Australian Journal of General Practice最新文献

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.

Background and objectives: Type 2 diabetes affects over half a million older Australians. Australian Medicare group exercise and education interventions can support older adults' diabetes management. However, the feasibility and acceptability of accredited exercise physiologist (AEP)-delivered services are yet to be assessed. This study aimed to assess the feasibility, acceptability and preliminary efficacy of a Medicare type 2 diabetes group exercise and education intervention for older adults.

Method: This study was a single-arm feasibility, acceptability and preliminary efficacy trial of an AEP-delivered type 2 diabetes group service for older adults with the condition. Participants attended the diabetes clinic once per week for eight weeks, through Medicare, for a group exercise and education session. Attendance, participation, enjoyment, suitability, usefulness and pre-post clinical health outcomes were assessed.

Results: The intervention was feasible and acceptable, with 40 participants (mean [±standard deviation] age 71.8±4.5 years [range 65-81 years]; 45% female) attending 87% of sessions. Almost all participants (97%) strongly agreed that the program was enjoyable. Participants also improved fitness and cardiometabolic health outcomes.

Discussion: More Australians should be referred to and attend Medicare-subsidised exercise physiologist-delivered group sessions. The potential for additional sessions to achieve greater physical activity engagement and diabetes self-management should be further investigated.

Background: Professional identity formation (PIF) as a general practitioner (GP) enhances the experience of meaning at work, reduces burnout, promotes patient-centred decision making and strengthens advocacy for the unique role of family medicine within the healthcare system. Unfortunately, there is insufficient emphasis on PIF in GP residency programs; it often remains a hidden curriculum. External factors limiting GP trainees' exposure to their own general practice community of practice further impede PIF. Thus, fostering general practice PIF requires deliberate, focused efforts; however, there is little empiric evidence on the GP professional identity or how to foster it.

Objective: The aim of this paper is to discuss strategies for effective GP PIF in family medicine residency.

Discussion: The authors recommend explicit attention to PIF in three key areas: curriculum; teaching and learning; and faculty development. Additionally, the authors encourage GPs to unite as a community to provide continuing and coordinated support for GP residents on their PIF journey.

Background: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is increasingly being diagnosed incidentally on imaging. It has malignant potential, making it vital to establish the correct diagnosis, assess its malignant risk and follow a management strategy to prevent development of invasive carcinoma of the pancreas.

Objective: This review focuses on the epidemiology, natural history, risk factors, diagnosis and management of IPMN of the pancreas, and will provide practical points for general practitioners.

Discussion: IPMN of the pancreas can transform into invasive pancreatic carcinoma at a low rate of approximately 2%/year. Upon diagnosis of IPMN, it is risk stratified based on the presence of worrisome or high-risk stigmata, which guides further management. Management needs to be individualised based on IPMN and patient factors due to limitations with the current diagnostic tools.