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    9266 results match your criteria Australian family physician[Journal]

    1 OF 186

    Occupational violence and staff safety in general practice.
    Aust Fam Physician 2017 Dec;46(12):952-956
    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. Read More

    You should get that mole checked out: Ethical and legal considerations of the unsolicited clinical opinion.
    Aust Fam Physician 2017 Dec;46(12):949-951
    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. Read More

    Understanding the decision to commence a dose administration aid.
    Aust Fam Physician 2017 Dec;46(12):943-947
    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. Read More

    Psychological distress and risky sexual behaviours among women aged 16-25 years in Victoria, Australia.
    Aust Fam Physician 2017 Dec;46(12):935-941
    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. Read More

    A mixed-methods feasibility study of routinely weighing patients in general practice to aid weight management.
    Aust Fam Physician 2017 Dec;46(12):928-933
    MBBS, MFM (Clin), PhD, DRANZCOG, FRACGP, General Practitioner and Roberta Williams Chair of General Practice, Graduate School of Medicine, University of Wollongong, and a general practitioner, New South Wales.
    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. Read More

    The Australian Mid-West Coastal Marine Wound Infections Study.
    Aust Fam Physician 2017 Dec;46(12):923-927
    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. Read More

    Management of bariatric patients beyond the scalpel.
    Aust Fam Physician 2017 Dec;46(12):918-921
    Background: Obesity management in general practice sometimes involves referral of patients for bariatric surgery. Integral to the success of long-term weight loss maintenance is supporting the patient's psychological, nutritional and exercise needs.

    Objective: This article is written to equip general practitioners (GPs) to manage the comprehensive needs, before and after bariatric surgery, of patients who are obese. Read More

    Growth disorders in adolescents.
    Aust Fam Physician 2017 Dec;46(12):913-917
    Background: Growth is one of the fundamental processes of adolescent development. Careful history and examination, and relevant tar-geted investigations, can streamline the referral process, highlighting the important role of primary healthcare clinicians.

    Objective: This article will provide a guide for clinicians to categorise growth patterns in adolescents, and recognise patients who may have a growth disorder. Read More

    Childhood constipation.
    Aust Fam Physician 2017 Dec;46(12):908-912
    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. Read More

    Depression in children.
    Aust Fam Physician 2017 Dec;46(12):901-907
    Background: Major depressive disorder (MDD) in children (5-12 years of age) is a confronting and serious psychiatric illness. MDD has significant ramifications for the psychosocial development of the child, yet it remains under-recognised and undertreated. General practice is where these children and their parents will first present. Read More

    Patients' attitudes towards chaperone use for intimate physical examinations in general practice.
    Aust Fam Physician 2017 Nov;46(11):867-873
    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. Read More

    The challenge of liver cancer surveillance in general practice: Do recall and reminder systems hold the answer?
    Aust Fam Physician 2017 Nov;46(11):859-864
    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. Read More

    Osteosarcopenia: A new geriatric syndrome.
    Aust Fam Physician 2017 Nov;46(11):849-853
    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. Read More

    Early detection of eating disorders in general practice.
    Aust Fam Physician 2017 Nov;46(11):833-838
    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. Read More

    Diverticular disease practice points.
    Aust Fam Physician 2017 Nov;46(11):829-832
    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. Read More

    Troponin testing in the primary care setting.
    Aust Fam Physician 2017 Nov;46(11):823-826
    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. Read More

    Pulmonary embolism An update.
    Aust Fam Physician 2017 Nov;46(11):816-820
    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. Read More

    Aust Fam Physician 2017 Nov;46(11):810-814
    FRACP, FCSANZ, Clinical Director of Coronary Care Unit, Gold Coast University Hospital, Associate Professor, Griffith University School of Medicine and Bond University, Gold Coast, QLD.
    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. Read More

    Practice-based research networks.
    Aust Fam Physician 2017 Oct;46(10):793-795
    PhD, BSc, Honorary Research Fellow at Mater Research Institute, The University of Queensland, Brisbane, QLD.
    Background: Practice-based research networks (PBRNs) are collaborations between clinical practitioners and academics. PBRNs aim to foster research in general practice through opportunities to learn more about how to undertake and participate in research, and assist in translating new knowledge into practice. Critically, PBRNs also offer clinicians the chance to contribute to research by posing questions of importance to quality clinical care. Read More

    Transport on prescription: How can GPs contribute to the promotion of active transport?
    Aust Fam Physician 2017 Oct;46(10):783-788
    Background: Active transport (ie walking, cycling, using public transport) can play a part in reducing non-communicable diseases (NCDs). Very little is known about how general practitioners (GPs) can contribute to promoting active transport. We explored GPs' ideas around active transport, and potential barriers and facilitators to its promotion in the clinical setting. Read More

    Morphine use in cancer care: A survey of attitudes and perceptions in general practice patients.
    Aust Fam Physician 2017 Oct;46(10):775-780
    Background: Morphine is widely prescribed for patients with cancer, although a number of attitudes have been cited as barriers to its use, including fear, addiction and associations with death. The aim of this study was to explore the nature of these beliefs, and assess the extent to which these attitudes exist in a general practice patient population that may require morphine in the future.

