed to HPV. Some may not have completed the course, or missed out on vaccination. Many may be exposed to one of the oncogenic strains not covered by the vaccination.The ongoing HPV vaccination program for 12-13 year old girls will ultimately lead to decreased abnormalities due to vaccination prior to sexual activity and greater response to vaccination when vaccines are administered at a younger age. When these young women are in their 20s and 30s it is likely that a different cervical screening program and schedule will be appropriate.

Duration: 5 minutes 34 seconds
File size: 1MB

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November

Spider bites

Professor George Braitberg talks about what GPs need to know the assessment and management of spider bites. He discusses problems with spider identification, the importance of toxindrome recognition and the controversy surrounding necrotizing arachnidism in Australia. In addition, he describes the clinical effects and treatment of redback and funnelweb spider envenomation.

Duration: 17 minutes 53 seconds
File size: 4MB

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Animal bites

Dr Claire Dendle talks about what GPs need to know the assessment and management of mammalian bites. In the setting of a mammalian bite, history and examination is directed at assessing whether the bite has damaged underlying structures or is at high risk of infection. Treatment of mammalian bites involves cleaning and irrigation and a decision about the use of antibiotics. Primary wound closure is usually only recommended in selected wounds where cosmesis is an issue. Patients should be provided with detailed instructions and reviewed after 24-48 hours. GPs have an important role in secondary prevention of animal bites.

Duration: 21 minutes 28 seconds
File size: 5MB

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Dengue

Dr Danille Esler talks about what GPs need to know about the clinical and public health ramifications of Dengue. The epidemiology of Dengue fever has changed in recent years and there has been a recent outbreak of the disease in northern Queensland. GPs can find out about recent outbreaks on the websites of the World Health Organisation, Centers for Disease Control and, in the case of outbreaks in Queensland, Queensland Health. Most commonly, Dengue presents as a debilitating illness lasting 7-10 days. The GP role involves exclusion of other illnesses such as malaria, appropriate diagnostic testing, monitoring for the development of Dengue Haemorrhagic Fever (DHF) and prevention of spread. Dengue is a notifiable disease; if a general practitioner suspects dengue, early notification is vital

Duration: 14 minutes 9 seconds
File size: 3MB

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October

Retinopathy: Screening recommendations

Geoffrey Spurling talks about what GPs need to know about screening patients for retinopathy. Geoffrey highlights that a quarter of Australians with diabetes are not appropriately screened. Geoffrey outlines the factors involved and describes who to screen and how often they require screening. Information about how to screen is also provided to guide GPs. Geoffrey also explains hypertensive retinopathy and points out that although regular monitoring is not recommended there is a role for the GP in management

Duration: 10 minutes 45 seconds
File size: 2MB

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Reducing vision loss in chronic eye disease

Anthony Fong discusses how GPs can help maintain vision for patients with chronic eye disease. Anthony focuses on three common conditions – cataract, age related macular degeneration and glaucoma. He details the common risk factors, presentations and management strategies for each of these important conditions along with valuable information about primary and secondary prevention strategies that the GP can use and educate patients about.

Duration: 18 minutes 44 seconds
File size: 4MB

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September

My hands shake: classification and treatment of tremor

David Williams talks about what GPs need to know about how to assess, investigate and treat patients who present with tremor. In particular, a detailed history and observation is vital to distinguish resting from action tremor and look for other clinical clues to the diagnosis. Investigation should include basic biochemistry in all cases. David discusses the clinical features and management of physiologic, essential, dystonic, parkinsonian, cerebellar, drug induced and psychogenic tremor.

Duration: 31 minutes 8 seconds
File size: 7MB

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August

HIV…chronic disease management

Justin Denholm discusses the current issues in long term management of patients living with HIV. Patients with HIV treated with combination antiviral therapy (cART) now often have rapid and sustained control of HIV viraemia (often to undetectable levels) and a sustained increase in CD4+ T-cell counts. This has resulted in decreased opportunistic infections and increased longevity. Management has therefore shifted more to a chronic disease management model, in which GPs are able to provide an important role. Management focuses on the effects of HIV and its treatment on long term health, the psychosocial impact of living with a chronic disease and the specific issues related to a sexually transmissible infection. Specific issues include psychosocial support, mental health, risk behaviour, assessing and managing increased risk of cardiovascular and metabolic disease, increased risk of malignancy and vaccination against preventable diseases.

