General Practice
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The Discipline of General Practice is part of the School of Population Health and Clinical Practice
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Item Metadata only 10-minute consultation: funny turn(British Med Journal Publ Group, 2011) Leung, E.; Hamilton-Bruce, M.; Stocks, N.; Koblar, S.Item Metadata only 75+ health assessments(Royal Australian College of General Practitioners, 2001) Newbury, J.; Marley, J.Item Metadata only A 5-year follow-up of general practice patients experiencing depression(Oxford Univ Press, 2003) Wilson, I.; Duszynski, K.; Mant, A.Background. Depression is a common disease in primary care and produces significant morbidity in the community. Little is known about the outcomes of depression in general practice. Objectives. This research set out to explore both the longitudinal management and outcomes of depression as seen in general practice. Methods. The Medic-GP database is a collection of the medical records of >50 000 people seen in nine Australian general practices. It was used to follow the management of depressed patients over 4–5 years. Records from 1994–1995 were searched for depression or similar words. Individual records of patients whose notes mentioned depression were randomly selected and examined to determine if they were diagnosed with depression. Records of patients who were diagnosed as suffering from depression were examined to determine progress over the ensuing 5 years. Results. Six hundred of 5889 patients were examined in detail. A total of 382 patients (63.7%) were diagnosed with depression; 219 had been diagnosed during this time interval. The main findings were 64.7% of patients were female; 93.6% of patients received an antidepressant at some time during the study; 16% of patients were referred to a psychiatrist; 7.3% were hospitalized; 30% of patients who ceased antidepressants without a recurrence had courses of antidepressants of 3 months or less; and only 22.5% of patients had a single episode of depression. Conclusion. Unlike cross-sectional studies, this study has shown a high rate of prescription of antidepressants. GPs often prescribed short courses of antidepressants, and depression behaves as a chronic, recurrent disease.Item Open Access A before and after study of the impact of academic detailing on the use of diagnostic imaging for shoulder complaints in general practice(BioMed Central Ltd., 2007) Broadhurst, N.; Barton, C.; Rowett, D.; Yelland, L.; Matin, D.; Gialamas, A.; Beilby, J.Background: The aim of this study was to assess the impact that Academic Detailing (AD) had on General Practitioners' use of diagnostic imaging for shoulder complaints in general practice and their knowledge and confidence to manage shoulder pain. Methods: One-to-one Academic Detailing (AD) for management of shoulder pain was delivered to 87 General Practitioners (GPs) in metropolitan Adelaide, South Australia, together with locally developed clinical guidelines and a video/DVD on how to examine the shoulder. Three months after the initial AD a further small group or an individual follow up session was offered. A 10-item questionnaire to assess knowledge about the shoulders was administered before, immediately after, and 3 months after AD, together with questions to assess confidence to manage shoulder complaints. The number of requests for plain film (X-ray) and ultrasound (US) imaging of the shoulder was obtained for the intervention group as well as a random comparison group of 90 GP's from the same two Divisions. The change in the rate of requests was assessed using a log Poisson GEE with adjustment for clustering at the practice level. A linear mixed effects model was used to analyse changes in knowledge. Results: In an average week 54% of GPs reported seeing fewer than 6 patients with shoulder problems. Mean (SD) GP knowledge score before, immediately after and 3-months after AD, was 6.2/10 (1.5); 8.6/10 (0.96) and; 7.2/10 (1.5) respectively (p < 0.0001). Three months after AD, GPs reported feeling able to take a more meaningful history, more confident managing shoulder pain, and felt their management of shoulder pain had improved. Requests for ultrasound imaging were approximately 43.8% higher in the period 2 years before detailing compared to six months after detailing (p < 0.0001), but an upward trend toward baseline was observed in the period 6 months to 1 year after AD. There was no statistically significant change in the rate of requests from before to after AD for plain-radiographs (p = 0.11). No significant changes in the rate of requests over time were observed in the control groups. Conclusion: These results provide evidence that AD together with education materials and guidelines can improve GPs' knowledge and confidence to manage shoulder problems and reduce the use of imaging, at least in the short term.Item Metadata only A bowel cancer screening plan at last(Australasian Medical Publishing Company, 2015) Frank, O.R.; Stocks, N.P.Item Metadata only A brief experience for medical students in a remote Aboriginal community(Royal Australian College of General, 2015) Benson, J.; Ryder, C.; Gill, M.; Balabanski, A.Background: Aboriginal and Torres Strait Islander peoples, particularly those in remote communities, have lower access to health services when compared with the rest of the Australian population. This research examined the expectations and outcomes of medical students who went on a 2-day trip to a remote Aboriginal community. Methods: Activities were organised by community members, ground staff and fly-in fly-out health professionals. Students wrote about their expectations