Biomedical subjects

Moira G Sim

Publications and source records attributed to Moira G Sim.

12 recordsLinked to original sources

PubMed2004

Cannabis and psychosis.

BACKGROUND: Cannabis use is commonly identified in people who present with psychosis. OBJECTIVE: This case study aims to provide a practical approach for general practitioners seeing patients with comorbid cannabis and mental health concerns. DISCUSSION: Cannabis related comorbidity is commonly seen in general practice. General practitioners can manage most presentations and help to reduce the likely occurrence of cannabis induced psychosis through the use of psychosocial support, brief interventions and harm minimisation.

Adult↗

PubMed2004

Cough mixtures: not always for cough.

BACKGROUND: Opioid based cough mixtures are readily available to the public and are generally used safely. However, like alcohol, their use can sometimes be a significant part of a dependence problem. OBJECTIVE: This case study provides practical information for general practitioners in the detection, assessment and management of patients with cough mixture opioid dependence. DISCUSSION: Opioid dependence is generally considered synonymous with heroin dependence or dependence on prescribed opioid analgesics. However, cough mixtures are a readily available source of opioids. People who become dependent on these mixtures commonly do not present for medical assistance until the problem is severe.

Adult↗

PubMed2004

Back pain and opioid seeking behaviour.

BACKGROUND: Back pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides general practitioners with a practical approach to seeing patients with chronic pain whom they suspect of opioid dependence and describes a framework for managing chronic pain and dependence within the general practice setting. DISCUSSION: Back pain, with or without opioid dependence, is commonly encountered in general practice. General practitioners frequently find themselves caught between the desire to treat and relieve symptoms, and not wanting to cause or exacerbate dependence. Clear guidelines and access to support are often lacking.

Adult↗

PubMed2004

Injecting drug use and skin lesions.

BACKGROUND: Many illicit drugs can be injected, with this mode of administration associated with a range of skin morbidities. OBJECTIVE: This article illustrates a dermatological presentation associated with injecting drug use. DISCUSSION: Track marks, injection site marks and skin abscesses are well known to be associated with injecting drug use. However, there are other dermatological manifestations that are less commonly known. Signs may be more subtle, particularly when drug use is recreational and patients do not fit commonly held stereotypes of injecting drug users.

Adult↗

PubMed2004

When the child with ADHD grows up.

BACKGROUND: There is significant controversy surrounding attention deficit hyperactivity disorder (ADHD). While the existence of this disorder is generally accepted, debate continues in relation to aspects of assessment, as well as the effectiveness and choice of treatment options and their continuation into adult life. Management is further complicated as people with ADHD often have chaotic lives which impedes medication compliance and motivation to continue treatment vacillates. Concern also exists over the misuse of amphetamine-like medications by some patients. OBJECTIVE: This case study does not provide comprehensive information on current diagnosis and ADHD treatment guidelines, but explores the issues and management role of general practitioners treating patients with ADHD. DISCUSSION: The diagnosis of ADHD is common, and many patients are managed using a range of social and behavioural interventions that are commonly combined with pharmacotherapies (provided in the main by psychiatrists and paediatricians). However, while specialists may appropriately choose not to treat where a diagnosis is unclear, or discontinue treatment for reasons such as doubtful response to treatment, possible medication misuse, concurrent illicit drug use or poor motivation, GPs frequently continue to manage ongoing care and the impact of ADHD on the rest of the family. When the specialist formulation suggests there is little to gain from further treatment, the GP is likely to be the sole health professional remaining engaged in support and ongoing management.

Adolescent↗

PubMed2004

Management of the impaired doctor.

BACKGROUND: The lifetime prevalence of substance abuse disorders among doctors in Australia has been estimated to be approximately 8%. These disorders can interfere with a doctor's ability to function and pose a risk to patient welfare and safety.' OBJECTIVE: This article identifies key indicators to the development of problem alcohol and drug use in a general practitioner, associated possible psychiatric morbidity, work deficits, and the need for colleagues to recognise and respond in a timely manner to resolve these events. DISCUSSION: Where intervention, treatment and monitoring are initiated early in problem drug use, outcomes for the GP are typically positive. Outcomes are better where there is adequate support by friends and colleagues, and where there is a clearly defined management strategy.

Alcoholism↗

PubMed2004

Alcohol and other drug use in later life.

