Aust Fam Physician
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The incidence of melanoma continues to rise in Australia. General practitioners treat the majority of skin cancers affecting Australians. In the past decade, there has been improved uptake of dermoscopy by GPs who realise its value in the assessment of pigmented and nonpigmented lesions. ⋯ A clinical overview of lentigo maligna, acral lentiginous and subungual melanoma, nodular melanoma, desmoplastic melanoma, verrucous melanoma and hypomelanotic melanoma is presented. Dermoscopy has become a vital diagnostic aid in the assessment of all skin lesions. Its value in the diagnosis of melanoma is highlighted where relevant. Expert dermatopathology assessment is equally as crucial in reaching a correct diagnosis, especially for some of these atypical variants.
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In Australia, most medical students graduate without a firm career choice, with this decision being made during their early postgraduate years. Strategies addressing the current lack of meaningful exposure to general practice during these formative prevocational years are likely to be the most effective in increasing the proportion and number of entrants to general practice. ⋯ These are important influences on the complex process of career choice. Much research has focused on isolated interventions at one point along the pipeline. Varied and conflicting conclusions emerge from individual studies. In complex systems it is hard to understand the influence of an isolated intervention without looking at the system as a whole.
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This review takes a narrative synthesis approach - a systematic approach to interpreting complex evidence - to a broad literature review of the complex issue of medical career decision making. Addressing the Australian general practice workforce crisis requires an understanding of career choice motivators.
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Interest by prescribers and pharmacists in the provision of individualised pharmaceutical therapy in the form of compounded medicines has grown in recent times. However, there have also been a number of case reports of patient harm associated with these medicines. ⋯ Regulators of pharmaceutical products have expressed concerns with the production, marketing and use of compounded medicines dispensed by pharmacists. This has prompted debate over the need for more regulation of these products. We propose an expansion of off label prescribing guidelines to include a risk based assessment of pharmaceutical quality, a consumer information/education strategy and the development of a code of practice for pharmacists engaging in compounding. These strategies recognise a shared responsibility among prescribers, dispensers and regulators to achieve contemporary quality, safety, and efficacy standards and support the quality use of compounded medicines.
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A national chronic disease strategy has been described focusing on health promotion and lifestyle change, screening and evidence based disease management. The Lifescripts resources complement this strategy by focusing on health promotion and lifestyle change. ⋯ Effective indigenous health promotion requires appropriate tools for behavioural modification and community engagement. This involves a greater emphasis on the social determinants of health to reduce the barriers to healthy behaviours. The indigenous Lifescripts provide a flexible tool for health care providers in the indigenous health sector to deliver lifestyle related brief interventions that accommodate local community resources and support structures. However, to maximise their potential, a systematic approach to incorporating these tools into practice must be adopted.