Current teaching about obesity in Australian universities, specialist medical colleges and through continuing medical education.
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Australia↗
Biomedical subjects
Leon Piterman
Publications and source records attributed to Leon Piterman.
Primary health care research--essential but disadvantaged.
Primary health care is the foundation of effective, sustainable population health and is associated with higher patient satisfaction and reduced aggregate health spending. Although improving patient care requires a sound evidence base, rigorously designed studies remain under-represented in primary care research. The pace of research activity in general practice and the rate and quality of publications do not match the pace of structural change or the level of funding provided. Recruitment difficulties are a major impediment, fuelled by general practitioners' time constraints, lack of remuneration, non-recognition, and workforce shortages. Radical reform is required to redress imbalances in funding allocation, including: funding of GP Research Network infrastructure costs; formalising relationships between primary care researchers and academic departments of general practice and rural health; and mandating that research funding bodies consider only proposals that include in the budget nominal payments for GP participation and salaries for dedicated research nurses.
Australia↗
Evaluation of a short course in psychiatry for general practitioners.
OBJECTIVE: To assess the acceptability and benefits to general practitioners (GPs) of a short course on the management of depression and anxiety. METHOD: One hundred and twenty-two GPs from southeast metropolitan Melbourne participated in a five-session short course. Pre- and post-measures of knowledge, attitude and self-evaluated clinical practice and a post-measure of participant satisfaction were completed. RESULTS: The course was overwhelmingly appreciated by participating GPs. In the group as a whole, knowledge, attitude and certain elements of clinical practice changed in a positive and predicted direction. General practitioners affirmed the use of an interpersonal and problem-solving framework for patients more commonly than a cognitive-behavioural one. CONCLUSIONS: Brief educational interventions are useful and, through improving GP knowledge, attitude and clinical practice, have an important role to play in enhancing the capacity of GPs to assist people with depression and anxiety.
Anxiety↗
CHAT--a study of a nurse-led system of care.
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Australia↗
Chronic heart failure--optimising care in general practice.
BACKGROUND: Chronic heart failure (CHF) is a significant cause of mortality and morbidity in developed countries where it predominantly affects elderly persons with a range of other comorbid conditions requiring polypharmacy. In Australia, over 300 000 people are affected by CHF. Quality general practice forms the cornerstone for early diagnosis and evidence based integrated care. OBJECTIVE: This article examines the epidemiology of CHF, its clinical diagnosis, contemporary management and future treatment possibilities, as well as current barriers to optimal care. DISCUSSION: The global prevalence of CHF is rising. Optimal treatment requires a coordinated interdisciplinary approach using a biopsychosocial model of care in order to maximise compliance with therapy. Pharmacological treatment is essential and should include an angiotensin converting enzyme inhibitor and beta blocker where possible. Device based treatment and cardiac surgery may benefit selected cases.
Adrenergic beta-Antagonists↗
Doctors and patients: gender interaction in the consultation.
BACKGROUND: Much research on gender differences in medicine has centered on women as better communicators, more egalitarian, more patient-centered, and more involved with psychosocial problems, preventive care, and female-specific problems. Hardly any research has examined the interaction between the doctor's gender and the patient's gender. The authors examined students' perceptions and comfort levels regarding patients' gender during consultation. METHOD: This cross-sectional study used a questionnaire to survey final-year medical students at one school in 1999. It tested students' patient-centeredness, "patient-care" values, and degree of comfort in performing certain intimate physical examinations. RESULTS: Women students were more patient-centered than were men students. Both genders were more attuned to the concerns of patients of their own gender, were more comfortable with personal rather than sexual issues, and were more uncomfortable with performing more intimate examinations upon the opposite gender. Using comparable case studies, it was also shown that the female student-female patient dyad had significantly greater "patient-care" values than did the male student-male patient dyad. CONCLUSION: Medical students did not behave in a gender-neutral way in the consultation. There is a powerful interaction between a student's gender and a patient's gender. This warrants further investigation in the real clinical situation because it has implications on the outcomes of the consultation.
Altruism↗
Interpersonal counselling in general practice.
BACKGROUND: Interpersonal counselling (IPC) derives from interpersonal psycho-therapy (IPT) but is briefer in the number and duration of sessions and is particularly suited to the primary care setting. While depression and other psychological symptoms are not necessarily 'caused' by interpersonal problems, they do occur in a social and interpersonal context. Problem areas commonly associated with the onset of depression are unresolved grief, interpersonal disputes, role transition and interpersonal deficits such as social isolation. OBJECTIVE: This article discusses IPC and how it can be used in the general practice setting. DISCUSSION: The structure of IPC is of a brief treatment of six sessions, each with an explicit focus: assessment, education about the interaction between interpersonal relationships and psychological symptoms, identifying current stress areas and helping the patient deal with these more positively and termination of the IPC relationship. Interpersonal counselling can be utilised general practice to reduce psychological symptoms, restore morale, improve self esteem and the quality of the patient's social adjustment and interpersonal relationships.