and post-trip reflections on personal, medical and cultural themes. Results: Twenty-three students participated in this study. Themes included complex, different and increased illnesses; how culture affects day-to-day life and health; personal growth; administrative, health delivery and advocacy skills; learning cultural awareness first-hand; and future career options. Discussion: The 2-day trip gave students a profound learning experience. To build a culturally appropriate and dedicated workforce for Aboriginal and Torres Strait Islander peoples, medical schools should consider incorporating short trips to remote Aboriginal and Torres Strait Islander communities into their curriculum.Item Metadata only A brief history of snake venoms affecting hemostasis(Marcel Dekker Inc, 2006) Marsh, N.The earliest reports of snake venoms affecting hemostasis occur in the 17th century and first half of the 18th century with the observations of Nieremberius (1635), van Helmont (1648), Richard Mead (1702), and Geoffrey and Hunauld (1737). However, our detailed knowledge of this field of toxinology stems largely from the work in the second half of the 18th century of Felice Fontana, who is credited with being the first investigator to inject viper venom into dogs. Fontana's work foreshadowed many seminal discoveries that were to be made in the next 200 years, but a fallow period of research followed Fontana until three Britons took up investigations into snake venoms beginning in the late 19th century: Charles Martin, who worked on Australian snake venoms; Gwyn Macfarlane, who studied Russell's viper venom, initially in relation to the treatment of hemophilia; and Alistair Reid, who worked on the Malayan pit viper and was the first to suggest the use of snake venom, thrombin-like enzymes in "therapeutic defibrination" as an alternative anticoagulant strategy. From the 1960s onwards, the explosion of research activity generated in part by molecular biology, has provided a vast amount of data in this field. Notably, studies on venom factors affecting platelet function are part of this more recent history, and in the last 20 years, a wide range of C-type lectins and disintegrins have been discovered. Molecular techniques have now enabled the identification of gene structure, the cloning of genes, the production of recombinant protein, and the elucidation of protein function at the molecular level. Overall, a significant number of snake venom toxins affecting hemostasis have been put to use in both the research and routine coagulation laboratory settings and show much promise in a variety of clinical situations. Copyright © 2006 Taylor & Francis Group, LLC.Item Metadata only A case-control study of the protective benefit of cervical screening against invasive cervical cancer in NSW women(Kluwer Academic Publ, 2008) Yang, B.; Morrell, S.; Zuo, Y.; Roder, D.; Tracey, E.; Jelfs, P.Objective: To examine the effects of different Pap screening patterns in preventing invasive cervical cancer among women in New South Wales, Australia. Methods: A total of 877 women aged 20–69 years diagnosed with invasive cervical cancer during 2000–2003 were matched with 2,614 controls by month and year of birth. Screening behavior patterns in 4 years preceding the time of cancer diagnosis in the cases were classified into none (no Pap test in the 4 years), ‘irregular’ (1 of the 4 years with Pap test(s)), and ‘regular’ (2 or more of the 4 years with a Pap test), and compared with those in the matched non-cases over the same period. Conditional logistic regression modeling was used to estimate the relative risk, approximated by the odds ratio, of invasive cervical cancer for regular and irregular cervical screening compared with no screening in the previous 4 years, before and after controlling for potential confounders including the first recorded Pap test result in the preceding 6-year reference period. Results Compared with no screening, irregular Pap screening in the 4 years preceding the cancer diagnosis is estimated to reduce the risk of invasive cervical cancer by about 85% (RR = 0.15, 95% CI: 0.120–0.19); regular Pap screening reduces the risk by about 96% (RR = 0.04, 95% CI: 0.03–0.05). After adjusting for the index Pap test result, the relative risks for invasive cervical cancer were 0.19 (95% CI: 0.13–0.27) for irregular screening and 0.07 (95% CI: 0.04–0.10) for regular Pap screening. Conclusions Regular and irregular Pap tests among women aged 20–69 years were highly effective in preventing invasive cancer. At-risk women with no Pap test history should be encouraged to undergo a Pap test every 2 years, but any Pap screening over a 4-year period remains highly protective against future invasive cervical cancer.Item Metadata only A chain is as strong as its weakest link but that link could be the subject matter of the questionnaire!