Aust Fam Physician
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Traumatic head injury is a common occurrence in the paediatric population, with the majority of patients sustaining only mild head injury. ⋯ A careful history including time of injury, the mechanism of injury, and any loss of consciousness or seizure activity; a thorough examination including a Glascow Coma Scale (GCS) score; and observation should be appropriate for most patients. Only a small number of injuries require further examination/imaging with computerised tomography. Indicators for transfer to hospital include GCS equal to or less than 12, focal neurological deficit, clinical evidence of skull fracture, loss of consciousness for more than 30 seconds, ataxia, amnesia, abnormal drowsiness, persistent headache, seizure following initial normal behaviour or recurrent vomiting. Postconcussive symptoms frequently occur after minor head injuries and parents and other family members should be aware of what symptoms to expect, and possible duration. Regular follow up until all symptoms have resolved is mandatory, with clear guidelines for stepwise resumption of physical activity.
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Aggressive and violent behaviour by patients, or their relatives or friends, toward general practice staff is a matter of national concern. Forms of this behaviour include verbal and physical abuse, property damage, theft, stalking, sexual harassment and sexual abuse. ⋯ Australian data investigating patient initiated aggression and violence in general practice are limited. Findings should be interpreted with caution due to methodological limitations. The lack of national data needs to be addressed.
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Children present to general practitioners with a wide range of problems, but most of the time they are not particularly unwell. Children with a more serious illness often compensate very well initially, so there is a risk that their illness will be overlooked or underestimated. ⋯ The initial assessment of an unwell child includes the paediatric assessment triangle: appearance, breathing and circulation to skin; primary survey that focuses on basic life support, patient assessment and immediate management; secondary survey with a detailed history of the event and physical examination; and ongoing assessment. Medical practitioners and their clinic staff must be prepared to undertake initial emergency management of a seriously ill child, and they must have the equipment and supplies available to carry out that management effectively.
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The Lancet in 1999 suggested that 'neglect of research has made primary care one of the most intellectually underdeveloped disciplines in medicine' and later labelled general practice research 'a lost cause'. According to the Medical Journal of Australia, this underdevelopment 'stems from a lack of research culture, a heavy service commitment and the late arrival of academic GPs'.
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The hospital 'grand round' concept was applied to a general practice continuing professional development activity. Interactive learning sessions were developed to deliver evidence based medicine clinical education for general practitioners and general practice learners (registrars/medical students). The acceptability of the GP grand round format was examined through analysis of participant responses to learning objectives. ⋯ Evaluations demonstrated that participants in the grand round valued the opportunity to interact with other participants in a small group format, exchanged and shared knowledge and had their learning needs met. The overall quality of the learning experience for the majority of participants was either good or excellent. The application of vertically integrated continuing professional development through a grand round format appears acceptable and effective.