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medical observer

The following articles have the tag medical observer

MO launches Australia’s first weekly iPad medical publication

MO launches Australia’s first weekly iPad medical publication

IN OUR efforts to keep you up to date and connected with your community, we are very excited to launch a free weekly iPad version of Medical Observer.

Sampling all general practice has to offer

MO/GPET Registrar of the Year nominee Dr Aileen Traves certainly can’t be accused of narrowing her options. After completing her GP training, extended skills in Indigenous health and an advanced rural posting in paediatrics, the Cairns-based GP is now in the middle of an academic post with regional training provider Tropical Medical Training. To complete the posting, Dr Traves works three days a week in general practice and spends the remaining two days teaching students at James Cook University’s clinical school and completing a research project. “I’m following up research we did [10 years ago] on ...

Pharmacists launch bid to triage minor GP cases

THE AMA has warned against proposals to transfer millions of GP consultations a year into pharmacies, claiming such a move would compromise patient care and pose a safety threat. The warning follows a call by the Australian Self Medication Industry (ASMI) for $2 million in Federal Government funding for a ‘health transformation’ program to better inform patients on their health care choices before presenting to general practice with minor ailments. In its federal Budget submission, ASMI said the campaign could initially focus on greater education about minor ailments such as URTIs and back pain and could eventually ...

One way to skin a nail

One way to skin a nail

I don’t know of even one way to skin a cat, but Dr Michael Rice from Beaudesert, Qld, sends in before-and-after photos of how to skin an ingrown toenail.   Figure 2: After shot After a ring block and tourniquet, Dr Rice marks out a wide area for skin incision and resects the whole side, exposing the large original nail spur. Alginate dressings allow the skin to heal, and by that time the spur has pushed to the end of the toe and ended its life as nail clippings.  ...

Cutaneous sarcoidosis

Cutaneous sarcoidosis

An elderly lady presents with ‘bumps’ on her cheek.

Outcry prompts college backdown on indicator plan

Outcry prompts college backdown on indicator plan

THE RACGP has bowed to pressure from GPs and watered down its controversial plan to build clinical indicators into practice accreditation standards. In the lead-up to the fourth review of the Standards for General Practices, the RACGP last year conducted an online survey seeking GP views on whether clinical indicators should be linked to practice accreditation. Dr Lynton Hudson (pictured), chair of the RACGP national expert committee on standards for general practice, said following negative feedback on the proposal, the college reconsidered the plan. In 2009 an MO poll showed such a move would ...

Walking the political tightrope

Walking the political tightrope

How can the AMA forcefully represent doctors’ interests and retain an effective relationship with Canberra? Andrew Bracey takes a look at whether current president Dr Andrew Pesce has been able to get it right. “It’s a tough gig,” says Professor Kerryn Phelps. She is, of course, talking about the AMA presidency, a role she filled from 2000 to 2003. It was a time of high emotion – a medical indemnity crisis was attracting widespread media attention, and several well-publicised clashes with then Federal Health Minister Dr Michael Wooldridge kept the AMA well ...

5 minutes with... Dr Richard Choong

5 minutes with... Dr Richard Choong

Dr Richard Choong AGPAL chair

Plan for pathologist role in test selection

A PROPOSAL by the Federal government that would see pathologists play a greater role in determining which tests doctors order has been cautiously welcomed by GP groups. As part of a review of pathology funding, the Medical Benefits Reviews Task Group suggested inappropriate tests could be reduced by encouraging doctors to consult with pathologists before requesting tests. Such consultations – which would attract an MBS fee for the pathologist – could also lead to better patient outcomes. Dr Nick Demediuk, RACGP pathology spokesman, said bridging the gap between the disciplines could be beneficial, provided it did not ...

Higher body mass index linked to longer life in older adults

BEING overweight in older age does not pose a higher risk of mortality – in fact, it’s associated with the highest chance of survival, Australian researchers have found. A study of more than 9000 Australians aged 70-75 years found those who were overweight (based on BMI) had a 13% reduced risk of death over a 10-year period than their contemporaries who fell in the normal weight range. The lowest mortality risk was found in those with a BMI of 26.6 kg/m2 for men and 26.26 kg/m2 for women. The researchers said the WHO needed to review its BMI ...

