Australian family physician最新文献

Background: Hepatocellular carcinoma (HCC) surveillance reduces mortality in at-risk people living with chronic hepatitis B (CHB), but is difficult to achieve in practice. The objective of this study was to measure participation and adherence to liver cancer HCC surveillance in eligible patients in a community health centre, following support from the Integrated Hepatitis B Service (IHBS).

Methods: A retrospective analysis of the medical records of patients with CHB who met the indications for HCC surveillance over a 4.5-year period of IHBS involvement was conducted. Data collected included the date of ultrasound examinations and HBV DNA viral load tests.

Results: Sixty-seven patients underwent HCC surveillance, representing 213 person years. The participation rate was 75%. Adherence to surveillance was considered good in 18 (27%) patients, suboptimal in 29 (43%) patients and poor in 20 (30%) patients. A greater proportion of patients were receiving HCC surveillance at the final audit (56%) than at baseline (10%; P DISCUSSION: It is difficult to achieve optimal adherence to HCC surveillance, even with additional support.

Background: Pulmonary embolism is a common condition and can be the source of significant morbidity and mortality.

Objective: This article reviews the approach to the diagnostic assessment and management of patients with suspected pulmonary embolism.

Discussion: Various clinical decision rules and algorithms are available to assist in the diagnosis of pulmonary embolism, and the Wells score and Pulmonary Embolism Rule-out Criteria rule are presented in this article. The utility of D-dimer testing and the role of imaging to confirm the diagnosis are also discussed. Treatment options once pulmonary embolism is confirmed are presented.

Background: The objective of this article is to investigate patients' attitudes to the use of chaperones for intimate physical examinations (IPEs) in a sample of Australian general practices.

Methods: A cross-sectional survey of adult patients from 13 randomly selected general practices in regional New South Wales was conducted between September and November 2012. Generalised linear mixed models were used for analysis.

Results: Of 780 surveys distributed, 687 (88%) were returned; the age range was 18-91 years and 356 (52%) were from female patients. Most women had never had a chaperone present for a Papanicolaou (Pap) smear (82.6%). Between 23% and 33% of respondents preferred a chaperone with their usual general practitioner (GP) across IPEs and gender of the respondents. The odds of preference for a chaperone were significantly less with a GP whom the respondents did not know well, compared with their usual GP, for a Pap smear (female) or genital examination (male).

Discussion: Individualised discussion regarding chaperone use for IPEs is warranted, especially with patients seeing their usual GP.

Background: General practitioners (GPs) are often the first health professional consulted in regard to eating disorders and their varied presentations. Given the prognostic significance of early detection of, and intervention for, such conditions, it is important that GPs feel confident to do so.

Objective: The aim of this article was to heighten awareness of the role of early identification and diagnosis of eating disorders, especially anorexia nervosa and bulimia nervosa, in the primary care setting. The focus will be on their presentations and diagnosis, including changes to the Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5), with a brief overview of management recommendations and admission criteria.

Discussion: Eating disorders are complex, potentially life-threatening illnesses with significant medical and psychosocial consequences. Early detection and intervention can significantly contribute to better outcomes, and GPs are ideally placed to effect this.

Background: Longevity, the increase in the ageing population and a lifestyle of minimal physical activity come with a hefty price. Consequently, two diseases are increasingly becoming a concern for the welfare of patients and the health industry: osteoporosis and sarcopenia. These conditions are usually interrelated through several mechanisms and metabolic pathways, and comprise a syndrome called osteosarcopenia.

Objective: As patients with osteosarcopenia represent an important subset of frail individuals at higher risk of institutionalisation, falls and fractures, the aim of this review is to further familiarise general practitioners with osteosarcopenia as a new geriatric syndrome that requires early diagnosis and effective therapeutic interventions.

Discussion: The most important aspects of osteosarcopenia are discussed here. These include pathogenesis, prevalence, diagnostic criteria, management and follow-up. Finally, the role of multidisciplinary clinics for the care of patients with osteosarcopenia is discussed in brief.

Background: Pericarditis is an important diagnosis to consider, along with various other differential diagnoses, in a patient who presents with chest pain.

Objective: This article describes in detail the common features, management and complications of pericarditis in the general practice setting.

Discussion: Characteristic clinical findings in pericarditis include pleuritic chest pain and pericardial friction rub on auscultation of the left lower sternal border. Electrocardiography may reveal diffuse PR-segment depressions and diffuse ST-segment elevations with upward concavity. The most common aetiologies of pericarditis are idiopathic and viral, and the most common treatment for these are nonsteroidal anti-inflammatory drugs and colchicine. The complications of pericarditis include pericardial effusion, tamponade and myopericarditis. The presence of effusion, constriction or tamponade can be confirmed on echocardiography. Tamponade is potentially life-threatening and is diagnosed by the clinical findings of decreased blood pressure, elevated jugular venous pressure, muffled heart sounds on auscultation and pulsus paradoxus.

Background: Diverticular disease and its spectrum of complications are increasingly encountered in the Australian population. Accurate management of patients before and after an acute episode entails extension beyond the acute event to include dietary advice and colonoscopy.

Objective: The objectives of this article are to evaluate the literature regarding dietary factors and diverticular disease, routine colonoscopy and antibiotic treatment in acute diverticulitis, to enable primary care physicians to manage patients and provide sound advice after hospital admission.

Discussion: Diverticulitis can often be managed in the community by general practitioners, but the necessity of antibiotics may not be definitive. When patients do require hospital admission, advice and management of patient lifestyle factors after admission, and investigations to rule out red flags are crucial. These elements of patient management are the subject of debate, as it appears that standard dietary advice does not alter a patient's clinical course, and colonoscopy is not always necessary and should be used judiciously.

Background: The pattern of menstrual bleeding seen in women during their reproductive years is the result of a finely tuned balance be-tween endogenous oestrogens, which stimulate the endometrial lining, and progesterone, which temporarily maintains that lining in anticipation of a pregnancy. Many women have expectations of a 'normal monthly' cycle, and may be wary of any-thing that has the potential to disrupt its regularity. From a clinical perspective, any alteration in vaginal bleeding may indicate underlying pathology, and lead to further investigation and management.

Objective: The aim of this article is to provide a practical approach to the investigation and management of altered vaginal bleeding patterns in women using various methods of contraception.

Discussion: Around 70% of Australian women of reproductive age use some form of contraception. Any discussion of 'normal bleeding' becomes even more complex given that modern contraceptive methods almost inevitably modify the pattern of bleeding experienced by the user.