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General Practice Conference & Exhibition

Magazine / October 2020

gpce.com.au


Contents 6 Thank you 7 Welcome 10  The GPCE Advisory Board: The year that was 17 Exercise is medicine 22  Chronic Kidney Disease (CKD) Management in Primary Care: 28 Product showcase 32  Detecting the late effects of polio: Top things to know 38  Why are women’s cardiovascular outcomes falling behind?

42 Test your knowledge 46  Tips for managing asthma with comorbid allergic rhinitis 52  Atopic dermatitis: A practical guide 58  Troubleshooting common feeding problems in infants 65 Company list 66 Company synopses 102 Category list

All information within the GPCE Digest is correct at time of publication.

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GPCE Digest 2020

Thank you Advisory Board

A/Prof Ralph Audehm

Dr Mike Browne

Dr Simon Cowap

Dr Gary Deed

A/Prof Gary Kilov

Dr Joe Kosterich

Dr Anita Sharma

Dr Jagdeesh Singh Dhaliwal

Management team

Marketing team

Education team

Sales team

Mike Simmonds Director of Reed Medical Education

Dina Ahmad Marketing Manager

Nick Wolf Conference Producer

Eunji Blacklow Sales Manager

John Curran Marketing Executive

Andrea Deely Education Manager

Emma Browne Account Manager

Penny Maber Project Manager

Jennifer Singleton Account Manager

GPCE Team

Event team Lara Low Senior Event Producer Sarah Emanuel Event Production Executive

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Aly Hayashi Digital Content Executive

Operations team Phil Batty Senior Operations Manager


Welcome

There have been a lot of changes in general practice, especially over the past 6 months, but one thing that will not change is GPCE’s commitment to being your source for CPD and your insight into the ever-changing world of general practice. It is with great excitement that I introduce GPCE Digest. There’s always so much to learn and do at GPCE, from accredited education to networking with colleagues and suppliers. Our aim with this new magazine is to deliver a taste of the GPCE experience. The content is closely linked to sessions from this year’s program as well as educational modules on our sister site ThinkGP, allowing readers a seamless journey between our two CPD platforms. Now more than ever, reconnecting and making new relationships is essential, and that’s why we’ve also included the new company directory. Find companies and their services by selecting an industry category or a company name. If you cannot find what you are looking for, please feel free to contact us via info@gpce.com.au and we’ll connect you directly with one of our partners. We hope you enjoy reading the first edition of GPCE Digest and browsing our library of content on ThinkGP. I look forward to meeting many of you at GPCE in 2021!

Mike Simmonds Director Reed Medical Education

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COMING SOON

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GPCE Digest 2020

The GPCE Advisory Board: The year that was Mike Browne / Simon Cowap / Gary Deed / Joe Kosterich Jagdeesh Singh Dhaliwal / Gary Kilov / Ralph Audehm

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GPCE Advisory Board

NSW / ACT Things we didn’t see coming! There have been so many changes to the way we do things this year that it’s hard to know where to start! First the magazines disappeared from the waiting room, then nearly all the seats went out to the back shed. Away went the sheets from the examination couch and the basket of kid’s toys from my room. Then came a sticky-tape ‘cross’ on the floor, warning the patient in the one remaining chair to stay just that bit too far away from my own sticky-taped cross for effective communication when phone triage deemed them to be well enough to come to the doctor’s. The staff meeting discussion right now is around masks – for doctors, nurses and staff? For patients? For some of us all the time? All of us some of the time? Oh, how quickly that novelty has worn off. Mask wearing has made nuances of speech and facial expression the stuff of memory, and the amount of communication confusion is raised to the power of the number of people in the conversation whose faces are covered and voices muffled! I suspect it’s not just my

There have been a lot of strange experiences during this COVID pandemic, but one of the strangest has been that the great majority of GPs have hardly seen a single case. When SARS-CoV-2 first arrived I expected it to be like flu season on steroids. I studied up on signs and symptoms and imagined donning PPE on a daily basis to do battle with the virus. But the reality is that so far out of our entire practice population of over 10000 there have only been 2 cases, and thanks to our infection control policies neither of those had a face to face appointment. In NSW at the time of writing this there have been 4218 cases out of a population of over 8 million, so only about 1 person in every 2000 has had a confirmed infection. Given the way outbreaks tend to occur in geographically limited clusters, that means some practices will have had quite a number of cases but most very few indeed. That’s absolutely not to say the practice hasn’t been affected. COVID and other respiratory viruses (with the notable exception of rhinovirus, that little

older patients who ‘lip read’. I do it too, at least when my glasses aren’t fogged up by my own expired hot air. We’ve taken to telehealth like a new best friend, but as can happen in such flight-of-fancy friendships, I feel my fervour failing. Some days it seems like hard work, a long day with a ‘needy’ new BFF. Tele-teaching, virtual conferences, a wide new world of webinars, even remote clinical teaching visits, Zoom job interviews and remote fellowship exams are with us and bring a heady mix of advantages and downsides. Perhaps our old ways were due for a shake up and they weren’t always the most effective, efficient nor fun, but the rapidity of the changes we’ve had to make in an atmosphere of uncertainty and stress has been unsettling. I hope we can find the best in the new ways of doing things and use them to ongoing advantage for ourselves, our colleagues and patients without losing what’s good: our long-held methods, traditions and skills.

Mike Browne

final thoughts... play video

We didn’t see this pandemic coming, but we’re not seeing it going any time soon either.

sucker seems immune to social distancing, or more likely it’s the toddlers that are immune to social distancing) aren’t the only things we’re not seeing. Like many practices we’re less busy, and our anecdotal experience supports MBS data showing significantly less people attending for screening and care of chronic conditions. What I am seeing (or typically hearing, via telehealth) more of is mental health problems. True, I’ve had a couple of socially anxious patients who are actually finding life less stressful working from home and having an excuse not to go out, but for most it’s been really tough. It’s pretty easy to see why general and heath anxiety would be worse, and depression too, but I’ve been struck by how many of my usually stable patients with psychotic illness have flared up. I suspect everyone has a different pandemic experience, but for me it’s been much more about treating anxiety, depression and psychosis than fevers, coughs and respiratory distress. I only hope all the missed chronic care doesn’t mean an epidemic of vascular disease and preventable cancers next year!

Simon Cowap 

final thoughts... play video

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GPCE Digest 2020

QLD 2020 has been a massive year, but it has also shown us many things as GPs and provided opportunities to develop resilience in the face of rapid change.

Gary Deed 

final thoughts... play video

The uncertainty of the global pandemic has affected our patients – both in a decline in attendance for health reviews, and an increase in mental health concerns. This decline in attendance has been especially pronounced for practices in metropolitan CBD areas and shopping districts, and we can only hope that this doesn’t lead to too many health complications in our patients in the years to come. Compounding the matter, restrictions on access to specialist services, especially hospital outpatient services, means that delays now extend into early 2021. Among all this chaos, opportunities have arisen for GPs to be proactive and prepared in managing our practice. We have had to rapidly adapt to telehealth, while some patients are now seeing a blended approach of face-to-face and telehealth consultations. With many patients now reluctant to visit their GP, we have had to increase training for all staff to accommodate for telehealth, and now more than

ever we have a need to be active in following up our chronic disease patients, and sending out reminders and recalls. Having lived with this pandemic for the good part of a year, we now have an abundance of resources at our fingertips, with the RACGP providing a wide variety of COVID-19 resources for GPs including a guide on managing diabetes during the pandemic. Online learning has responded well to our educational needs and will remain an increasingly important tool for GPs – but it still cannot provide all the benefits of face-to-face education. This year has also seen the release of new editions of major clinical guidelines, including the Australian Asthma Handbook, the RACGP Management of type 2 diabetes: A handbook for general practice, and Chronic kidney disease management in primary care. These resources are key to providing up-to-date care for some very common chronic conditions, should be a valuable aid to GPs going forward. Finally, while we are all doing our best to care for our patients’ health, please don’t forget that managing your own health – and that of your loved ones – is equally important in these uncertain times.

WA / NT What has happened in my general practice and in WA general practice in 2020? Since June, living in WA has had a degree of surrealism about it. Aside from closed borders and no footy each week at Optus (as the hub weeks) life is fairly normal on a day to day basis. Traffic is normal and the restaurants full!

Joe Kosterich

final thoughts... play video

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What has been interesting is talking to patients over 70 who wanted to come to the GP even at the height of restrictions but were discouraged by family. Most are far more worried about jobs for their children and grandchildren than the virus. For me personally, telehealth which made up 40 to 50 per cent of my consults in May has now dropped below 5%. My initial enthusiasm waned when it

became apparent how little can be achieved over the phone. WA has also relied heavily on IMGs to fill roles in rural areas, so this task has been made even more difficult than usual. The ability of practices to adapt is a testimony to the nimble nature of general practice. Yes, the waiting room has less chairs – and yes, we are more focussed on hygiene but service to patients has continued. This lifting of harsh restrictions in June certainly helped in WA and I feel for my colleagues in Victoria. Going forward, my concern is that we have severely underestimated the collateral health damage caused. General practice will be confronting this over the next five years – at least.


GPCE Advisory Board

VIC / SA / TAS As a GP working in aged care in Melbourne during the height of the pandemic, one of the key things I have learnt in 2020 is the value and the vital need for wide, multi-disciplinary professional networks. There’s a lot we can accomplish as individuals; we often forget how powerful we are as doctors and the considerable influence we have in advocating for our patients and for quality healthcare. For other tasks, our practice team and the organisational engine that it provides is critical. But during the pandemic, we have faced far bigger logistical challenges that require collaboration with networks comprising a wider breadth of actors in health and social care. For my part, this has meant closer working relationships with GPs from other practices, with hospital InReach geriatric services, with our local

final thoughts... play video

PHNs, with the public health department, with pharmacists and with aged care facility senior nurses and managers. This has allowed us to share the experience from our coalface with those making strategic decisions, facilitated the sharing of knowhow between healthcare professionals from different disciplines in managing COVID-positive patients, to club together to share workload via in-synch visiting rosters and provided much-needed peer support to keep our batteries charged and our spirits up. What’s been uplifting is how everyone wants to help; what was needed was to eke out precious time out of a frantically busy day to connect with other colleagues. The time expended was more than recouped through the efficiencies gained through better coordination and collaboration. This is something I will remember and something I will aim to continue to do, to better serve my patients and to enhance the quality of my working life.

I have resolved not to take things for granted and to be thankful for the privileged position that I find myself in. My practise continues unimpeded and my high-risk patients are, at least for the moment, safe from the ravages of the coronavirus.

To say that COVID-19 has left no one untouched, is an understatement. I count myself incredibly fortunate. Tasmania, by good fortune or good design, or a measure of both, got our coronavirus outbreaks under control early. (Having a highly effective natural moat probably assisted too!)

With that in mind, I have dusted off my camera, rediscovered my bushwalking equipment (with an upgrade or two) and implemented a much better life balance.

To date, we appear to be virus-free, but of course that could change at any time.

I do still slip back to old habits, but I am getting better at filtering the wheat from the chaff.

Observing the challenges that my family members and others in Melbourne and beyond are facing, has brought my good fortune into sharp focus.

To my friends, colleagues and patients, I would recommend doing an audit of what you wish to retain from pre COVID-19 life, what you might adopt from the imposed coronavirus slowdown, and emerge with a better life balance, and a physically and mentally healthier you.

This has served as a timely reminder of all the things I am grateful for.

final thoughts... play video

and final thoughts from... Ralph Audehm

On a personal level I, like many others, have been forced to slow down and take stock. I have done what is long overdue, and that is to assess my priorities and to jettison the energy and timesapping aspects of my life that provide little or no utility and optimise those that provide value, pleasure or benefit to myself and others.

Gary Kilov 

Jagdeesh Singh Dhaliwal

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GPCE Digest 2020

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Exercise is medicine Jonathan Freeman Founder and Managing Director, Club Active Accredited Exercise Physiologist. Adjunct Professional Fellow SCU Jonathan is an Accredited Exercise Physiologist and adjunct professional fellow at SCU in Musculoskeletal Health and Biomechanics. He is the founder of Club Active, a chain of wellness centres for the over 50s that incorporates allied health in a safe fun and non-intimidating environment. He has helped thousands of people rehabilitate from injuries and chronic illness from A list celebrities, Olympic athletes to everyday people wanting to live a better quality of life. Club Active’s mission is to change the way we age by providing a safe fun and non-intimidating exercise environment that supports a patient’s goals and abilities. We’re currently looking for likeminded partners by providing joint venture opportunities so to give all Australians an opportunity to exercise safely.

GPCE Digest 2020 17 17


GPCE Digest 2020

Exercise is rapidly growing as a method of prescription to combat chronic health conditions. It’s known that physical inactivity is estimated to be the main cause for approximately 21-25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischaemic heart disease. It is the second greatest contributor, behind smoking, to the cancer burden in Australia.

Physical Inactivity: Effect of low cardiorespiratory fitness (CRF) on mortality Contributing factors for all-cause deaths; study of 40,482 men and 12,943 women 18 16 14 12 10 8 6 4 2 0

‘By achieving the recommended daily guidelines for physical activity, we can reduce the risk of colon cancer by 60%’

Low CRF

Obese

Smoker

High Cholesterol

Diabetes

Men

Women

Adapted from Blair, SN 20091 Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

By achieving the recommended daily guidelines for physical activity, we can reduce the risk of colon cancer by 60%, reduce the risk of heart disease by 40%, decrease depression and reduce the risk of developing Alzheimer’s disease by one third. It has been further shown to have a 50% reduction in the incidence of hypertension as well as lower the risk of stroke by 27%. The problem is more than 80% of Australian adults do not meet the current physical activity guidelines.

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Hypertension

So how much is enough? For adults (18-64 years), the Australian Physical Activity and Sedentary Behaviour Guidelines recommend 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity per week, including at least two days of muscle strengthening activities. Note that this refers to structured exercise, and does not include activities of daily living.


Exercise is medicine

How can exercise physiologists help? Within the Medicare system, Australia recognises the impact an accredited exercise physiologist (AEP) and exercise intervention plays in a patient’s cycle of care by providing help through the chronic disease management (CDM) program and the coordinated veterans’ care (CVC) program. Exercise physiologists are also recognised through state and territory workplace health and safety regulations, NDIS and all private health insurers.

