Australian Journal of General Practice最新文献

Background and objectives: This study comprehensively reviews the contemporary empirical literature on direct-to-consumer (DTC) telemedicine services within primary care.

Method: MEDLINE, Embase and SCOPUS were strategically searched and screened. Data on the modality of consultations, population of focus, condition of focus and treatment of focus were extracted, narratively synthesised and tabulated.

Results: Forty-four articles were included in this review. Most used quantitative methods, with predominantly cross-sectional or retrospective cohort designs. DTC telemedicine user characteristics and perspectives were most researched, followed by quality and safety. Most services used video or text messaging. Articles typically examined a specific health condition (eg acute respiratory infections) and its treatment, and several focused on a specific population (eg men).

Discussion: In light of the poor evidence base and lack of rigorous studies, there is a critical need for more robust research on DTC telemedicine within primary care. Quality assessment tool development and health economics analyses are necessary to support the integratation of DTC telemedicine services with traditional primary care systems and improve primary healthcare quality and efficiency.

Background: Genital skin conditions are rare and pose a diagnostic challenge due to their diverse pathology. Patient anxiety and referral decisions add complexity for primary caregivers. Demographics and overlapping symptoms complicate diagnosis, causing anxiety for both patients and clinicians. Social stigma and apprehension to seek healthcare might delay treatment. Accurate differentiation between benign and potentially serious conditions is crucial.

Objective: We aim to provide clinicians with a clear and concise framework to assist them in risk stratification, treatment decisions and referral pathways for common genital skin conditions.

Discussion: Differentiating normal variations is crucial to minimise unnecessary investigations and alleviate patient anxiety. Circumcision status, pigmentation and genetics influence disease presentation. We highlight benign conditions for reassurance. Inflammatory genital lesions might arise from various causes. Biopsies remain essential for accurately diagnosing uncertain cases. Sexually transmitted infections (STIs) should be promptly diagnosed and treated. Neoplastic conditions can evolve rapidly, requiring an urgent specialist referral.

Background: Miscarriage is a common and distressing event that impacts women's physical and psychological wellbeing. Determining the appropriate time for a subsequent pregnancy and providing holistic care are essential for affected individuals.

Objective: This article aims to address the question of when it is deemed safe to attempt conception after a miscarriage and discuss strategies to promote a healthy pregnancy, considering inter-pregnancy intervals, psychological implications and medical management.

Discussion: Current evidence suggests that delaying conception does not yield any tangible benefits, and conception immediately after a miscarriage is safe. Psychological support, screening for depression and access to mental health services are crucial for comprehensive care. Medical considerations, including addressing modifiable risk factors and preconception counselling, play a vital role in reducing the risk of future miscarriages. A multidisciplinary and patient-centred approach is essential for holistic care and improving overall outcomes.

Background and objectives: Management of skin cancer comprises a substantial proportion of general practitioner (GP) workload in Australia. Flap and graft procedures below the knee have an increased risk of infection. Antibiotic resistance is a threat to global health, and any decision about antibiotic prophylaxis must balance adverse outcomes of antibiotic use with patient morbidity. This study will investigate the effectiveness of two interventions to prevent surgical site infection (SSI) after below-knee surgery: (1) 450 mg of clindamycin preoperatively and postoperatively; and (2) preoperative chlorhexidine wash and nasal mupirocin.

Method: This prospective randomised controlled trial will be conducted across three skin cancer clinics over nine months, with 155 participants. Consecutive patients presenting for below-knee flap and graft procedures will be eligible to participate. The primary outcome is superficial SSI in the first 30 days following excision. Secondary outcomes include adverse effects (anaphylaxis, skin irritation and foreign body reaction) and patterns of antibiotic resistance.

Results: As this is a study protocol paper, there are no results available to present.

Discussion: As this is a study protocol paper, there are no results to be discussed.

