The guts of it

December 2009

AFP Cover 2009 December

The guts of it

December 2009 Vol 38 (12) 945-1010

The theme for the December issue of AFP is The guts of it. This month's articles include GORD, Update in inflammatory bowel disease, IBS or intolerance?, Irritable bowel syndrome – the role of complementary medicines in treatment & Laparoscopic adjustable gastric banding – effects, side effects and challenges

Focus

Laparoscopic adjustable gastric banding - Effects, side effects and challenges

Wendy Brown, Anna Korin, Paul Burton, Paul E O'Brien

Irritable bowel syndrome

The role of complementary medicines in treatment

Marie Pirotta

IBS or intolerance?

Terry Bolin

Update in inflammatory bowel disease

Graham Morrison, Belinda Headon, Peter R Gibson

Up front

Letters to the editor

The guts of it

Rachel Lee

Clinical

Abnormal Pap tests after the HP V vaccine

Stella Heley, Julia Brotherton

Influencing behaviour change in general practice

Part 2 – motivational interviewing approaches

Moira G Sim, Toni Wain, Eric Khong

The role of micronutrients in pregnancy

Chi Eung Danforn Lim, Ming Fong Yii, Lisa N C Cheng, Yui Kwan Maria Chow

Research

Are general practice networks ‘ready’ for clinical data management?

Jill Kelly, Peter Schattner, Jane Sims

Detecting breast cancer in a general practice

Like finding needles in a haystack?

Andrew Beattie

GORD

Graeme C Miller, Janice Charles

GP interest in teaching junior doctors

Does practice location, size and infrastructure matter?

Jennifer Thomson, Belinda Allan, Katrina Anderson

Professional

General practice

The ‘ground central’ of rural health care

Peter Rischbieth

Viewpoint

Connecting care for life

Justin Beilby

Back pages

Book reviews

Clinical challenge

Rachel Lee

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AFP Podcasts

Interviews December 2009

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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