Australian Journal of General Practice最新文献

Background and objectives: General practitioners' (GPs) specialised qualifications and upskilling in medical roles strengthen healthcare systems and improve patient outcomes. This study aimed to describe additional qualifications attained, or being undertaken, by early career GPs and establish associations of obtaining/undertaking postgraduate and post-Fellowship qualifications.

Method: This was a questionnaire-based, cross-sectional study of early career college-Fellowed GPs in NSW/ACT, Tasmania and Eastern Victoria (New alumni Experiences of Training and independent Unsupervised Practice [NEXT-UP] study). Univariable and multivariable logistic regression analyses estimated associations of additional postgraduate/post-Fellowship qualification attainment with personal factors and factors related to their current practice and to their vocational training experience.

Results: Of 339 participants, 43% reported having obtained postgraduate, medically related qualifications, 23% had obtained or were undertaking post-Fellowship qualifications and 35% reported no additional qualifications. There was a strong negative association of additional qualifications with having dependent children (odds ratios 0.76 and 0.63 for postgraduate and post-Fellowship qualifications, respectively).

Discussion: Most early career GPs obtained or were pursuing postgraduate/post-Fellowship qualifications. A barrier to obtaining postgraduate or post-Fellowship qualifications might be having dependent children.

Background: Breathlessness is a subjective experience of breathing discomfort and is one of the most common symptoms in patients receiving palliative care.

Objective: This paper reviews the palliative management of breathlessness.

Discussion: Current management guidelines for the palliative management of breathlessness recommend treatment of reversible causes followed by non-pharmacological interventions such as breathing exercises, use of mobility aids, fans and focused psychological strategies. For those not responding, opioids might be considered with a reasonable starting dose being immediate release oral morphine 1-2.5 mg hourly as required (prn). Benzodiazepines, such as lorazepam 0.5 mg every 3-4 hours prn, might be used for the treatment of breathlessness-associated anxiety but do not a have role in the management of breathlessness per se. Systemic corticosteroids have limited evidence but can be considered in some cases. The use of home oxygen in patients who are non‑hypoxic lacks evidence but might be used after consideration of patient preferences. Patients might benefit from a breathlessness management plan.

Background: Patients with advanced cancer often have type 2 diabetes mellitus (T2DM) and are on multiple medications that affect glycaemic control. Patients can have pre‑existing diabetes or treatment- and glucocorticoid-induced hyperglycaemia. Optimal management of glycaemic control differs at varying stages of life and depends on overall goals of care.

Objective: This article summarises the evidence-based management of T2DM in patients with advanced cancer, including management of glucocorticoid-induced hyperglycaemia, and appropriate targets for glycated haemoglobin (HbA1c).

Discussion: T2DM often co-exists in patients with advanced cancer. Management is aimed at reducing the complications of hyperglycaemia and hypoglycaemia, and maximising quality of life. Interventions and treatments need to be balanced against quality of life and prognosis.

Background: This paper presents a collection of important topics that are not related to the other Focus papers in this AJGP issue on palliative care but are nevertheless important for clinical practice.

Objective: This article reviews the safe use of fentanyl, the proper use of buprenorphine and oxycodone-naloxone, and the potential pitfalls of equianalgesic tables.

Discussion: Sublingual and transdermal fentanyl are contraindicated in patients who are opioid-naïve. Opioid-naïve has a strict definition. Buprenorphine does not reduce the efficacy of other analgesics. Equianalgesic tables should not be followed blindly - they have many shortcomings, even if they are the best guidance we have. The benefit of combined oxycodone-naloxone products is modest in patients receiving palliative care in whom there is a higher risk of therapeutic failure and adverse effects. In summary, these are clinical topics that frequently arise when specialist input is sought but are not directly addressed in most clinical articles.