Aust Fam Physician
-
Recent drought conditions and diminishing drinking water storage levels in Australian capital cities have led to increasing attention being directed to water recycling and the use of alternative water sources for urban domestic use. Despite the 'in principle' acceptance by the Australian public for water recycling, support for proposed schemes is constrained by public perception of possible adverse health effects from exposure to micro-organisms and chemical contaminants. ⋯ Two complementary research approaches, quantitative microbial risk assessment and epidemiology, may be employed to assess health impacts of using recycled water for nondrinking or drinking purposes. The first of these approaches involves water quality monitoring and experimental studies. The second involves disease surveillance in which genera practitioners may play a part.
-
Randomized Controlled Trial
Promoting patient centred palliative care through case conferencing.
What are the characteristics of case conferences between general practitioners and specialised palliative care services (SPCS)? ⋯ Case conferencing involving SPCS, the GP, other health professionals and the patient can be an efficient part of routine care.
-
In recent years, four specific strategies have emerged which have proven clinical benefit in treating acute stroke. These are the administration of tissue plasminogen activator (tPA), aspirin, management in a stroke care unit (SCU) and the use of hemicraniectomy in patients with severe cerebral oedema. ⋯ Although tPA has been shown to be remarkably clinically effective, less than 5% of eligible stroke patients receive this therapy. The main obstacle is its very narrow therapeutic time window of 3 hours. This necessitates the immediate recognition of stroke and rapid transfer to hospital. Computerised tomography is mandatory to rule out cerebral haemorrhage. Starting aspirin within 48 hours of stroke onset in patients with ischaemic stroke results in a significant reduction in mortality and morbidity. Management in a SCU is the most useful intervention with significant reductions in mortality and morbidity for all stroke subtypes. The management of stroke is changing, and the role of the GP is crucial in facilitating the rapid transfer of patients to a SCU together with subsequent risk factor control and community support.
-
Hypertension is the most commonly managed problem in general practice. Systematic errors in blood pressure measurements caused by inadequate sphygmomanometer calibration are a common cause of over- and underidentification of hypertension. ⋯ Most sphygmomanometer surveys report high rates of inadequate calibration and other faults, particularly in aneroid sphygmomanometers. Automatic electronic sphygmomanometers produce systematic errors in some patients. All sphygmomanometers should be checked and calibrated by an accredited laboratory at least annually. Aneroid sphygmomanometers should be calibrated every 6 months. Only properly validated automatic sphygmomanometers should be used. Practices should perform regular in house checks of sphygmomanometers. Good sphygmomanometer maintenance and traceable sphygmomanometer calibration will contribute to reducing the burden of cardiovascular disease and the number of patients overtreated for hypertension in Australia.
-
Review Case Reports
Disenfranchised grievers--the GP's role in management.
Disenfranchised grief results from a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported. This article aims to explain the concept and varying presentations of disenfranchised grief and outlines the importance of the general practitioner's role. ⋯ Disenfranchised grievers present with various symptoms, however, primary care has focused on mental illness, with little recognition of loss and grief issues, especially disenfranchised grief. Further research is required and currently underway to design and formally test a model that can be implemented within an Australian fee-for-service setting.