Australian Journal of General Practice最新文献

Background: Acute otitis externa (AOE) is an inflammatory condition of the outer ear seen in Australian general practice and is prevalent in tropical climates like North Queensland.

Objective: This article aims to delineate key facets of AOE, identify high-risk populations and propose a streamlined management approach aligned with the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guideline, emphasising the role of primary care in optimal patient care.

Discussion: Outlined within this article are key elements of AOE, from anatomy to risk factors, examination, diagnosis, differentials, management, prevention and indications for referral. Emphasis is placed on topical antibiotic use, drug delivery techniques and recognising refractory cases. The importance of early intervention is highlighted to prevent complications, particularly in at-risk populations, aligned with AAO-HNS guidelines and enhancing general practice's role in mitigating AOE-related complications.

Background: Oral cancer remains a significant public health issue. General practitioners (GPs) can play an important role in raising awareness of oral cancer.

Objective: This paper explores why providing advice relating to modifiable risk behaviours associated with oral cancer and undertaking routine oral cancer screening are important for GPs in clinical practice.

Discussion: To support GPs, an e-learning module on oral cancer screening, prevention and early detection was established as part of the Oral Cancer Screening and Prevention Program (funded by the Victorian Department of Health). The development of the e-learning module was led by Dental Health Services Victoria in partnership with The Royal Australian College of General Practitioners (RACGP), and the content was developed in consultation with experts from the University of Melbourne, Cancer Council Victoria and the Victorian Comprehensive Cancer Centre. The Oral Cancer: Prevention, early detection and referral e-learning module was launched on the RACGP training website in November 2023.

Background: A head and neck cancer patient has completed treatment and five-year surveillance with their oncologists and surgeons and has been discharged back into your care. What is next and what do you not want to miss in this patient?

Objective: This article aims to provide the general practitioner with a practical guide and an up-to-date evidence-based review on how to manage the head and neck cancer survivor.

Discussion: Attentive surveillance encompassing risk stratification and guidance, early detection of recurrence and second malignancies, effective management of chronic symptoms and the provision of psychosocial support are fundamental in providing a holistic and comprehensive care plan for the head and neck cancer survivor.

Background: Melasma, a condition characterised by hyperpigmented patches on the face, is one of the common skin conditions in women seeking treatment from primary care practitioners (PCPs). Several treatment modalities are available for PCPs as well as dermatologists. Each treatment option has its pros and cons, including accessibility and cost.

Objective: This article aims to explore and address the treatment options that PCPs can offer for melasma.

Discussion: This article outlines how to offer treatment from the PCP's perspective conveniently and cost-effectively. Combined topical treatment seems to be the first-line form that PCPs can offer and manage in the general practice setting. Of the various treatments available, the triple combination of topical hydroquinone with retinoid and corticosteroid is widely described in the literature.

Background and objectives: Smoking, poor diabetic control and excessive body mass index (BMI) increase the risk of infection following joint replacement. This study investigated Australian general practitioners' (GPs) perception of these modifiable risk factors in patients with end-stage osteoarthritis.

Method: A structured online survey tool was developed and widely distributed to Australian GPs.

Results: Responses were received from 131 GPs. Most attempted to address current smoking (90%), poor diabetic control (94%) and excessive BMI (89%) prior to referral. The majority felt that joint replacement should be delayed until these risk factors had been modified (57%, 84% and 74%, respectively). However, many respondents did not believe that these risk factors were contraindications to joint replacement (76%, 46% and 43%, respectively).

Discussion: This study suggests that Australian GPs are mindful of modifiable risk factors in patients with hip and knee osteoarthritis; however, many do not support restricting access to joint replacement.

Background and objectives: Otitis externa (OE) is a very common disease in Australia. It is associated with swimming and exposure to water. Typically, treatment consists of aural toileting and the use of topical antimicrobial drops. Antimicrobial treatment is empiric, and most Australian guidelines advise the use of dexamethasone/framycetin/gramicidin as first-line therapy. This study aimed to identify the most prevalent pathogens implicated in OE in Queensland, Australia, and determine if there was any variability with the season, proximity to a coastline, age, gender and First Nations status.

Method: The primary pathogen cultured, the specimen type, the date of collection and the patient demographics were retrieved from microbiology swabs sent from hospitals to Pathology Queensland. Multivariate analysis was performed on the swabs.

Results: Pseudomonas aeruginosa was the most prevalent pathogen cultured in the external ear in Queensland, at 37.9%. In inland regions, Staphylococcus aureus was the most prevalent organism. Children were three-fold less likely to have OE resulting from a fungal pathogen.

Discussion: The use of targeted antimicrobials against Pseudomonas aeruginosa in coastal regions during summer is sensible. Due to the low burden of fungal disease in children, there should be a high threshold for the commencement of antifungal ear drops.

Background: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency requiring urgent medical attention and care.

Objective: This article, based on up-to-date evidence and clinical guidelines, aims to equip general practitioner (GP) specialists with a structured and practical approach to SSNHL management, emphasising the need for prompt evaluation and appropriate interventions. From initial evaluation to treatment strategies and follow-up, this guide offers a step-by-step framework to optimise patient care and improve outcomes in patients suffering SSNHL.

Discussion: Distinguishing SSNHL from conductive hearing loss (CHL), with early identification and prompt initiation of high-dose corticosteroid therapy, are key considerations for the management of SSNHL. Appropriate referrals when indicated for audiometric evaluation, emergency and/or otolaryngology services are also essential. Furthermore, this study aims to outline emerging therapies including intratympanic steroid administration, hyperbaric oxygen therapy and their potential roles in augmenting standard treatment approaches.

Background and objectives: Australian general practices are highly involved with accreditation programs; however, there is evidence to suggest variability in their levels of performance. The aim of the current study was to determine the association with between several metrics of preparation with accreditation performance outcomes.

Method: Several metrics were synthesised that measured preparation time to general practice accreditation. Performance outcomes were: (1) conformity to 124 indicators of the standards; (2) time to remediate indicator non-conformities; and (3) level of assistance required.

Results: A greater number of months between registration with the accrediting agency and practice accreditation expiry date was associated with higher indicator conformity at the site visit (OR=1.04, P=0.001), as well as less time (β=-0.02, P=0.002) and less assistance (β=-0.66, P=0.02) to remediate non-conformant indicators post site visit.

Discussion: Adequate preparation time for several components within the accreditation framework for general practices were associated with small-to-moderate improvements in key performance outcomes.

Background and objectives: Despite increasing urbanisation, little is known about skin health for urban-living Aboriginal children and young people (CYP, aged <18 years). This study aimed to investigate the primary care burden and clinical characteristics of skin conditions in this cohort.

Method: A one-year retrospective cohort study of urban-living Aboriginal CYP presenting for general practitioner (GP) consultation at an Aboriginal Community Controlled Health Organisation (ACCHO) was conducted.

Results: At least one dermatological diagnosis was made in 27% (253/939) of GP face-to-face consultations for the 585 urban-living Aboriginal CYP included. Infections and dermatitis accounted for 54% (152/284) and 18% (50/284) of all dermatological diagnoses, respectively. Bacterial skin infection (BSI) cumulative incidence was 13% (74/585; 95% CI 10-16%), with recurrent BSI affecting <1% (5/585; 95% CI 0.3-2%) and hospitalisation required in 1% (1/82; 95% CI 0.06-7%) of incident BSI cases.

Discussion: We present a culturally secure, multidisciplinary skin health assessment model within an urban ACCHO, where dermatological conditions account for a significant proportion of GP workload.