Australian Journal of General Practice最新文献

Background: Allergic rhinitis (AR) is a common condition that affects 19% of Australians in the community, accounting for approximately 0.6% of all general practitioner presentations. Recent years have seen the emergence of new treatment options, many of which can be delivered in the primary care setting.

Objective: The aim of this paper is to provide a contemporary and accessible framework for the clinical assessment, investigation and management of AR in the primary care setting, and to establish appropriate referral criteria for ear, nose and throat and/or allergist/immunologist referral.

Discussion: AR is common, and can have a significant effect on both quality of life and function. The diagnosis can be made based on history, examination and appropriate investigations, including serum specific allergen IgE (immunoglobulin E) and/or skin prick testing. Radiological imaging is not part of the work-up for AR. Management consists of four main aspects: allergen avoidance, pharmacotherapy, immunotherapy and procedural interventions. Biological pharmacotherapies are on the horizon.

Background: The widespread use of cross-sectional imaging has led to the increased detection of urological incidentalomas. Incidental renal and adrenal masses are the most commonly detected urological incidentalomas and are often encountered by general practitioners.

Objective: This review aims to provide an evidence-based approach to managing renal and adrenal masses.

Discussion: Renal lesions occur in 14% of computed tomography (CT) scans. Differentials include cysts (benign or malignant), angiomyolipomas, oncocytomas and renal cell carcinomas (RCCs). The Bosniak classification should be used for cystic renal lesions. Active treatment should be considered for RCCs that are >4 cm, symptomatic or rapidly growing. Patients with adrenal lesions should undergo functional work-up. If clinically concerned, screening tests include 1 mg overnight dexamethasone suppression test and plasma or urinary metanephrines. In the presence of hypertension or hypokalaemia, screening for hyperaldosteronism with the plasma aldosterone-to-plasma renin ratio should be considered. Benign adrenal adenomas on CT are <4 cm, homogenous and hypodense (Hounsfield unit <10).

Background: Chronic limb-threatening ischaemia (CLTI) is an advanced and severe form of lower limb peripheral arterial disease (PAD) and can pose significant challenges in clinical management. Not all patients are able to undergo surgical intervention due to patient-related and disease-related factors.

Objective: This review article aims to provide general practitioners with an overview of conservative management of patients with end-stage CLTI in the community.

Discussion: The review aims to provide an overview of end-stage CLTI and approaches that are required to preserve patients' quality of life. It outlines symptom control, wound care, psychosocial support and end-of-life considerations to preserve the quality of life for patients facing this challenging condition.

Background and objectives: Chronic breathlessness is a frequent diagnostic challenge in primary care. Our aim is to evaluate the feasibility of a stepwise breathlessness diagnostic algorithm for primary care.

Method: This mixed-methods study included: (1) a general practitioner (GP) nominal group technique study; (2) focus groups on GPs' views on the algorithm; and (3) analysis of algorithm alignment against patterns of diagnostic referrals and diagnoses of breathlessness presentations (2014-19) from the MedicineInsight primary care electronic health record (EHR) dataset of 1,961,264 patients (405 general practice sites).

Results: All the tests in our algorithm, except for echocardiography, were ranked in the top 10 tests used by most GPs for patients presenting with chronic breathlessness. Themes from the focus group include similarity with current practice and test accessibility. Analysis of EHR diagnostic referrals revealed that all tests in the algorithm are regularly utilised and covered the major tests needed for breathlessness diagnoses recorded.

Discussion: The results of the three studies support the acceptability and feasibility of the clinical algorithm in primary care.

Background and objectives: This study describes the prevalence of risky alcohol consumption in Australian women aged 40-45 years. It explores the relationship between demographic factors and access to and usage of primary healthcare services.

Method: Data were obtained from the Australian Longitudinal Study on Women's Health, Survey 8 (1973-78 cohort). Descriptive statistics and univariate logistic regression were used to assess associations of specific factors with risky alcohol consumption.

Results: Eleven per cent of respondents reported drinking >10 standard drinks per week. These 'risky alcohol drinkers' attend general practice as frequently as low-risk drinkers despite perceived poorer health. They reported 'rarely or never' seeing the same general practitioner (GP) and described themselves as having 'poor' access to a GP that bulk bills.

Discussion: This study provides unique insight into the primary healthcare attendance patterns and health status of early middle-aged Australian women who are 'risky alcohol drinkers'. They do not consistently see the same GP, which might present challenges in identifying them in primary care.

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 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: 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: 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: 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.