Australian family physician最新文献

Background: Procedural skills are an essential component of general practice vocational training. The aim of this study was to investigate the type, frequency and rural or urban associations of procedures performed by general practice registrars, and to establish levels of concordance of procedures performed with a core list of recommended procedural skills in general practice training.

Methods: A cross-sectional analysis of a cohort study of registrars' consultations between 2010 and 2016 was undertaken. Registrars record 60 consecutive consultations during each six-month training term. The outcome was any procedure performed.

Results: In 182,782 consultations, 19,411 procedures were performed. Procedures (except Papanicolaou [Pap] tests) were performed more often in rural than urban areas. Registrars commonly sought help from supervisors for more complex procedures. The majority of procedures recommended as essential in registrar training were infrequently performed.

Discussion: Registrars have low exposure to many relevant clinical procedures. There may be a need for greater use of laboratory-based training and/or to review the expectations of the scope of procedural skills in general practice.

Background: Many women report gaining weight as they transition through menopause. For most, the weight gain is modest and can be reduced with a conscious effort to limit energy intake and increase energy expenditure. However, many women who are already overweight and obese will gain more weight as they approach menopause.

Objective: The aims of this paper are to explain the reasons for menopausal weight gain and to detail a method for achieving and sustaining a substantial weight loss.

Discussion: Weight gain during menopause is predominantly due to a reduction in spontaneous activity. For women who are lean, advice about controlling energy intake and increasing physical activity may be all that is required to prevent weight gain. For women who are overweight and obese rapid weight loss is best achieved with the help of a very low energy diet. This must be followed by lifelong behaviour modification with or without the help of hunger-suppressing pharmacotherapy.

Background: Although venesection was widely applied in the past for the treatment of various ailments and diseases, in modern medical practice, it is indicated in very few conditions, namely, hereditary haemochromatosis, polycythaemia and porphyria cutanea tarda.

Objective: This article briefly reviews the pathophysiology of these conditions, and the rationale and goals of therapeutic venesection as a treatment modality. It also summarises the venesection procedure itself and the considerations for setting up a venesection service in a doctor's surgery.

Discussion: Venesection is generally safe and carries few side effects. Before commencing therapeutic venesection, management goals in terms of laboratory parameters should be set for individual patients. These patients should be monitored regularly so that set targets are met and not overshot as to render them anaemic and acutely symptomatic. Venesections should also be performed by persons familiar with the procedure and management of the attendant complications.

Background: Routine primary care checks in infants and prepubertal boys aim for early detection and intervention of undescended testes (UDT). Congenital and acquired UDT cause infertility, and congenital UDT also increases testicular cancer risk. We examined 20 years of Australian orchidopexy data (1995-2014) to explore the national orchidopexy operation rates over time.

Methods: Orchidopexy and population data were collected from the Australian Bureau of Statistics (ABS) for 1995-2014, and census data for each age group were also collected. Poisson regressions were used to analyse the data.

Results: For patients aged DISCUSSION: The rate of orchidopexy per age has decreased in patients aged 5-14 years over the past 20 years, possibly indicating that acquired UDT is not being diagnosed and treated in some boys, risking infertility in adulthood.

Background: Burn injuries are common and costly; each year, there are more than 200,000 cases, costing the Australian community $150 million. Management of smaller burn injuries in the community can be improved by appropriate first aid, good burn dressings and wound management. This can reduce the risk of the burn becoming deeper or infected, and can potentially reduce the requirement for specialist review or surgery.

Objective: The objective of this article is to provide healthcare professionals with information about the pathophysiology of burn wound progression. This information includes the aims of burn wound dressings and indications for different types of dressings in different burn depths, advantages of blister debridement, and the reasoning behind advice given to patients after healing of the burn wound.

Discussion: This article provides a framework used by the State Burn Service of Western Australia, by which clinicians can understand the needs of a specific burn wound and apply these principles when choosing an appropriate burn dressing for their patient. Every intervention in the journey of a patient with a burn injury affects their eventual outcome. By managing all burn injuries effectively at every single step, we can reduce burn injury morbidity as a community.

Background: Pharmaceuticals play an important role in modern day healthcare, and prescribing is a very common activity in Australian general practice. However, there are significant harms associated with medicine use. Vocational training is a critical period in the development of clinical practice patterns for the future general practitioner (GP), including prescribing behaviour. The general practice supervisor, therefore, has a key role to play in educating registrars about rational prescribing.

Objective: In this article, we discuss a range of practical strategies for general practice supervisors to use when teaching their registrars rational prescribing in the practice setting.

Discussion: Teaching rational prescribing should take on a patient-centred focus and incorporate an approach to managing uncertainty. Role-modelling of quality prescribing and use of guidelines is a strong influence on registrar behaviour. Specific strategies include random case analysis, audit and feedback of prescribing practice, topic tutorials and use of specific prescribing resources.

Background: The single rod etonogestrel contraceptive implant is available in Australia as Implanon NXT. It is a highly effective, long-acting reversible contraceptive method, which is suitable for most women across the reproductive lifespan.

Objective: This article provides practical advice for clinicians who already insert and remove the contraceptive implant, as well as advice for those who have not yet acquired this procedural skill.

Discussion: Contraceptive implant procedures are usually performed in the general practice setting. Clinicians can support women in making an informed choice to have an implant by providing information about their benefits, side effects and risks, and timely access to insertion. Training in the procedures and compliance with procedural instructions are essential to minimise risks, including deep insertion and damage to neurovascular structures.

Background: Overactive bladder syndrome (OAB) is a common medical condition that causes significant distress and impact on the quality of life in women. Muscarinic receptor antagonists remain the mainstay of therapy, but they are limited by their efficacy and adverse effects. The objective of the article was to compare the clinical efficacy and tolerability of medications used to treat OAB in women through network meta-analysis.

Methods: Data from eligible studies of commonly prescribed pharmacological agents in the treatment of OAB in women were entered into Net-MetaXL after a literature search using two online databases (PubMed and Cochrane). Studies between 31 July 2000 and 31 July 2015 were included in this study.

Results: Five quantitative studies were eligible for analysis. The most efficacious drug to treat OAB in women appears to be solifenacin 10 mg once daily (OD), followed by oxybutynin 3 mg three times a day. However, solifenacin 10 mg OD caused more adverse effects that the other treatments.

Discussion: Our results are similar to those of another systematic review. When considering efficacy, tolerability and cost, solifenacin 5 mg once daily is the drug of choice as it is more efficacious, albeit with more adverse effects, than other treatments. If solifenacin is unsuitable, oxybutynin 3 mg TDS is recommended.

Background: Vaccine hesitancy is a public health concern. The objectives of this article were to describe Australian parents' attitudes, behaviours and concerns about vaccination, determine the factors associated with vaccination non-compliance, and provide sources of vaccination information for general practitioners (GPs).

Methods: We conducted a nationally representative online survey of Australian parents in 2012. We determined associations between demo-graphic and vaccination attitudes and behaviour.

Results: The 452 respondents were parents of children aged DISCUSSION: GPs have pivotal roles in addressing concerns regarding vaccination. Education and communication with parents will improve their knowledge and trust in vaccination, thereby improving vaccination compliance.