    Methods: A 30-item survey was distributed through general practices in Victoria, Australia. Read More

    Barriers to effective conversations regarding overweight and obesity in regional Victoria.
    Aust Fam Physician 2017 Oct;46(10):769-773
    Background: General practitioners (GPs) have a crucial role to play in engaging patients in discussions about overweight and obesity. However, such discussions are currently uncommon. The aim of this study was to examine how GPs in rural areas talk about overweight and obesity with their patients, specifically to identify key barriers to effective conversations. Read More

    Electronic clinical decision support tool for the evaluation of cardiovascular risk in general practice: A pilot study.
    Aust Fam Physician 2017 Oct;46(10):764-768
    Background: Cardiovascular disease (CVD) is a major cause of death in Australia. Electronic medical record (EMR)-based clinical decision support (CDS) tools have the potential to support absolute CVD risk (ACVDR) evaluation and management. The objective of this study was to test the acceptability and feasibility of the Treat to Target CVD (T3CVD), an EMR-based CDS tool, for the evaluation of ACVDR in general practice. Read More

    Growing and retaining general practice research leaders in Australia: How can we do better?
    Aust Fam Physician 2017 Oct;46(10):757-762
    Background: The aim of this study was to explore the experiences of Australian general practitioners (GPs) with a Doctor of Philosophy (PhD) about their choice to abandon or pursue an academic career.

    Methods: A qualitative study of 18 GPs (PhD obtained between 2006 and 2016) was conducted. Semi-structured telephone interviews were transcribed and analysed using concurrent thematic analysis. Read More

    Lifestyle risk factors and corresponding levels of clinical advice and counselling in general practice.
    Aust Fam Physician 2017 Oct;46(10):751-755
    Background: The objective of this study was to examine prevalence rates of lifestyle risk factors in the Western Victorian Primary Health Network (WV PHN) general practice patient population and the corresponding levels of clinical advice and counselling.

    Methods: Analysed data from the Bettering the Evaluation and Care of Health (BEACH) program from April 2011 to March 2015 were examined, providing a comparison of three geographical areas of general practice patients: WV PHN, Victoria and Australia.

    Results: Rates of clinical advice and counselling for diet and exercise provided by general practitioners (GPs) in the WV PHN network were significantly lower than Victorian and Australian rates, despite the region's higher obesity rates. Read More

    Non-invasive prenatal testing.
    Aust Fam Physician 2017 Oct;46(10):735-739
    Background: Non-invasive prenatal testing (NIPT), also known as cell-free DNA testing and non-invasive prenatal screening (NIPS), is an important addition to the range of screening tests for fetal chromosomal abnormalities. For trisomy 21 in particular, NIPT is superior to other screening modalities. However, NIPT has limitations and complexities that requesting clinicians and their patients should understand. Read More

    Oral hormonal contraception in special circumstances.
    Aust Fam Physician 2017 Oct;46(10):728-732
    Background: Despite the general consensus that long-acting reversible contraceptives (LARCs) are the most appropriate choice of contraception for most women, there are special circumstances when the contraceptive and non-contraceptive needs of the patient are met by oral methods.

    Objective: By using case histories, we seek to demonstrate the medical and practical complexities in managing contraceptive needs that may result in oral contraception being the most appropriate choice. The cases also illustrate the resources available to enable evidence-based management. Read More

    Emergency contraception: Oral and intrauterine options.
    Aust Fam Physician 2017 Oct;46(10):722-726
    Background: Emergency contraception can be used to prevent pregnancy where contraception has not been used, or there has been contraceptive misuse or failure. Australian women have three options for emergency contraception: two types of oral pills (levonorgestrel [LNG]-containing pill and ulipristal acetate [UPA]) and the copper intrauterine device (IUD). Both pills are available from pharmacies without prescription, whereas the copper IUD requires insertion by a trained provider. Read More

    The management of irregular bleeding in women using contraception.
    Aust Fam Physician 2017 Oct;46(10):717-720
    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. Read More

    LARCs as first-line contraception - What can general practitioners advise young women?
    Aust Fam Physician 2017 Oct;46(10):710-715
    DHSc, MPH, BSc, is Associate Professor and Director, Research Training, General Practice, University of Melbourne, Victoria.
    Background: The use of long-acting reversible contraceptives (LARCs) is globally accepted as a strategy that is successful in decreasing rates of unintended pregnancy, especially in very young women. Currently, Australia has very low uptake rates of LARC.

