Welcome to the April edition of Being specific.
This edition has an obesity management focus as RACGP Specific Interests Obesity Management Chair, Dr Georgia Rigas, and her colleagues prepare to deliver the 2018 webinar series. Thanks go out to Prof Paul O’Brien for reporting his research on twenty years of delivering laparoscopic adjustable gastric band (lap-band) surgery and Dr Adrian Sartoretto for his article on endoscopic sleeve gastroplasty (ESG).
The RACGP Specific Interests Board held a face-to-face meeting and workshop on 19 March 2018 in Melbourne. Twenty-one members attended to review progress at RACGP Specific Interests and discuss its future directions, plus it gave the opportunity for many of us to meet for the first time.
GP18 is not far away – registrations are opening on 1 May 2018.
RACGP Specific Interests will have a strong presence at the conference. There will be a combined ALM presentation from Disability and Child and Young Persons Health on developmental disability, and an ALM from Sexual Health Medicine on sexually transmitted infections and the new cervical screening protocols.
Many of our other groups and members are currently preparing presentations and workshops, including Cancer and Palliative Care and Integrative Medicine. I will provide program updates as they develop.
Have a great and productive month.
You may find that patients with obesity either know a lot about their treatment options or, alternatively, know very little and appear surprised when you mention how their weight affects their health.
This series of webinars aims at assisting GPs in facilitating conversation on the issue of a patient’s weight and the effect that excessive weight has on patient wellbeing in a sensitive and non-judgemental manner.
These webinars will provide the tools that will assist in identifying which patients with obesity are high risk and require referral to an appropriate service.
The webinars will be held on the following Thursdays at 7.00–9.00 pm: 3 May – The role of psychology in obesity management (sold out – email to go on the wait list) 17 May – Why is losing weight sometimes so difficult and maintaining weight loss even harder? Is there a role for pharmacotherapy? 31 May – Bariatric endoscopic procedures and metabolic surgery 14 June – Nutritional needs of patients with obesity, post-metabolic surgery. How can the GP and dietitian implement very low energy diet (VLED) use? 21 June – Management of women with obesity who are planning to be, or are currently, pregnant.
The webinars are free to RACGP members. You can register through the RACGP Specific Interests events page.
Dr Adrian Sartoretto writes on endoscopic sleeve gastroplasty (ESG). Dr Sartoretto is a Gastroenterologist, Hepatologist and Bariatric Endoscopist with the Bariatric and Metabolic Institute (BMI), Sydney. He will be contributing to the RACGP Specific Interests Obesity Management webinar series on endoscopic bariatric techniques on Thursday 31 May 2018.
Australia, like other parts of the world, is coming to grips with a crisis in healthcare that has been evolving over the last 30 years. In 2014, the last time an accurate snapshot was taken, almost two-thirds of Australians had a BMI over 25, and 28% of Australians were identified as affected by obesity. Thanks in part to the public health measures that have reduced smoking rates to one of the lowest in the world, things have now progressed to the point where by many measures, overweight is a larger contributor to burden of disease in Australia than smoking.
Unfortunately, owing to the many physiologic mechanisms designed to defend weight, lifestyle intervention alone produces surprisingly lacklustre results: most well-designed studies suggest an average total weight loss (TWL) of 5% or so of baseline weight. With the addition of even the most effective pharmacotherapies, the average weight loss only increases to 10%. Conventional surgical interventions for obesity are far more effective – laparoscopic sleeve gastrectomy (LSG) results in an average 25% TWL – but are limited in their application and reach by poor patient acceptance and relatively high requirements for healthcare resources. In this context, endoscopic techniques are emerging as appealing and effective therapies in the management of overweight and obesity.
Endoscopic bariatric therapies (EBTs) represent a growing group of minimally invasive techniques to supress appetite and enhance satiety to achieve clinically significant weight loss. Average weight loss with currently available techniques can range from 12–20% TWL and are generally performed as day surgery cases.
The technique creating the most interest at present is the ESG. Developed in 2013 at the Mayo Clinic, this technique employs the use of an endoscopic suturing device to reduce gastric capacity by approximately 70%. This technique can be safely performed on an outpatient basis and recovery is remarkably swift. Most patients overcome symptoms in less than three days and most are able to return to work within a week. Major complications are uncommon, typically occurring at a rate of less than one per cent and are usually able to be managed conservatively. Contraindications include obligate anticoagulation, pre-malignant conditions of the stomach or family history of gastric malignancy.