Post-exposure prophylaxis prevents cases of chickenpox

Varicella vaccination up to five days after exposure to the virus can effectively prevent and ameliorate chickenpox in both adults and children, a study confirms. Until now advice for postexposure prophylaxis has been based mainly on studies with experimental vaccines or in children only, said the authors of the Spanish study. Their research was one of the first to assess the current commercially available vaccines, which have different formulations and lower antigenic content. The authors found the vaccine effectiveness in preventing varicella postexposure was 62.3% but the vaccine was highly effective in attenuating the severity of ...

Training programs for young males putting female athletes at risk

Training programs based on research in young men may be contributing to a growing number of injuries among female athletes, a Canadian expert is warning. Across a range of sports, female athletes have  two- to six-times greater risk of musculoskeletal injuries and other medical conditions, said exercise physiologist Dr Vicki Harber (PhD), from the University of Alberta, Canada. The most common injuries sustained by female athletes include injuries to the anterior cruciate ligament, patellofemoral joint and shoulder. The medical conditions they experienced included disordered eating, menstrual cycle disruption and impaired bone mineral health, Dr Harber found after ...

Black saturday: One year on, the scars are still healing

ONLY a year ago Australia was mourning the loss of 173 people in Victoria’s devastating Black Saturday bushfires. Though the survivors have made headway rebuilding their lives and community, the scars that have been left from trauma are a deep, and a less visible injury. Marysville GP Dr Lachlan Fraser, who lost his home and practice to the fires, said patients were experiencing ongoing mental health problems, and recent hot weather had created anxiety in the community. “When hot north winds blow, it brings back memories...It [puts] a lot of people on edge,” he said. ...

Doubts cast over funding of GP-based INR testing

AS data continues to emerge from the government-funded point-of-care testing (PoCT) trial, a top government advisor has cast doubt over the likelihood of future MBS funded INR tests in general practice. The latest figures from the PoCT trial, published in Pathology, shows GP INR testing was comparable to lab tests over six months in a sample of 417 patients from 26 general practices. Dr Caroline Laurence (PhD), senior research fellow at the University of Adelaide and member of the trial management group, said the study only reaffirmed safety and accuracy of INR PoCT in the short term. ...

‘Salt to taste’ message in mags a recipe for trouble

AUSTRALIAN public health experts have questioned the excessive number of high-salt recipes in leading magazines, calling for the introduction of editorial guidelines for salt use. An analysis of 747 recipes in 10 of Australia’s highest circulating magazines (that regularly included recipes) from August 2007 and 2008 found many advised adding salt, contradicting national guidelines which recommend a salt intake of 4g per day. Almost two-thirds of the recipes included high-salt ingredients, 37% instructed to season with salt, 10% advised to add a specific quantity of salt and only 15% recommended the selection of low-salt ingredients. ...

Hypokalaemia a mortality risk in CKD patients with heart failure

HYPOKALAEMIA may be more common in patients with chronic heart failure and chronic kidney disease (CKD), and even mild hypokalaemia may significantly increase the risk of death. US researchers have found hypokalaemia (<4 mmol/L) occurred in around 20% of a cohort of 2793 patients with CKD. These patients had a 56% greater mortality risk than those who were normokalaemic. The vast majority (87%) had mild hypokalaemia (3.5-3.9 mmol/L) still had a 31% increased mortality risk compared to patients with a normal potass-ium level. The authors said while hyperkalaemia was often considered a more common problem ...

Yellow fever vaccine virus transmitted by transfusion

EVIDENCE has emerged confirming yellow fever vaccine virus can be transmitted by blood transfusion. The US Centers for Disease Control (CDC) recently investigated an incident in which soldiers donated blood four days after receiving yellow fever vaccine, despite the deferral policy of two weeks, introduced because of the theoretical possibility of transmission. Among five patients who received affected blood products, three had evidence of a serologic response to the virus, providing the first documented evidence for transfusion transmission. Australian Red Cross Blood Service donor and product safety specialist Dr Tony Keller said the service had ...

Ginkgo biloba may lower epilepsy seizure threshold

PEOPLE with epilepsy may increase their risk of seizure by taking products containing ginkgo, according to German researchers. Their review of existing data uncovered at least 10 reports of seizures possibly triggered by people taking products containing ginkgo. Previous animal studies had shown Ginkgo biloba leaf extract exerted a proconvulsive effect, and a small Chinese study also found it could affect other medications when taken concurrently, the authors said. “It is possible that G. biloba products…may accelerate the degradation of antiepileptic drugs,” the authors said. Laboratory studies also found that ginkgotoxin, one of the chemical ...

