Australian Family Physician audio

David Williams talks about what GPs need to know about how to assess, investigate and treat patients who present with tremor. In particular, a detailed history and observation is vital to distinguish resting from action tremor and look for other clinical clues to the diagnosis. Investigation should include basic biochemistry in all cases. David discusses the clinical features and management of physiologic, essential, dystonic, parkinsonian, cerebellar, drug induced and psychogenic tremor.

Justin Denholm, BMed MBioethics, is a research registrar, Victorian infectious Diseases Service, Royal Melbourne Hospital. He discusses the current issues in long term management of patients living with HIV with Jenni Parsons.

Advances in the treatment of human immunodeficiency virus (HIV) have resulted in sustained improvements in the general health and longevity of people living with the virus.

Dr Fiona Millard discusses research she has published in August 2009 AFP on what patients with dementia and their carers required from primary care providers, and the knowledge, attitudes and beliefs of health providers about dementia.

Health professionals have varying levels of knowledge about, and interest in, providing dementia services. This article compares patient experiences in dealing with dementia with the perceived role of health care providers in providing dementia care.

Dr Anna Ralph discusses whats new in diagnosis and management of the very old disease of TB with Dr Jenni Parsons.

Australia has among the world’s lowest rates of tuberculosis (TB). However, it remains a leading global cause of morbidity and mortality. In Australia, TB remains more common in Indigenous than non-Indigenous Australians, and rates are rising among migrants, reflecting changing immigration patterns and rising rates in their homelands.

Abbe Anderson discusses the role and training of Medical Assistants in primary care. Medical assistants undertake a variety of administrative, reception and clinical duties in a primary care setting work under the supervision of doctors, nurses or practice managers. A 12 month TAFE course has been developed to train staff for this role. The clinical tasks that can be undertaken by medical assistants include wound dressings; venepuncture; and vision, hearing, height, weight and blood pressure checks. This role potentially provides flexibility of staffing in medical practices, with medical assistants undertaking administrative or clinical duties as required, freeing up nursing time for chronic disease management and more complex tasks. It also formalises and provides specific training for a role many medical receptionists have already partially undertaken in the primary care setting.

Dr Fiona Millard discusses research on what patients with dementia and their carers required from primary care providers, and the knowledge, attitudes and beliefs of health providers about dementia. Important themes from patients and carers include the need for timely investigation of symptoms, early and accurate diagnosis, explanation and support in the home. Up to 35% of GPs in the postal survey component said they preferred not to look after patients with dementia and about 15% of primary health providers indicated they thought early diagnosis may be harmful.

Dr Anna Ralph discusses whats new in diagnosis and management of the very old disease of TB. Despite lower incidence of TB in Australia compared to other places in the world, TB remains a significant problem in a number of at risk groups including migrants from sub Saharan Africa, India, Vietnam, the Phillipines, China and Indonesia; patients with HIV; and Indigenous Australians. While newer diagnostic tests (interferon gamma release assays) are available, they have some limitations and in Australia sputum microscopic examination and cuture remains the main method of diagnosis in symptomatic individuals. Developments in pharmacotherapy include a metronidazole related antibiotic and agents targeting MTB genes. However, the standard first line treatment remains 6 months of rifampicin, isoniazid plus pyrazinamide and ethambutol for the first 2 months. In Australia, patients with TB are managed in specialty treatment units, the GP has an important roole in avoiding diagnostic delay, infection control, avoiding drug interactions (particularly with rifampicin), nutrition, smoking cessation, psychological support and encouraging adherence to therapy.

Justin Denholm discusses the current issues in long term management of patients living with HIV. Patients with HIV treated with combination antiviral therapy (cART) now often have rapid and sustained control of HIV viraemia (often to undetectable levels) and a sustained increase in CD4+ T-cell counts. This has resulted in decreased opportunistic infections and increased longevity. Management has therefore shifted more to a chronic disease management model, in which GPs are able to provide an important role. Management focuses on the effects of HIV and its treatment on long term health, the psychosocial impact of living with a chronic disease and the specific issues related to a sexually transmissible infection. Specific issues include psychosocial support, mental health, risk behaviour, assessing and managing increased risk of cardiovascular and metabolic disease, increased risk of malignancy and vaccination against preventable diseases.

Dr Belinda Welsh, MBBS, MMed, FACD, is consultant dermatologist, St Vincent's Hospital Melbourne and Sunbury Dermatology and Skin Cancer Clinic, Sunbury. Belinda discusses the causes and clinical features of a variety of bullous skin rashes with Dr Jenni Parsons. Belinda discusses distinguishing features such as blister location, presence of mucosal involvement or whether the blisters are tense and intact (indicating dermal blistering) or fragile (indicating superficial blistering). Most presentations to GPs will be the result of infection, topical contact reaction, insect bites or drug reactions. However, if common conditions such as these are excluded, then often histology and immunofluoresence is required for diagnosis.

Blistering of the skin can be due to a number of diverse aetiologies. Pattern and distribution of blisters can be helpful in diagnosis but usually biopsy is required for histopathology and immunofluoresence to make an accurate diagnosis.

Dr Adriene Lee, BSc(Med), MBBS(Hons), FACD,is visiting dermatologist, St Vincent's Hospital and Monash Medical Centre, and Lecturer, Department of General Practice, Monash University, Victoria. She discusses the association between skin problems and systemic disease with Dr Jenni Parsons. Adrienne discusses skin conditions such as generalised pruritis, cutaneous vasculitis and erythema that may be an indicator of an underlying systemic condition; skin conditions that are much more rare but have an association with occult malignancy; and typical skin manifestations of connective tissue disorders.

Dermatologic complaints are a common reason for presentation to a general practitioner. In some cases, one needs to determine if the complaint may be a manifestation of a more serious underlying systemic disease.