(Oxford Univ Press, 2002) Stocks, N.; Gunnell, D.Item Metadata only A checklist for comprehensive health assessment for the over 70's(Council Ageing, 2002) Byles, J.; Tavener, M.; Fitzgerald, P.; Nair, B.; Higginbotham, N.; Jackson, C.; Heller, R.; Newbury, J.Objectives: To describe the development and performance of an instrument for health assessment of older Australian veterans and war widows, including: (a) the underlying dimensions of the assessment instrument, (b) problems identified and (c) associations with health related quality of life. Method: Participants were randomly selected veterans and war widows aged 70 years and over, living independently in 10 regions of NSW and QLD. The intervention consisted of a series of preventive care home visit health assessments by health professionals using a specially developed 113‐item screening checklist, together with targeted health education materials, telephone follow‐up and computer generated reports to the veteran's local medical officer. Main outcome measures were underlying facets of the checklist, and associations with self reported quality of life. Results: 904 home visit assessments were conducted using the checklist. Problems identified included having no recent hearing check, poor rate of vaccination against pneumonia and tetanus vaccination, and problems with feet. Exploratory factor analysis of the checklist reported four main factors, explaining 31% of the variance. Three out of four checklist scales were significantly associated with both physical and mental component scores of the SF‐36 quality of life measure.Conclusions: The preventive care checklist proved easy to administer, acceptable to participants, and contained valid items for use with an older veteran population.Item Metadata only A community population survey of prevalence and severity of dyspnea in adults(Elsevier Science Inc, 2009) Currow, D.; Plummer, J.; Crockett, A.; Abernethy, A.Given the progress in the symptomatic treatment of breathlessness, and the physical and psychological morbidity associated with chronic breathlessness, estimates of the size of the population that may benefit from better support become imperative. Prevalence estimates have varied widely (0.9% of clinical encounters to 32%) and have largely relied only on respondents who used clinical services. Whole-of-population approaches may be able to define better the "true" prevalence of chronic breathlessness and quantify exertion limited by breathlessness. The aim of this study was to estimate population levels of chronic breathlessness, severity of limits to exercise, and demographic predictors of the presence of breathlessness. A whole-of-population face-to-face survey method (n=8,396) in South Australia was used, directly standardized for age, gender, country of birth, and rurality. Respondents were asked about breathlessness and levels of exertion causing breathlessness for at least three of the last six months using a modified Medical Research Council dyspnea scale. Univariate and multivariate analyses identify the demographic characteristics of people more likely to experience chronic breathlessness. With a participation rate of 65.3%, 8.9% of respondents had breathlessness that chronically limited exertion. Significant associations with chronic breathlessness in multivariate analysis included female sex (P<0.001), not working full time (P<0.001), low income (P=0.007), and older age (P=0.031). There are significant levels of chronic breathlessness in the community. Given the prevalence, it is feasible to explore the onset of breathlessness, the underlying etiologies and subsequent health service utilization, and health consequences.Item Open Access A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly(Massachusetts Medical Soc, 2003) Wing, L.; Reid, C.; Ryan, P.; Beilin, L.; Brown, M.; Jennings, G.; Johnston, C.; McNeil, J.; MacDonald, G.; Marley, J.; Morgan, T.; West, M.Background Treatment of hypertension with diuretics, beta-blockers, or both leads to improved outcomes. It has been postulated that agents that inhibit the renin–angiotensin system confer benefit beyond the reduction of blood pressure alone. We compared the outcomes in older subjects with hypertension who were treated with angiotensin-converting–enzyme (ACE) inhibitors with the outcomes in those treated with diuretic agents. Methods We conducted a prospective, randomized, open-label study with blinded assessment of end points in 6083 subjects with hypertension who were 65 to 84 years of age and received health care at 1594 family practices. Subjects were followed for a median of 4.1 years, and the total numbers of cardiovascular events in the two treatment groups were compared with the use of multivariate proportional-hazards models. Results At base line, the treatment groups were well matched in terms of age, sex, and blood pressure. By the end of the study, blood pressure had decreased to a similar extent in both groups (a decrease of 26/12 mm Hg). There were 695 cardiovascular events or deaths from any cause in the ACE-inhibitor group (56.1 per 1000 patient-years) and 736 cardiovascular events or deaths from any cause in the diuretic group (59.8 per 1000 patient-years; the hazard ratio for a cardiovascular event or death with ACE-inhibitor treatment was 0.89 [95 percent confidence interval, 0.79 to 1.00]; P=0.05). Among male subjects, the hazard ratio was 0.83 (95 percent confidence interval, 0.71 to 0.97; P=0.02); among female subjects, the hazard ratio was 1.00 (95 percent confidence interval, 0.83 to 1.21; P=0.98); the P value for the interaction between sex and treatment-group assignment was 0.15. The rates of nonfatal cardiovascular events and myocardial infarctions decreased with ACE-inhibitor treatment, whereas a similar number of strokes occurred in each group (although there were more fatal strokes in the ACE-inhibitor group). Conclusions Initiation of antihypertensive treatment involving ACE inhibitors in older subjects, particularly men, appears to lead to better outcomes than treatment with diuretic agents, despite similar reductions of blood pressure.Item Metadata only A comparison of the effect of high- and low-dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly(Lippincott Williams & Wilkins, 2006) Silbert, B.; Scott, D.; Evered, L.; Lewis, M.; Kalpokas, M.; Maruff, P.; Myles, P.; Jamrozik, K.BACKGROUND: Postoperative cognitive dysfunction (POCD) after coronary artery bypass graft surgery is a common complication for which, despite