References: 1. Blair, S.N. Physical inactivity: the biggest public health problem of the 21st century. British Journal of Sports Medicine 2009;43:1-2. 2. Callaghan, P., Khalil, E., Morres, I., & Carter, T. (2011). Pragmatic randomised controlled trial of preferred intensity exercise in women living with depression. BMC Public Health, 11(1), 465. 3. Dunbar, J. A., Jayawardena, A., Johnson, G., Roger, K., Timoshanko, A., Versace, V. L., ... & Best, J. D. (2014). Scaling up diabetes prevention in Victoria, Australia: policy development, implementation, and evaluation. Diabetes Care, 37(4), 934-942. 4. Hayes, S. C., Spence, R. R., Galvão, D. A., & Newton, R. U. (2009). Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. Journal of Science and Medicine in Sport, 12(4), 428-434. 5. Meyerhardt, J. A., Heseltine, D., Niedzwiecki, D., Hollis, D., Saltz, L. B., Mayer, R. J., ... & Schilsky, R. L. (2006). Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. Journal of Clinical Oncology, 24(22), 3535-3541. 6. Rosenbaum, S., Tiedemann, A., Sherrington, C., Curtis, J., & Ward, P. B. (2014). Physical activity interventions for people with mental illness: a systematic review and meta-analysis. 7. Spence, R. R., Heesch, K. C., & Brown, W. J. (2010). Exercise and cancer rehabilitation: a systematic review. Cancer treatment reviews, 36(2), 185-194. 8. Spence, R. R., Heesch, K. C., & Brown, W. J. (2011). Colorectal cancer survivors’ exercise experiences and preferences: qualitative findings from an exercise rehabilitation programme immediately after chemotherapy. European journal of cancer care, 20(2), 257-266. 9. Schuch, F. B., Deslandes, A. C., Stubbs, B., Gosmann, N. P., da Silva, C. T. B., & de Almeida Fleck, M. P. (2016). Neurobiological effects of exercise on major depressive disorder: a systematic review. Neuroscience & Biobehavioral Reviews, 61, 1-11.

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GPCE Digest 2020

Chronic Kidney Disease (CKD) Management in Primary Care: Clinical tips to help identify, manage, and refer patients with CKD in your practice

Mr Chris Forbes Chief Executive Officer, Kidney Health Australia At Kidney Health Australia, we are a leading voice for the kidney community, providing vital resources and support to people affected by kidney disease and working closely with clinical and research community to support treatment and research improvements, so that one day every Australian can live with better kidney health. Following the release of the 4th edition of the highly regarded handbook CKD Management in primary care, we recently launched a ground-breaking public awareness campaign promoting the early detection of kidney disease. The campaign targets the 1 in 3 Australians at risk of kidney disease and urges them to visit their primary care practice for a kidney health check. Now, is a great time to evaluate your practice and put systems in place to drive change and promote early detection and subsequent management of this insidious disease. Kidney Health Australia asks you to support our important work by identifying patients at risk of CKD, particularly those with diabetes and high blood pressure, performing a Kidney Health Check, and utilising the free resources and support available at kidney.org.au. Together, I know we can make a difference.

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Chronic Kidney Disease (CKD) Management in Primary Care

In Australia, chronic kidney disease (CKD) is common, harmful, and treatable – yet often overlooked. 1.7 million Australian adults have signs of kidney disease, however, only 10% are aware they have the condition.1 Most people with CKD won’t experience any symptoms until they have lost 90% of their kidney function – and by then it is often too late. CKD is defined as the occurrence of kidney damage and / or reduced kidney function that lasts for three months or more and usually develops over a number of years.2 Early detection and proactive management can make a huge difference to the outcomes for people with CKD – it can be the difference between travelling for hours multiple times a week to attend dialysis sessions or peace of mind knowing that the risk of a cardiovascular event such as a heart attack or stroke is reduced. Early detection has been shown to prevent the deterioration in kidney function by as much as 50%.3

1.7 million Australian adults have signs of kidney disease

CKD in Australia - the facts Common

1.7

million

Harmful People with CKD have a 2-3 fold greater risk of cardiac death than people without the condition.5

Approximately 1.7 million Australians (1 in 10) aged 18 years and over have indicators of CKD such as reduced kidney function and/or albumin in the urine.2

65

Around 65 Australians die every day with kidney disease, which is more than breast cancer, prostate cancer, or road traffic accidents.6

CKD Diabetes

The publication Chronic Kidney Disease (CKD) Management in Primary Care is a useful tool for GPs and other health professionals when detecting and managing CKD in a primary care practice.

Why use the handbook? u

Easy to use and interactive

u

C  olour-coded CKD staging table and clinical action plans outlining goals of management, key management tasks and frequency of assessment required by CKD stage

u

Medication advice and treatment targets

u

M  anagement framework for common CKD complications

u

Nephrology referral guidelines

u

U  seful links to additional fact sheets, websites, and additional resources.

CKD is twice as common as diabetes.3

CKD is a stronger risk factor for future coronary events and all-cause mortality than diabetes.7

1 in 3 Australian adults has risk factors for CKD.4

CKD can have significant impact on work, family, and psychosocial wellbeing.

Treatable

50%

If CKD is detected early and managed appropriately, then the otherwise inevitable deterioration in kidney function can be reduced by as much as 50% and may even be reversible.8 Early management of CKD (lifestyle changes, prescription of ACE inhibitors or ARBs, optimal glycaemic control) includes cardiovascular disease risk reduction.

Often overlooked Fewer than 10% of the people with CKD are aware they have this condition.9 10%

Late referral is common. 18% of people commence dialysis within 90 days of being referred to a renal service.10 18%

See ‘Key Steps for best practice detection and management of CKD’ on next page.

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GPCE Digest 2020

Key Steps for best practice detection and management of CKD 1

Identify people who are at risk of CKD CKD is easily primary care by a series of simple test performed on individuals with Who is atidentified risk ofinCKD? identified risk factors. Identifying people in your practice who are at risk of CKD is the first step. Adult Australians are at increased risk of developing CKD if they have any the following risk actors: There areof nine risk factors for CKD:

2

Diabetes

Hypertension

Established cardiovascular disease

Family history of kidney failure

Smoker

60 years or older

Aboriginal or Torres Strait Islander origin

History of acute kidney injury (AKI)

Obese (body mass index ≼30kg/m 2 )

Perform a kidney health check Individuals identified as being at increased risk of CKD should undergo a Kidney Health Check every 1 -2 years.2 Primary care practices are the usual setting for initial assessment and diagnosis of CKD, and are well-placed to conduct kidney health checks led by either the GP or the primary healthcare nurse. There are three components to a kidney health check, and these are easy to build into your existing practice.

Kidney health check

Blood test

Urine test

eGFR calculated from serum creatinine

Albumin/Creatinine Ratio (ACR) to check for albuminuria

BP check Blood pressure *maintain consistently below BP goals

It is important to note that CKD in itself is not a primary diagnosis and attempts to identify the underlying cause of the CKD should be made. There are three components to a CKD diagnosis, with each element essential to the overall classification

eGFR results to give CKD Stage (1-5)

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urine ACR results

normo, micro or macro albuminuria?

underlying pathology to determine cause of CKD

CKD diagnosis


Chronic Kidney Disease (CKD) Management in Primary Care

3

Implement best practice CKD management The goals of best practice CKD management are to: • detect CKD in its earliest stages • implement optimal management strategies that: o delay progression of the disease o reduce cardiovascular risk o d etect and address complications of worsening CKD o lead to optimal patient outcomes

Algorithm for initial detection of CKD Indication not present

Kidney Health Check not recommended

Offer Kidney Health Check to people with any of the following indications: • Diabetes • Hypertension • Established cardiovascular disease • Family history of kidney failure

If urine ACR and eGFR are normal repeat Kidney Health Check in 1-2 years (annually if diabetes or hypertension present)

• Obesity • Smoking • Aboriginal or Torres Strait Islander origin aged ≥30 years

eGFR

Urine ACR

Elevate urine ACR (males ≥2.5mg/mmol, females ≥3.5 mg/mmol)

eGFR <60 mL/min/1.73m2 Possible acute kidney injury discuss with Nephrologist

≥20% reduction in eGFR

Repeat eGFR within 7 days

Repeat urine ACR twice within next 3 months (preferably first morning void)

Stable reduced eGFR Minimum 2 out of 3 elevated urine ACRs present for ≥3 months

Repeat eGFR twice within 3 months Minimum 3 reduced eGFRs present for ≥3 months Albuminuria Stage Normal Kidney GFR Function (mL/min/1.73m2) (urine ACR mg/mmol) Male: <2.5 Stage Female: <3.5 1

≥90

2

60-89

3a

45-59

3b

30-44

4

15-29

5

<15 or on dialysis

Microalbuminuria (urine ACR mg/mmol) Male: <2.5-25 Female: <3.5-35

Macroalbuminuria (urine ACR mg/mmol) Male: >25 Female: >35

Not CKD unless haematuria, structural or pathological abnormalities present

Investigations to determine underlying diagnosis

Combine eGFR stage (1-5), albuminuria stage and underlying diagnosis to fully specify CKD (e.g., stage 2 CKD with microalbuminuria due to diabetic kidney disease).

Best practice management includes managing cardiovascular risk, blood pressure, and diabetes appropriately, encouraging lifestyle modification and providing resources and education to people with CKD to assist with their self-management goals, and adjusting the use of medications to account for worsening kidney function. The first step in managing CKD is to correctly stage the CKD utilising the staging table found in the CKD Management in Primary Care handbook. From there the colour coded action plan relevant to each stage will provide you with key treatment goals, recommended assessments, and relevant management tips. For people with CKD, halting further progression of the condition is vital. CKD is a major independent risk factor for cardiovascular disease, with the risk of dying from a cardiovascular event up to 20 times greater than the risk of ever needing dialysis or transplantation.4 The increased cardiovascular risk is noted from the time a patient first develops albuminuria, again highlighting the importance of early detection. of CKD. There are several treatment goals that if met, will improve the outcomes of CKD care. The most important of these are blood pressure targets, which have recently been updated in the 4th edition CKD handbook. The new blood pressure recommendations in people with CKD are to maintain blood pressure consistently below a target of 130/80mmHg.2 The use of ACE inhibitors or ARBs has been shown to slow the progression of albuminuria in addition to lowering blood pressure – both key goals of CKD management.2 Some of newer diabetes medications have shown promising results in terms of renal and cardiovascular benefits in people with CKD and should be considered in the overall management of people with CKD and diabetes.5-8 CKD rarely occurs in isolation and shares many treatment goals and management strategies with other common chronic conditions such as diabetes and cardiovascular disease. Taking a ‘whole of person’ approach and managing chronic conditions in conjunction with one another will lead to improved patient outcomes.

Refer to colour-coded action plans on page 31 for management strategies

Image Source: CKD Management in Primary Care, 4th Addition, Kidney Health Australia, Melbourne 2020.

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GPCE Digest 2020

4

Utilise the education and resources available from Kidney Health Australia

• M  y Kidneys My Health is a free handbook and app designed to help people navigate a CKD diagnosis and assist them with self-management and support

Kidney Health Australia has large range of resources, education and support available to assist in the management of kidney disease in your practice.

• K  idney Helpline Ph: 1800 454 363 or email kidney.helpline@kidney.org.au

• K  idney Health Australia Resource Hub has free downloadable factsheets, booklets and information for people living with kidney disease.

Is a national service that provides free support and information for anyone who has questions or concerns about their kidney health, their family and health professionals. The service is operated by trained health professionals and takes both bookings and spontaneous enquires.

For more information on managing CKD in your practice: u Download the CKD Management in Primary Care handbook u Complete the free online education available at thinkgp.com.au/kha

References: 1. Australian Bureau of S. Australian Health Survey: Biomedical Results for Chronic Diseases, 201112. ABS, Canberra;2013. 2. Kidney Health Australia. Chronic Kidney Disease (CKD) Management in Primary Care (4th edition). Melbourne2020. 3. Johnson DW. Evidence-based guide to slowing the progression of early renal insufficiency. Intern Med J. 2004;34(1-2):50-57. 4. Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164(6):659-663. 5. Perkovic V, Jardine M, Neal B, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. New Engl J Med. 2019;380:2295-2306. 6. Neuen BL, Ohkuma T, Neal B, et al. Cardiovascular and Renal Outcomes With Canagliflozin According to Baseline Kidney Function. Circulation. 2018;138(15):1537-1550. 7. Wanner C, Lachin JM, Inzucchi SE, et al. Empagliflozin and Clinical Outcomes in Patients With Type 2 Diabetes Mellitus, Established Cardiovascular Disease, and Chronic Kidney Disease. Circulation. 2018;137(2):119. 8. Wanner C, Heerspink HJL, Zinman B, et al. Empagliflozin and Kidney Function Decline in Patients with Type 2 Diabetes: A Slope Analysis from the EMPA-REG OUTCOME Trial. Journal of the American Society of Nephrology. 2018;29(11):2755.

26


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We have some great General Practitioner roles available in remote and rural Queensland and can provide you with the following services: 

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Contact our team to discuss your next job opportunity in remote or rural Queensland!  07 3105 7800  hws@healthworkforce.com.au  healthworkforce.com.au GPCE Digest 2020 27


GPCE Digest 2020

Microdacyn® Wound Treatment Solution New breakthrough technology to control and prevent infection, with one solution. Cleanse, debride and protect wounds with Microdacyn® Wound Treatment Solution, a pH-neutral, super-oxidised solution for firstline treatment of acute and chronic wounds, including burns. With proven (>99.99%) efficacy against bacteria including MRSA, fungi, viruses, spores and uniquely penetrating biofilm, Microdacyn® is clinically proven to improve surgical outcomes and heal wounds faster. Compatible with: • all wound dressings including Ag • leaving soaked gauze in the wound • wound irrigation • wounds under occlusion • n egative pressure wound therapy with installation (NPWTi) and ultrasonic debridement • positive pressure irrigation systems

Dermatoscopes

Check out the HEINE DELTAone video

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Product showcase HEINE DELTAone Mobility and quality have now become one. This mobile masterpiece is taking medical professionals by storm. A crystal-clear image is accomplished using the new achromatic HEINE optical system. What’s more, it produces extraordinary colour rendering due to the quality of HEINE’s LEDHQ. Examinations are now particularly comfortable due to the polarisation allowing Doctors to work glare-free and without disrupting reflections. These three features – clarity, LEDHQ and non-reflective working – are what turn the DELTAone into a vital tool to carry in your pocket wherever you go. Visit Website

28


Dermatoscopes HEINE DELTA 30 – If there’s something to discover, you’ll be sure to see it.