    Objective: The aim of this paper is to explore the latest information on using LARCs as first-line contraception in young women. Read More

    Clinical Challenge.
    • Authors:
    Aust Fam Physician 2017 Sep;46(9):703-704
    Questions for this month's clinical challenge are based on articles in this issue. The clinical challenge is endorsed by the RACGP Quality Improvement and Continuing Professional Development (QI&CPD) program and has been allocated four Category 2 points (Activity ID: 109894). Answers to this clinical challenge are available immediately following successful completion online at http://gplearning. Read More

    Locating advance care planning facilitators in general practice increases consumer participation.
    Aust Fam Physician 2017 Sep;46(9):691-695
    Background: Advance care planning (ACP) can positively affect end-of-life care experiences. However, uptake of ACP completion is low. The aim of this study was to investigate whether co-locating ACP facilitators in general practice increased participation METHODS: Barwon Health commenced promoting its ACP program in 2008. Read More

    Knowledge and practices of chronic hepatitis B virus testing by general practitioners in Victoria, Australia, 2014-15.
    Aust Fam Physician 2017 Sep;46(9):683-689
    Background: More than one-third of people living with chronic hepatitis B virus (HBV) in Australia have not been diagnosed. The aim of this study was to assess general practitioners' (GPs') knowledge and practices regarding chronic HBV diagnosis, and identify opportunities to improve testing rates.

    Methods: A cross-sectional survey was conducted with GPs working in Victoria, Australia. Read More

    Helping mothers with the emotional dysregulation of borderline personality disorder and their infants in primary care settings.
    Aust Fam Physician 2017 09;46(9):669-672
    Background: Six per cent of patients who present to primary care have borderline personality disorder (BPD). Mothers with full or partial features of BPD, often undiagnosed and perhaps previously functioning adequately enough on the surface, may rapidly be-come emotionally dysregulated by the normal needs of an infant. Family and maternal functioning can rapidly destabilise. Read More

    Adult male stress and urge urinary incontinence - A review of pathophysiology and treatment strategies for voiding dysfunction in men.
    Aust Fam Physician 2017 Sep;46(9):661-666
    MBBS, is a urological surgeon, Princess Alexandra Hospital and St Andrew's Hospital, Brisbane, Queensland.
    Background: Male urinary incontinence adversely affects health-related quality of life and is associated with significant psychosexual and financial burden. The two most common forms of male incontinence are stress urinary incontinence (SUI) and overactive bladder (OAB) with concomitant urge urinary incontinence (UUI).

    Objective: The objectives of this article are to briefly review the current understandings of the pathophysiological mechanisms in SUI and OAB/UUI, and offer a set of practical, action-based recommendations and treatment strategies. Read More

    Peyronie's disease - Watch out for the bend.
    Aust Fam Physician 2017 Sep;46(9):655-659
    Background: Peyronie's disease is a relatively common condition in urological practice, but is still poorly identified and understood in the wider medical community and by most of the public. Identifying the condition and appropriate referral for expert opinion can significantly lessen the physical and psychological effect on patients.

    Objective: The objective of this article is to provide general practitioners with a concise and updated review of Peyronie's disease, with the aim of helping them to provide appropriate advice to their patients. Read More

    Urolithiasis - Ten things every general practitioner should know.
    Aust Fam Physician 2017 Sep;46(9):648-652
    Background: Upper urinary tract stones are a common problem in Australia, with an incidence of 0.13% per year, and a lifetime prevalence of up to 15% in males and 8% in females. Many of these patients first present to general practitioners (GPs), so a thorough understanding of the diagnosis, treatment and prevention of stone disease is an important part of any GP's arsenal. Read More

    Male infertility - The other side of the equation.
    Aust Fam Physician 2017 Sep;46(9):641-646
    Background: A male factor contributes to infertility in approximately 50% of couples who fail to conceive, causing significant psychosocial and marital stress.

    Objective: This article reviews the general practitioner's (GP's) evaluation of male infertility and indications for referral to a male infertility specialist, and gives an overview of the specialist management of male infertility.

    Discussion: Male infertility can result from anatomical or genetic abnormalities, systemic or neurological diseases, infections, trauma, iatrogenic injury, gonadotoxins and development of sperm antibodies. Read More

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