Aust Fam Physician
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In recent years there has been a worldwide increase in the number of diagnoses of type 2 diabetes mellitus (T2DM) in children and adolescents. This has become a major focus for the work of the International Diabetes Federation. In Australia, most children and adolescents with diabetes have type 1 diabetes. However, more young Australians are developing T2DM. ⋯ Type 2 diabetes is the consequence of a complex interaction between genes and the environment in a susceptible individual. Children with T2DM are generally overweight, often with central adiposity. Having one or more parents with T2DM gives offspring up to an 80% chance of developing T2DM. At risk children and adolescents should be screened for T2DM. It is important to check the glutamic acid decarboxylase (GAD) antibody to exclude type 1 diabetes. Symptoms and signs of the metabolic syndrome should be sought. Child and adolescent patients with T2DM face the psychological burden of living a lifetime with a chronic disease. Management is team based and team members include the general practitioner, diabetes educator, dietician and endocrinologist. Goals include achieving and maintaining normoglycaemia, weight reduction and increased physical activity. Lifestyle modification alone may control minor hyperglycaemia and metformin can be added to control moderate hyperglycaemia. In severe hypoglycaemia, insulin may be required initially to achieve normoglycaemia and can be phased out and metformin phased in later. Insulin is likely to be required again later in the natural history of disease. Little is known about factors affecting complication risk in children and adolescents with T2DM but they essentially have a 'double whammy' of diabetes and the metabolic syndrome and are likely to develop macrovascular complications much earlier than adults who develop T2DM.
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This study evaluated a clinical audit and evidence based practice guide designed to improve general practitioners' assessment and management of erectile dysfunction. ⋯ This clinical audit and practice guide was developed specifically and uniquely for GPs in Australia. Findings provide some support for the combined use of the clinical audit and practice guide to elicit positive changes in erectile dysfunction assessment and management.
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A vegetarian is a person who consumes a diet consisting mostly of plant based foods including fruit, vegetables, legumes, nuts, seeds and grains. Some vegetarians also consume eggs and dairy foods. Individuals choose to follow a vegetarian diet for a range of reasons, including animal rights and religion, but two common reasons are the health and environmental benefits of plant based eating.
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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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An invitation to discuss the role of the doctor begs the question, 'What is wrong with the status quo?' Given the guild nature of the medical profession, any reform will need to be well substantiated.