RACGP supports no-fault insurance for long-term care

MOVES to establish a national no-fault insurance scheme to cover the long-term care needs of disabled Australians are gaining momentum, with the RACGP now adding its support to the proposal. In its 2010-11 federal health Budget submission, the college called on the Government to introduce a scheme that would fund care and support services for people with long-term disabilities, as well as for their carers and their families. RACGP president Dr Chris Mitchell said GPs were frustrated by the amount of paperwork required by the legal system to explore adequate compensation and support for victims of accidents ...

Primary care reform needs $830m kickstart: AGPN

Primary care reform needs $830m kickstart: AGPN

THE Federal Government needs to make a “critical down-payment” on general practice with $830 million in infrastructure grants to fund health reforms, according to the AGPN. As part of its 2010-11 federal Budget submission, the network has restated previous calls from United General Practice Australia for the Government to invest $530 million in general practice. A further $300 million is also needed to help practices transform into comprehensive primary health care centres as proposed by the National Health and Hospitals Reform Commission, the AGPN submission claims. Practices would be able to apply for tax-exempt grants ...

Deaths linked to low HbA1c levels spark call for revised limits

EXPERTS are issuing new warnings about the dangers of excessive glucose lowering in patients with type 2 diabetes, after further evidence linking low HbA1c levels to increased mortality has emerged. An analysis of almost 50,000 patients from a UK general practice database found a 52% increased risk of death in those with the lowest HbA1c levels, compared to median levels of 7.5%. The relationship was U-shaped, with the greatest mortality risk at HbA1c levels above 10.5% and below 6.4 per cent. The lowest mortality appeared to be at an HbA1c of 7.5 per cent. Following on ...

Sunscreens and the effect on vitamin D levels

THERAPEUTIC Guidelines: Dermatology version 3 includes a section about sunscreens and vitamin D. Ultraviolet (UV) radiation causes sunburn, photoageing, cataracts, immunosuppression and skin cancer. It can activate latent viruses and trigger photosensitivity-related dermatoses. Therefore minimisation of UV radiation exposure throughout life has many benefits. The active ingredients in sunscreens work by either absorbing or reflecting UV radiation. Absorbent sunscreen chemicals act mainly in the UV range, whereas reflectants (also known as physical blockers) provide a barrier across the whole of the solar spectrum. There is continuing debate about regular use of sunscreens ...

Sunscreens and the effect on vitamin D levels

THERAPEUTIC Guidelines: Dermatolog y version 3 includes a section about sunscreens and vitamin D. Ultraviolet (UV) radiation causes sunburn, photoageing, cataracts, immunosuppression and skin cancer. It can activate latent viruses and trigger photosensitivity-related dermatoses. Therefore minimisation of UV radiation exposure throughout life has many benefits. The active ingredients in sunscreens work by either absorbing or reflecting UV radiation. Absorbent sunscreen chemicals act mainly in the UV range, whereas reflectants (also known as physical blockers) provide a barrier across the whole of the solar spectrum. There is continuing debate about regular use of sunscreens ...

Listeriosis warnings renewed for pregnant women

AUSTRALIA’s food regulator has ramped up a campaign to warn pregnant women of the dangers of listeriosis, after a major outbreak occurred last year. Contaminated chicken served to airline passengers last August resulted in eight pregnant women developing listeriosis and three subsequent foetal deaths, Food Standards Australia New Zealand (FSANZ) spokeswoman Lydia Buchtmann said. At the time, it was reported widely that two women went into premature labour and delivered healthy babies. However, listeriosis has a long incubation period, and an OzFoodNet investigation found that 13 passengers became ill after eating chicken wraps served on the ...

Death: the right to choose

Were UK doctors right to let a depressed woman suicide under their care because she had a living will? Lynnette Hoffman looks at some of the issues raised by the case. TWO years ago, a 26-year-old British woman with a history of mental illness arrived in hospital having drunk enough anti-freeze to have killed her.  She was reportedly depressed about her inability to have children, and had attempted suicide several times previously. This time she seemed determined to die. Three days before she swallowed the poison, she wrote a ‘living will’, stating clearly ...