Duration: 16 minutes 34 seconds
File size: 4MB

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TB... what's new, what's not?

Dr Anna Ralph discusses whats new in diagnosis and management of the very old disease of TB. Despite lower incidence of TB in Australia compared to other places in the world, TB remains a significant problem in a number of at risk groups including migrants from sub Saharan Africa, India, Vietnam, the Phillipines, China and Indonesia; patients with HIV; and Indigenous Australians. While newer diagnostic tests (interferon gamma release assays) are available, they have some limitations and in Australia sputum microscopic examination and cuture remains the main method of diagnosis in symptomatic individuals. Developments in pharmacotherapy include a metronidazole related antibiotic and agents targeting MTB genes. However, the standard first line treatment remains 6 months of rifampicin, isoniazid plus pyrazinamide and ethambutol for the first 2 months. In Australia, patients with TB are managed in specialty treatment units, the GP has an important roole in avoiding diagnostic delay, infection control, avoiding drug interactions (particularly with rifampicin), nutrition, smoking cessation, psychological support and encouraging adherence to therapy.

Duration: 24 minutes 26 seconds
File size: 6MB

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Dementia - community needs versus primary care services

Dr Fiona Millard discusses research on what patients with dementia and their carers required from primary care providers, and the knowledge, attitudes and beliefs of health providers about dementia. Important themes from patients and carers include the need for timely investigation of symptoms, early and accurate diagnosis, explanation and support in the home. Up to 35% of GPs in the postal survey component said they preferred not to look after patients with dementia and about 15% of primary health providers indicated they thought early diagnosis may be harmful.

Duration: 12 minutes 41 seconds
File size: 3MB

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Medical Assistants… developing a role in primary care

Abbe Anderson discusses the role and training of Medical Assistants in primary care. Medical assistants undertake a variety of administrative, reception and clinical duties in a primary care setting work under the supervision of doctors, nurses or practice managers. A 12 month TAFE course has been developed to train staff for this role. The clinical tasks that can be undertaken by medical assistants include wound dressings; venepuncture; and vision, hearing, height, weight and blood pressure checks. This role potentially provides flexibility of staffing in medical practices, with medical assistants undertaking administrative or clinical duties as required, freeing up nursing time for chronic disease management and more complex tasks. It also formalises and provides specific training for a role many medical receptionists have already partially undertaken in the primary care setting.

Duration: 16 minutes 13 seconds
File size: 4MB

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July

Blistering skin

Dr Belinda Welsh discusses the causes and clinical features of a variety of bullous skin rashes. Belinda discusses distinguishing features such as blister location, presence of mucosal involvement or whether the blisters are tense and intact (indicating dermal blistering) or fragile (indicating superficial blistering). Most presentations to GPs will be the result of infection, topical contact reaction, insect bites or drug reactions. However, if common conditions such as these are excluded, then often histology and immunofluoresence is required for diagnosis. (Belinda discussed the techniques for biopsy for both histology and immunofluorescence). Early referral to a dermatologist is recommended for Immunobullous disorders and serious non immunobullous diosorders such as porphyria cutanea tarda.

Duration: 20 minutes 15 seconds
File size: 5MB

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Skin and systemic disease

Dr Adriene Lee discusses the association between skin problems and systemic disease. Adrienne discusses skin conditions such as generalised pruritis, cutaneous vasculitis and erythema that may be an indicator of an underlying systemic condition; skin conditions that are much more rare but have an association with occult malignancy; and typical skin manifestations of connective tissue disorders.

Duration: 14 minutes 50 seconds
File size: 3MB

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Difficult to diagnose and aggressive BCCs

Dr Steven Tomas discusses the features and management of subtypes of BCCs that have a more aggressive course.‘Infiltrative’ , ‘micronodular’ and ‘morphoeic’ BCCs can infiltrate widely and deeply with relatively little change in the overlying skin surface. Assessing the margins of the lesion histologically can bedifficult increases the chance of incomplete resection and recurrence. Recurrent or residual disease is more difficult to treat, and itself has higher recurrence and incomplete removal rates. These tumours require carefully planned, aggressive treatment to cure.