BACKGROUND: Problem alcohol and other drug use is rarely suspected in the elderly. However, the elderly are more susceptible to problems related to drug use at lower doses because of age related changes, comorbidities and polypharmacy. Like other age groups, the elderly sometime seek the use of alcohol and other drugs, to help them feel better or to avoid negative feelings such as loneliness and depression. Drug use in the elderly is associated with significant morbidity anid can be masked by other medical problems. OBJECTIVE: This article demonstrates a gradual onset alcohol problem in a longstanding elderly patient, in whom changes in drug or alcohol use may not be easily detected. It also highlights some key differences in drug related presentations in the elderly. DISCUSSION: Some health professionals consider intervention for problem alcohol or other drug use in the elderly ineffective. However, because of the high prevalence of polypharmacy and comorbid pathology, intervention is more likely to result in a significant health improvement. General practitioners have a high level of contact with and are trusted by the elderly, giving them an unparalleled opportunity among health professionals to intervene in problem alcohol and other drug use.

Aged↗

PubMed2004

Benzodiazepine dependence.

BACKGROUND: Benzodiazepine dependency can occur as a result of treatment for anxiety disorders or sleep disturbance. While benzodiazepine withdrawal can be challenging, cessation of use can be even more difficult if there are other comorbidities such as oestrogen deficiency with vasomotor symptoms and anxiety disorders. OBJECTIVE: This article provides practical information for general practitioners in the management of patients with benzodiazepine dependence. DISCUSSION: Some patients may have common medical presentations and coexisting drug dependence. It is often difficult to separate these two issues. In the case of benzodiazepine dependence, gradual withdrawal over time and nonpharmacological treatment of the symptoms of withdrawal such as anxiety or insomnia is effective. Better outcomes are achieved where the GP discusses and plans strategies well in advance with the patient. Treatment often involves multiple interventions from various health professionals. General practitioners are ideally placed to coordinate such treatment.

Anti-Anxiety Agents↗

PubMed2004

Acute pain and opioid seeking behaviour.

BACKGROUND: Acute pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides a practical approach for general practitioners seeing patients with acute pain whom they suspect of seeking opioids because of dependence. DISCUSSION: Acute pain commonly presents as an emergency appointment 'squeezed in' between booked appointments. General practitioners have to make a rapid assessment of the possible underlying causes, relieve pain, and establish a plan for further investigation and management. Furthermore, some opioid dependent people can and do effectively feign acute pain in order to obtain opioid medication.

Acute Disease↗

PubMed2002

The identification and management of the drug impaired doctor.

BACKGROUND: Problem drug use occurs within the medical fraternity as it does in other parts of the population. However, doctors have traditionally been discouraged from admitting vulnerability and frequently fail to recognise or respond to early signs of problem alcohol and drug use. OBJECTIVE: This article aims to identify sequential strategies to assist the doctor to detect and intervene early when problem drug use arises in themselves or a colleague. DISCUSSION: Where treatment and monitoring is instituted early in problem drug use, outcomes are typically positive while late acknowledgment commonly results in sanctions for the impaired practitioner and greater risk to patients. Medical boards in Australia have developed supportive mechanisms for doctors to facilitate early management. Procedures are aimed at maintaining or restoring ability to work while maintaining public confidence.

Australia↗

PubMedDate not supplied

Teen pregnancy--a program for awareness and health education.

BACKGROUND: Baby Think It Over is a health program that provides Perth adolescents in metropolitan schools with a 'virtual' parenting experience using an infant simulation program. Baby Think It Over seeks to modify attitudes toward teen pregnancy and parenting and to delay pregnancy until the participants have a better understanding of the demands and responsibilities of caring for an infant. At the same time, this program provides an opportunity to introduce adolescents to health services within their community with a particular focus on general practice. OBJECTIVE: This article describes the methodology and qualitative assessment of the program, examines some outcomes associated with its uptake and lessons learnt in its implementation. DISCUSSION: The program demonstrates that divisions of general practice can work together with schools to deliver innovative programs. The value of projects like this is in the community partnerships and social capital that they build across the health and education sector.

Adolescent↗

PubMedDate not supplied

Prevention--building on routine clinical practice.

BACKGROUND: The role of general practice in preventing disease and promoting health is strongly supported by research and health policies. OBJECTIVE: This article examines the role of general practitioners in illness prevention and health promotion activities. DISCUSSION: Despite time and other barriers, such as competing priorities, to the implementation of preventive activities, prevention is part of routine general practice. In providing care for the whole person over a long period of time prevention and treatment are not separate entities and the line between these are necessarily blurred. From a pragmatic point of view, if a practice is to increase its activity in prevention there needs to be a driver that makes this happen and strategies to suit the structure of the individual practice. Introducing small interventions and making use of the practice team is a good place to start in a range of health promotion activities including opportunistic education, brief interventions for patients with disease risk factors, and specific interventions for a known disease.

Australia↗