Adult↗
Gastro-oesophageal reflux disease--current concepts in management.
BACKGROUND: Gastro-oesophageal reflux disease (GORD) is defined as recurring symptoms or mucosal damage resulting from exposure of the distal oesophagus to reflux of gastric contents. In the past, GORD has been managed with a 'step up' approach beginning with antacids and progressing to H2 antagonists or proton pump inhibitors (PPI) as required. OBJECTIVE: This article presents a systematic approach to the management of GORD. DISCUSSION: Diagnosis of GORD is made on the basis of symptoms and the decision to treat is based on the symptom pattern. Endoscopy is reserved for cases where there are alarm symptoms, diagnostic uncertainty, poor response to treatment or clinical suspicion of a complication such as Barrett's oesophagus or stricture. A 'step down' approach to treatment involves treating with a PPI for 4-8 weeks. Aggressive therapy is then reduced to maintenance doses, intermittent therapy or in some cases, withdrawn. However, relapse occurs in about 70% of all patients within 6 months. A step down approach ensures more rapid resolution of symptoms, improved quality of life, reduced risk of complications, and overall lower cost.
Anti-Ulcer Agents↗
GP attitudes to male reproductive and sexual health education and promotion. A qualitative study.
BACKGROUND: Despite evidence that men believe the general practitioner is an appropriate person to assist with sexual health issues, few men actually access medical practitioners for such assistance. Raising community awareness of male sexual and reproductive health issues is expected to generate a clinical demand for men's health services. OBJECTIVE: The aim of this study was to determine GP perceptions of their own education needs and those of the community in the area of men's health. DISCUSSION: A total of 27 GPs from four Victorian divisions of general practice (three metropolitan and one rural) participated in three focus groups. Key themes from the data were identified after analysis of the data by three researchers. General practitioners indicated that a clinical demand for men's health services needed to be generated in order for GPs to be interested in professional development. They suggested community education providing general information to men about sexual and reproductive health issues and emphasising the importance of accessing their GP for health checks. However, due to a lack of information for GPs about some areas of male sexual and reproductive health, e.g., androgen deficiency and male infertility, a case based practical approach to GP education was recommended. General practitioners also requested concrete information, current specialist recommendations and details of locally available services working in men's health.
Adolescent↗
Rethinking general practice for the 21st century. The patient counts!
BACKGROUND: Increasingly, reforms to health care systems appear to interfere with the traditional (healer) role of the general practitioner, and are perceived to disrupt patient care and the therapeutic relationship. OBJECTIVE: To outline measures for the survival and future development of the discipline of general practice in Australia. DISCUSSION: In order to preserve longitudinal relationship centred care and high level primary care clinical expertise, health bureaucracies and general practice itself, must re-focus care on the individual and community, integrating new developments rather than allowing 'new ideas and system pressures' to continually distort functional general practice.
Attitude of Health Personnel↗
Osteoporosis risks. A comparative study of Asian Australian and Caucasian Australian women.
OBJECTIVE: To describe the self reported level of osteoporosis knowledge, attitudes and preventive activities, including dietary calcium intake of Asian and Caucasian women. METHOD: Self administered questionnaires in English and Chinese including a food frequency survey were posted to potential respondents that were recruited via general practices, community newsletters and notices. RESULTS: Asian women had less osteoporosis knowledge and lower calcium intake (mean 793 +/- 49 mg/day standard error of the mean) than Caucasian women (1298 +/- 56 mg/day). Postmenopausal Asian women were at greater risk of being below the recommended daily intake (73%) than Caucasian women (31%). CONCLUSION: Osteoporosis knowledge and preventive activities among Asian and Caucasian women could be better. Higher dietary or supplementary calcium intake should be considered.
Adult↗
A Graduate Certificate and Master in General Practice Psychiatry by distance education--1998-2001.
BACKGROUND: The General Practice Psychiatry Program is a collaborative initiative between two universities and two professional colleges. Since 1998 it has offered general practitioners a one year part time Graduate Certificate, and a two year Master of General Practice Psychiatry. The learning is by distance education and multimode, including text packages sent out, tapes, teleconferences and two annual residential weekends with role plays and didactic teaching. OBJECTIVE: To describe the development of a Graduate Certificate and Master in General Practice Psychiatry. DISCUSSION: The program has been well supported with 141 general practitioners enrolling in the Graduate Certificate and 48 in the Masters during 1998-2001. General practitioners have been enrolling from around Australia, with rural, female and more experienced GPs predominating.
Adult↗
Bush telegraph. Improving outcomes for rural and remote patients with chronic heart failure.
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Aged↗