Australian Journal of General Practice最新文献

Background: Tremor is a common but complex involuntary movement disorder often first assessed by general practitioners (GPs). Due to its diverse causes and manifestations, an accurate assessment of a patient's tremor helps guide initial investigations and treatments.

Objective: The purpose of this paper is to equip GPs with a framework for the identification, diagnosis and management of different types of tremors.

Discussion: This paper offers a comprehensive, current overview of tremor assessment in general practice. It particularly focuses on Parkinson's disease, essential tremor syndrome and dystonic tremor, while highlighting diagnostic masquerades and red flags for urgent neurological evaluation.

Background: Chronic rhinosinusitis (CRS) is a very common reason for presentation to a general practitioner. It can be very difficult to manage and can have a significant effect on the quality of life of patients.

Objective: The objective of this article is to provide an up-to-date review of the pathophysiology, diagnosis and multimodal approach to management of this chronic condition.

Discussion: Biologic agents are becoming increasingly common in Australia for the management of CRS with polyposis. This review includes an overview of these biologic agents and highlights their indications, efficacy and place in the management of CRS.

Background: Grants are a vital element in clinical research activities and research careers, unlocking opportunities to delve into an area and make new discoveries. However, securing a grant can be a daunting task.

Objective: In this article, the authors provide guidance for novice researchers regarding the grant application process. The article is aimed especially at clinicians with an interest in research, acknowledging the current need for more clinician researchers.

Discussion: The authors encourage those writing grant applications to view their task as that of a narrator. This will help identify several key questions: What is the topic? Why is it important? How will you examine it? Who will work with you? When and where will you do the research? Then what will you do? How much will it cost? The authors encourage applicants to create a diverse, complementary team to support them and to be mindful of the resource constraints.

Background: Hypertensive disorders in pregnancy (HDIP) are among the leading causes of maternal and perinatal morbidity and mortality and should not be reserved for specialist care and expertise.1 General practitioners (GPs) are inevitably involved in the care of women with HDIP, particularly in the preconception, early pregnancy and postpartum periods and, also, as shared maternity care providers. It is, therefore, critical that GPs can assess and manage HDIP.

Objective: This article aims to provide GPs with a practical approach to the diagnosis and management of hypertensive disorders in pregnancy, including postpartum monitoring and ongoing cardiovascular risk surveillance.

Discussion: The spectrum of HDIP includes gestational hypertension, chronic hypertension, pre-eclampsia (PET)/eclampsia and PET superimposed on chronic (pre-existing) hypertension, and this can affect up to 8-10% of pregnant women.

Background: Chronic kidney disease (CKD) is a significant healthcare problem. More advanced stages are associated with increased mortality, morbidity and cost. Instigating measures to slow down disease progression at an early stage can save lives, and millions of dollars of taxpayers' money.

Objective: This article aims to provide evidence-based information to general practitioners, aiding the decision to initiate sodium-glucose cotransporter 2 (SGLT2) inhibitors for CKD patients in their day-to-day practice.

Discussion: SGLT2 inhibitors have emerged as a promising and safe addition to the renin-angiotensin-aldosterone system blockers for managing CKD. Randomised controlled trials have shown that SGLT2 inhibitors effectively slow CKD progression in both early and more advanced disease stages, regardless of diabetes status. SGLT2 inhibitors can be a valuable additional treatment option for CKD management in primary care and should be considered for most CKD patients.

Background and objectives: The Royal Australian College of General Practice recommends that all women contemplating pregnancy or in early pregnancy should be offered reproductive genetic carrier screening (RGCS). In November 2023, a new Medicare item number was introduced for RGCS to detect cystic fibrosis (CF), spinal muscular atrophy (SMA) and fragile X syndrome (FXS) carrier status. The role of general practice in offering RGCS is recognised as being of crucial importance, but only a minority of general practitioners (GPs) are offering such screening. This study investigates the facilitators and barriers to offering RGCS in general practice.

Method: Fifteen Victorian GPs who had offered RGCS for CF, SMA and FXS participated in semi-structured telephone interviews. A behavioural change framework was used for this study.

Results: Barriers to offering screening (eg out-of-pocket costs, low frequency of preconception care and lack of GP education) mapped predominantly onto the 'opportunity' domain of the behaviour change framework.

Discussion: Reducing out-of-pocket costs and increasing the provision of preconception care and GP education will provide more people with the opportunity to make informed choices about participation in RGCS.

Background and objectives: Familial hypercholesterolaemia (FH) is a genetic condition contributing to premature cardiovascular disease. Currently, general practitioners (GPs) do not proactively screen for the condition. This study implemented and evaluated a digital FH self-screening questionnaire administered in general practice.

Method: Patients aged 18-60 years in four general practices were sent an FH screening questionnaire via SMS prior to their GP appointment. The survey identified at-risk patients, and results were exported to the patients' electronic medical record.

Results: In all, 1258 patients were sent the survey; 234 (18.6%) interacted with it, 137 completed self-screening and nine patients were identified as high risk. Self-screening took 3.5 minutes (on average) and was positively evaluated by patients.

Discussion: This proof-of-concept study identified that FH self-screening can be implemented, but further refinements to the self-screening method and interface might be required for greater patient engagement. FH self-screening has the potential to increase FH detection and reduce preventable cardiovascular disease.

Background and objectives: The COVID-19 pandemic caused upheaval of healthcare systems, with evolving consequences. The aim of this study was to evaluate the impact of the pandemic on melanoma diagnosis and management in New South Wales, Australia.

Method: In this retrospective cohort study, we analysed all new melanomas diagnosed at a tertiary care hospital over a three-year period. We compared outcomes between pre-pandemic (1 January 2019 - 30 March 2020) and pandemic (31 March 2020 - 31 December 2021) periods.

Results: A total of 426 melanomas were included. No significant differences in patient demographics, Breslow thickness, ulceration, subtype or lymph node positivity were observed. During the pandemic, there was an 11% decrease in the number of melanomas diagnosed in the community (P=0.016) and an 11-day reduction in time from referral to wide local excision (P=0.013).

Discussion: The prioritisation of melanoma care during the pandemic in New South Wales, Australia, has resulted in no apparent diagnostic delays.