Aust Fam Physician
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General practitioners are usually the first point-of-contact for young people seeking sexual health and contraceptive advice. Although the combined oral contraceptive pill is still the most common choice for contraception by Australian women, there is an increasing drive to encourage the consideration and use of long acting reversible contraception. ⋯ If presented with information about the range of contraceptive choices, including long acting reversible contraception, young women will commonly choose a longer acting method. Good counselling is important before advocating either implant or depot injections as irregular bleeding can occur and is likely to be of particular concern to younger women. Clinicians are increasingly considering intrauterine devices in nulliparous women and in women aged less than 25 years. It is uncommon for women to have complications with intrauterine device insertion, the most significant potential problem being pelvic infection. The key to minimising problems in contraceptive practice is the consideration of sustainability (cost, efficiency, duration of action and suitability), making a careful choice and then counselling the patient well.
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The prevalence of type 2 diabetes is on the rise in Australia. A large number of patients with type 2 diabetes do not reach currently recommended glycaemic targets. ⋯ Early, tight glycaemic control in patients with type 2 diabetes has been shown to result in better outcomes in terms of micro- and macrovascular disease and mortality even if control is relaxed later in the course of the disease. Clinical inertia is one of the contributing factors that prevent patients from reaching glycaemic targets. A proactive approach to treating type 2 diabetes is recommended: therapy should be individualised with early consideration of combination therapy and ongoing reinforcement of lifestyle modification messages. In newly diagnosed patients, the goal should be to achieve an HbA1c of.
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In 2010, the federal government introduced the first comprehensive national policy statement for primary healthcare in Australia. This policy identifies key reform initiatives with the overall aim of improving the quality of healthcare. However, what constitutes quality and how to measure it is the subject of ongoing debate both nationally and internationally. ⋯ There are multiple and varying definitions of quality in general practice, but most emphasise patient experience as their primary focus. The quality frameworks used in the countries investigated are all based on Donabedian's systems-based framework of structure, process and outcome. Implementation and application varies however, with top-down approaches in New Zealand and the United Kingdom, and bottom-up approaches in Germany. Provision of high quality care is the primary goal in all the systems described. External standards, targets and incentives are important initiatives, but countries with high quality general practice excel at empowering general practice to own the quality agenda.
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Folic acid supplementation has an established role in early pregnancy for preventing neural tube defects. However, there is controversy over a possible link between late pregnancy folic acid supplementation and childhood asthma. ⋯ The currently available evidence regarding an association between folate in pregnancy and childhood asthma or wheeze is conflicting. We offer suggestions for discussing the potential risk with patients and recommend further research on this subject be conducted.
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Bennett fracture dislocation is an intra-articular fracture of the base of the first metacarpal with resultant dislocation of the first carpometacarpal joint. The fracture is unstable, and with inadequate treatment leads to osteoarthritis, weakness and/or loss of function of the first carpometacarpal joint. ⋯ Bennett fractures usually result from falling on an extended or abducted thumb or an impact onto a clenched fist. The patient presents with pain and loss of function of the first carpometacarpal joint. Management can involve closed reduction, with or without percutaneous Kirschner wire fixation, or open reduction and internal fixation, with adequate reduction and the maintenance of reduction being the key to a successful outcome. Due to the difficulty of management it is recommended that patients be referred to a specialist hand surgeon.