Aust Fam Physician
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There is a pressing need to improve alcohol treatment services for Aboriginal and Torre Strait Islander peoples with alcohol dependence. One component of treatment is the use of medicines including naltrexone and acamprosate. Access to these medicines among the general drinking population is poor and, anecdotally, even worse for Aboriginal and Torre Strait Islander peoples who drink. ⋯ The major effect of naltrexone is reducing episodic heavy drinking, a pattern often seen in Aboriginal and Torre Strait Islander peoples with alcohol dependence. Possible genetic and epigenetic factors, and practical considerations including once-daily dosing also make naltrexone an appealing agent in this population.
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Adults with autism spectrum disorder (ASD) may require medical assessment and care, especially for mental health conditions. Although substantial knowledge and resources are available regarding the management of mental ill health in children with ASD, substantial gaps remain for adults with ASD. Diagnostic overshadowing, limitations of communication skills and the heterogeneous nature of this patient population can make practice in this area more challenging, and can contribute to poorer outcomes, including overprescribing of psychotropic medications. ⋯ The incorporation of specific knowledge and adaptations in the areas of communication, awareness of physical health comorbidities, management of challenging behaviour, impact of the environment, role of carers and an approach that values neurodiversity has the potential to positively influence mental health outcomes of adults with ASD.
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Within the apprenticeship model of general practice training, the majority of teaching and learning occurs in the practice under the guidance of the general practice supervisor. One of the foundations of a high-quality general practice training program is the delivery of relevant, evidence-based educational continuing professional development (EdCPD) for general practice supervisors. Despite The Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM) standards requiring EdCPD, there is currently no standardised educational curriculum for Australian general practice supervisors. There are a number of emerging themes with significant implications for future general practice supervisor EdCPD. These include clinical supervision and structural issues, capacity constraints, and emerging educational issues. ⋯ A national general practice supervisor core curriculum would provide standardisation, encourage collaboration, allow for regional adaptation, focus on developing competencies and require rigorous evaluation.
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Marine stings are common but most are minor and do not require medical intervention. Severe and systemic marine envenoming is uncommon, but includes box jellyfish stings, Irukandji syndrome, major stingray trauma and blue-ringed octopus envenoming. Almost all marine injuries are caused by jellyfish stings, and penetrating injuries from spiny fish, stingrays or sea urchins. ⋯ First aid for jellyfish includes tentacle removal, application of vinegar for box jellyfish, and hot water immersion (45°C for 20 min) for bluebottle jellyfish stings. Basic life support is essential for severe marine envenomings that result in cardiac collapse or paralysis. Irukandji syndrome causes severe generalised pain, autonomic excess and minimal local pain, which may require large amounts of analgesia, and, uncommonly, myocardial depression and pulmonary oedema occur. Penetrating marine injuries can cause significant trauma depending on location of the injury. Large and unclean wounds may have delayed healing and secondary infection if not adequately irrigated, debrided and observed.
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Most women who attend assisted reproductive technology (ART) clinics believe women should receive fertility-awareness education when they first report trouble conceiving. Interest in fertility awareness among women who attend general practice is largely unknown. We aimed to measure fertility-awareness knowledge, attitudes and practices of women attending general practice. ⋯ One-third of women who attend general practice show interest in fertility awareness, but far fewer can correctly identify the fertile period of the menstrual cycle. All women who report using fertility awareness as contraception should be counselled on their actual knowledge and advised accordingly. Concordant with our previous study of women who experience infertility, most women who attend general practice believe that women should receive fertility-awareness education when they first report trouble conceiving. Further research is needed to determine how best to do this.