Check out the HEINE DELTAone video here

Not only would HEINE’s new high-end dermatoscope win any beauty pageant, it stands out due to the best imaging HEINE has ever developed; with a field of view measuring a veritable 30 millimetres, unprecedented colour rendering (in LEDHQ, of course), and polarisation which also provides glare-free and non-reflective working conditions. Above all, the HEINE DELTA 30 is comfortable to operate with its angled, ergonomic design and intuitive control. Visit Website

Here is a selection of new products that would have been featured on GPCE exhibition stands in 2020.

MESI mTABLET DIAGNOSTIC SYSTEM The MESI mTABLET, a certified medical tablet, is a unique healthcare solution, integrating wireless diagnostic modules, patient records and medical apps in one system.

MESI mTABLET ABI: the smartest wireless ankle-brachial index

Check out the MESI mTABLET ABI video here

The MESI mTABLET ABI module performs an automated wireless Ankle-Brachial Index system with its 3Cuff™ technology, allowing a simultaneous measurement of brachial and ankle pressures. It also incorporates PADsense™ algorithm for detection of severe Peripheral Arterial Disease. Get quick and reliable measurements with pulse waveforms shown directly on the screen. Visit Website

29


Detecting the late effects of polio: Top things to know Australia was declared polio-free by the World Health Organization in October 2000.1 While GPs today are unlikely to ever see a case of acute polio, Australia has a large population of living polio survivors,2 as many as 80% of whom will develop late effects of polio.1 GPs play an essential role in detecting and helping patients manage late effects of polio.3,4

32


Detecting the late effects of polio

Epidemiological clues as to who may have had polio

Do the ‘late effects of polio’ mean ‘post-polio syndrome’?

• A  t least 20,000–40,000 Australians were estimated to have developed paralytic polio from 1930 to 1988, but the overall number of people who were infected with the virus is probably much higher.5 As the last epidemic in Australia occurred in the early 1960s, most polio survivors are likely to be aged over 50 years today.1

• These are terms that are often used interchangeably; however ‘late effects of polio’ has a broader definition that includes post-polio syndrome (symptoms believed to relate to the body’s failure to maintain the level of recovery achieved after poliovirus infection) and a wider range of symptoms.5,8 • No specific diagnostic criteria exist for the late effects of polio. However, the diagnostic criteria for post-polio syndrome are as below:9,10

• H  owever, there is also a younger group of survivors, who contracted polio in countries where the poliovirus remained endemic for longer.6 For example, in 2007 wild poliovirus was isolated from a man in Australia who had recently arrived from Pakistan.1 • The late effects of polio will therefore need to be addressed for many years to come in Australia.6

Practice tip: How to identify patients in your practice who have had polio • Spinal Life Australia recommends that GPs update their new patient registration forms to include the tick-box question: ‘Have you ever had polio?’ • Have a poster/ brochures in the waiting area (or on hand) indicating that your practice is aware of the issue of late effects of polio.

What are the challenges in detecting the late effects of polio? • T  he late effects of polio can manifest many decades after the initial polio infection.3 • Symptoms are non-specific, can be attributed to a number of other conditions and can be hard to fit together if the history of polio is unclear. • Many individuals living with the late effects of polio are unaware their symptoms could be related to their initial polio infection.4 • Having polio was associated with trauma and stigma in the past.4,7

Symptoms of late effects of polio include:5 u u u u u u

general fatigue muscle weakness pain and twitching respiratory and sleep problems dysphagia and dysphonia cold intolerance

Prior paralytic poliomyelitis with evidence of motor neuron loss, as confirmed by history of the acute paralytic illness, signs of residual weakness and muscle atrophy or examination, or signs of denervation of EMG.

A period of partial or complete function recovery after acute paralytic poliomyelitis, followed by an interval (usually ≥ 15 years) of stable neuromuscular function.

Gradual onset (rarely abrupt) progressive and persistent new muscle weakness or abnormal muscle fatigability (decreased endurance), with or without generalised fatigue, muscle atrophy, or muscle and joint pain. Onset may at times follow trauma, surgery, or a period of inactivity. Less commonly, bulbar dysfunction or respiratory weakness occurs.

Symptoms that persist for ≥ 1 year.

Exclusion of alternative neuromuscular, medical or orthopaedic problems as causes of symptoms.

EMG: electromyography.

33


GPCE Digest 2020

Initial assessment Questions to ask if a patient has symptoms suggestive of the late effects of polio:10,11

1 Has the patient had polio? If YES, take a detailed history of their polio.

Refer to a rehabilitation specialist, neurologist, other specialist, and/or allied health services as necessary.5

2 If the new symptoms are attributable to polio, are they biomechanical or due to new neurological deterioration?

3 Are their symptoms due to a different disease?

If YES diagnose unrelated problems and refer for ongoing care as needed.4

A neurologist can help exclude other diagnoses and offer comprehensive treatment plans for neurological effects of polio.8 Specialised services that can also help with diagnosis and management can be found at www.poliohealth.org.au/australian-post-polio-clinics

Learn more about how to identify and support individuals experiencing the late effects of polio

Participate in ThinkGP’s 1-hour education module ‘What’s polio got to do with general practice in Australia in 2020?’

References: 1. National Centre for Immunisation Research and Surveillance. (NCIRS) Poliomyelitis vaccines for Australians | NCIRS Fact sheet: February 2016. http://www.ncirs.org.au/sites/default/files/2018-12/polio-fact-sheet_February-2016.pdf. Accessed January 2020. 2. Polio Australia. Position Paper, Numbers of polio survivors living in Australia, April 2014. https://www.australianpolioregister.org.au/?ddownload=414. Accessed January 2020. 3. Khan F. Rehabilitation for postpolio sequelae. Australian family Physician. 2004; 33(8):621-24. 4. Cooper MM. What is happening to patients who have had polio? The role of the patient in assessment and management. Australian family Physician. 2016;45(7):529-30. 5. Queensland Health. The Late Effects of Polio. Information for General Practitioners, March 2001. Available at:https://www.polionsw.org.au/wp-content/uploads/2013/07/The-Late-Effects-of-PolioInformation-for-General-Practitioners.pdf. Accessed January 2020. 6. House of Representative Committee. Late effects of polio discussion paper released , 2012. Available at: https://www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_Committees?url=haa/leop%20pps/media. htm Accessed January 2020. 7. Backman ME. The post-polio patient: psychological issues. Journal of rehabilitation. 1987;53(4): 23. 8. Polio Australia. The Late Effects of Polio: Introduction to Clinical Practice, 2012. Available at: https://www.polioaustralia.org.au/wp-content/uploads/2010/09/The-Late-Effectsof-Polio-Introduction-Module-Online-Version.pdf Accessed January 2020. 9. March of Dimes Birth Defects Foundation. Post-polio syndrome: identifying best practices in diagnosis and care. Available at: http://www.marchofdimes.com/mission/polio.aspx. Accessed January 2020. 10. Farbu E. Update on current and emerging treatment options for post-polio syndrome. Ther Clin Risk Manag 2010;6:307–13. 11. Halstead LS. Assessment and differential diagnosis for post-polio syndrome. Orthopedics. 1991;14(11):1209–1217.

34


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NSW Fitness to Drive medical assessments online It’s now quicker and easier to complete your patient’s Fitness to Drive medical assessment form online. We’ve improved the online Fitness to Drive form, which you can access through your practice management system or a secure web portal. Benefits of completing the form online: •

Patients don’t need to visit a Service NSW Centre to hand in a paper form.

Detailed, accurate information is instantly sent to Transport for NSW.

The assessment can be completed during a telehealth consult.

A real-time response is generated, which you can print or email to your patient, confirming the submission was received.

• • •

Forms are automatically populated with relevant information.

For information about Fitness to Drive

A copy of the assessment is securely stored for

medicals visit nswroads.work/fittodrive or

future reference.

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Online links to national medical standards are

form call HealthLink on 1800 125 036.

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Why are womenâ&#x20AC;&#x2122;s cardiovascular outcomes falling behind? Dr Anita Sharma MBBS FRACGP / Director Platinum Medical Centre

Dr Sharma is an accredited supervisor for first and second year registrars (GPTQ) and medical students from University of Queensland and Griffith University. She is a member of the National Faculty of Specific Interests RACGP, co-author of the RACGP General Practice Management of type 2 diabetes handbook and member of the RACGP Education Committee.

38


Why are women’s cardiovascular outcomes falling behind?

It may be easy to think that the days of medicine being a ‘man’s world’ are long behind us. Since 2017 female GPs have outnumbered male GPs in Australia,1 and women make up 43.8% of all registered medical practitioners in Australia.2 Unfortunately, recognition of sex-specific factors in the guidelines, medications and procedures we rely on has not caught up with the times, and to this day women are not achieving the same goals of care that we as GPs should be striving for. The understanding that women are treated – whether actively or through unconscious bias – as second-class citizens in medical care is hardly new. In 1991 Dr Bernadine Healy, cardiologist and first female director of the US National Institutes of Health, wrote that women with coronary heart disease tend not to receive the same treatment as men, until a woman experienced a myocardial infarction “just like a man”.3 Dr Healy named this phenomenon the ‘Yentl syndrome’ after the protagonist of a 19th-century short story who had to disguise herself as a man to attend a male-only school,3 and two decades on this syndrome is still a deadly issue.

What are the ongoing issues? In the decades since the ‘Yentl syndrome’ was coined, we have seen the recurring theme that women present with more complex cardiovascular presentations, are less like to receive adequate treatment, and have higher mortality rates.3,4,5 A recent Australian study has shown that women with ST-elevation myocardial infarction are more likely to be older and have more comorbidities, yet they are less likely to receive invasive management, revascularisation, or preventive medication at discharge.5 Additionally, many Australians hold the mistaken assumption that heart disease mostly affects middle-aged men, when the reality is that Australian women are more likely to die from heart disease than breast cancer.6 The Women and Heart Disease Forum held by the National Heart Foundation of Australia in 2019 highlighted five key contributors to disparities in care leading to poor outcomes among women with heart disease.

Key contributors to poor outcomes in women’s cardiovascular care7 1. Poor understanding of cardiovascular presentations frequently observed in women, including myocardial infarction with nonobstructive coronary arteries (MINOCA,) atherosclerosis, spontaneous coronary artery dissection (SCAD), and heart failure with preserved ejection fraction (HFpEF). 2. A lack of personal awareness of heart disease and the competing priorities that prevent women receiving adequate care. 3. Doctors’ lack of awareness or bias regarding sex-specific factors in clinical presentation and management. 4. Inadequate acknowledgement and response to sex-specific CVD risk factors. 5. Clinical studies that do not analyse results by sex, and an inadequate representation of women in cardiovascular research.

As these points demonstrate, poor outcomes cannot be attributed to any one cause, but it is a systematic issue incorporating clinical, structural and social factors. For example, traditional cardiovascular risk calculators do not take into account the ever-growing evidence behind sex-specific risk factors, limiting their practicality in the female population. The presence of ‘non-traditional’ cardiovascular risk factors in women – ranging from chromosomal and hormonal mechanisms to hypertensive disorders of pregnancy, menopause and use of hormonal therapies for contraception and menopausal symptoms – remain under-recognised despite the current trend towards individualised medicine.4 These issues extend to the use of medications, where female under-representation in clinical trials has resulted in a lack of evidence-base to many of the cardiovascular treatments used in both women and men. This historical bias against women in clinical trials allegedly arose from an intent to protect women from potential consequences in case they became pregnant during the study, but poignantly this lack of representation has resulted in medications being pulled from the market due to adverse effects in women and their children.8

39


GPCE Digest 2020

What can GPs do? A key aspect of improving women’s health outcomes is to engage in education and raise awareness that cardiovascular disease affects more than half a million Australian women and contributes to the death of 3 in 10 women.9

Recent research has also revealed a higher mortality rate among female heart attack patients who were treated by male doctors, while patients of female doctors showed similar outcomes regardless of their sex.11 Furthermore, the study found that male doctors with more exposure to female patients and doctors had more success treating female patients.11

Given that coronary artery disease occurs in women approximately 10 years later than men due to the protective benefits of oestrogen prior to menopause, we have more time to encourage women to adopt cardio-protective preventative measures in their lifestyles. With women’s competing priorities being identified as a potential barrier to CVD management,7 we should proactively work towards identifying risk factors and potential symptoms, and engage in regular follow-up.

While it is easy to draw the blanket conclusion that female patients should be treated by female doctors for better outcomes, such a simplistic argument fails to address the systematic inequities working against women in the health system. Rather, we need to address issues with training and awareness so that heart disease is not simply cast as a male condition, and ensure that all health professionals are adequately equipped to meet the needs of all patients.

Additionally, identifying sex differences in the presentation of cardiovascular symptoms plays a key role in successful treatment.10 While chest pain is less predictive of coronary artery disease in women compared to men, we should keep in mind that women often experience ‘associated’ symptoms before or during acute coronary events including unusual fatigue, sleep disturbance, shortness of breath, nausea or vomiting.4,10

In conclusion, as our patients’ first port of call for health concerns, we GPs should overcome these biases and implement sex-appropriate prevention and management strategies to reduce the burden of cardiovascular disease in women. Working alongside cardiologists, we should offer collaborative care incorporating sex-specific risk factors and management so we can improve women’s cardiovascular outcomes in the years to come.

Find out more about how GPs can overcome the cardiovascular gender gap in the article ‘Stopping the Yentl syndrome’ by cardiologist Dr Fiona Foo.

