Australian Journal of General Practice最新文献

Background: Australian general practice patients commonly have significant solar damage. This can lead to the manifestation of actinic keratoses (AKs) as discreet lesions or as field disease, with these lesions potentially giving rise to keratinocyte cancers (KCs). Therefore, a pragmatic approach is needed to assess and manage these higher-risk patients.

Objective: This article discusses an approach to managing patients with significant solar damage from a primary care perspective, focusing on the assessment and treatment of AKs as individual lesions and within a field.

Discussion: Significant solar damage is typified by the presence of AKs, commonly seen as field disease. Several field treatment modalities are available for patients. Treatment options need to be tailored to the individual patient and site of disease to maximise adherence and efficacy.

Background and objectives: The burden of disease for Australian children from non-acute conditions is growing; however, little is known about how well prevocational training experiences prepare trainee doctors. This study examines the confidence of general practice registrars in managing paediatric consultations in primary care and whether confidence varies by prevocational training type.

Method: This was a cross-sectional national survey of Australian general practice registrars that measured confidence in managing paediatric primary care presentations.

Results: Respondents reported feeling confident (65%) or very confident (8%) in managing paediatrics in primary care, with higher confidence for those more advanced in their training or with greater exposure to paediatrics during prevocational training. Regression models showed registrars were more likely to report higher confidence when managing acute versus non-acute presentations.

Discussion: Although most registrars reported confidence in managing paediatric presentations, confidence levels were notably lower for non-acute conditions and when prevocational training experiences included limited exposure to paediatric patients.

Background and objectives: Transition from hospital to community care is well established as a high-risk time for patients. Inadequate clinical handover to general practice puts patients at risk of medical error, adverse events and rehospitalisation. We sought to understand the effects on general practitioners (GPs) of poor clinical handover from the inpatient, outpatient and emergency department settings.

Method: Qualitative methodology was used through conducting semi-structured interviews with purposively selected GPs. Interviews were undertaken until data reached saturation and no new themes emerged. The interviews were thematically analysed and coded.

Results: Key themes emerging included poor communication leading to patient safety concerns, time taken away from patient care and GPs experiencing a lack of professional respect.

Discussion: Clinical handover from the hospital sector remains a source of frustration for GPs. Poor handover demonstrates a lack of appreciation for the important role of the GP in continuing the care of patients and puts patients at risk of poor outcomes.

Background: Australia and New Zealand have the greatest burden of skin cancer in the world. General Practitioners (GPs) are the first interaction for most patients with skin cancer concerns and are well placed to provide information regarding primary and secondary skin cancer prevention.

Objective: This article aims to discuss primary and secondary prevention of skin cancer in Australia.

Discussion: GPs can help reduce the incidence of skin cancer by identifying high-risk individuals in primary care clinics, enrolling them in a surveillance program and tailoring skin cancer prevention advice. GPs should encourage patients to practise sun safety through the use of shade, photo-protective clothing, sunglasses and sunscreen and being aware of the ultraviolet index through tools such as the SunSmart App to guide behaviours and activities.

Background: Skin cancer specimen handling in Australian histopathology laboratories, while largely standardised, exhibits significant variations that affect clinical decision-making and patient outcomes.

Objective: This article provides clinicians with an understanding of histopathological processes to enhance diagnostic precision, inform surgical margin evaluations and refine management approaches.

Discussion: Understanding specimen handling and protocols is vital for accurate interpretation of pathology reports and management of skin cancers. Variations in sampling, examination and sectioning can affect pathological diagnosis and margin assessment. Clinician insights into laboratory processes are crucial for best practice. Retention of specimens and reports allows for further evaluation if clinical circumstances evolve or additional investigations are required.

Background and objectives: Climate change is one of the biggest threats to the healthcare sector. In addition, healthcare contributes significantly to greenhouse gas emissions. Virtual consultations are a growing tool to assess patients. The carbon emissions from virtual consultations have the potential to be much smaller than in-person consultations, predominantly through reduced transportation. This study assesses the carbon footprint of general practitioner referrals for skin lesions evaluated by a store-and-forward teledermatology service compared to an estimated equivalent in-person review.

Method: The carbon footprint of virtual consultations for skin lesions was compared to estimated equivalent in-person reviews based on the average transportation modalities in New Zealand.

Results: Virtual consultations for 484 patients resulted in an average saving of 48 km and 11.17 kg carbon dioxide equivalent per consultation compared to equivalent in-person review.

Discussion: This study encourages the use of store-and-forward skin lesion assessment as a way of reducing carbon emissions in the healthcare sector.

Background: Australia has the highest incidence of skin cancer globally. Early detection and treatment of skin cancer is critical for positive patient outcomes. General practitioners (GPs) play a central role in skin cancer management in Australia.

Objective: Collaboration between GPs and pathologists can improve the accuracy of skin cancer diagnosis. However, for improvement to occur, clear communication and high-quality specimens are essential.

Discussion: Inadequate clinical information and suboptimal biopsy specimens can hinder diagnosis. Improved communication, targeted training and selecting appropriate biopsy techniques are essential. A collaborative approach, guided by recommended techniques and clear guidelines, can minimise errors and improve patient outcomes in Australia's GP-led skin cancer management system.

Background: Most skin cancers diagnosed in Australia, including melanomas, are identified and managed in a primary care setting. Most skin cancers have the diagnosis confirmed by histopathology, and surgical excision is the most common form of treatment. Therefore, it is important that all primary care doctors in Australia are competent and confident in the diagnostic sampling and surgical management of skin cancers.

Objective: This article considers the process of performing biopsies and excisions from the skin to diagnose or treat skin cancers.

Discussion: Primary care is the appropriate setting for the management of most skin cancers in Australia. Small simple lesions can be sampled for diagnosis and excised as definitive treatment of the tumour. This can be simpler, cheaper and more efficient for the patient compared to the hospital setting, allows the resources of speciality care to be used for more difficult scenarios and be quite a satisfying part of providing primary care.