Background: Parotid gland masses form part of a heterogenous subset of head and neck pathology. Surgery for both benign and malignant disease is relatively common in Australia and is associated with a diversity of idiosyncratic postoperative phenomena that might represent a challenge to identify and navigate in the primary care setting.

Objective: The aim of this paper is to provide the primary care physician with a useful guide for the assessment, evaluation and initial management of common and not-to-be-missed clinical presentations post parotid surgery, and a framework for appropriate escalation and referral.

Discussion: Primary care can be a valuable setting for the identification and initial management of common complaints post parotid surgery and providing patient access to escalation and onward referral where necessary. Ambiguous, unresolving or worsening presentations should be referred to the treating (or local) surgeon or department.

Background: Recommencement of oral anticoagulation (OAC) for patients post-intracerebral haemorrhage (ICH) remains a challenging decision for clinicians. High-quality evidence to assist with this decision is lacking and current guidelines primarily focus on balancing thromboembolic and bleeding risk.

Objective: This study evaluated the literature and current guidelines for recommencement of OAC in patients who have experienced an incident ICH.

Discussion: Patients with recurrent ICH while on anticoagulation therapy have associated poor outcomes. However, predicting which patients will experience recurrent ICH with OAC resumption remains challenging, and failure to resume OAC carries risks of thromboembolic events. Current data suggest that it is reasonable to resume OAC in many patients post-ICH, depending on careful consideration of individual risk factors for haemorrhagic and thromboembolic events. The application of existing risk stratification tools for thromboembolism and haemorrhage, and radiological biomarkers such as cerebral microbleeds, might also assist in decision making.

Background: General practitioners (GPs) face the challenge of diagnosing conjunctivitis accurately and confidently. Conjunctivitis and red eye are common presentations that confer diagnostic uncertainty. GPs are pivotal in diagnosing and managing conjunctivitis-like symptoms, making them a critical first port of call for patients. Accurately identifying and treating this common eye infection can help ensure the best possible outcomes.

Objective: This article presents an overview of conjunctivitis, exploring its causes and how to accurately assess and diagnose. We also discuss how to safely refer patients for investigation and provide appropriate safety netting.

Discussion: Conjunctivitis can be secondary to a range of conditions, commonly viral, bacterial and allergic pathogens. It tends to be a self-limiting disease; however, symptoms might persist for up to three weeks. Accurate clinical diagnosis for conjunctivitis is difficult, and thus it can be useful to send a swab for polymerase chain reaction and culture to confirm the diagnosis.

Background: Foreign bodies (FBs) in the ears and nose are common presentations among paediatric patients, necessitating prompt and appropriate management to avoid potential complications.

Objective: This article presents a standardised approach for FB retrieval based on local clinical data from a tertiary paediatric centre, addressing the challenges of identifying patients requiring specialist referral.

Discussion: The approach involves a detailed initial consultation and succinct examination to determine the most suitable retrieval method. Patient preparation and equipment availability are key to successful outcomes. A combination of microsuction and alligator forceps with adequate illumination is strongly recommended, along with various adjunct tools commonly available. Urgent referral to otorhinolaryngology is indicated for button batteries and previous failed attempts. This comprehensive approach seeks to achieve successful FB removal and optimise patient outcomes in both community and hospital settings.

Background: Preconception care (PCC) entails a comprehensive suite of interventions to improve the health of potential parents, their babies and future generations. PCC is not limited to a first pregnancy, and addressing health and wellbeing is equally important in the interconception period.

Objective: The aims of this paper are to discuss the evidence for and components of PCC, as well as the role of the general practitioner in the delivery of PCC.

Discussion: It is estimated that 90% of women and over 50% of men have preconception health issues to address. Although all people stand to benefit from PCC, certain population groups experience increased risk of adverse outcomes and require more targeted attention. Although most do not present for a dedicated PCC consultation, asking about pregnancy intention can start the conversation. Evidence shows that interventions delivered in primary care can improve preconception health knowledge and reduce preconception risk factors.