Australian Journal of General Practice最新文献

Background: Concussion, or mild uncomplicated traumatic brain injury (mTBI), is a common condition that can occur in sports, motor vehicle accidents, falls, assaults/violence and occupational settings. While symptom resolution is usually expected within 2-4 weeks, a minority of patients (up to 30%) experience persistent post-concussion symptoms (PPCS) that impact cognitive, physical and emotional functioning. These prolonged symptoms can interfere with a patient's ability to return to school or work, creating uncertainty for patients, employers and treating practitioners.

Objective: This article provides an evidence-based clinical approach to supporting return to learning and return to work in patients with PPCS, with a focus on the general practice setting.

Discussion: The general practitioner (GP) has a key role in recognising PPCS, educating patients/families, facilitating a stepwise return to cognitive and vocational activity and coordinating multidisciplinary care. This article outlines current return-to-study and return-to-work recommendations, age- and context-specific considerations, guidance on certification, communication with schools and employers and criteria for specialist referral. A biopsychosocial model is emphasised, recognising the interplay between physical symptoms, psychological responses and environmental demands in recovery from concussion.

Background: Harmful alcohol consumption is a common presentation in primary care. Naltrexone is a safe and effective treatment for alcohol use disorder (AUD) that remains underused because of prescriber unfamiliarity, inconsistencies in guidelines, stigma and historical safety considerations.

Objective: This article reviews recent key research to assist naltrexone prescribing, including prescribing for patients with liver disease.

Discussion: Naltrexone is prescribed for fewer than 3% of patients with AUD in Australia, including patients with alcohol-related liver disease who access tertiary care and for whom treatment can be lifesaving. Evidence indicates that naltrexone is safe for patients with severe alcohol-associated cirrhosis. Naltrexone's safety in patients with severe acute hepatitis or acute-on-chronic liver failure remains unknown; however, naltrexone's ability to reduce alcohol consumption may outweigh any risks. Prescribers can align treatment with the patient's goal: naltrexone can be initiated with or without prior alcohol withdrawal, and targeted (non-daily) dosing is suitable for some patients.

Background: Mild traumatic brain injury (mTBI), or concussion, is common in the adult civilian population and is associated with an array of physical, cognitive and affective symptoms. Many individuals recover from these symptoms rapidly and experience a full return to pre-injury work/study and broader life demands. The proportion of individuals who continue to report elevations in symptoms more than 3 months after injury is substantial, however.  OBJECTIVE: This paper aims to provide clinically relevant, evidence-based advice for general practitioners who are treating patients with post-concussion symptoms (PCS).

Discussion: Recommendations are provided to assist with management and treatment of the cognitive, psychological distress, fatigue and sleep disturbance aspects of PCS, as well as considerations relating to returning to work.

Background: Since Australia's Therapeutic Goods Administration down-scheduled two psychedelic medicines from July 2023, psychotherapeutic treatment using these medicines has become available in the private sector, making it possible for general practitioners (GPs) to refer their patients with treatment-resistant depression or post-traumatic stress disorder (PTSD). Several other psychedelic medicines are also legally in use as off-label or unapproved medicines.

Objective: The aim of this article is to help GPs make sense of this new type of treatment by discussing the Australian context, with focus on what a GP can expect for their patient and the GP's potential role.

Discussion: Psychedelic medication, when used to facilitate a psychotherapy process, can provide a very different and powerful way to allow patients to access emotions, thoughts, beliefs and traumatic memories that may otherwise remain subconscious or hard to access. This treatment is currently available privately in Australia for patients with treatment-resistant PTSD and depression. Meta-analyses of clinical trial results to date have shown some substantial effect sizes. Such trials continue to clarify and expand indications, efficacy and safety, as not everyone is suited to, safe for or will respond to psychedelic treatment.

Background: About 30% of people who experience a concussion have longer-lasting symptoms and complex care requirements. The new Australian and New Zealand clinical practice guidelines for the management of concussion, mild traumatic brain injury and persisting concussion symptoms provide guidance for their management, which often requires the involvement of multiple disciplines in a collaborative approach - the multidisciplinary concussion team.

Objective: The aim of this article is to review the characteristics of people with concussion who may need multidisciplinary concussion care and current service models.

Discussion: Across Australia, publicly funded concussion services are few, and models of care vary depending on funding time and availability of expertise. Given their knowledge of the patient's premorbid and social background, the general practitioner often plays a large part in diagnosis, referral and care coordination, especially in complex cases such as those with repeated concussions, vestibular or cervical dysfunction, severe pain and/or psychological concerns.

Background and objectives: Voluntary assisted dying (VAD) is lawful in all Australian states, and doctors are an integral part of the VAD process. There are limited reports so far on general practitioners' (GPs') experiences with VAD. This study explores GPs' perspectives on the first year of VAD in Queensland and any factors that influence choices on whether to participate in VAD.

Method: This was a qualitative interview study of 12 GPs with no in-principle objection to VAD, undertaken 1 year after VAD became available in Queensland.  RESULTS: Thematic analysis identified four themes: nature of GPs' participation, various factors influencing participation, experience of GPs with VAD provision and the ongoing needs of GPs.

Discussion: This study highlights how GPs are well suited to VAD provision with their generalist approach to care. However, there are ongoing structural and logistical barriers to GP participation, including the need for appropriate remuneration and further education on VAD to support GP knowledge.