Australian family physician最新文献

Background: The recent death of a Victorian surgeon who was assaulted by a member of the public when leaving work has re-highlighted the risk and potential cost of violence experienced by healthcare workers.

Objective: The aim of this article is to outline the risk of occupational violence experienced by doctors, and general practitioners in particular, and to discuss practical measures that can be taken to manage this risk.

Discussion: The majority of doctors have experienced aggression or violence in their workplaces in the past 12 months. Risks for violence include elements of workplace design, policy and procedures, and client factors. A series of practical tools designed to assist the assessment and management of risk of occupational violence are discussed.

Background: The optimal role of general practice in population weight management remains unclear. The aim of this mixed-methods study was to test the feasibility of routinely weighing all adult patients attending their general practice as an intervention to aid weight management in clinical practice.

Methods: Consenting patients in six general practices were weighed at each presentation over a 12-month period. Data were analysed using linear mixed growth models. Participants' interviews at the completion of the study were thematically analysed.

Results: The overall weight loss in patients who completed the study (n = 217) was 0.51 kg (P = 0.26; not significant); in patients who were obese (n = 106) there was a greater weight loss of 1.79 kg (P = 0.04). Patients were receptive to the intervention; however, there was disruption to clinical workflow.

Discussion: Routinely weighing adult patients in general practice is feasible, requires resources and may be associated with weight loss in patients who are obese. Further research is required to inform support for implementation within practices.

Background: Identifying factors related to risky sexual behaviour may contribute to preventive and interventional approaches to reduce negative mental health outcomes among young women. The aim of this study was to investigate the association between psychological distress and risky sexual behaviours in females aged 16-25 years in Victoria, Australia.

Methods: Data were extracted from the Young Female Health Initiative (YFHI), a study in which participants were recruited via advertisements on Facebook. Logistic regression was used to assess associations between psychological distress, as measured by the Kessler 10 (K10) Psychological Distress Scale, and risky sexual behaviours.

Results: Data were available from 200 sexually active participants and 40 non-sexually active participants. We found that the K10 score was independently associated with sex while under the influence of alcohol or drugs (odds ratio: 1.7; 95% confidence intervals: 1.2, 2.7; P = 0.006).

Discussion: Although data were collected from a small sample of young women, we found that those with underlying psychological distress may adopt risky sexual behaviours, especially if concomitantly drinking alcohol or taking drugs.

Background: The use of dose administration aids (DAAs), such as compartmentalised boxes (eg dosette) or medicine packs (eg Webster-pak), is common, particularly among patients with chronic disease. The aim of this study was to investigate factors influencing patients' decisions to commence using a DAA with a view to summarising implications for practice for general practitioners (GPs).

Methods: Semi-structured interviews were undertaken with participants living in a regional town in South Australia. Analysis of transcripts was facilitated using a qualitative analysis grid.

Results: Eight participants were interviewed. Four main themes included complexity of managing medications, DAAs as a cultural artefact, taking the lead in decision making, and weight of influence of health professionals.

Discussion: This study highlights the role of individual autonomy, close relatives and pharmacy staff in decisions to commence using a DAA. Tablets included in DAAs can take priority over inhaled and injected medications. GPs have an important role in ensuring that commencing a DAA helps empower patients to improve their healthcare management and does not inhibit communication between patient, doctor and pharmacist.

Background: Acne vulgaris affects more than 90% of Australian adolescents aged 16-18 years. It may have a significantly deleterious effect on their self-esteem and emotional state. Moderate-to-severe acne can lead to scarring. There are many treatment options available. Most teenagers obtain information from their peers or from the internet.

Objective: The aim of this article is to inform general practitioners (GPs) of the pathogenesis, physiology and description of acne, as well as therapeutic options, including topical and systemic therapies. Skin care, diet and other factors of importance are also discussed.

