Evaluation of pathology ordering by general practitioners in Australia

This thesis describes and evaluates pathology test ordering by general practitioners (GPs) in Australia, using data collected in the BEACH program (2000-2010). From 2000-02 to 2006-08, the total increase in volume of GP-ordered pathology tests was due to: increased likelihood of GPs’ ordering test(s), increased number of tests ordered per episode, increased number of problems managed at encounters, and increased population attendance rates. Significant independent predictors of the volume of pathology ordered by GPs were investigated. The principal explanatory variable was the type of problem being managed. For six problems, appropriateness of ordering was assessed, by measuring alignment of GPs’ ordering with guidance documents. Alignment was good for: hypertension, Type 2 diabetes, lipid disorders and weakness/tiredness; and poor for ‘health checks’ and overweight/obesity. Of the total volume of tests for these problems, only a small proportion was deemed inappropriate. I found no evidence to support concerns raised in the literature about widespread inappropriate ordering. For the ongoing management of chronic problems, pathology testing guidance was poor. Australia has an ageing population and therefore chronic problem management, and the testing associated with it, will inevitably increase. Improved pathology guidance could help support GPs’ to order appropriately in this high growth area

Evaluation of imaging ordering by general practitioners in Australia, 2002–03 to 2011–12

Introdução: A deteção dos abusos contra crianças não é fácil para o médico, pois a história clínica recolhida é muitas vezes enganosa, os achados físicos são muitas vezes inespecíficos e os médicos, na maioria dos casos, não incluem o abuso no diagnóstico diferencial dos quadros clínicos com que se confrontam. Este diagnóstico é particularmente complexo no caso das queimaduras, cujas consequências, pelo menos do ponto de vista psicológico, são sempre graves. Daí a necessidade de cada vez se conhecerem mais profundamente estas situações, nas suas diversas vertentes, em cada país e comunidade, para que as medidas de detenção, diagnósticos e prevenção se possam adequar a cada realidade. Objetivo: Contribuir para conhecer melhor esta realidade e para reforçar a ideia da necessidade urgente da organização dos serviços em Angola, para que as equipas multidisciplinares possam existir e intervir adequada e atempadamente, para bem das vítimas, da comunidade e da justiça. Material e Métodos: Foram estudadas 230 crianças admitidas por queimaduras na Unidade de Queimados do Hospital Neves Bendinha, em Luanda. A ficha de recolha de dados foi preenchida durante o período de internamento das crianças, incluindo dados constantes do processo clínico hospitalar e outros obtidos através da entrevista de um dos progenitores ou representante legal da criança. Resultados e Discussão: As vítimas eram muito novas (50% até aos 5 anos; média de idade 7 anos), encontrando-se 99.6% a cargo dos familiares os quais, em apenas 69% dos casos, foram as pessoas que as levaram ao hospital; 57% não foram levadas ao hospital no dia do evento, sendo que em 77% dos casos este aconteceu em casa. Estes aspetos podem estar relacionados com a tentativa de ocultação dos cassos abusivos. De acordo com os registos clínicos, 47% das queimaduras associava-se a negligência, 33% a acidente e 20% a abuso. A queimadura provocada por imersão em água quente verificou-se em 75% dos casos alegadamente abusivos. Os locais mais atingidos foram os membros superiores (22%), tórax/mamas (22%) e membros inferiores (18%), para todos os casos, verificando-se que a região genital e nádegas sofreu mais queimaduras nas situações alegadamente abusivas (7%). As queimaduras figuradas, apesar de muito escassas no geral, surgiram em 50% dos casos de suspeita de abuso, bem como a distribuição bilateral e simétrica das lesões (em 57% destes casos), o que é altamente sugestivo de lesões intencionalmente infligidas. As queimaduras foram de 2º grau em 65% dos casos, sendo as mais graves nos casos supostamente devidos a abuso; no entanto, foi nestes casos que houve menos atingimento da área corporal (74% até 10% da área corporal), talvez porque a queimadura intencional foi aplicada a uma área concreta. Em 63% dos alegados abusos encontraram-se outras lesões distintas das queimaduras e em 28% cicatrizes de lesões (o que pode traduzir reiteração do abuso). A denúncia da suspeita de abuso foi apresentada em apenas 26% dos casos, o que está de acordo com a ocultação típica destes casos. Os supostos abusadores seriam maioritariamente familiares da vítima e do sexo feminino (58% e 56%), respetivamente, com idade média de 24 anos (20% menores de idade) e em 62% dos casos havia referência a consumo abusivo de álcool. Estes casos seriam melhor apoiados se conseguisse: (1) promover a sua deteção precoce pelos profissionais que trabalham com crianças; (2) incentivar a sinalização/denúncia da sua suspeita por esses mesmos profissionais; (3) a colaboração de especialistas em medicina legal para apoiar o diagnóstico mais seguro dos casos; (4) definir normas procedimentais e protocolos que apoiassem o diagnóstico por esses especialistas e a sua boa articulação com os outros profissionais os quais, no seu conjunto, deveriam constituir uma equipa multidisciplinar de intervenção nestes casos.Introduction: It is difficult for a doctor to detect a children abuse, due to the fact that the history about the event is sometimes not true, the physical findings are usually unspecific, frequently doctors don´t include the abuse in the differential diagnosis. This diagnosis is particularly difficult to perform in burns, which consequences, at least from the psychological point of view, are always severe. That´s why is important to know deeply this situations, in their several strands, in each country and community, so the detection measures, diagnosis and prevention can be adjust to each reality. Objective: To contribute to better understand this reality and to reinforce the necessity to organize the services in Angola, so that the multidisciplinary teams can exist and act in accordance and within a suitable way and schedule, for the welfare of the victims, community and justice. Material and Methods: 230 children were studied; they were admitted in the burn unit from the Hospital Neves Bendinha, in Luanda, Angola. The collection of data forms was fulfilled during the inpatient period; it includes information from their medical historical process and others collected through an interview to the children´s parents or their legal representative. Results and Discussion: The victims are very young (50% until the age of 5; average: 7 years-old), in 99.6% their relatives were in charge, and in only 69% of the cases, the relatives took the children to the hospital; 57% were not taken to the hospital in the day of the event, and in 77% of the cases the event happened at home. These aspects can be related with the attempt to hide these abusive cases. Accordingly to the clinic registrations, 47% of the burns were associated to neglecting acts, 33% to accidents and 20% to abuse. Burns caused by the immersion in hot water were showed in 75% of the alleged abusive cases. The body parts more affected were the upper limbs (22%), chest/breast (22%) and lower limbs (18%), for all the cases; the genital area and buttocks were the regions where more burns were suffered by the alleged abused children (7%). The patterned burns, in spite of being very rare, appeared in 50% of the suspected abuses cases, as well as the bilateral distribution and symmetrical of the burns (in 57% of these cases); these may suggest that the burns were intentional inflicted. The burns were of 2nd degree in 65% of the cases, being the more severe in the abuse cases; however, in these cases there was less body burn (74% until 10% of body area), maybe because the intentional burn was applied in a concrete area. In 63% of the alleged abuses there were other injuries and in 28% scars (that may suggest the reiteration of the abuse). The abuse complaints were presented in only 26% of the cases, which is in accordance with the attempt to hide them. The alleged abusers were mainly the victims’ relatives and the females (58% and 56%, respectively), with an average age of 24 years (20% minors) and in 62% of the cases there was a reference to an abusive alcohol consumption. These cases would be better supported if it was possible to: (1) promote the early detection by the professional that work with children; (2) promote the report of the professionals regarding these events; (3) obtain collaboration from the forensic doctors to support a more secure diagnosis in these cases; (4) set some procedure rules and protocols that can support the diagnosis performed by these physicians and their better cooperation with other professionals, creating together a multidisciplinary team for the intervention in these cases

