{"title":"Hypertensive disorders in pregnancy: Approach to diagnosis and management in general practice.","authors":"Vanessa Fowosere","doi":"10.31128/AJGP-01-24-7133","DOIUrl":"https://doi.org/10.31128/AJGP-01-24-7133","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders in pregnancy (HDIP) are among the leading causes of maternal and perinatal morbidity and mortality and should not be reserved for specialist care and expertise.1 General practitioners (GPs) are inevitably involved in the care of women with HDIP, particularly in the preconception, early pregnancy and postpartum periods and, also, as shared maternity care providers. It is, therefore, critical that GPs can assess and manage HDIP.</p><p><strong>Objective: </strong>This article aims to provide GPs with a practical approach to the diagnosis and management of hypertensive disorders in pregnancy, including postpartum monitoring and ongoing cardiovascular risk surveillance.</p><p><strong>Discussion: </strong>The spectrum of HDIP includes gestational hypertension, chronic hypertension, pre-eclampsia (PET)/eclampsia and PET superimposed on chronic (pre-existing) hypertension, and this can affect up to 8-10% of pregnant women.</p>","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12 Suppl","pages":"S52-S55"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad M Javaid, Rachel Frederick, Sheema Itrat, Adel Ekladious
{"title":"Sodium-glucose cotransporter 2 inhibitors for chronic kidney disease: Why, when and when not.","authors":"Muhammad M Javaid, Rachel Frederick, Sheema Itrat, Adel Ekladious","doi":"10.31128/AJGP-11-23-7041","DOIUrl":"https://doi.org/10.31128/AJGP-11-23-7041","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a significant healthcare problem. More advanced stages are associated with increased mortality, morbidity and cost. Instigating measures to slow down disease progression at an early stage can save lives, and millions of dollars of taxpayers' money.</p><p><strong>Objective: </strong>This article aims to provide evidence-based information to general practitioners, aiding the decision to initiate sodium-glucose cotransporter 2 (SGLT2) inhibitors for CKD patients in their day-to-day practice.</p><p><strong>Discussion: </strong>SGLT2 inhibitors have emerged as a promising and safe addition to the renin-angiotensin-aldosterone system blockers for managing CKD. Randomised controlled trials have shown that SGLT2 inhibitors effectively slow CKD progression in both early and more advanced disease stages, regardless of diabetes status. SGLT2 inhibitors can be a valuable additional treatment option for CKD management in primary care and should be considered for most CKD patients.</p>","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12 Suppl","pages":"S15-S19"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A fire to be kindled.","authors":"Chris Dickie","doi":"10.31128/AJGP-12-24-1234e","DOIUrl":"https://doi.org/10.31128/AJGP-12-24-1234e","url":null,"abstract":"","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12","pages":"885"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Updates in the management of chronic rhinosinusitis.","authors":"Howard Webb, Samuel Morcom","doi":"10.31128/AJGP-11-23-7032","DOIUrl":"https://doi.org/10.31128/AJGP-11-23-7032","url":null,"abstract":"<p><strong>Background: </strong>Chronic rhinosinusitis (CRS) is a very common reason for presentation to a general practitioner. It can be very difficult to manage and can have a significant effect on the quality of life of patients.</p><p><strong>Objective: </strong>The objective of this article is to provide an up-to-date review of the pathophysiology, diagnosis and multimodal approach to management of this chronic condition.</p><p><strong>Discussion: </strong>Biologic agents are becoming increasingly common in Australia for the management of CRS with polyposis. This review includes an overview of these biologic agents and highlights their indications, efficacy and place in the management of CRS.</p>","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12","pages":"928-931"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recruiting general practitioners: The role of the 'hidden curriculum'.","authors":"Tim Tse, Bosco Wu","doi":"10.31128/AJGP-08-23-6942","DOIUrl":"https://doi.org/10.31128/AJGP-08-23-6942","url":null,"abstract":"","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12","pages":"921-922"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruth Leibowitz, Sharon Lewis, Martin Delatycki, John Massie, Jon Emery, Alison Archibald