Discussion: The first point of contact with patients is in general practice. GPs effectively manage most patients with acne. Treatment choice is guided by experience, with many clinical acne treatment guidelines available. The most common reason for treatment failure is insufficient duration of therapy. Successful treatments require months of topical agents and, in many cases, additional systemic therapies. Internationally, there is a resurgence in the basic research of acne vulgaris, leading to new topical and systemic treatments.

Background: Legal and ethical obligations do not always align when doctors become aware of a clinical situation involving a person with whom they have no pre existing therapeutic relationship. Noting a potentially malignant skin lesion, such as a melanoma on a person outside the clinical setting, provides a pertinent example.

Objective: The aim of this article is to describe the legal, ethical and professional considerations surrounding proffering a dermatological opinion in the case of suspected melanoma outside the clinical setting.

Discussion: The application of professional and ethical standards may require the doctor to act in some way to alert the person of their findings in a context whereby there is no defined positive duty to do so in Australian law. The degree to which the doctor is ethically obligated to provide an unsolicited dermatological opinion is affected by numerous and, oftentimes, competing factors.

Background: Atopic eczema is a relapsing inflammatory skin condition that can be lifelong. Management of eczema is often focused on infants, with many school-aged children undertreated. Uncontrolled eczema has a significant impact on the quality of life of the child and their family.

Objective: The objective of this article is to discuss the practical management of eczema in school-aged children.

Discussion: This article will describe how eczema manifests in school-aged children, focusing on when to suspect triggers and how to manage these from a general practice perspective, and when to refer the child on to specialist services.

Background: Constipation is best defined as difficulty passing stools that may be infrequent (≤2 per week), painful and associated with stool retention. Childhood constipation is common, with a prevalence of 3-30% worldwide. Most constipation in children is functional and related to behavioural withholding after an unpleasant stool event. Successful diagnosis and management can occur in primary care, and specialist referral is only needed for refractory cases or concerns regarding organic pathology.

Objective: This article aims to provide a structure for evaluating, diagnosing and managing childhood functional constipation in general practice.

Discussion: Structured history and examination can screen for organic pathology or red flags that require specialist referral. Investigations such as abdominal X-ray are not routine. Early management of childhood constipation provides improved quality of life for patients and their families. Management, including disimpaction and maintenance, should maintain continuity of care and provide long-term support for families.

Background: Marine organism wound infections are common in coastal regions of Western Australia. Local treatment guidelines are based on studies from elsewhere. The objective of this article was to identify the causative organisms in marine wounds sustained in the subtropical and tropical coastal waters of the Indian Ocean, Gascoyne region (north-west), Western Australia.

Methods: This was a prospective study. A single wound swab was taken from 28 consenting patients who presented with a suppurating marine wound to the emergency departments of Carnarvon and Exmouth hospitals.

Results: The wounds of 27 out of 28 patients returned a positive culture. The two most common organisms were Staphylococcus aureus (n = 18/28; 64.3%) and Vibrio species (n = 9/28; 32.1%). The culture was polymicrobial in 11 patients (39.3%).

Discussion: S. aureus or Vibrio species were frequently seen in marine wounds, and infections were often polymicrobial. Our results suggest that flucloxacillin (or clindamycin) and doxycycline (or ciprofloxacin) would be a reasonable combination for empirical oral therapy in adults.

Background: Chest pain is a common presenting complaint in general practice. Serum troponin testing is an important clinical tool to help identify patients who present with suspected acute coronary syndrome (ACS).

Objective: This article will discuss the role of troponin testing in the diagnosis of ACS, and the role of high-sensitive troponin, which is now in widespread use. The importance of clinical acumen in the interpretation of troponin testing and the pitfalls of troponin testing in the primary care setting will also be explored.

Discussion: Patients should be promptly referred to the hospital when there is a high clinical suspicion of ACS. This is to ensure early diagnosis, provide specialist care and minimise the risk of complications. For patients who present with suspected ACS, troponin testing in the community should not delay referral to the emergency department. Troponin testing has a limited role in the primary care setting, which will be discussed in this article.