References: 1. Aubusson K. Female GPs outnumber male GPs for the first time in Australia. The Sydney Morning Herald. https://www. smh.com.au/healthcare/female-gps-outnumber-male-gps-for-the-first-time-in-australia-20170721-gxg1my.html Accessed October 2020. 2. Medical Board of Australia. Statistics: Registration data table – June 2020. https://www.medicalboard.gov.au/News/Statistics.aspx Accessed October 2020. 3. Healy B. The Yentl syndrome. N Engl J Med. 1991 Jul 25;325(4):274-6. 4. Harvey RE, Coffman KE, Miller VM. Women-specific factors to consider in risk, diagnosis and treatment of cardiovascular disease. Women’s Health. 2015 Mar;11(2):239-57. 5. Khan E, Brieger D, Amerena J, Atherton JJ, Chew DP, Farshid A, Ilton M, Juergens CP, Kangaharan N, Rajaratnam R, Sweeny A. Differences in management and outcomes for men and women with ST‐elevation myocardial infarction. Medical Journal of Australia. 2018 Aug;209(3):118-23. 6. Healthdirect. Differences between heart disease in women and men. https://www.healthdirect.gov.au/differences-between-heart-disease-women-andmen Accessed October 2020. 7. National Heart Foundation of Australia. The women and heart disease forum 2019 report. https://www. heartfoundation.org.au/getmedia/d13606b2-70c9-496b-87c2-9ea3ebf89c5b/WHD_Forum-Report_2019.pdf Accessed October 2020. 8. Carey JL, Nader N, Chai PR, Carreiro S, Griswold MK, Boyle KL. Drugs and medical devices: adverse events and the impact on women’s health. Clinical therapeutics. 2017 Jan 1;39(1):10-22. 9. Australian Institute of Health and Welfare. Cardiovascular disease in Australian women – a snapshot of national statistics. https://www.aihw.gov.au/getmedia/a09eedb7-2a0d-43c1-a511-e424fca70635/aihw-cdk-10.pdf.aspx?inline=true Accessed October 2020. 10. van Oosterhout RE, de Boer AR, Maas AH, Rutten FH, Bots ML, Peters SA. Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta‐analysis. Journal of the American Heart Association. 2020 May 5;9(9):e014733. 11. Greenwood BN, Carnahan S, Huang L. Patient–physician gender concordance and increased mortality among female heart attack patients. Proceedings of the National Academy of Sciences. 2018 Aug 21;115(34):8569-74. 40


GPCE Digest 2020

Test your

knowledge Vertigo Beth, aged 68, presents to you having experienced two episodes of dizziness and nausea recently. She is clearly anxious, and worries that she may have a brain tumour or stroke. She finds it difficult to describe her sensation of dizziness.

Which of these descriptions of dizziness is most indicative of vertigo? Spinning sensation Feeling of imbalance Sensation of giddiness Sensation of feeling faint All of the above Find out the answer and continue on the ThinkGP vertigo case study quiz

42


Urinary tract infection Malia is a 25-year-old woman who presents Quizzes Content to you complaining of frequent andPiece painful urination as well as general malaise. She mentions that this is the second time in the past six months that these symptoms have occurred. Malia reports no vaginal discharge and is otherwise healthy. When asked, she says she is not pregnant and has recently started a new relationship with a man.

What is the most likely diagnosis? Recurrent, uncomplicated urinary tract infection Complicated urinary tract infection Urinary incontinence Vaginal yeast infection Find out the answer and continue on the ThinkGP UTI case study quiz

Work through a series of questions and select the best-practice management options in ThinkGPâ&#x20AC;&#x2122;s online case study quizzes. 43


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Tips for managing asthma with comorbid allergic rhinitis Michele Goldman Asthma Australia CEO Although we won’t have the opportunity to meet you at GPCE this year, Asthma Australia has partnered with Reed Medical to deliver you with online CPD learning to help make a difference to you and your patients with asthma. The Think GP online Asthma in Australia: Practical Solutions for challenges in primary care is an accredited learning module. It contains six modules which explore the impact asthma has on patients and common challenges GPs face in providing best practice care. There is nothing else quite like this available, it puts the patient at the centre of the conversation. The modules have CPD value for practice nurses and pharmacists alike. I encourage you and your team to dedicate time to complete the modules. “I’ve learned that the more educated patients are about their condition, the less attacks and more progress they will have” – GP testimonial. If you’re short of time and you identify that a patient needs extra help to stay on track, you can refer them to our Asthma Educators via the COACH ® program. This is a free, funded and proven asthma service which provides people with the time they need understand how to live well with asthma.

46


Tips for managing asthma with comorbid allergic rhinitis

Allergic rhinitis (hay fever) is a common comorbidity in individuals with asthma.1 An estimated threequarters of people with asthma also have allergic rhinitis.2 The presence of allergic rhinitis is associated with worse control of asthma,2 and, in a particular individual, the severity of allergic rhinitis often mirrors that of asthma.3

Diagnosing allergic rhinitis • Diagnosis of allergic rhinitis is symptom-related – the use of the Sinonasal Questionnaire (SNQ) or Score for Allergic Rhinitis (SFAR) questionnaires may be helpful.3 • Allergic rhinitis can be classified as intermittent or persistent according to its pattern of symptoms.4 • Allergic rhinitis and asthma may share the same trigger factors.5 • The symptoms of allergic rhinitis compared with those of asthma as well as COVID-19 are shown in the below table.

Asthma, hay fever or COVID-19? Know the symptoms

Asthma

Hay Fever

Fever X

COVID-19

X Common

Aches & pains

X

X

Common

Cough

Common

Occasional, dry

Common

Shortness of breath

Common

Rare

Common

Runny/blocked nose

X

Common

Common

Sneezing

X

Common

Uncommon

Fatigue

X

Occasional

Occasional

Headache

X

Occasional

Occasional

Sore throat

X

X

Common

Loss of taste or smell

X

X

Common

Itchy/watery eyes

X

Common

X

Itchy nose

X

Common

X Source: Asthma Australia

47


GPCE Digest 2020

Classification of allergic rhinitis by symptom frequency/severity4 Intermittent

< 4 days/week or < 4 weeks

Persistent

≥ 4 days/week or < 4 weeks

Mild

Moderate-Severe

Normal Sleep No impairment of daily activities, sport or leisure Normal work and school performance Normal troublesome symptoms

Has one or more of: Abornmal sleep Impairment of daily activities, sport or leisure Abnormal work and school performance Troublesome systoms

Management of comorbid allergic rhinitis • Management of allergic rhinitis can be initiated in primary care, with specialist referral at the discretion of the primary care physician or if treatment responses are unsatisfactory.3 • Treatment may include intranasal corticosteroids (INCS), antihistamines and allergen-specific immunotherapy.3 • Provide the patient an allergic rhinitis treatment plan.

Adapted from ASICA, 2017.4

Adapted from ASICA, 2017.4

Management of allergic rhinitis in adults/adolescents (left) and children <12 years (right)

See enlarged image

Source: National Asthma Council Australia. Australian Asthma Handbook. 5

• N  ote that patients and parents should be advised to use intranasal corticosteroids if appropriate, even if they are using regular inhaled corticosteroids for asthma. 5

48

See enlarged image


Tips for managing asthma with comorbid allergic rhinitis

Thunderstorm asthma Warn individuals with allergic rhinitis and allergy to ryegrass pollen (i.e. most people with springtime allergic rhinitis symptoms) that they may be at risk of thunderstorm asthma if they live in, or are travelling to a region with seasonal high grass pollen levels – even if they have not previously had asthma symptoms.5

Advise those at risk to:5 • Check grass pollen counts for their region every day during spring and early summer. • On high grass pollen days, avoid exposure to outdoor air when a thunderstorm is approaching, especially during wind gusts just before the rain front hits (e.g. by going indoors with windows closed and air conditioner off or on recirculation mode, or shutting car windows and recirculating air). In those who are not already using an inhaled corticosteroid preventer, consider its prophylactic seasonal use.5 Remind patients to keep their reliever inhaler with them and check their inhaler technique regularly.5

Resources: • ASCIA’s Pollen Calendar • A  usPollen and AirRater websites/apps • More information on thunderstorm asthma from the Australian Asthma Handbook, the Better Health Channel and Asthma Australia • Asthma Australia provide a wide range of resources, including the Spring Asthma Pack

References: 1. Australian Institute of Health and Welfare. Asthma, associated comorbidities, and risk factors. Cat no ACM 41. https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma-associatedcomorbidities-risk-factors/contents/about-asthma-and-associated-comorbidities. Accessed October 2020. 2. National Asthma Council Australia. Managing allergic rhinitis in people with asthma. Melbourne: National Asthma Council Australia, 2017. 3. Bardin PG, Rangaswamy J, et al. Managing comorbid conditions in severe asthma. The Medical journal of Australia. 2018 Jul 16;209(S2):S11–17. 4. ASCIA (Australian Association of Clinical Immunology and Allergy). Allergic rhinitis Clinical update. December 2017. https://www.allergy.org.au/ images/stories/pospapers/ar/ASCIA_HP_Clinical_Update_Allergic_Rhinitis_2020.pdf. Accessed October 2020. 5. National Asthma Council Australia. Australian Asthma Handbook. www.asthmahandbook.org.au. Accessed October 2020.

49


HOW TO REFER TO ASTHMA AUSTRALIA

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This FREE coaching and support service* is available for patients with asthma and/or their carers.

REFERRAL TEMPLATES Web: asthmaaustralia.org.au/referrals Fax: 07 3257 1080 Secure Message: search “asthma” Medical-Objects: FA40060001U HealthLink: (asthmaus)

For more information, contact Asthma Australia on 1800 ASTHMA (1800 278 462) or visit asthma.org.au/health-professionals

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Atopic dermatitis: A practical guide Dr Nerilee Wall BBSMN/BSC, MBBS, FACD

Dr Wall studied Medicine at the University of Queensland. She completed her specialist training in Queensland at the Royal Brisbane and Womenâ&#x20AC;&#x2122;s Hospital, the Princess Alexandra Hospital, the Queensland Childrenâ&#x20AC;&#x2122;s Hospital and the Mater Hospital Brisbane. She is a Fellow of the Australasian College of Dermatologists. She has a keen interest in research and has published literature in international peer-reviewed medical journals.

52


Atopic dermatitis: A practical guide

Atopic dermatitis (AD) is the most common inflammatory skin disease, with a devastating impact on quality of life.1 It affects up to 30% of children and 10% of adults.2,3 AD is often the first manifestation of the ‘atopic march’, with the later development of sensitisation to foods and environmental allergens, asthma and allergic rhinitis.4

Clinical features of AD Diagnostic features are: pruritus + typical eczematous lesions + chronic or relapsing course. Supporting features include: onset during infancy or early childhood, personal or family history of atopy, and xerosis.

Did you know: • Six out of 10 children with AD experience disrupted sleep, which has been linked to impaired neurocognitive function.5 • Having AD increases the odds of depression, anxiety and learning delay. This may be due to the reduction in sleep, resulting fatigue at school, impact on relationships with peers and teachers, and social isolation.6 • AD imposes a financial burden on families due to treatment costs and missed days of work/school for medical visits.7

AD by age Infant

Child 2–12 years

• C  heeks, scalp, neck, extensor aspects of the limbs and trunk • Range from papules and papulovesicles to large oozing and crusted plaques

• Lesions are often lichenfied and classically involve the antecubital and popliteal fossae • Eyelids, neck, wrists, hands, ankles and feet may also be involved

• F lexural involvement • Involvement of hands, eyelids and face may become more significant

• Marked xerosis (rather than the flexural propensity seen in adolescents/ adults)

Adolescent/adult Images: DermNet NZ

Older adult >60 years

53


GPCE Digest 2020

Treatment is proactive and multifaceted Treatment comprises education of the individual/ parent, gentle skin care with regular use of moisturisers, avoidance of irritant triggers and food allergens, and use of anti-inflammatory medications.

Skin care and moisturisers

Tips for baths • Bathe once daily for 5–10 minutes in warm water using a soap-free wash. • After patting dry, apply topical steroid followed by moisturizer. • When infection is suspected, bleach (sodium hypochlorite) can be added to the bath at a dilution of 1 ml/L or ¼ cup per half bath. This can also be useful as a maintenance strategy in children with a history of frequent infections.

• M  oisturisers are mainstay treatment and may reduce the need for anti-inflammatory agents.8 • They should be applied liberally and frequently8 – suggest linking application to habitual activities such as brushing teeth, or at time of nappy changes in infants. • Wet wraps can help to increase skin hydration, enhance absorption of topical steroids, and act as a barrier to scratching.8

Anti-inflammatory medications • T  opical corticosteroids (TCS) are first-line; topical calcineurin inhibitors such as tacrolimus and pimecrolimus can supplement TCS.8 • The use of appropriate potency is key, with the aim to promptly settle the flare, and then continue use until completely clear to minimise recurrence. • Generally, mild to moderate eczema on the face or body can be treated with class I or II TCS. Moderate to severe eczema requires class II or more often class III. Thickened or lichenified lesions may require class III or IV. • Unwell patients with generalised flares or marked secondary infection may need to be managed in hospital. • Individuals with severe or non-responding eczema can be referred to a dermatologist for potential treatments such as narrowband UVB, cyclosporin, methotrexate and azathioprine. • In exciting news, dermatologists and immunologists may have access to dupilumab, a recombinant human IgG4 monoclonal antibody, on the Pharmaceutical Benefits Scheme for treatment of AD in people aged over 12 years, by the end of 2020.

54

Steroid phobia can impact care • Fears around the use of topical steroids can affect the care of many families, and even occur among healthcare professionals.9-11 • Patients should be reassured about the safety of topical steroids when used appropriately.


