Infections that last

August 2009

AFP Cover 2009 August

Infections that last

August 2009 Vol 38 (8) 561-656

The theme for the August issue of AFP is Infections that last. This month's articles include Management of HIV/AIDS, Long term management of people with HIV, What's new in TB?, Ross River Virus, Influenza A (H1N1 09) - public health lessons and questions, Pandemic lessons and Preventing the psychosocial risks of hearing loss

Focus

Long term management of people with HIV

Justin T Denholm, Michelle K Yong, Julian H Elliott

Ross River virus

Bridget Barber, Justin T Denholm, Denis Spelman

Up front

Influenza A (H1N1 09)

Public health lessons and questions

Louis Irving, Alan Hampson

Letters to the editor

Clinical

Management of HIV/AIDS

Salma Fahridin, Graeme C Miller

Motherhood and mental illness

Part 1 – toward a general understanding

Jacqueline Frayne, Thinh Nguyen, Suzanna Allen, Jonathan Rampono

Meeting nutritional needs on a vegetarian diet

Kate Marsh, Carol Zeuschner, Angela Saunders, Michelle Reid

Preventing the psychosocial risks of hearing loss

William Noble

Research

Dementia – who cares?

A comparison of community needs and primary care services

Fiona Millard, Bernhard Baune

Diabetic retinopathy screening in general practice

A pilot study

Deborah A Askew, Philip J Schluter, Geoffrey Spurling, Clare M Maher, Peter Cranstoun, Craig Kennedy, Claire Jackson

GP management of erectile dysfunction

The impact of clinical audit and guidelines

Catherine N Kirby, Leon Piterman, Caroline Giles

Professional

Drug and herb interactions

Searching the web

Felix W S Wong, Linda Lin, Chi Eung Danforn Lim

Health promotion in Australian general practice

A gap in GP training

Amit Achhra

Impact of home based long term care on informal carers

Geetha Ranmuthugala, Binod Nepal, Laurie Brown, Richard Percival

Medical assistants

A primary care workforce solution?

Abbe Anderson, Judith G Proudfoot, Mark F Harris

What’s new in TB?

Anna Ralph, Vicki Krause, Paul Kelly

Viewpoint

Pandemic lessons

Nicholas Collins

Back pages

Book reviews

Clinical challenge

Rachel Lee

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AFP Podcasts

Interviews August 2009

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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