Topics
General medicine
Low HIV testing rates among people with a sexually transmissible infection diagnosis in remote Aboriginal communities
Adhering to screening recommendations is essential to avoiding increased HIV infection rates in remote communities
James S Ward · Amalie Dyda · Skye McGregor · Alice Rumbold · Linda Garton · Basil Donovan · John M Kaldor · Rebecca J Guy
Osteoporosis treatment: a missed opportunity
Effective treatment is available, but under-used, for a common and very costly health problem
Frances Milat · Peter R Ebeling
English as a second language and outcomes of patients presenting with acute coronary syndromes: results from the CONCORDANCE registry
To the Editor:The retrospective observational study by Juergens and colleagues1 raises some concerning questions. They chose the variable of English either as first language (EFL) or second language (ESL) and measured significant inferiority of care and outcome for people with ESL. This variable has the advantage of being reasonably easy to collect in a standardised way, but the effect that is being measured is likely to be a proxy for limited English proficiency. We do not need a large trial to know that a patient who is unable to communicate with his or her doctor will have inferior care and outcomes. To be able to provide clinical care, we need to know the language proficiency of the patient. To assess the outcome of the clinical care using an EFL or ESL variable, we need to know whether an interpreter was used and if the interpreter was professional or ad hoc. The authors acknowledge this omission, but they make the contentious statement that “using non-professional interpreters can be expedient”. I would argue that in the setting of an admission for acute coronary syndrome, where vital issues of informed consent and patient understanding of the condition are involved, the use of non-professional interpreters is unethical.2 This is particularly true in Australia where, as Phillips notes, “the Translating and Interpreting Service offers the most extensive telephone interpreting system in the world, providing doctors and pharmacists with rapid, 24-hour access to interpreters”.3 Although, as the authors point out, we cannot know how much of this adverse outcome in correlation with ESL is related to poor communication and how much is related to a higher prevalence of cardiovascular risk factors, it is inconceivable that poor communication is not part of the explanation. A professional interpreter should be used routinely in the setting of an admission for acute coronary syndrome because this will almost certainly improve outcomes4 and is likely to decrease costs,5 and it is a basic right for a patient to be able to communicate fully with clinicians when suffering from a potentially fatal illness.
Ben Gray
Global lessons for Australian general practice
We have much to share, but also much to learn, about providing truly universal health coverage
Michael R Kidd
Prioritising general practice research
Cuts to federal funding put us in grave danger of wasting the investment made to achieve current gains in research capacity
Tania M Winzenberg · Gerard F Gill
Detecting ascites
Most cases can be diagnosed by good clinical assessment at the bedside
Martin Veysey
Relieving the pressure: new Australian hypertension guideline
The National Heart Foundation guideline has been updated to reflect recent evidence and Australian conditions
Garry LR Jennings
Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey
The speed with which patients are referred to specialists depends on the cancer type
Karen Lacey · James F Bishop · Hannah L Cross · Patty Chondros · Georgios Lyratzopoulos · Jon D Emery
Estimating non-billable time in Australian general practice
The significant amount of unpaid patient care between consultations is an inherent problem of the fee-for-service system
Joan Henderson · Lisa A Valenti · Helena C Britt · Clare Bayram · Carmen Wong · Christopher Harrison · Allan J Pollack · Julie Gordon · Graeme C Miller
Guideline for the diagnosis and management of hypertension in adults — 2016
Updated recommendations from the National Heart Foundation take into account the findings of recent meta-analyses, systematic reviews and randomised controlled trials
Genevieve M Gabb · Arduino A Mangoni · Craig S Anderson · Diane Cowley · John S Dowden · Jonathan Golledge · Graeme J Hankey · Faline S Howes · Les Leckie · Vlado Perkovic · Markus Schlaich · Nicholas A Zwar · Tanya L Medley · Leonard Arnolda
Appropriate use of serum troponin testing in general practice: a narrative review
Cardiac troponin testing in general practice should be limited to patients presenting with ischaemic symptoms that occurred more than 24 hours previously
Constantine N Aroney · Louise Cullen
Are general practice characteristics predictors of good glycaemic control in patients with diabetes? A cross-sectional study
N/A
Adrian J Esterman · Robyn McDermott
Towards an integrated model for child and family services in central Australia
An innovative model for the delivery of child and family services
Donna Ah Chee · John D Boffa · Edward Tilton
Clinical examination: evidence and eminence
Introducing a new MJA series outlining essential clinical skills for generalists, doctors in training and medical students
Balakrishnan (Kichu) R Nair · Simon O’Connor
Ankles jerk — yes, but how?
Eliciting an ankle jerk requires the skills of an experienced bell-ringer, an expert golfer and a mechanical engineer
David B Williams
Uptake of long-acting, reversible contraception in three remote Aboriginal communities: a population-based study
The high acceptability of LARCS in these communities concords with international recommendations on contraception
Emma K Griffiths · Julia V Marley · Domenica Friello · David N Atkinson
Financial toxicity in clinical care today: a “menu without prices”1
Out-of-pocket costs are rising rapidly and can influence treatment decisions and health outcomes
David Currow PhD, FRACP, FAHMS · Sanchia Aranda PhD, MN, BAppSci
Strengthening primary health care to improve Indigenous health outcomes
We need better, more culturally sensitive models for delivering primary care
John Wakerman MTH, FAFPHM, FACRRM · Cindy Shannon BA, MBA, DSocSci
To screen for depression or not?
Screening may be appropriate to reconsider once we can ensure adequate response to any identified potential cases
Malcolm J Hopwood MB BS, MD, FRANZCP · Gin Malhi FRCPsych, MD, FRANZCP
How can we ensure that people with lung cancer living in rural and remote areas are treated surgically when appropriate?
We have the will to improve cancer services for patients outside major cities but, thus far, not the way
Elizabeth Tracey BSc(Hons), MPH, PhD · Brian C McCaughan MB BS, FRACS · Jane M Young MPH, PhD, FAFPHM · Bruce K Armstrong MB BS(Hons), DPhil, FRACP
Using opioids in general practice for chronic non-cancer pain: an overview of current evidence
Careful clinical selection of patients can help optimise the evidence-based use of opioids for chronic non-cancer pain
David C Currow PhD, FRACP, FAHMS · Jane Phillips PhD · Katherine Clark MMed, FRACP, FAChPM
Acute pain management: scientific evidence, fourth edition, 2015
The increase in evidence over the past 15 years in acute pain management is impressive
Stephan A Schug MD, FANZCA, FPMANZCA · Greta M Palmer MB BS, FANZCA, FFPMANZCA · David A Scott PhD, FANZCA, FFPMANZCA · Richard Halliwell MB BS, FANZCA · Jane Trinca MM(Pain Management), FANZCA, FPPMANZCA
Absolute risk of cardiovascular disease events, and blood pressure- and lipid-lowering therapy in Australia
An estimated 970 000 Australians may not be receiving recommended combination blood pressure- and lipid-lowering therapy
Emily Banks MB BS, PhD, FAFPHM · Simon R Crouch MB BS, PhD, FAFPHM · Rosemary J Korda PhD · Bill Stavreski BEcon, MPPM · Karen Page RN, MNursStud, BEd · Katherine A Thurber MPhil · Robert Grenfell MB BS, MPH, FAFPHM