Atopic dermatitis: A practical guide

Class of topical corticosteroids and their usual concentrations Class I: Mild Hydrocortisone 0.5–1.0% Hydrocortisone acetate 0.5–1.0%

Class II: Moderate Clobetasone butyrate 0.05% Hydrocortisone butyrate 0.1% Betamethasone valerate 0.02% Betamethasone valerate 0.05% Triamcinolone acetonide 0.02% Methylprednisolone aceponate 0.1% Triamcinolone acetonide 0.05%

Class III: Potent Betamethasone dipropionate 0.05% Betamethasone valerate 0.05–0.1% Mometasone furoate 0.1%

Class IV: Very potent Betamethasone dipropionate in optimized vehicle 0.05% Clobetasol propionate 0.05%

Source: Adapted from Mooney E et al, 2015.12

References: 1. Weidinger W, Beck LA, Bieber T et al. Atopic dermatitis. Nat Rev Dis Primers 2018;4:1. 2. Mooney et al. Medicine Today 2015;16:40-50. 3. Asher MI, Montefort S, Björkstén B, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006;368:733-743. 4. Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence, 5th ed. Elsevier 2015. 5. Camfferman D, Kennedy JD, Gold M, et al. Sleep and neurocognitive functioning in children with eczema. Int J Psychophysiol 2013;89(2):265-272. 6. Garg N, Silverberg JI. Association between childhood allergic disease, psychological comorbidity, and injury requiring medical attention. Ann Allergy Asthma Immunol 2014;112(6):525532. 7. Su JC, Kemp AS, Varigos GA, et al. Atopic eczema: its impact on the family and financial cost. Arch Dis Child 1997;76 (2):159-162. 8. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol 2014;71:116-132. 9. Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000;142(5):931-936. 10. Smith S, Lee A, Blaszczynski et al. Pharmacists’ knowledge about use of topical corticosteroids in atopic dermatitis: Pre and post continuing professional development education Australas J Dermatol 2016;57(3):199-204. 11. Aubert-Wastiaux H, Moret L, Rhun AL et al. Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol 2011;165(4):808-814. 12. Mooney E, Rademaker M, Dailey R, et al. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement. Australas J Dermatol 2015;56(4):241-251.

55


Troubleshooting common feeding problems in infants What do you do when your youngest patients present with symptoms of unsettledness, crying, reflux, diarrhoea or constipation?

58


Troubleshooting common feeding problems in infants

Colic Infant colic is a behavioural phenomenon of long periods of inconsolable crying with no apparent cause, and hard-to-calm behaviour, that occurs in babies aged 1 to 4 months. 1 Although colic itself is benign, it is a major burden to families – colic is a risk factor for maternal depression and child abuse and is a common cause of early breastfeeding cessation.2

Diagnostic criteria for colic are:1* 1. Infant is 5 months of age when the symptoms start and stop. 2. Recurrent and prolonged periods of infant crying, fussing, or irritability reported by caregivers that occur without obvious cause and cannot be prevented or resolved by caregivers. 3. No evidence of infant failure to thrive, fever, or illness. Exclude organic causes of crying by careful history and examination. Where red flags are present, screen for anatomical, metabolic, infectious, allergic, neurological or behavioural conditions.3

Management

Red flags: 3 u u u u

u u u u u u u u

Extreme or high-pitched cry Lack of diurnal rhythm Symptoms persist beyond 5 months in age Frequent regurgitation, vomiting, diarrhoea, weight loss Failure to thrive Family history migraine Family history atopy Abnormal physical exam Maternal drug ingestion Fever or illness Severe anxiety in parents Parental depression

• Offer reassurance and support – explain the natural history of colic, offer strategies to deal with infant feeding and sleep, explore settling techniques.1,2 • For exclusively breastfed infants there is evidence a 3-week trial of the probiotic Lactobacillus reuteri DSM17938 may help reduce crying time – but efficacy in formula-fed infants in unknown).2,4,5 • A minority of cases may be caused by cow’s milk allergy. In these infants a trial of dietary exclusion in breastfeeding mothers, or hypoallergenic formula in formula-fed babies, may be beneficial.2 • NOT RECOMMENDED: Drug therapies (e.g. anticholinergic drugs, simethicone).2

* Note that Wessel’s ‘rule of threes’ (i.e. crying for >3 hours/ day, on at least 3 days/week of the last week) was excluded from the Rome IV criteria for diagnosing colic in clinical practice. The criterion of >3 hours/day of crying was found to be unsupported by evidence and culturally dependent. Filling out behaviour diaries for 7 days is unduly onerous for parents. Furthermore, Wessel’s rule focuses on crying amount rather than the inconsolable character of the crying episodes.1

59


GPCE Digest 2020

Regurgitation/reflux Regurgitation/ gastroesophageal reflux is common and resolves spontaneously in most infants.6 A small number develop complications such as GORD, poor weight gain and growth, respiratory disease or oesophagitis.6

Diagnostic criteria for regurgitation are:1 • 2 or more regurgitations/day for ≥ 3 weeks. • No retching, vomiting blood, aspiration, apnoea, failure to thrive, feeding or swallowing difficulties, abnormal posturing.

Management • Provide reassurance – regurgitation/reflux are generally benign in nature and tend to resolve by age 12 months.1,6 • Other conservative treatments that may help include thickened feeds, anti-regurgitation formulas for formula-fed infants, and positioning after feeding.1 • NOT RECOMMENDED: Proton pump inhibitors, unless there is evidence of acid-induced disease.6,7  

Functional constipation

The Bristol Stool Chart is useful for classifying types of stool. Type 1 and 2 indicate presence of constipation,12 while types 5 to 7 may indicate diarrhoea and urgency.12

Constipation refers to the hard, dry consistency of stools – not their frequency.6 Diagnosis of functional constipation in infants and children up to 4 years of age requires ≥ 2 of the following criteria for at least 1 month:1 • 2 or fewer defecations per week • history of excessive stool retention • history of painful or hard bowel movements • history of large-diameter stools • presence of a large fecal mass in the rectum Functional constipation is more common in toddlers than infants, and is rare in exclusively breastfed infants.1,6 Healthy infants often show signs of discomfort before passing soft stools (dyschezia). This is normal, and will self-resolve.6,8 Formula-fed infants tend to pass firmer and fewer stools than breastfed infants; however hard, dry stools may indicate incorrect preparation of formula.6 Constipation often occurs after the introduction of solid foods.6

Red flags: 8 u u

u

u u u

Management • Exclude organic causes (e.g. cow’s milk allergy, coeliac disease, spinal cord or sphincter anomalies).9 • In formula fed babies, check formula is being prepared correctly.6 • Osmotic and lubricant laxatives are often required – reassure parents that this is safe and does not cause a ‘lazy bowel’.8 • Aim for one soft, easy to pass bowel action per day.8

More information is available from The Royal Children’s Hospital Melbourne 60

infants presenting < 6 weeks of age delayed passage of meconium (consider Hirschsprung disease or anorectal malformation) ribbon-like stools (could indicate anorectal malformation). weight loss/poor growth persistent vomiting abdominal mass not consistent with large faecal mass


Troubleshooting common feeding problems in infants

Lactose intolerance and diarrhoea Primary lactose intolerance is an extremely rare genetic condition in infancy.10,11 Secondary lactose intolerance occurs due to damage to the villi of the small intestine; common causes include viral gastroenteritis, food intolerance or allergy, parasitic infection, coeliac disease, or after bowel surgery).10,11 Cow’s milk protein allergy (CMA) is not the same as lactose intolerance, however CMA can be an underlying cause of secondary lactose intolerance.10

Diarrhoea is the main symptom in infants.11 Diagnosis is based on observation of gastrointestinal symptoms after ingesting lactose-containing foods.11 Note that frequent runny stools do not mean that a breastfed baby has diarrhoea or lactose intolerance.6 Secondary lactose intolerance is a temporary condition; however, depending on the underlying disorder, it can take 4 to 8 weeks for the gut to recover.11

Management of secondary lactose intolerance • Breastfed infants should continue breastfeeding as usual.11 • In formula-fed babies, lactose-free formulas are available and are intended for short-term use. Once symptoms resolve, the infant can be transitioned back to their regular formula.11 • If coeliac disease or other intestinal pathology is present, lactose restriction might be required until the underlying condition has resolved or been treated.11

More information is available from the Australian Breastfeeding Association

References: 1. Zeevenhooven J, Koppen IJ, Benninga MA. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatr Gastroenterol Hepatol Nutr. 2017;20(1):1-13. doi:10.5223/pghn.2017.20.1.1 2. Sung V. Infantile colic. Aust Prescr 2018;41:105–10 3. Zeevenhooven J, Browne PD, L’Hoir MP, de Weerth C, Benninga MA. Infant colic: mechanisms and management. Nat Rev Gastroenterol Hepatol. 2018;15(8):479-496. doi:10.1038/s41575-018-0008-7 4. World Gastroenterology organisation Global Guidelines. Probiotics and prebiotics. February 2017. https://www.worldgastroenterology.org/guidelines/global-guidelines/probiotics-and-prebiotics/ probiotics-and-prebiotics-english 5. Sung V, D’Amico F, Cabana M, Chau K, Koren G, Savino F, et al. Lactobacillus reuteri to treat infant colic: a metaanalysis. Pediatrics 2018;141:e20171811. 6. National Health and Medical Research Council (2012) Infant Feeding Guidelines. Canberra: National Health and Medical Research Council. 7. Safe M, Chan WH, Leach ST, Sutton L, Lui K, Krishnan U. Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?. World J Gastrointest Pharmacol Ther. 2016;7(4):531-539. doi:10.4292/wjgpt.v7.i4.531 8. Royal Children’s Hospital Melbourne. Constipation. Available at: https://www.rch.org.au/clinicalguide/guideline_index/Constipation_Guideline/ Accessed September 2020. 9. Singh H, Connor F. Paediatric constipation. An approach and evidence-based treatment regimen. AJGP 2018; 47(5): 273-77. 10. Anderson J. Lactose intolerance and the breastfed baby. Available at: Australian Breastfeeding Association. https://www. breastfeeding.asn.au/bf-info/lactose 11. Heine RG et al. Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited. World Allergy Organization Journal 2017;10:41. 12. Continence Foundation of Australia. Soiling. Available at: https://www.continence.org.au/who-it-affects/children/soiling Accessed September 2020.

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IMPORTANT NOTICE: Breast milk is best for babies and provides ideal nutrition. Good maternal nutrition is important for the preparation and maintenance of breastfeeding. Introducing partial bottle feeding could negatively affect breastfeeding and reversing a decision not to breastfeed is difficult. Professional advice should be followed on infant feeding. Infant formula should be prepared and used exactly as directed or it could pose a health hazard. The preparation requirements and weekly cost of providing infant formula until 12 months of age should be considered before making a decision to formula feed. INFORMATION FOR HEALTHCARE PROFESSIONALS ONLY

BREASTFEEDING IS BEST FOR BABIES


Company list and synopses Weâ&#x20AC;&#x2122;re bringing our 2020 exhibitors to you.


Company list

13SICK, National Home Doctor Abbott

Cornerstone Health

Lumos Diagnostics

Cynergex Group

Macquarie Medical Systems

Actelion

Dementia Training Australia

Adviceline Injury Lawyers

DermaSensor

Alcoholics Anonymous

Doctors’ Health Fund

AMA Products

Doctors on Demand

Amplifon

EBOS Healthcare

Asthma Australia

Experien Insurance Services

Australasian Medical & Scientific Limited

Marie Stopes Australia Medic Oncall by Healthcare Australia Medical and Surgical Requisites

Premier Financial Advocates QCLASS Queensland Specialist Dermatology Rural Workforce Agency Victoria RxTro

Medifit Design & Construct

Seer Medical

MediSuccess

Serco

Frost & Sullivan

MedRecruit

SmartClinics Family Medical Centres

Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM)

Fullerton Health Medical Centres

Menarini

Sock it to Sarcoma!

Monash IVF Group

Spectrum Therapeutics

MyHealth1st

SSS Australia

Australian Digital Health Agency

GlaxoSmithKline

National Asthma Council Australia

Stallergenes Greer

National Investment Advisory

Team Medical Supplies

Avidity Rewards Bayer Australia Black Dog Institute bloom hearing specialists BOQ Specialist Cancer Australia CannaPacific CANNect Group Cassins Healthcare Design & Construct Club Active Complete ENT Contact Lens Centre Australia

GBMA Education

Haemochromatosis Australia Health Workforce Queensland HealthLink HealthShare

Neptune Bio-Innovations Nestlé Australia

Supagas

Translating and Interpreting Service (TIS National)

Novo Nordisk Pharmaceuticals

Transport for NSW

NSW Health, Office for Health and Medical Research

True Relationships & Reproductive Health

Justmed Medical Fitouts

NSW Rural Doctors Network

Vantre Health Services

Key Pharmaceuticals

OptiPharm

WaterWipes

Lilly Australia

Osteoporosis Australia

Wavelength Medical Recruitment

LINK Business Brokers

Parkinson’s NSW

Little Green Pharma

Perfect Practice

Heart Foundation HepatitisWA JDL Strategies for Medigrow

Tresillian

Valley Eye Specialists

Wesley Private Hospitals Sydney

65


Company synopses

13SICK, National Home Doctor has over 30 years experience as Australiaâ&#x20AC;&#x2122;s most trusted network of after hours, home visiting doctors. We provide acute, episodic care to patients at home, when their GP is closed. We also relieve pressure on hospital Emergency Departments, delivering better outcomes for the community at large.

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritional and branded generic medicines. Our 103,000 colleagues serve people in more than 160 countries.

13SICK, National Home Doctor

Abbott

13sick.com.au

freestylelibre.com.au

Australasian Medical & Scientific Limited

Australasian Medical & Scientific Limited (AMSL) Regenerative Medicine Division distributes an extensive range of products used in appearance medicine, sports medicine, MSK and plastic surgery. This includes Tropocells Platelet-Rich Plasma (PRP) used for tissue regeneration. For more information on PRP, please contact us at orders@amsl.com.au or 1800 201 760.

amsl.com.au

At Janssen, weâ&#x20AC;&#x2122;re creating a future where disease is a thing of the past. Weâ&#x20AC;&#x2122;re the Pharmaceutical Companies of Johnson & Johnson, working tirelessly to make that future a reality for patients everywhere by fighting sickness with science, improving access with ingenuity, and healing hopelessness with heart.

Adviceline Injury Lawyers is a specialist boutique personal injury law firm with offices across Victoria. For more than 50 years, Adviceline has assisted Victorians claim compensation for injuries at work, on the road, in a public place or through the negligence of another person.

Actelion

Adviceline Injury Lawyers

janssen.com/australia

advicelineinjurylawyers.com.au

Contents 66

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Discover a life free from addiction Our private hospital facilities in Ashfield and Kogarah offer a highly-regarded, evidence-based treatment program that will assist your patients through to recovery.

Call 1300 924 522

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wesleymission.org.au


Company synopses

Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.

AMA Products is a family owned company and a leading supplier of medical devices, products and solutions to Healthcare Practitioner’s and Medical Facilities all over Australia. We supply most of the major brands in Australia and have a portfolio of over 20,000 products to support the demands of our customers.