Duration: 17 minutes 42 seconds
File size: 4MB

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June

Lesbian and bisexual women's sexual health

Dr Ruth McNair talks about what GPs need to know about lesbian and bisexual women's sexual health and the kinds of sexual health issues faced by this group of patients. In particular, it is important that GPs make their practice welcoming to lesbian and bisexual women. This can include providing signs and pamphlets in the waiting room, encouraging reception staff to use inclusive language and taking a non judgemental social and sexual history from patients. Ruth outlines important sexual health messages for lesbian and bisexual women including the need for pap smears and discussion of safer sex.

Duration: 11 minutes 6 seconds
File size: 3MB

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Bacterial Vaginosis: More questions than answers

Dr Catriona Bradshaw talks about what GPs need to know about Bacterial Vaginosis. Bacterial Vaginosis is the most common cause of abnormal discharge in women of reproductive age and yet the precise pathophysiology is contraversial. Research is continuing into the cause of this disease, whether or not it is a sexually transmissible infection (STI) and to establish effective evidence based treatments. BV is diagnosed with the Amsel or Nugent methods and treatment is with oral metronidazole or vaginal clindamycin with the aim to reduce symptoms and/or prevent complications

Duration: 25 minutes 38 seconds
File size: 6MB

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May

Sleep and depression

Professor Michael Berk discusses the relationship between sleep and depression and the clinical implications

Duration: 7 minutes 24 seconds
File size: 2MB

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April

Cancer Screening – pros, cons, choice, and the patient

Dr Lyndal Trevena discusses some of the principles and controversies in cancer screening.

Duration: 10 minutes 15 seconds
File size: 2MB

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Bowel cancer screening – a role for general practice

Dr Linda Foreman talks about the bowel cancer screening, including the National Bowel Cancer Screening Program. She discusses the role of the GP in the program and also reminds us to consider patients who may not be in the program.

Duration: 22 minutes 2 seconds
File size: 2MB

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Heart health: CHD management gaps in general practice

Dr Nancy Huang, National Manager – Clinical Programs, Heart Foundation, talks about the article “Heart health: CHD management gaps in general practice.” She discusses the concept of assessing absolute risk for all people over 45 years of age, and also the 3 key management gaps identified in CHD management relevant to general practice.

Duration: 22 minutes 2 seconds
File size: 3MB

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March

Post traumatic stress syndrome

David Forbes discusses the assessment and management of post traumatic stress syndrome (in particular the role of trauma focussed psychological therapy). GPs can assist patients who have experienced trauma within the past 2 weeks by providing psychological first aid, and monitoring and assessment for the development of acute stress disorder and symptoms of PTSD. Trauma focused psychological treatment is the first line of treatment for PTSD, and in this interview David Forbes outlines what is involved in this specialised form of cognitive behavioural therapy.

Duration: 21 minutes 11 seconds
File size: 5MB

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The newly single man

Darren Russell discusses health issues of the newly single man with Dr Jenni Parsons. For men who are newly single there are a range of health issues that may arise including sexual health, alcohol and drug use, stress and mood disorders.

Duration: 14 minutes 43 seconds
File size: 3MB

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Men and depression

Kay Wilhelm discusses the differences in presentations of depression between men and women. Men often display irritability and withdrawal in response to depression and are less likely than women to talk about their depression or how they feel.

Duration: 15 minutes 52 seconds
File size: 4MB

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January/February

Overcoming communication barriers-working with patients with intellectual disabilities

Jane Tracy, discusses successful communication in consultations with patients with intellectual disabilities. Jane discusses the range of verbal and non verbal communication that is used by patients with intellectual disabilities, including augmentative and alternative communication (AACT) systems.

Duration: 21 minutes 32 seconds
File size: 5MB

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Compounded medicines and ‘off label’ prescribing- a case for more guidance

Romano Fois discusses benefits and risks of compounded medicines. There has been an increase in the prescribing and dispensing of individualised pharmacotherapy in the form of compounded medicines in recent years.

Duration: 19 minutes 35 seconds
File size: 4MB

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HPV vaccination catch up program- utilisation by young Australian women

Edith Weisberg discusses research into young women’s attitudes to and uptake of HPV vaccination. Two hundred and ninety-four women aged 15–26 years attending Family Planning NSW clinics completed the a questionnaire.

Duration: 11 minutes 1 seconds
File size: 3MB

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