Australian Journal of General Practice最新文献

Background: Low back pain is one of the most common presentations in general practice. Although there is excellent evidence regarding best management of the condition, in primary care there is often overuse of less effective and expensive options, whereas effective, inexpensive options are underused. After broad consultation and evidence review, the Australian Commission on Safety and Quality in Health Care has developed a clinical care standard in response to this identified gap between best and actual practice. A clinical care standard focuses only on key areas of care where the need for quality improvement is greatest.

Objective: We explore the new standard using a typical patient scenario in primary care to highlight evidence-based approaches for challenging aspects of management, such as imaging and pain management.

Discussion: General practitioners (GPs) might find the practical GP 'quick guide' resource from the standard useful to support their care of patients with low back pain.

Background: Keratinocyte cancer (KC) in Australia poses a unique healthcare challenge due to its high prevalence and the requirement for multidisciplinary management of many cases. Advances in radiation therapy (RT) have increased its use in treating different keratinocyte cancer presentations. Understanding the indications for RT and the role that general practitioners (GPs) play in the treatment pathway are imperative to ensure best patient outcomes.

Objective: This review examined the efficacy, advances and treatment considerations of RT for the management of keratinocyte cancer, and role of the GP in the treatment pathway.

Discussion: Radiation therapy offers effective alternatives to, or adjuvants for, surgery in existing keratinocyte cancer treatments in appropriate cases. The evolving RT landscape necessitates GPs to be well informed for effective case identification, referral and management. This includes understanding RT advances, protocols, treatment reactions and managing patient expectations. Continuing education in this space is important for GPs to understand the suitability of RT for their patients.

Background: Therapeutic inertia describes a failure to establish appropriate treatment targets and escalate treatment to achieve those targets. This inertia can be measured, and evidence of this inertia is present in approximately one-third of diabetes management consultations. This inertia describes a failure in the system to produce change, rather than assigning fault to the physician or patient.

Objective: This article discusses the importance of reducing therapeutic inertia in type 2 diabetes and focusing on reducing overall cardiovascular risk.

Discussion: This article discusses approaches to reducing treatment inertia in type 2 diabetes (ie identify the problem, get permission, set goals, measure progress and alter treatment to reach those goals). The treat-to-target methodology, the STABLE (Smoking cessation, Target organ involvement, HbA1c, Blood pressure, Lipid profile, Energy balance) acronym and practical approaches are described.

Background: In Australia, artificial intelligence (AI) is increasingly being used in the field of melanoma diagnosis. Early diagnosis is arguably the most important prognostic factor for melanoma survival. The use of digital monitoring of naevi, especially dysplastic naevi, might reduce the number of biopsies needed in managing patients at risk of melanoma, especially in patients with high naevi counts.

Objective: This article discusses advances in imaging and early diagnosis including the use of AI in this process.

Discussion: The benefits of performing biopsies must be balanced with the potential to cause harm. Whole-body imaging can assist with more accurate detection of changing lesions and enable clinicians to focus on lesions where change is detected.