Aust Fam Physician
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Review Case Reports
Chronic nonmalignant pain - the rational use of opioid medication.
Every general practitioner has patients with chronic nonmalignant pain issues. At some point the possibility of using prescribed opioids is raised. ⋯ All prescribing needs to be under strict control, with patients picking up medication from a pharmacy relatively frequently. If the GP feels they have lost control of the situation, urgent advice from a specialist in pain or drug and alcohol medicine should be sought.
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Shared decision making (SDM) is a process within a patient centred consultation that involves both the patient and doctor discussing management options and agreeing on management decisions in partnership. Decision aids are designed to help patients understand the options relating to management for certain conditions and their possible benefits and potential adverse effects. We discuss the evolution and rationale behind SDM and the evidence relating to outcomes, the types of decision aids available, and research relating to their use.
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Minor injuries in children are extremely common in the general practice setting. ⋯ Wound management goals are to avoid infection, minimise discomfort, facilitate healing and minimise scar formation. The care of the patient as a whole should be the first management priority. Successful examination requires gaining the child's trust, relieving pain early, and using a flexible and creative examination technique. Superficial abrasions and lacerations can be safely cleaned with good quality water, and all foreign material removed. Deeper wounds with suspected damage to nerves, tendons or circulation need formal exploration under general anaesthetic. Good local anaesthesia can be produced by topical preparations, and many wounds can be closed with tissue adhesives with an excellent cosmetic result. All children with injuries should be checked for adequate tetanus cover for prrophylaxis.
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The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of diagnostic imaging ordered by Australian general practitioners. This provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.
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Articles published in the research section of Australian Family Physician (AFP) are subject to an editorial process comprising several stages. ⋯ There is less clinical research submitted to AFP than expected for a clinical discipline. Authors and reviewers cause the most delay in manuscripts' passage through the editorial process.