Avoiding DIY super slip-ups

The tax office is cracking down on DIY super funds, so it’s essential for fund trustees to know the rules and stick to them. Jodie Thomson reports. THERE’S no doubting the popularity of self-managed, or DIY, superannuation funds. For business owners such as GPs they offer many benefits, from personal control of investments and tax advantages to access to assets, so it’s no surprise the industry is booming.  The latest Australian Taxation Office figures show there are more than 417,000 funds in Australia, with almost 800,000 trustees nationwide and ...

Reality check for parents banishing imaginary fears

MOST parents will be acutely aware of their children’s fears of real and imaginary creatures. And most will be equally aware of how difficult it can be to allay these fears and ensure decent sleep for the child and themselves. So new US research that offers some ideas of what to do about the fear of the ‘boogie monster’ will be welcome. Researchers from the University of California analysed the response of 50 children aged from four to seven years to a series of illustrated short stories.  Each story featured one child alone ...

Call for end to 10-year IMG rule

PROFESSIONAL bodies and workforce agencies have clashed over fresh calls to scrap the 10-year moratorium for international medical graduates (IMGs). The AMA last week called for the controversial moratorium to be dismantled; however, Rural Health Workforce Australia has raised concerns that if the policy was abandoned, many rural and remote communities would lose their GPs. Under the current Health Insurance Act 1973, IMGs must work in designated areas of need for up to 10 years if they are to gain access to a Medicare provider number. IMGs make up an estimated 41% of the rural workforce. ...

Experts push for adding newborn screening test

STATE governments are ignoring evidence and expert opinion by not screening newborns for congenital adrenal hyperplasia (CAH), Australian experts say. Some apparent sudden infant deaths and the incorrect assignment of gender could be avoided if the test was included in the existing screening programs, they argue in a letter published in the MJA. The syndrome affects around one in 15,000 newborns in Australia and the test has been available for 30 years and used in other countries, including the US and New Zealand. The Human Genetics Society of Australasia has endorsed use of the test and ...

GPs best for smoking cessation

A SPECIFIC MBS item number should be created so GPs can carry out detailed smoking cessation interventions, including motivational interviewing, an Australian expert says.  Associate Professor Renee Bittoun, head of the Smoking Cessation Unit at the Brain & Mind and Research Institute at the University of Sydney, was commenting on a Cochrane Review released last week, that showed motivational interviewing techniques for smoking cessation were most effective when delivered by GPs. The reviewers found motivational interviewing was three times more effective when it was conducted by a GP compared to nurses, counsellors or pscyh-ologists. However, the ...

Medication compliance poor after stroke

JUST two years after a stroke patients who survive are likely to be poorly compliant with critical medications, according to Swedish research.  Among 21,077 survivors of stroke studied, the proportion of patients who continued regularly using their discharge medications rapidly declined. At the end of the study only 74% of patients were still taking antihypertensive agents, 64% continued with their antiplatelet therapies and just 45% were still taking warfarin.  Professor Geoffrey Donnan, professor of neuroscience at the University of Melbourne, said the findings from the prospective study highlighted the need for coordinated care.   Factors ...

Review examines pathology lab rebate limits

A GOVERNMENT review of funding for pathology services could spell the end of the controversial “episode cone”, which currently caps MBS reimbursements for pathologists.  Under the system, the Medicare benefit paid for a set of pathology services containing more than three items is only equivalent to the sum of the benefits for the three items with the highest MBS fees. Introduced 15 years ago, the system was designed to curb unnecessary test referrals; however, pathologists have argued this forces them to absorb the costs of tests that fall outside the “cone”. Dr Edmund Bateman, ...

High vit D reduces colon cancer risk

THE risk of colorectal cancer appears to be reduced in those with higher circulating vitamin D levels, according to European researchers. In the case-control study of more than 520,000 participants, those with the highest quintile of serum vitamin D levels had a 40% lower risk of colorectal cancer compared with those in the lowest quintile. Even participants with mid-level serum vitamin D concentrations (50 nmol/L to 75 nmol/L) had a significantly reduced risk, the authors found. Previous studies had produced conflicting evidence on the link between vitamin D levels and risk of colorectal cancer, they ...

Survival doubles for smokers who quit when diagnosed with lung cancer

PATIENTS who continue to smoke after a diagnosis of early-stage lung cancer have a higher risk of recurrence and all cause mortality compared with those who stop smoking. A review and meta-analysis of 10 studies examining the impact of smoking after lung cancer diagnosis found not quitting was linked to a three-fold increase in all-cause mortality. Five-year survival rates in people who quit smoking were estimated to be around 70-75% compared with 35-40% in those who continued to smoke after a diagnosis of lung cancer. “These findings indicate that offering smoking cessation treatment to patients presenting ...