Published weight loss results from multiple centres around the world, including BMI Sydney, show an average weight loss of approximately 20%, and at this early stage, the results appear durable. As with all endoscopic techniques, however, results are highly dependent on adjuvant lifestyle intervention, and should be accompanied by a comprehensive program addressing diet, behaviour and exercise.
This technique, along with existing and emerging endoscopic techniques, represents a major advance in our ability to provide safe, tailored and effective bariatric therapy in a manner that patients accept.
The Centre of Bariatric Surgery (CBS) team in Melbourne, led by Prof Paul O’Brien, has recently released the 20-year follow-up data on lap-band patients to show long-term outcomes. The data contrast strongly with the flow of negative comments that have become widespread among the medical and lay community, particularly on social media websites. With over 8500 patients treated, the data demonstrates that the band patient excess weight loss of around 50% is being maintained to 20 years.
In addition, re-operation rates are no different from sleeve gastrectomy or gastric bypass.
Explaining the difference in outcomes from community sentiment, Prof O’Brien points to two key influences. First, there has been a major growth of our understanding of optimal lap-band patient care in recent years.
Much of this has come from the research centre he established at Monash University – many surgeons have not yet picked this up.
The second factor is recognition of the critical importance of a strong aftercare program. At CBS, the physicians maintain an active involvement with their patients in a partnership that facilitates substantial and durable weight loss safely.
This study provides the longest follow up available for any weight loss surgical procedure and will be published in a peer-reviewed journal in the next few months.
Success is not just measured by the number of kilos that patients lose. Success is also about what patients gain, such as the ability to participate in activities, enjoy family and friends, and enhanced health and confidence.
As one of Prof O’Brien’s patients who lost 50 kgs, Melissa (pictured) said, ‘My weight loss has had a huge impact on my life. I turned from a mum that slept all day to the mum that was getting everybody out of bed saying, “Let's go to the beach! Let's go and play netball, let's do this!” I was really active and involved in my children's lives and became a netball coach. I returned to the workforce after being out of work. I really believe that I wouldn't have had the confidence to be able to go back into the workforce, especially the industry that I am in that is beauty-based, without having lost the weight that I did.’
For more information on CBS’ research and experiences with lap-band, please contact Prof O’Brien’s practice.
Nestlé Healthcare Nutrition presents one-day workshops around Australia and New Zealand for GPs to become accredited OPTIFAST® VLCD™ healthcare professionals.
The workshop includes:
Visit the OPTIFAST® VLCD™ website for dates and venues or register now.
Earlier this month, the RACGP supported Healthy Futures – an organisation of health professionals, students and community members taking action to address climate change and related threats to health.
Healthy Futures made a submission to EPA Victoria to make the setting of annual toxic emission limits a condition for the relicensing of Victoria’s brown coal-fired power stations.
Dr Janie Maxwell, Chair of RACGP Specific Interests Environmental Impacts in General Practice, considered the content and context of the submission, and recommended that the RACGP support this grass roots campaign.
Dr Maxwell (far left) is pictured presenting the letter to EPA Victoria Chief Executive Officer, Nial Finegan (far right).
Friday and Saturday 15–16 June 2018
This two-day conference is designed to highlight current issues facing female GPs in general practice. In addition to the educational component, delegates and sponsors will have the opportunity to network, relax and socialise with peers and colleagues at the cocktail event on Friday evening.
Consisting of an ALM presented by the RACGP Specific Interests Sexual Health Medicine Network (SHMN), and a variety of sessions presented by the RACGP Victoria Women in General Practice Committee (WiGP), this conference provides participants with a range of practical, evidence-based topics.
Participants will advance their clinical skills and confidence in a range of procedures and interventions relevant to sexual and reproductive health. Business sessions will equip attendees with the knowledge and personal skills to build their practices.
Visit the RACGP website for more information, including accommodation options or to register online.
Save the date – Sunday 8 July 2018
Developed jointly by RACGP Specific Interests Disability and Child and Young Person’s Health, this ALM focuses on dealing effectively with health vulnerabilities of individuals with developmental disability within the general practice and community settings.
Discussion will highlight the importance of both diagnostic accuracy and the need to assess functional strengths and weaknesses. The ALM will provide ready access to information relevant to their patients with developmental disability.
The ALM will be held on Sunday 8 July at the RACGP NSW&ACT office in Sydney. Please email RACGP Specific Interests to register your interest.
Applications are now open for the 2019 Australian General Practice Training (AGPT) Program with the RACGP.
The AGPT program is the leading program for doctors wishing to pursue the specialty of general practice. Doctors interested in the program can apply through the RACGP website.
