Aust Fam Physician
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While systematic reviews should be of assistance in decision making, currently many reviews are unreliable, poorly reported or not clinically useful. It is therefore important that they are read critically. ⋯ Guidelines for undertaking and reporting systematic reviews should eventually improve their quality and usefulness. In the meantime, reviews must be appraised critically, particularly those outside the Cochrane Library.
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Diabetes, heart disease and other vascular diseases are a great problem in Aboriginal communities and there are many reasons for this. As a health professional it is easy to feel overwhelmed by both the magnitude of the problem and the feeling that it is just too hard when patients don't seem to take charge of their own health. ⋯ To improve health outcomes we need to focus on two parts of the same problem. First, we need to tackle the vascular diseases at their roots--the vascular risk factors. Second, we need to look at ways to promote self management so that our patients can identify personal barriers to self care and be partners in their health care. There is evidence that better organised systems of care, such as recall systems and improved screening systems, are very beneficial. The most successful interventions are culturally appropriate and developed and implemented with Aboriginal community control.
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It is generally accepted that adherence or compliance to medical therapy can be poor in indigenous Australian communities. ⋯ First, the importance of gaining trust and credibility with a community is discussed. Approaches to gain that trust are then described. It is critical to overcome the considerable language and world view barriers that exist to good communication. The use of anatomical models and high quality illustrations combined with the development of 'key language concept' in the indigenous language have achieved some success in this area.