Aust Fam Physician
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Expenditure through major commonwealth funded health programs such as the Pharmaceutical Benefits Scheme (PBS) is much lower for Aboriginal and Torres Strait Islander peoples than other Australians. Section 100 of the National Health Act (1953) allows for special access arrangements where pharmaceutical benefits cannot be conveniently supplied. ⋯ The implementation of S100 medications for remote area Aboriginal health services (AHSs) represents a breakthrough in medicines access, and is one of the most significant improvements in health service delivery for many years. If we are to achieve equity in access to the PBS for all Aboriginal and Torres Strait Islander peoples, an extension of this initiative is necessary for rural and urban AHSs.
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Case histories are based on actual medical negligence claims, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. In all Australian states and territories, except Western Australia, general practitioners are required by law to report cases of child abuse to the appropriate child protection service. This article outlines the GP's duty to report cases of child abuse, including the legislative requirements in each state and territory.
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While many children presenting with apparent disorders of growth will be short or tall children growing normally, it is important to identify those children who have an underlying pathological cause. Parental expectation and anxiety will often accompany growth issues and this needs to be addressed. ⋯ Pathological short stature can be distinguished from normal variants by careful history and examination followed by accurate assessment of the growth parameters of height, weight, body proportions and growth velocity, and judicious use of investigations. Growth is a dynamic process that requires multiple measurements over time. If the patient has a nonpathological cause of short stature, explanation and reassurance are critical--for both the parents and child--to feel supported and comfortable with their height outcome.
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Facial pain is a relatively frequent cause of presentation to both general medical and dental practitioners. Although in the vast majority of cases the cause is dental disease or tempero-mandibular joint dysfunction, the remaining patients are often difficult to diagnose and treat. ⋯ A detailed history, clinical examination, imaging and laboratory investigations may be required to establish the cause of atypical facial pain. An assessment of the patient's mental state is mandatory, as depression or psychological overlay is common. In a small number of cases, the diagnosis remains unclear despite detailed investigation. These patients may have their symptoms ameliorated by empirical pharmacological therapy.
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Routine clinical measurements of glycated haemoglobin first became available during the early 1970s and are now accepted as the standard for estimated overall glycaemic exposure and risk of microvascular complications in diabetes. ⋯ Blood glucose gives immediate day-to-day information and A1C usually gives a reliable estimate of the average glycaemic exposure over the past 6-8 weeks. Both are important components of glycaemic monitoring. Discrepancies between these two estimates of glycaemia can usually be resolved by checking blood glucose and A1C techniques. Target A1C is less than 7%, but encouraging patients to aim slightly lower (eg. by 0.5%) on A1C can result in significant reduction in complication risk. There is a clear relationship between glycaemic control reflected by A1C and the progression of microvascular complications in both type 1 and type 2 diabetes.