Alcoholics Anonymous

AMA Products

aa.org.au

amaproducts.com.au

Australian Digital Health Agency

The Agency is improving health outcomes for all Australians through the delivery of digital healthcare systems and implementing Australia’s National Digital Health Strategy in collaboration with partners across the community. The Agency is the System Operator of My Health Record – an electronic summary of an individual’s heath information that can be shared securely online.

digitalhealth.gov.au

Amplifon, formerly known as National Hearing Care, is one of Australia’s leading audiology providers with 300+ clinics. We have helped over 200,000 Australians rediscover their hearing and many of those have been in partnerships with local GP’s. We look forward to working with you to help your patients receive the best professional health care.

Aspen manufactures, markets and distributes pharmaceutical products in most therapeutic categories. The Aspen range includes Prescription brands, Speciality products, and OTC healthcare. For more details on specific Aspen products, please visit the Aspen Australia website or the Aspen Xpress app (download from the App store or Google play).

Amplifon

Aspen Australia

amplifon.com.au

aspenpharma.com.au

Contents 68

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Medicinal cannabis Learn how to prescribe confidently

Access free education, training and resources via our comprehensive Medical Portal including:

CPD course

SAS B template

Video training

Case studies

and more

Did you know… Any GP can apply for medicinal cannabis via an SAS B application SAS B applications only take approximately 10 minutes with our assistance 61,000+ applications have been approved by the TGA for the use of medicinal cannabis in treating 130+ conditions

Medicinal Cannabis – we’re here to help Assistance: littlegreenpharma.com Contact:

medical@lgpharma.com.au

Phone:

1300 118 840

An Australian grower and manufacturer of medicinal cannabis


Company synopses

Asthma Australia is a consumer organisation for people with asthma. 1800ASTHMA assists thousands of people with asthma annually. Our COACH program helps people with asthma achieve better control of their condition. We teach the community, schools and health professionals what to do when someone has an asthma flare-up or attack.

ASHM is a peak organisation of health professionals who work in HIV, viral hepatitis and sexual health. ASHM works collaboratively to produce high quality guidelines, resources and training tailored to specific health professional groups and service settings. We also run s100 prescriber programs enabling GPâ&#x20AC;&#x2122;s to prescribe treatment for HIV and Hepatitis B.

Asthma Australia

Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM)

asthma.org.au

ashm.org.au

Bayer is a life science company with a more than 150 year history and core competencies in the areas of health care and agriculture. The company employs 99,820 people worldwide, and around 900 in Australia/New Zealand. Worldwide operations are managed from Group headquarters in Leverkusen, Germany.

Bayer Australia bayer.com

Avidity Rewards is a FREE program designed to save health practitioners time and money. We put in the hard work to source and negotiate with well-known brands and companies so you donâ&#x20AC;&#x2122;t have to! Sign up and start receiving exclusive offers from our premium partners today.

The Black Dog Institute is a translational research institute that aims to reduce the incidence of mental illness and the stigma around it, to actively reduce suicide rates and empower everyone to live the most mentally healthy lives possible.

Avidity Rewards

Black Dog Institute

avidityrewards.com.au

blackdoginstitute.org.au

Contents 70

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Founded in 1972, True Relationships & Reproductive Health are experts in reproductive and sexual health.

STUDY

Study accredited courses for healthcare professionals • Online • F2F • Blended education options

ACCESS

Access information and resources to support you in your practice • Clinical health information sheets • Community responsive resources for the health care professional

REFER

Refer your complex cases to our specialist clinics • Endometriosis • Cervical screening • Colposcopy • Contraception

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Investigating symptoms of

a guide for all health professionals

lung cancer

Cancer Australia has released a new guide to assist primary care health professionals to investigate symptomatic people with suspected lung cancer and support their early and rapid referral into the multidisciplinary diagnostic pathway. Lung cancer is the leading cause of cancer death in Australia

Look out for the following symptoms and signs of lung cancer and refer to the guide for the appropriate action to take:

Diagnosing lung cancer at an earlier stage leads to better outcomes for patients,1 however diagnosis can be challenging. Symptoms such as cough or shortness of breath are often non-specific, and imaging results are not always definitive.

– – – – – – – –

Haemoptysis Stridor New or changed cough Chest and/or shoulder pain Shortness of breath Hoarseness Weight loss/loss of appetite Persistent or recurrent chest infection – Fatigue

During the COVID-19 pandemic it is also important to consider that patients presenting with respiratory symptoms may in fact be presenting with symptoms of lung cancer.2 In the three months leading to diagnosis, patients will often see a GP four or more times before a diagnosis of lung cancer is made. 3,4

Systematic pathway for investigation in primary care General practitioners play a key role in the identification of lung cancer, as the majority of patients first present to primary care settings.5 Investigating symptoms of lung cancer: a guide for all health professionals provides general practitioners with an evidence-based systematic pathway for the appropriate investigation and referral of people with symptoms or signs of lung cancer. The guide provides optimal timeframes for action at each step in the pathway, and information about different types of imaging for lung cancer.

To access the Guide online and the evidence underpinning the Guide, visit:

– – – –

DVT Abnormal chest signs Finger clubbing Signs of superior vena caval obstruction – Cervical and/ or supraclavicular lymphadenopathy – Pleural effusion – Thrombocytosis

Evidence-based information The guide is underpinned by an evidence-based methodology which is outlined in the accompanying Evidence Report. It includes information on: – – – –

lung cancer in Australia risk factors for lung cancer symptoms and signs of lung cancer the importance of the multidisciplinary team in lung cancer care.

The Evidence Report also includes information on facilitating referral and patient support, and the impact of stigma on people with lung cancer.

Visit canceraustralia.gov.au/islcguide

– canceraustralia.gov.au/islcguide – canceraustralia.gov.au/islcreport

1. Cancer Australia 2019. National Cancer Control Indicators (NCCI). Relative survival by stage at diagnosis (lung cancer). Accessed October 2019; https://ncci.canceraustralia.gov.au/outcomes/relative-survivalrate/relativesurvival-stage-diagnosis-lung-cancer 2. Singh AP, Berman AT, Marmarelis ME, Haas AR, Feigenberg SJ, Braun J, et al. Management of Lung Cancer During the COVID-19 Pandemic. JCO Oncology Practice. 2020: OP.20.00286.

3. Scott N, Crane M, Lafontaine M, et al. Stigma as a barrier to diagnosis of lung cancer: patient and general practitioner perspectives. Prim Health Care Res Dev. 2015;16(6):618-22. 4. Chambers SK, Dunn J, Occhipinti S, et al. A systematic review of the impact of stigma and nihilism on lung cancer outcomes. BMC Cancer. 2012;12(1):184. 5. Emery JD. The challenges of early diagnosis of cancer in general practice. Med J Aust. 2015;203(10):391-3.

© Cancer Australia 2020

Endorsed by


Company synopses

bloom™ hearing specialists has a national network of clinics, offering hearing health assessments, hearing device fittings, repairs and other hearing health services – in clinic or via phone or video conference. Our qualified clinicians support our customers on their journey to better hearing health.

BOQ Specialist has been Australia’s leading financial services partner for doctors, dentists and vets for over 30 years. Our distinctive range of personal and business banking products includes property and asset finance as well as everyday and savings accounts.

bloom hearing specialists

BOQ Specialist

bloomhearing.com.au

boqspecialist.com.au

CANNect Group empowers medical practitioners with a safe, simplified and informed clinical pathway to medicinal cannabis for their patients. CANNect connects patients, doctors and pharmacists, providing a logical process for doctors to safely and methodically meet and comply with regulatory requirements.

CANNect Group cannectgroup.com

Cancer Australia is Australia’s leading cancer control agency that aims to reduce the impact of cancer, address disparities and improve outcomes for people affected by cancer by leading and coordinating national, evidence-based interventions across the continuum of care.

CannaPacific is a fast-growing Australian biotech, developing effective and innovative medical cannabis solutions to improve patients’ quality of life. Our team of experts are committed to develop registered cannabinoid based medicines for symptomspecific treatments, using the purest cannabinoids from our world-class production facility in Australia’s Northern Rivers district.

Cancer Australia

CannaPacific

canceraustralia.gov.au

cannapacific.com.au

Contents 74

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medical supplies

JOIN THE TEAM THAT DELIVERS. LOOKING AFTER YOUR TEAM We are Australiaâ&#x20AC;&#x2122;s fastest growing independently owned healthcare supplies provider. We aim to provide customers with a reliable supply partner who always puts service first. Consistently delivering excellent service partnered with flexibility, reliability, and trust. Our team looking after your team.

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Choose Team Medical for all of your medical equipment, consumables, pharmaceuticals and vaccines. GET IN TOUCH Phone: 1300 22 44 50 | Email: info@teammed.com.au

www.teammed.com.au


Company synopses

Cassins specialises in fitouts and builds for medical practices. Whether it’s a refurbishment or alterations to an existing practice, or a new build, we take healthcare fitouts seriously. With more than 30 years’ experience, we are here to help your practice boost profitability, efficiency and productivity with custom fitout solutions.

CompleteENT are a team of leading otolaryngologists who are proudly delivering outstanding care to adults and children with ear, nose and throat conditions in Queensland. The specialists at CompleteENT provide holistic care for their patients to ensure that their patients receive the most comprehensive treatment to meet their individual needs.

Cassins Healthcare Design & Construct

Complete ENT

cassins.com.au

completeent.com.au

Discover the Club Active Franchise Partnership Program, an opportunity to financially diversify your practice whilst creating positive change within local communities by improving the physical, mental and social well-being of the over 50’s market.

Club Active clubactive.com.au

Contact Lens Centre supplies dry eye products including TheraTears Gel and Drops, Nutrition & Sterilid along with the Evolve preservative multidose range to Optometrists and Pharmacies throughout Australia.

At Cornerstone Health, we’re motivated to make a difference. We offer one system with one purpose. To provide quality healthcare for all Australians. Our contemporary medical centres offer a full spectrum of primary healthcare services under one roof. Contact us for GP opportunities in Sydney, Melbourne, and South East Queensland.

Contact Lens Centre Australia

Cornerstone Health

contactlenscentreaustralia.com.au

cornerstonehealth.com.au

Contents 76

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Company synopses

Cynergex Group has been providing medical emergency training for GPs and their teams for 20 years. Our education provides a simplified approach to team resuscitation and coordination. Cynergex can also supply emergency resuscitation equipment which is available to view and purchase from our web site.

Funded by the Australian Government Dementia Training Australia (DTA) provides dementia education and training to the health and aged care workforce across Australia. DYA is a consortium bringing together leading experts from four universities and Dementia Australia to offer a wide range of dementia education resources for all health disciplines.

Cynergex Group

Dementia Training Australia

cynergexgroup.com.au

dta.com.au

DermaSensor is a health technology company designing tools to better equip primary care providers for skin cancer checks. DermaSensorâ&#x20AC;&#x2122;s mission is to improve outcomes and save on healthcare costs by providing easy access to effective skin cancer evaluation.

DermaSensor dermasensor.com

Since 2015, Doctors on Demand has been forging a path to make healthcare more accessible via a national purpose-built telehealth platform. If you are an AHPRA registered practitioner and want a flexible and secure way to deliver primary care, join the Doctors on Demand clinical team.

Experien Insurance Services is a national insurance brokerage specialising in insurance solutions for doctors. We arrange personal insurance such as life and income protection, business insurance including cyber, business interruption and liability insurance and medical indemnity insurance. Our personalised advice is tailored to your needs by fully qualified insurance advisers.

Doctors on Demand

Experien Insurance Services

doctorsondemand.com.au

experien.com.au

Contents 78

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SPECIAL OFFER

Special Offers

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MESI mTABLET ABI

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For more information contact your Account Manager or call Customer Service on 1800 269 534 or visit www.eboshealthcare.com.au

MULTIPLE


Complimentary

Practice Design Package Perfect Practice creates smart, high-performing healthcare practices.We understand that there are many factors involved in deciding to start, renovate, or relocate your healthcare practice. It can be hard to visualise what your practice could look like and understand how much the fit-out will cost. Our team takes the time to understand your needs and provides a detailed proposal, floorplan, and accurate cost for your project. From concept to completion, we guide you through the whole process – starting with this complimentary practice design package.

Here are some of the inclusions in your practice design package: • Site Inspection • Site Assessment & Scope • Value Engineering Process • Floorplan Design Concepts • Design Review • Project Scope • Virtual Reality Walk-Through

11 Anvil Road, Seven Hills NSW 2147 | PO Box 8099, Baulkham Hills BC NSW 2153 P 1300 00 11 22 | W www.perfectpractice.com.au | E info@perfectpractice.com.au Follow us for inspiration and tips

Healthcare Practice Design and Construction


COVID-19 restrictions may reduce access to Aspen Representatives, however, to support you at this time, Aspen’s resources are available via the Aspen Xpress App.

Download the app to order starter packs (including antibiotics), clinical materials and even contact your Aspen Representative directly from the app for support.

Select an option:

Download http://bit.ly/iosxp

Download http://bit.ly/andxp

For more information visit http://aspen.li/aal

Aspen Australia acknowledges and respects the privacy of individuals. For details on our Privacy Policy please refer to https://www.aspenpharma.com.au/privacy/ Aspen Australia includes Aspen Pharmacare Australia Pty Ltd (ABN 51 096 236 985) and Aspen Pharma Pty Ltd (ABN 88 004 118 594). All sales and marketing requests to: Aspen Pharmacare Pty Ltd, 34-36 Chandos Street, St Leonards, NSW 2065. Tel. +61 2 8436 8300 Email. aspen@aspenpharmacare.com.au Web. www.aspenpharma.com.au | App Store® and iPhone® are trademarks of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google LLC. Date prepared: May 2020 | ASP2298 AF05058


Company synopses

Fullerton Health Medical Centres is one of Australia’s leading primary healthcare providers with 61 clinics located throughout metropolitan and regional centres, comprising 46 medical centres, four dedicated skin clinics and a specialist breast clinic.

GSK is a science-led global healthcare company with a special purpose: to help people do more, feel better and live longer. In Australia, we offer a broad portfolio of innovative and established medicines, vaccines and consumer healthcare products.