many clinical investigations, no definitive etiology has been found. The current use of both high- and low-dose fentanyl as anesthetic techniques allowed us to investigate the effect of fentanyl on the incidence of POCD. METHODS: Three hundred fifty patients scheduled to undergo elective coronary artery bypass graft surgery were randomized to receive either high-dose fentanyl (50 microg/kg) or low-dose fentanyl (10 mug/kg) as the basis of the anesthetic. All patients underwent neuropsychological testing before surgery and at 1 week, 3 months, and 12 months after surgery. RESULTS: One hundred sixty-eight patients in the low-dose group and 158 patients in the high-dose group were included in the final analysis. Neuropsychological testing was performed on 88%, 93%, and 92% of patients at 1 week, 3 months, and 12 months, respectively. There was no difference between group mean scores at any of the three testing times. Analysis of individual patients by the 20% rule did not detect any differences between groups. The one SD rule, which has fewer false-positive results, detected significantly more patients with POCD in the low-dose group than in the high-dose group at 1 week (23.6% vs. 13.7%; P = 0.03) but not at the other testing times. Patients with POCD spent an average of 1.2 days longer in the hospital than those without POCD (P = 0.021). CONCLUSIONS: High-dose fentanyl is not associated with a difference in the incidence of POCD at 3 or 12 months after surgery. Low-dose fentanyl leads to shorter postoperative ventilation times and may be associated with a greater incidence of POCD 1 week after surgery. Early POCD is associated with an increased duration of stay in the hospital.Item Metadata only A culturally sensitive consultation model(Medicine Today Pty Ltd, 2005) Benson, J.Item Metadata only A fistful of prescriptions: is there a better way?(Royal Australian College of General Practitioners, 2011) Frank, O.Since the inception of the Pharmaceutical Benefits Scheme (PBS) in the late 1940s there has been a dramatic increase in the range of medicines that are available to the Australian community. The simultaneous rise in the prevalence of chronic disease means that many patients are taking multiple medicines on a long term basis, with a concommitent increased risk of drug related problems including adverse effects, and drug-drug interactions and drug-disease interactions.Item Metadata only A guide for the assessment and management of vitamin D status in people with intellectual disability (developed as an AADDM Working Party initiative)(Carfax Publishing Ltd, 2008) Vanlint, S.; Nugent, M.; Durvasula, S.; Downs, J.; Leonard, H.Item Metadata only A guide to computer-generated prescriptions(1996) Frank, O.; Kidd, M.The use of computer systems to produce prescriptions offers many benefits at a reasonable cost. This article summarises the benefits and costs and the steps recommended for general practitioners who wish to start using a computer to generate their prescriptions.Item Metadata only A memorable patient: A plastic plug resurfaces(British Med Journal Publ Group, 2000) Newbury, J.Item Open Access A multiple intelligences approach to counseling: enhancing alliances with a focus on strengths(American Psychological Association, 2015) Pearson, M.; O'Brien, P.; Bulsara, C.This qualitative study investigated the experiences of eight counselors as they introduce multiple intelligences theory and activities into therapy with adult clients. As research on the application of multiple intelligences in the field of education has revealed many positive psychological benefits, this study explores possible therapeutic benefits from incorporating multiple intelligences within therapy. Semi-structured interviews conducted three months post multiple intelligences training, were transcribed and analyzed using interpretative phenomenological analysis. The major themes that emerged included perceptions of enhanced therapeutic alliances, more effective professional work, experiences of increased confidence, positive client response to a strength-based approach, positive client responses to a multiple intelligences preference survey, and positive outcomes from the use of music. Implications include the value of further long-term research on the benefits of using a multiple intelligence approach to therapy as an integrating meta-theory, and instructing counseling trainees in the routine assessment of client abilities through the use of the multiple intelligences approach.Item Open Access A new era in mental health care in Vanuatu(Hindawi Publishing Corporation, 2011) Benson, J.; Pond, D.; Funk, M.; Hughes, F.; Wang, X.; Tarivonda, L.Inequity in health-care delivery for those with mental illness is widespread throughout low- and middle-income countries. In the Pacific Island countries there are many barriers to addressing the growing mental health burden. In an effort to address this problem, the WHO is coordinating the Pacific Islands Mental Health Network involving 18 countries in the Pacific region with the financial support of New Zealand Aid (NZAid). JB and DP have developed and presented mental health training to health professionals, community leaders, and social service personnel in an environment in Vanuatu that is very different from that of their usual Australian-based general practices. They discuss evidence for their work, an outline of the programme, some difficulties working across different cultures, and the enthusiasm with which the training has been greeted. Vanuatu is now well on its way to addressing the inequity of access to mental health care with a culturally appropriate and self-sustaining mental health workforce.