If you have previously registered with AGPT, please log in to your account.
Applications close at 10.00 am AEST, Monday 30 April.
Visit the RACGP website for further information or apply now.
The RACGP has released Information security in general practice after an open consultation with members, the broader general practice community and industry. The resource reflects the changing technology environment, new security risks and threats, and supports general practice in meeting legal and professional obligations for information security.
Information security involves:
The resource details and recommends essential business practice, policies and procedures to protect general practice information systems. It is not designed to be a technical document, but as an educational and training resource for GPs and practice teams.
The RACGP has released a new guide that aims to assist GPs in the fields of genetics and genomics.
Advances in genetics and genomics offer great potential for identifying patients at risk of disease and targeting treatment; GPs need up-to-date knowledge and skills in this domain.
Genomics in general practice is designed to assist in clinical decision-making by presenting a snapshot view of the identification and diagnosis of a range of genetic conditions, and the use of genetic testing and technologies encountered in general practice.
This guide will assist GPs with providing information on genetics and genomics to patients and their families, and refer to specialist services as required.
Genomics in general practice is primarily intended for use by GPs and other primary care staff. Although it was not designed for use by patients and consumers, this resource does contain some information for that audience.
Genomics in general practice is now available on the RACGP website.
Would you like to earn an additional Fellowship with RACGP?
The Fellowship in Advanced Rural General Practice (FARGP) is a qualification awarded by the RACGP in addition to the vocational Fellowship (FRACGP). For practising GPs, it is recognition of the additional training undertaken to develop advanced general practice skills specific to rural and remote communities.
The FARGP has designated pathways for both registrars and practising GPs. For practising GPs the process is quite simple – the FARGP is completed via recognition of prior learning where you provide evidence of your knowledge, skills and experience that match the requirements for the FARGP. The FARGP is completed online through gplearning.
Call 1800 636 764, email firstname.lastname@example.org or read more for further information.
To continue providing you with membership services that are right for you, we need to know if your circumstances have changed – you may be working less hours, working overseas or taking time away from your practice to start a family.
Additionally, you may have recently changed your preferred address, mobile or email. By updating your details, you will receive timely and relevant information that applies to you.
Login to My account to update your details today.
Up to half a million dollars in research grant funding is available to GPs and general practice registrars through the 2018 RACGP Foundation general practice research grants and awards. RACGP Foundation is committed to continuous improvement in all areas of general practice through original, high-quality research. We support research that can be implemented on the frontline, from researcher to GP to patient. Grant details are available on the RACGP Foundation website.
Applications close on Monday 7 May.
Saturday and Sunday 5–6 May 2018 – Brisbane
RACGP Queensland's leading annual general practice conference is celebrating 60 years. Clinical Update offers two days of relevant and informative clinical information and networking opportunities.
The program includes two self-record ALMs in dermatology and paediatrics. Other topics on the program include domestic violence, medicinal cannabis, diabetes management and illicit drug addiction.
RACGP members are invited to submit nominations for the 2018 RACGP Awards. If you know a worthy candidate, please consider nominating them today.
Nominations close on Friday 18 May 2018.
Awards are offered in state and national categories. National winners will be announced at GP18.
The 7th Annual National Health and Medical Research Council (NHMRC) Symposium on Research Translation will be held at the University of Sydney in November. This year, the NHMRC will be partnering with Reward Alliance, an international network of funders, editors, researchers and other stakeholders with a shared interest in ensuring value in health and medical research.
The symposium is for anyone with an interest in ensuring that research contributes to knowledge and improved health outcomes in the most effective and efficient way. Symposium participants will also have the opportunity to network with, learn from, and establish collaborations with others committed to ensuring value in research.
Abstracts for 15-minute oral presentations and posters are now sought in the following categories:
Abstracts can be submitted online until Friday 11 May 2018.
The Second Australasian Fetal Alcohol Spectrum Disorder Conference (FASD2018) will be held in Perth on 21–22 November 2018. The conference theme is based around the theme, ‘FASD our science, our stories.’
The conference aims to:
The organising committee is seeking abstracts for 20-minute oral presentations, 60-minute workshops, five-minute ‘short and sharp’ oral presentations and posters on one or more of the following themes:
Abstracts can be submitted online until Friday 11 May 2018.
*Inclusion does not imply RACGP endorsement
Disclaimer: Every care is taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or inaccuracies contained therein or for the consequences of any action taken by any person as a result of anything contained in this publication. The content of any advertising or promotional material contained within or mailed with the RACGP Specific Interests newsletter is not necessarily endorsed by the publisher.