Aust Fam Physician
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Osteoporosis is a major contributor to morbidity and mortality in Australia, and is predicted to accelerate as the population grows and increases in age. The aim of this study was to audit 10 general practitioners for their identification of patients with risk factors for osteoporosis, and appropriate screening, treatment and follow up care. ⋯ General practitioners are the healthcare hubs of our communities, including for prevention of diseases such as osteoporosis. The low level of concordance with the guidelines suggests that in this general practice community, passive screening for osteoporosis has been less than effective. Active surveillance, such as the PENCAT tool used in this study, would offer an alternative approach. Further studies could then evaluate whether incorporating this into the usual practice audit process leads to improved patient outcomes.
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Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis. It affects 10-15% of the general population, and is often asymptomatic; leading to under-diagnosis and under-treatment. Atherosclerotic risk factors are often not intensively managed in PAD patients. ⋯ Careful history, clinical examination, and measurement of ankle-brachial index remain the initial means of diagnosing PAD. More detailed anatomic information from duplex imaging, computed tomography angiography and magnetic resonance angiography, is usually unnecessary unless endovascular or surgical intervention is being considered, or if abdominal aortic aneurysm or popliteal aneurysm need to be excluded. Management is focused on lifestyle modification, including smoking cessation and exercise; medical management of atherosclerotic risk factors, including antiplatelet agents, statins, antihypertensive therapy; and agents to improve walking distance, such as cilostazol and ramipril. Endovascular or surgical interventions are usually considered for lifestyle limiting intermittent claudication not responding to conservative therapies, and for critical limb ischaemia.
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Hot water immersion can be used to treat bluebottle (Physalia spp.) stings. Bluebottle stings are most common in non-tropical areas and can be very painful. After initial management, hot water (ideally at 42-45°C) applied to the site of the sting for 30-90 minutes can be used to manage pain. ⋯ Hot water application for bluebottle stings has NHMRC Level 2 evidence of efficacy. The most common adverse effect is that the patient cannot tolerate the heat, and there has been one case of a thermal burn reported. This article forms part of a series on non-drug treatments, which summarise the indications, considerations and the evidence, and where clinicians and patients can find further information.
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Peripheral arterial disease (PAD) is a process that occludes blood flow in limb arteries, which is often asymptomatic and therefore undiagnosed in primary care. It is significantly associated with cardio- and cerebro-vascular events, reduced physical functioning, and in extreme cases, loss of limbs. It is more prevalent with increasing age, in males, in those who smoke, in those with diabetes, and in those with dyslipidaemia.
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A commonly used learning activity within The Royal Australian College of General Practitioners accredited teaching practices is general practice registrar (GPR) observation of general practitioner supervisor (GPS) consultations. This study aimed to examine the views of GPRs and GPSs on the benefits and limitations of this teaching method. ⋯ While this teaching method was beneficial, it would be more valuable with improved planning, increased time for discussion of consultations, and further training of GPSs in session planning.