A decade of Australian general practice activity 2001–02 to 2010–11

In the last decade, the opening and the bigger exposure of Azores Autonomic Region in the media, as well the assumption of the importance of tourism to the regional economy by the local government, introduced the planning of this sector in those islands. Even if all regions have specific features as the main touristic Portuguese regions such as Algarve, Madeira and Lisboa, the Azores product - Natural landscape - is different from the all the rest. Its difference and specification is directed to niche markets, which means not to attract the consumer populations of the most searched touristic product - Sun and beach. Due the fragility and weak capacity of the Azorean touristic product renovation, but still with the necessity of economical income, it’s essential the non-allowance of tourist masses but at- tract a highly economic value and academic instructed tourist type. The Scandinavian population has been one of the bets for a sustainable tourism in Azores, and Finland one of the some questions: Is this a correct bet? What can Azores offer? What are Finnish searching in their vacations periods? To answer those questions a bibliographic search and an inquiry were Azores offer it ́s pretended

General practice activity in Australia 2014–15

This is the 17th annual report and the 38th book in the General Practice Series from the BEACH (Bettering the Evaluation and Care of Health) program, a continuous national study of general practice activity in Australia.Australian Government Department of Health, AstraZeneca Pty Ltd (Australia), Novartis Pharmaceuticals Australia Pty Ltd, bioCSL (Australia) Pty Ltd, AbbVie Pty Ltd, Australian Government Department of Veterans' Affair

General practice activity in Australia 2014–15

This is the 17th annual report and the 38th book in the General Practice Series from the BEACH (Bettering the Evaluation and Care of Health) program, a continuous national study of general practice activity in Australia.Australian Government Department of Health, AstraZeneca Pty Ltd (Australia), Novartis Pharmaceuticals Australia Pty Ltd, bioCSL (Australia) Pty Ltd, AbbVie Pty Ltd, Australian Government Department of Veterans' Affair