{"title":"Offering reproductive genetic carrier screening for cystic fibrosis, spinal muscular atrophy and fragile X syndrome: Views of Victorian general practitioners.","authors":"Ruth Leibowitz, Sharon Lewis, Martin Delatycki, John Massie, Jon Emery, Alison Archibald","doi":"10.31128/AJGP-10-23-6989","DOIUrl":"10.31128/AJGP-10-23-6989","url":null,"abstract":"<p><strong>Background and objectives: </strong>The Royal Australian College of General Practice recommends that all women contemplating pregnancy or in early pregnancy should be offered reproductive genetic carrier screening (RGCS). In November 2023, a new Medicare item number was introduced for RGCS to detect cystic fibrosis (CF), spinal muscular atrophy (SMA) and fragile X syndrome (FXS) carrier status. The role of general practice in offering RGCS is recognised as being of crucial importance, but only a minority of general practitioners (GPs) are offering such screening. This study investigates the facilitators and barriers to offering RGCS in general practice.</p><p><strong>Method: </strong>Fifteen Victorian GPs who had offered RGCS for CF, SMA and FXS participated in semi-structured telephone interviews. A behavioural change framework was used for this study.</p><p><strong>Results: </strong>Barriers to offering screening (eg out-of-pocket costs, low frequency of preconception care and lack of GP education) mapped predominantly onto the 'opportunity' domain of the behaviour change framework.</p><p><strong>Discussion: </strong>Reducing out-of-pocket costs and increasing the provision of preconception care and GP education will provide more people with the opportunity to make informed choices about participation in RGCS.</p>","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12 Suppl","pages":"S78-S84"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie Eid, Katrina Giskes, Donna Jeong, Luke Jennings, Edward Dababneh, Margot Woods, Charlotte Hespe
{"title":"Patient digital self-screening tool for familial hypercholesterolaemia: A pilot study.","authors":"Stephanie Eid, Katrina Giskes, Donna Jeong, Luke Jennings, Edward Dababneh, Margot Woods, Charlotte Hespe","doi":"10.31128/AJGP-03-24-7187","DOIUrl":"10.31128/AJGP-03-24-7187","url":null,"abstract":"<p><strong>Background and objectives: </strong>Familial hypercholesterolaemia (FH) is a genetic condition contributing to premature cardiovascular disease. Currently, general practitioners (GPs) do not proactively screen for the condition. This study implemented and evaluated a digital FH self-screening questionnaire administered in general practice.</p><p><strong>Method: </strong>Patients aged 18-60 years in four general practices were sent an FH screening questionnaire via SMS prior to their GP appointment. The survey identified at-risk patients, and results were exported to the patients' electronic medical record.</p><p><strong>Results: </strong>In all, 1258 patients were sent the survey; 234 (18.6%) interacted with it, 137 completed self-screening and nine patients were identified as high risk. Self-screening took 3.5 minutes (on average) and was positively evaluated by patients.</p><p><strong>Discussion: </strong>This proof-of-concept study identified that FH self-screening can be implemented, but further refinements to the self-screening method and interface might be required for greater patient engagement. FH self-screening has the potential to increase FH detection and reduce preventable cardiovascular disease.</p>","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12 Suppl","pages":"S91-S97"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meryl Thomas, Maria Jones-Caballero, Marlene Wijaya, Pablo Fernandez-Penas, Raquel Ruiz Araujo