Fullerton Health Medical Centres

GlaxoSmithKline

fullertonhealthmedicalcentres.com.au

au.gsk.com

Doctors’ Health Fund is the only private health fund created to exclusively serve the medical community. As part of Avant Mutual, Doctor’s Health Fund has become one of the fastest growing health funds in Australia with over 24,000 members now trusting the fund for their private health insurance.

Doctors’ Health Fund doctorshealthfund.com.au

Health Workforce Queensland is a not-for-profit, nongovernment organisation whose purpose is to create sustainable health workforce solutions that meet the needs of remote, rural, regional, and Aboriginal and Torres Strait Islander communities, challenged by a shortage of health professionals.

HealthShare is a leading digital health company. We are dedicated to improving health outcomes with our innovative products. Our digital platform seamlessly connects health stakeholders, delivering information when, where and how people want to receive it. We leverage technology to empower patients, support delivery of care and increase efficiencies in the health system.

Health Workforce Queensland

HealthShare

healthworkforce.com.au

healthsharedigital.com

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The Heart Foundation in a non for profit organisation with a mission to prevent heart disease and improve the heart health and quality of life of all Australians through our work in prevention, support and research.

HepatitisWA (Inc) is a non-profit community-based organisation providing free services to the community. HepatitisWA aims to assist in obtaining the best possible care and support for people affected by hepatitis, reducing discrimination and stigma directed at people living with viral hepatitis and raising community awareness in relation to hepatitis.

Heart Foundation

HepatitisWA

heartfoundation.org.au

hepatitiswa.com.au

EBOS Healthcare

For over 98 years EBOS Healthcare have been supplying General Practice, Hospitals, Day Surgeries, Aged Care and Specialist Clinics with the best products from around the world. With over 35,000 products, 1,000 suppliers and 10 office locations across Australasia, EBOS Healthcare is well placed to meet the needs of healthcare.

eboshealthcare.com.au

We know medical professionals work hard. With our specialized software, we show you how to establish goals for your professional and personal circumstances so you can prosper financially with new knowledge and skills. Our experts in Business, Finance and Investment Management will teach you strategies to achieve your future prosperity.

Key Pharmaceuticals is an Australian-owned consumer healthcare company committed to providing evidence-based over-the-counter (OTC) consumer healthcare products within Australia, New Zealand and export markets. Our portfolio includes OsteVit-D One-A-Week 7000IU, Australiaâ&#x20AC;&#x2122;s #1 weekly dose Vitamin D, and OsmoLax, a clinically proven game changer in the management of constipation.

JDL Strategies for Medigrow

Key Pharmaceuticals

medigrow.com.au

keypharm.com.au

83


We were made for you Preferred Provider

“I am impressed with the level of service offered by the team and how simple it was to switch health funds.” Dr Victoria Phan General Practitioner Doctors’ Health Fund member since 2019

Join the health fund where GPs belong There’s a reason we’re one of the fastest growing health funds in Australia. It’s because we recognise the importance of supporting our members both as a patient and as a medical practitioner by delivering choice, value and service.

GET A QUOTE 1800 226 126 doctorshealthfund.com.au Join in just 5 minutes

Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy.


Company synopses

Lillyâ&#x20AC;&#x2122;s three core values are: Integrity: We conduct our business with all applicable laws and are honest in our dealings Excellence: We pursue innovation, provide high quality products and strive to deliver superior business results. Respect for People: We maintain an environment built on mutual respect and openness.

Sally Stuart joined LINK after working with doctors for more than a decade. After selling GP, Dental, Allied Health, Aged Care and NDIS businesses for the last 7 years, she is well versed in understanding the intricacies of a clinic sale. Sally can sell your business (and building) once ready!

Lilly Australia

LINK Business Brokers

lilly.com.au

linkbusiness.com.au

Frost & Sullivan is a consulting and research company. We work with clients in the healthcare and other sectors to grow their business, through research, consulting and brand & demand solutions.

Frost & Sullivan frost.com

Little Green Pharma has been helping doctors with prescribing assistance and SAS applications since we launched Australiaâ&#x20AC;&#x2122;s first medicinal cannabis products in 2018. We are a reliable, Australian grower and manufacturer producing rigorously tested, locally-made products in an Australian, TGA-approved GMP facility. We provide affordable products and ensure ongoing supply.

Macquarie Medical Systems is the biomedical division of Macquarie Health Corporation. We are active in research, design, manufacture and sale of the biomedical monitoring equipment. MMS products range from Dermlite Dermatoscopes disposable surgical consumables and patient monitoring devices.

Little Green Pharma

Macquarie Medical Systems

littlegreenpharma.com

macquariemed.com.au

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We are a fiercely pro-choice sexual & reproductive health provider that operates a network of licensed day surgeries, medical clinics & telehealth services throughout Australia. We’re independently accredited against the NSQHS Standards. Our expertise & holistic approach to healthcare combine to deliver safer clinical outcomes & better client wellbeing.

HCA Doctors – now known as Medic Oncall by Healthcare Australia – is recognised as the leading healthcare recruiter in Australia. Specialising in both the recruitment of permanent and locum junior doctors, specialists as well as general practitioners.

Marie Stopes Australia

Medic Oncall by Healthcare Australia

mariestopes.org.au

mediconcall.com.au

GBMA Education

GBMA Education was awarded the Biosimilar Education Grant by the Australian Government to help increase confidence in the use of biosimilar brands of biological medicines that are listed on the PBS. Visit the Biosimilar Hub to access CPD accredited activities, multilingual patient factsheets and other resources to support you and your patients.

biosimilarhub.com.au

MSR offers a range of medical consumables and equipment to enable you to cost effectively run your practice. We offer the highest quality products at the best prices, delivery on time every time, easy to use ordering systems and second to none back-up service.

Medifit Design & Construct is an award winning, specialist healthcare practice design and construction company, providing a comprehensive one stop solution for specialists looking to build new premises or renovate their existing practices. Since 2002, Medifit has created more than 600 practices all across Australia, many in the eastern states.

Medical and Surgical Requisites

Medifit Design & Construct

medsurg.com.au

medifit.com.au

87


Company synopses

Boutique specialist accountancy, tax and advisory practice with a focus on reducing hours, increasing income and creating strategies to achieve real financial freedom.

We believe anything’s possible, and that any individual or organisation can be exceptional. It’s our purpose to discover what exceptional means for you and provide opportunities, tools and support to help you achieve what’s important including; Long Term Locum Experiences, Short Term Locum Work, Permanent Career Opportunities & Finance Support Services.

MediSuccess

MedRecruit

medisuccess.com.au

medrecruit.com

Haemochromatosis Australia is a not for profit support and advocacy group for Australians affected by hereditary haemochromatosis, the most common genetic condition in Australia.

Haemochromatosis Australia haemochromatosis.org.au

A member of the Menarini Group, a leading European biopharmaceutical company headquartered in Florence, Italy. Menarini Australia is a company dedicated to bringing drugs to Australia that make a difference, with a product portfolio to treat a range of diseases from COPD, which is common, Breakthrough Cancer Pain, to rare diseases such as HT-1.

Monash IVF Group are the pioneers of IVF in Australia. They operate throughout Australia and Asia offering IVF, genetic testing and Ultrasound services.

Menarini

Monash IVF Group

menarini.com.au

monashivf.com

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Company synopses

MyHealth1st is the online health services marketplace that simplifies and facilitates patient engagement with Healthcare. By enhancing consumer choice and access through our suite of clever patient engagement tools, we strengthen the relationship between you and your patients. To date, we have booked over 12 million appointments for healthcare practices.

The National Asthma Council Australia (NAC) is the lead authority for asthma in Australia. We set and disseminate the standards of care through the Australian Asthma Handbook, our responsive and evidence-based asthma guidelines which inform our renowned education program, the Asthma Best Practice for Professionals Program.

MyHealth1st

National Asthma Council Australia

myhealth1st.com.au

nationalasthma.org.au

HealthLink connects more than 15,000 medical organisations across Australia and New Zealand and exchanges over 100 million clinical messages annually. Enabling the electronic delivery of pathology and radiology results, referrals, clinical documents, and discharge summaries. HealthLink healthlink.net

Our proven strategies have helped hundreds of Australians reduce their debt, decrease their tax burden and build wealth through property investment planning and education.

Novo Nordisk is a leading global healthcare company, founded in 1923 and headquartered in Denmark. Our purpose is to drive change to defeat diabetes and other serious chronic diseases. We do so by pioneering scientific breakthroughs, expanding access to our medicines and working to prevent and ultimately cure disease.

National Investment Advisory

Novo Nordisk Pharmaceuticals

mynia.com.au

novonordisk.com.au

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Endometriosis & fertility management As health practitioners we all know how important it is to manage our patients’ reproductive health. At Monash IVF we help women with fertility issues every day, and we see many women suffering with endometriosis and the significant impact it can have on their chances of having a baby. Endometriosis is a common medical condition that affects approximately 10% of women. The condition can impact from their first period through to menopause [1] to varying degrees, with females who have close relatives with this disease 7-to-10 times more likely to develop it [2]. It has been found that 1 in 3 women with endometriosis will also have fertility problems, and the average delay between onset and diagnosis is between 7 and 12 years.

Endometriosis Related Infertility

Symptoms

Endometriosis causes infertility in different ways.

Endometriosis can be displayed as Dysmenorrhoea, Dyspareunia, Dyschezia, and Dysuria (also commonly known as the 4 D’s). Other symptoms can include chronic pelvic pain, abnormal bowel or urinary symptoms related to the periods, pre-menstrual or mid-cycle spotting, fatigue and depression. Some women with this disease can also have no or minimal symptoms of endometriosis.

The female reproductive system, including the ovaries and fallopian tubes, are quite delicate and can be easily compromised. When the fallopian tubes are affected, the delicate fimbrial ends of the tubes are matted together (the fimbriae sweep the surface of the ovaries picking up the egg during ovulation) and when they are heavily affected by endometriosis, they lose this function. Chronic inflammation of the pelvic cavity can also occur. This changes the peritoneal fluid affecting egg quality, folliculogenesis, and luteal function and sperm-oocyte interaction. Endometriosis may also induce inflammatory changes within the pelvis creating a ‘hostile’ environment for the egg, sperm and embryo. The endometrium is often affected in severe cases and this in turn can affect the implantation of an embryo. Depending on the severity of the condition, simple medication or laparoscopic surgery to attempt to remove the endometriosis may assist women to conceive naturally. However, there may be other fertility issues present, such as poor sperm quality and IVF may then be required.

SYDNEY ULTRASOUND

or

WOMEN

Referral To Endometriosis Expert Referral to a specialist is recommended if a patient has severe, persistent or recurrent symptoms of endometriosis, they have signs of deep endometriosis on examination or imaging, if initial management is not effective, and/or treatment is not tolerated or is contraindicated. Treating Endometriosis Most commonly, endometriosis is treated with either medications or surgery. The approach will vary from woman to woman and some treatment options may not be suitable for patients currently trying to conceive. For patients with endometriosis and severe pain - an ultrasound is recommended. Patients experiencing infertility, a multifactorial decision by a Fertility Specialist would be recommended as they will also take into consideration the patient’s egg reserve. 1. Attention to lifestyle can improve fertility and your chance of having a healthy baby. http://yourfertility. org.au/for-women/other-factors/ 2. Fertility https://jeanhailes.org.au/health-a-z/endometriosis/fertility

Would you like to find out more about Endometriosis? Please contact us on 1800 628 533 or email seminars@monashivf.com to receive a recording of our latest Endometriosis webinar for GPs. Monash IVF has clinic locations across VIC, SA, NSW, NT, QLD, TAS and WA.


Company synopses

The Office for Health and Medical Research (OHMR) was established to implement the NSW Governmentâ&#x20AC;&#x2122;s strategic plan to build research capability in NSW.

NSW Health, Office for Health and Medical Research medicalresearch.nsw.gov.au

NSW Rural Doctors Network (RDN) is a not-for-profit, non-government charitable organisation and is the Australian Governmentâ&#x20AC;&#x2122;s designated Rural Workforce Agency (RWA) for health in NSW. We seek to support better health and wellbeing for people living in remote, rural, regional and disadvantaged communities, particularly those in NSW and the ACT.

NSW Rural Doctors Network nswrdn.com.au

We are a specialised medical design and fitout company building modern, state of the art, and innovative medical and health Fitouts state and nationwide. Catering for all budgets and providing high quality and adaptable services.

Justmed Medical Fitouts justmedfitouts.com.au

Optislim is the #1 Australian very low calorie diet (VLCD) program in Australia. Optislim is affordable, tastes great and helps people lose weight fast. Optislim can be used to facilitate large or small amounts of weight loss. Optislim is a well trusted brand to get the results safely and effectively.

Osteoporosis Australia is a national not for profit organisation focused on reducing unwanted fractures related to osteoporosis and raising community awareness about risk factors for osteoporosis. Osteoporosis Australia is committed to supporting GP and health professional education to improve diagnosis and management of this chronic disease.

OptiPharm

Osteoporosis Australia

optislim.com.au

osteoporosis.org.au

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ABOUT US OptiPharm Pty Ltd is a privately owned Australian company currently in its 24th year of operation. After 24 years it's no surprise Optislim is Australia’s weight loss category leader as the #1 Australian very low calorie diet (VLCD) program in Australia. Optislim was developed after closely following the trend of morbidly obese patients being turned away from surgery rooms and told to come back when they had lost weight. There was a clear market in Australia for a VLCD product that: 1. Helped people lose weight fast 2. Was a total meal replacement 3. Was affordable 4. Tasted good Optislim is designed so that healthy individuals can also use our product to help maintain a healthy weight or to simply lose a few kilos. Whether your patient needs to lose only a few kilos or 80 kilos or more, Optislim is a well trusted brand to get the results safely and effectively.

Fairly supporting local dairy farmers and local jobs for over 23 years

Australian made & owned

Quality

Affordability

Supporting local farmers & jobs

Available from Chemist Warehouse or online at www.optislim.com.au Contact customerservice@optipharm.com.au for free sample requests.