Breastfeeding may protect against cardiovascular disease

THE advantages of breastfeeding may extend beyond the known benefits for babies and mothers, with evidence now revealing mothers who do not breastfeed are up to five times more likely to have aortic calcification than those who have breastfed. Failure to breastfeed was associated with an increased risk of a range of markers of subclinical cardiovascular disease, including carotid plaque and larger carotid adventitial diameters in middle-aged women, researchers showed. The study included nearly 300 women aged 45-58 years, who were free of clinical cardiovascular disease and who self-reported their lactation history. Previous studies had ...

Regular soft drink intake linked to higher risk of mental illness

PEOPLE who regularly consume large amounts of soft drink may be at increased risk of depression and suicidal ideation, an Australian study shows. A population-based survey of nearly 5000 people linked consumption of more than half a litre of soft drink per day to depression and psychological distress, but not anxiety. The study was adjusted for possible confounding by chronic diseases such as diabetes and asthma. The authors said it was unclear whether the effect related to the sugar content of soft drinks or to other factors. Meanwhile, other Australian researchers have found that, among 1000 ...

Experts still divided over perinatal depression plan

EXPERTS are still debating the framework for Australia’s national perinatal depression screening plan despite it being announced with much fanfare in 2008. The Rudd Government committed $55 million over five years to the National Perinatal Depression Plan in the 2008-2009 budget, with a further $30 million to come from the states and territories.  However, debate continues over which screening tool should be used and whether screening represents value for money. NHMRC guidelines, due for release in draft form by Easter, are expected to advocate routine screening of pregnant women in primary care, although precise details remain ...

Push for broader practice nurse items

PRACTICE nurse item numbers should be expanded to better reflect the capabilities of this professional group, the AMA has argued in its 2010-11 federal Budget submission. While the MBS currently allows practice nurses to claim services such as immunisations and wound dressings for and on behalf of GPs, the AMA is now pushing for these services to be widened to include, for example, patient education. AMA vice-president Dr Steve Hambleton said the changes would allow practices to make better use of nurses, while allowing more efficient use of GPs’ time. “The ‘for and on ...

Uniform industry code of conduct on Govt agenda

CONSUMER groups and academics have expressed optimism that a single code of conduct governing the activities of all pharmaceutical, medical device and complementary medicine manufacturers may soon be laid down by the Government. Speaking after a meeting with the Parliamentary Secretary for Health, Mark Butler, La Trobe University senior research fellow Dr Ken Harvey said while it was early days, there were “positive signs” from the Government that a single code would be pursued before the next election. Consumer Health Forum executive director Carol Bennett shared Dr Harvey’s optimism. “The indications are that [Mr ...

Weak incentives limit uptake of insulin pumps

PRESSURE is mounting on the Federal Government to overhaul its failing insulin pump subsidy program, which continues to be hampered by low uptake. Just 41 children with type 1 diabetes have received the subsidised pumps – less than a quarter of the 174 that were expected when the $5.5 million program began in November 2008. With the maximum available subsidy capped at $2500 and pumps costing up to $8000, the technology remains unaffordable for many patients without private health insurance, critics say. Paediatrician Dr Peter Goss of Gippsland, Victoria, is Australia’s largest single user of the scheme, ...

Push to remove tax burden from rural grants program

RURAL doctors have urged the Rudd Government to rework its rural infrastructure grant program so GPs can access funding without facing major tax bills. Announced in the 2009-10 Budget, the National Rural and Remote Health Infrastructure Program provides $46 million over four years to improve  GP access to funding for essential health infrastructure, equipment and service planning. However, RDAA CEO Steve Sant said many rural practices had been discouraged from applying for the grants – worth up to $500,000 – due to the tax component, which the RDAA has estimated is set at a rate ...

GP shortage clouds future of super clinic

ONGOING workforce shortages and tangled bureaucratic processes are threatening the viability of a planned GP super clinic in rural NSW.  Narrandera GP Dr Joseph Romeo, whose practice won the $1 million contract to establish the super clinic in the Riverina region, said the town’s already stretched workforce of three GPs would not be sufficient. Dr Romeo told MO that  efforts to recruit an IMG to fill the town’s area of need position had been hampered by the NSW Medical Board. It had turned down two applicants despite the practice believing both were suitable for their ...

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