{"title":"Impact of the COVID-19 pandemic on the diagnosis and management of primary cutaneous melanomas in New South Wales, Australia: A retrospective cohort study.","authors":"Meryl Thomas, Maria Jones-Caballero, Marlene Wijaya, Pablo Fernandez-Penas, Raquel Ruiz Araujo","doi":"10.31128/AJGP-10-23-6991","DOIUrl":"10.31128/AJGP-10-23-6991","url":null,"abstract":"<p><strong>Background and objectives: </strong>The COVID-19 pandemic caused upheaval of healthcare systems, with evolving consequences. The aim of this study was to evaluate the impact of the pandemic on melanoma diagnosis and management in New South Wales, Australia.</p><p><strong>Method: </strong>In this retrospective cohort study, we analysed all new melanomas diagnosed at a tertiary care hospital over a three-year period. We compared outcomes between pre-pandemic (1 January 2019 - 30 March 2020) and pandemic (31 March 2020 - 31 December 2021) periods.</p><p><strong>Results: </strong>A total of 426 melanomas were included. No significant differences in patient demographics, Breslow thickness, ulceration, subtype or lymph node positivity were observed. During the pandemic, there was an 11% decrease in the number of melanomas diagnosed in the community (P=0.016) and an 11-day reduction in time from referral to wide local excision (P=0.013).</p><p><strong>Discussion: </strong>The prioritisation of melanoma care during the pandemic in New South Wales, Australia, has resulted in no apparent diagnostic delays.</p>","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12 Suppl","pages":"S71-S77"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph Hanna, Joshua Bruinsma, Mitchell Barns, Mark Hanna, Basim Boulos, Stefan Ponosh
{"title":"Pelvic congestion syndrome: Not all pelvic pain is gynaecological.","authors":"Joseph Hanna, Joshua Bruinsma, Mitchell Barns, Mark Hanna, Basim Boulos, Stefan Ponosh","doi":"10.31128/AJGP-07-23-6889","DOIUrl":"https://doi.org/10.31128/AJGP-07-23-6889","url":null,"abstract":"<p><strong>Background: </strong>Chronic pelvic pain is a debilitating but common syndrome that is a burden both for patients and health systems. Pelvic congestion syndrome (PCS) contributes to 30-40% of patients presenting with chronic pelvic pain where no other cause is identified. However, PCS is poorly understood, underdiagnosed and undertreated, with the average time to diagnosis being reported as up to four years after initial presentation.</p><p><strong>Objective: </strong>This article describes the pathophysiology of PCS and outlines the symptomatology, the most efficient diagnostic pathway and the optimal treatment methods for practitioners encountering patients presenting with PCS.</p><p><strong>Discussion: </strong>The aetiology of PCS is multifactorial and it is thought to be caused by both hormonal and anatomical dysfunction. Patients with PCS present with a cluster of symptoms related to pelvic venous congestion, including pelvic pain worse on standing, irritable bowel symptoms, dyspareunia, vulval varicosities and lower limb venous pathology. Transvaginal ultrasound is a non-invasive and sensitive test for PCS. Ovarian vein embolisation is a safe, minimally invasive and efficacious treatment for PCS.</p>","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12 Suppl","pages":"S41-S44"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Consultation skill tips for new general practice registrars: An update.","authors":"Simon Morgan, Jessica V Wrigley","doi":"10.31128/AJGP-07-23-6891","DOIUrl":"https://doi.org/10.31128/AJGP-07-23-6891","url":null,"abstract":"<p><strong>Background: </strong>The consultation is the vehicle by which general practitioners (GPs) 'ply their trade'. Consultation skills comprise the range of skills that underpin the effective and safe doctor-patient encounter and include communication skills, relationship building, data gathering, identifying the patient agenda, shared decision making, time management and follow-up. Development of consultation skills is a fundamental element of Australian general practice training.</p><p><strong>Objective: </strong>We build upon a previous article and discuss a number of additional practical tips to support new (and not so new) registrars to navigate the general practice consultation safely and effectively.</p><p><strong>Discussion: </strong>We address consultation tips across a range of aspects of the consultation, including preparation, building rapport, patient-centred care, data gathering, managing uncertainty, management planning, follow-up and time management.</p>","PeriodicalId":54241,"journal":{"name":"Australian Journal of General Practice","volume":"53 12","pages":"916-920"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}