“For over 20 years, I have been prescribing very low calorie diet (VLCD) products to my patients suffering from obesity. Over time, it was clear that one of the biggest barriers for my clients was the actual taste. Apart from the significant cost savings, our patients like the appetising taste of the Optislim VLCD range. I have no doubt that the combination of taste and of course cost are behind our continued success with obesity.” Dr Peter Lewis Recreational Medical Centre, Armadale, VIC, Australia


Company synopses

Parkinson’s NSW is a not for profit organisation striving to make life better for people living with Parkinson’s, their families and carers. We provide essential services and programs including Counselling, Support groups, Education and the InfoLine service. We raise awareness and funds for research to improve the lives of people affected by Parkinson’s.

Perfect Practice creates smart, high-performing healthcare practices. With over a decade of experience, we are dedicated to providing the healthcare sector with unique practice design and seamless fit-out services. We offer an end-to-end solution to your fit-out needs which integrates design, budget planning, project management, and construction.

Parkinson’s NSW

Perfect Practice

parkinsonsnsw.org.au

perfectpractice.com.au

Lumos Diagnostics

Lumos Diagnostics is an Australian and USA based developer of point-of-care diagnostic solutions. FebriDx® is the first rapid all-in-one point-ofcare test device that identifies acute respiratory infections and differentiates viral from bacterial causes. It can be used to triage patients at the point-of-care to reduce uncertainty and avoid unnecessary antibiotics.

lumosdiagnostics.com

Premier Financial Advocates specialises in Medical Finance. We have over 15 years of experience in providing finance to General Practitioners, Dentist and Medical Specialist’s. We also do commercial loans to purchase Medical Centres and Medical Equipment. For approved customers we can provide 100% Finance.

Q-CLASS is a paediatric clinic specialising in respiratory, sleep, allergic and immune disorders. Its teams of medical specialists and allied health professions provide compassionate, expert care. We offer hospital and home sleep studies, allergy testing and lung function testing. We treat infants, children and teenagers.

Premier Financial Advocates

QCLASS

pfadvisors.com.au

qclass.com.au

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Free Interpreting Service for private medical practitioners New service: Telehealth video interpreting In response to the growing demand for Telehealth consultations, TIS National launched a new service – Telehealth video interpreting services. Medical practitioners can now book an interpreter to assist in their patient consultations over most thirdparty video conferencing platforms. These include, but are not limited to, healthdirect Video Call, Skype, WebEx, and Zoom. More information on Telehealth video interpreting can be found at www.tisnational.gov.au/en/Agencies/FrequentlyAsked-Questions-for-agencies

Translating and Interpreting Service (TIS National) TIS National delivers the Free Interpreting Service on behalf of the Australian Government. The Free Interpreting Service aims to provide equitable access to key services for people with limited or no English language proficiency. Private medical practitioners can access the Free Interpreting Service to provide Medicare rebateable services to anyone in Australia who has a Medicare card.

Services available to private tisnational.gov.au/en/Agencies/Frequently-Askedmedical practitioners Questions-for-Agencies Private medical practitioners can use the Free Interpreting Service to access the following services Read: Telehealth Frequently Asked Questions: delivered by TIS National: ● immediate telephone interpreting Medical Practitioner Priority Line 1300 131 450 available 24 hours a day, 7 days a week ● pre-booked telephone interpreting ● pre-booked on-site interpreting, and ● Telehealth video interpreting.

Register for a client code

More information

To register for a client code, complete the online client registration form on the TIS National website tisonline.tisnational.gov.au/RegisterAgency

● Read: about the Free Interpreting Service at tisnational.gov.au/FIS

If you require assistance with registering, contact TIS National on 1300 575 847.

● Watch: videos about TIS National services and how to work with interpreters at tisnational.gov.au/videos ● Contact TIS National on: 1300 575 847 or tis.freeinterpreting@homeaffairs.gov.au


Company synopses

We are a large group practice of specialist dermatologists, with sites at Stones Corner (Greenslopes) and Toowong. We see all dermatology conditions, including medical and surgical conditions, as well as cosmetic/laser dermatology. We see all ages, including paediatrics. We are delighted to accommodate any urgent referrals.

Rural Workforce Agency Victoria is a government funded not-forprofit organisation connecting health professionals to regional, rural and Aboriginal and Torres Strait Islander communities. We specialise in a no fee recruitment service and provide grants for professional development, as well as offer support to doctors on their pathway to fellowship.

Queensland Specialist Dermatology

Rural Workforce Agency Victoria

qsderm.com.au

rwav.com.au

Neptune Bio-Innovations (NBI) is a wholly-owned Australian business that was founded in 2008. NBI develops innovative consumer health and nutrition products to support Australians dealing with important health issues.

Neptune Bio-Innovations nepbio.com

RxTro improves communication between Medical Practices and the Pharmaceutical Industry. A secure web platform that centralises all representative appointments, patient resources and gives users the control to connect with reps that are relevant to each doctor.

Seer Medical is an Australian-based medical technology company that has revolutionised at-home diagnostics for seizure investigation. A long-term hospital stay used to be the only way to access video-EEG-ECG monitoring. Today, thereâ&#x20AC;&#x2122;s another option. Widely accessible across Australia, the Seer Medical service offers advanced technology, an exceptional service experience, and rapid reporting.

RxTro

Seer Medical

rxtro.com

seermedical.com

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Serco delivers on-base clinical and allied health care to the 80,000 service men and women in the Australian Defence Force. We have a clinical workforce of more than 1700 people and offer career opportunities across Australia for GPs, nurses, psychologists, dentists, dental assistants and health clerks.

SmartClinics is a growing group of modern day family medical centres operating in Queensland and Tasmania, owned in part by our very own GPs. We offer a number of GP employment opportunities to suit a broad range of individual needs. Please contact James Tibbetts at james.tibbetts@smartclinics.com.au.

Serco

SmartClinics Family Medical Centres

serco.com/ahsc

smartclinics.com.au

Nestlé Australia

Nestlé Nutrition is the global leader in infant nutrition. Helping to grow a healthier generation is our ultimate goal. Exclusive breastfeeding is the first step towards this objective, as breastmilk is best for babies. Through integrating scientific & research expertise, Nestlé Nutrition aims to launch innovative & evidence-based nutrition feeding solutions for infants.

nestlebabyandme.com.au

Spectrum Therapeutics has established operations in medicinal cannabis across 4 continents. We maintain only the highest standards for production. We drive forward preclinical and clinical research to support understanding and innovation in this class of therapeutics. We offer industry-leading accredited education, resources, and support for healthcare professionals.

SSS Australia is Australia’s leading independent healthcare supplier. We deliver real solutions to meet the unique requirements of our customers at all levels of business. We supply the highest quality brands at prices that suit your budget. Our customer service is industry-leading. Try us out today.

Spectrum Therapeutics

SSS Australia

spectrumtherapeutics.com

sssaustralia.com.au

97


Company synopses

Supagas is a leading supplier of LPG, industrial, medical, specialty and helium gases in Australia. We are fast-growing nation-wide company and are rapidly building a reputation for growth and success based on an exceptional ‘YES WE CAN’ customer service offering and quality product in the highly competitive market.

Team Medical Supplies was founded in 2011 and is an Australian owned, family run medical wholesaler. We distribute nationwide and cater for almost all medical practitioners and centres in Australia. We have access to over 100,000 high-quality medical products and stock most well-known and reputable brands in the market.

Supagas

Team Medical Supplies

supagas.com.au

teammed.com.au

Sock it to Sarcoma! exists to reduce the impacts of sarcomas, devastating bone and connective tissue cancers. We support medical research; patient support services; early detection of sarcoma through greater awareness of symptoms and referral pathways and we work to improve the quality of life for people impacted by sarcoma.

Sock it to Sarcoma! sockittosarcoma.org.au

The Translating and Interpreting Service (TIS National) delivers the Free Interpreting Service on behalf of the Australian Government. The Free Interpreting Service aims to provide equitable access to key services. TIS National has more than 50 years’ experience and access to over 2300 interpreters, speaking more than 140 languages.

Tresillian Family Care Centres is Australia’s largest Early Parenting Service offering professional advice, education and guidance to families with a baby, toddler or pre-schooler. Tresillian has helped generations of parents over the last 100 years providing reassurance and support.

Translating and Interpreting Service (TIS National)

Tresillian

tisnational.gov.au

tresillian.org.au

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True Relationships & Reproductive Health is an allied Family Planning Organisation based in Queensland. Founded in 1972, True’s clinics provide expert specialist reproductive and sexual health services to consumers. True is a leading provider of clinical education and training to health care professionals offering faceto-face, online and blended learning options.

Valley Eye Specialists strive to provide personalised and exceptional ophthalmic care for infants, children and adults. We pride ourselves on working together as an experienced and highly qualified team in providing timely appointments for both routine and urgent care when required.

True Relationships & Reproductive Health

Valley Eye Specialists

true.org.au

valleyeye.com.au

Stallergenes Greer

Stallergenes Greer is a global biopharmaceutical company leading innovation in allergen immunotherapy (AIT) and providing allergy solutions around the world. Stallergenes Greer offers a comprehensive approach to allergic diseases providing a wide range of products to allergy specialists; from diagnostic tests to AIT, offering allergy sufferers innovative and customized solutions.

stallergenesgreer.com

Vantre Health Services is the leading provider of general practice services in the Gold Coast and Ipswich regions. We offer our GPs excellent conditions and practice support; fantastic earning potential; well-equipped accredited practices; a commitment to quality and safety; the opportunity to combine a great career with a great lifestyle.

WaterWipes are the world’s purest baby wipes, made with two ingredients – 99.9% purified water and a drop of fruit extract. WaterWipes are safe to use on sensitive newborn skin and are so gentle they can also be used on premature baby skin.

Vantre Health Services

WaterWipes

vantrehealth.com.au

waterwipes.com

99


Company synopses

Let us help you find the most rewarding locum and permanent General Practice jobs. Experience the Wavelength difference for yourself by joining our network of +100,000 doctors and access a wide variety of exclusive locum jobs and permanent roles across all areas of Australia and New Zealand.

Owned by Wesley mission, our expert staff at Ashfield and Kogarah locations in Sydney provide quality, compassionate care in mental health, trauma, addictions and eating disorders. We help patients successfully overcome their challenges, build resilience and live full and productive lives.

Wavelength Medical Recruitment

Wesley Private Hospitals Sydney

wave.com.au

wesleyhospital.org.au

We lead the development of safe, integrated and efficient transport systems for the people of NSW. Our customers are at the centre of everything that we do, including transport planning, strategy, policy, procurement and other non-service delivery functions across all modes of transport â&#x20AC;&#x201C; roads, rail, ferries, light rail and point to point.

Transport for NSW rms.nsw.gov.au

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Category list Allied Health Services

JDL Strategies for Medigrow

Diagnostics and Imaging

Avidity Rewards

LINK Business Brokers

EBOS Healthcare

Club Active

Medifit Design & Construct

Lumos Diagnostics

Amplifon

BOQ Specialist

MediSuccess

Cornerstone Health

MyHealth1st

Cynergex Group EBOS Healthcare

National Investment Advisory

Fullerton Health Medical Centres

Perfect Practice

Medical and Surgical Requisites

Premier Financial Advocates

MyHealth1st

SmartClinics Family Medical Centres

Perfect Practice

SSS Australia

Serco

Valley Eye Specialists

SmartClinics Family Medical Centres

Vantre Health Services

Wesley Private Hospitals Sydney Business Services

Complementary Medicine

BOQ Specialist Club Active

13SICK, National Home Doctor

Cornerstone Health

Seer Medical SmartClinics Family Medical Centres

Medical and Surgical Requisites SmartClinics Family Medical Centres SSS Australia Team Medical Supplies Medical Devices/ Equipment

Australian Digital Health Agency

AMA Products

Abbott

Cancer Australia

Asthma Australia

NSW Health, Office for Health and Medical Research

Australasian Medical & Scientific Limited

Rural Workforce Agency Victoria

Cynergex Group

Serco Translating and Interpreting Service (TIS National) Transport for NSW

Experien Insurance Services

Fullerton Health Medical Centres

Frost & Sullivan

Key Pharmaceuticals

AMA Products

Fullerton Health Medical Centres

SmartClinics Family Medical Centres

Contact Lens Centre Australia

Company list

Macquarie Medical Systems

Government Organisations/ Associations

Medical Consumables/ Supplies

Contents 102

Wavelength Medical Recruitment

Medical and Surgical Requisites

EBOS Healthcare

bloom hearing specialists

DermaSensor EBOS Healthcare Lumos Diagnostics Macquarie Medical Systems Medical and Surgical Requisites SmartClinics Family Medical Centres SSS Australia Stallergenes Greer


Supagas Team Medical Supplies Medical Publications & Education Asthma Australia Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM)

Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM) GBMA Education Haemochromatosis Australia Health Workforce Queensland

Pharmaceutical OTC

Software Solutions

Bayer Australia

Avidity Rewards

Contact Lens Centre Australia

Doctors on Demand

EBOS Healthcare Key Pharmaceuticals Menarini

HealthLink HealthShare MyHealth1st RxTro

Neptune Bio-Innovations Other

Black Dog Institute

Heart Foundation

Nestlé Australia

CANNect Group

HepatitisWA

Cornerstone Health

Marie Stopes Australia

Pharmaceutical Prescription

Cassins Healthcare Design & Construct

Cynergex Group

National Asthma Council Australia

Actelion

Complete ENT

Bayer Australia

Doctors’ Health Fund

CannaPacific

Justmed Medical Fitouts

GBMA Education

NSW Rural Doctors Network

CANNect Group

Marie Stopes Australia

Osteoporosis Australia

National Asthma Council Australia

Rural Workforce Agency Victoria

Contact Lens Centre Australia

Medic Oncall by Healthcare Australia

Dementia Training Australia

Adviceline Injury Lawyers

MedRecruit

EBOS Healthcare

Parkinson’s NSW

Sock it to Sarcoma!

GlaxoSmithKline

QCLASS

Tresillian

Lilly Australia

WaterWipes

SmartClinics Family Medical Centres

True Relationships & Reproductive Health

Little Green Pharma

True Relationships & Reproductive Health

Nutrition

NSW Health, Office for Health and Medical Research

Not for Profit Association Alcoholics Anonymous Asthma Australia

EBOS Healthcare OptiPharm SmartClinics Family Medical Centres

Menarini Novo Nordisk Pharmaceuticals SmartClinics Family Medical Centres Spectrum Therapeutics Stallergenes Greer

103


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GPCE Digest October 2020