Saturday 6 January, 2007

The new cervical cancer vaccine

Posted in General Practice, May Su, Medicine, Resources at 17:55 by May Su

Original article by: May Su :: Printer friendly

There has been much in the media recently about the new cervical cancer vaccine, “Gardasil”. The first vaccine was initially produced in the 1990s by a team of researchers in Queensland, headed by Professor Ian Frazer; who received Australian of the Year in 2006 for his work. The vaccine was then marketed by CSL pharmaceuticals and released in 2006. It is a vaccine aimed at preventing infection with the human papilloma virus (HPV), also known as the wart virus.

There is a clear relationship to human papilloma virus (HPV) and the development of cervical cancer (1). There are more than 100 different forms of human papilloma virus (HPV), but not all of them are linked to causation of cervical cancer (2). HPV 16 and 18 are indicated in causing over 70% of cervical cancers detected. The other genotypes linked to developing cervical cancer are types 45 and 31. Types 6 and 11 are linked to the clinical manifestation of genital warts and are low risk for developing cervical cancer.

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Sunday 3 December, 2006

Opioid analgesic dose conversions

Posted in General Practice, Medicine, Michael Tam, Wards at 19:37 by Michael Tam

Original article by: Michael Tam :: Printer friendly

morphine

Opioid analgesics are the cornerstone to treatment and control of severe pain. Equivalence of dose potency is not absolute and care must be taken in changing analgesics. In general, it is safer to use a lower regular dose with breakthrough analgesia rather than to convert immediately to the “equivalent” dose.

It is important nevertheless to know the approximately dosage conversions.

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Monday 27 November, 2006

Topical corticosteroids

Posted in Dermatology, General Practice, May Su, Wards at 22:18 by May Su

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Topical corticosteroids are used for a variety of dermatological conditions – dermatitis (atopic eczema), psoriasis, or in conjunction with anti-fungal agents for severe tinea.

There is a confusing array of topical steroid preparations available in Australia. The question is which to use, and when.

Potency is dependent on the type of corticosteroid, the vehicle it is applied with (i.e., lotion, cream or ointment) and whether an occlusive dressing is used.

Potency is directly proportional to the risk of side effects associated with their use. It is preferable to use the lowest potency agent required to effect treatment.

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Sunday 19 November, 2006

Management of obesity

Posted in General Practice, May Su, Medicine, Wards at 15:51 by May Su

Original article by: May Su :: Printer friendly

As medical students and doctors we know that obesity is bad. It leads to all sorts of problems – hypertension, hypercholesterolaemia, diabetes, ischaemic heart disease (and other vasculopathies), arthritis, obstructive sleep apnoea, gastro-oesophageal reflux disease. Certainly there is a much higher mortality and morbidity associated with being overweight or obese.

We have been aware of the term “metabolic syndrome” (also known as syndrome X, insulin resistance syndrome) since the 1970s. This is characterised by a group of metabolic risk factors in one person leading to an increased risk for diabetes type II, and for vascular disease such as ischaemic heart disease or cerebrovascular disease (1) (2). The biological reasons for why it occurs is poorly understood, however we are aware that abdominal obesity and increased insulin resistance plays a key factor.

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Sunday 12 November, 2006

Common MBS item numbers for general practitioners

Posted in General Practice, Michael Tam, Resources at 17:32 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

MBS Item Numbers for GPs

A one page list of the most commonly used MBS item numbers used in general practice. (Last updated: 12 November 2006) [57 Kb]

For better or worse, general practitioners who chose to run a bulk billing practice must wade through the arcane tome that is the Medicare Benefits Schedule (MBS). Despite Medicare Australia’s attempts to make this volume “user friendly” with copious indices, colour coding and cross-referencing, it is nevertheless futile using it to find an item number on-the-fly. Although the MBS has now been released on-line, I still find it next to useless given its primitive search capabilities.

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Know the NSW Public Hospital (Medical Officers) Award

Posted in Advice, Emergency Dept., Michael Tam, Resources, Wards, Workplace at 9:29 by Michael Tam

Original artcle by: Michael Tam :: Printer friendly

Resources

Public Hospital (Medical Officers) Award

Serial C4272. Industrial Relations Commission of New South Wales. Issued 16 December 2005. [117 Kb]

Public Hospital (Medical Officers) Award – Hours of Work and Tenure

NSW Health Department Policy Directive (no. PD2005_457). Issued 28 January 2005. [32 Kb]

Looking back, I never even once received a copy of the Public Hospital (Medical Officers) Award when starting work at a number of NSW Public Hospitals. The Award sets out the conditions of employment for junior medical officers (i.e., interns, residents, registrars) and is set by the Industrial Relations Commission of NSW.

The second publication is a policy directive from the NSW Department of Health that I will go through.

I strongly encourage that all JMOs read through the Award. My experience is that NSW Public Hospitals (or their administration) do not follow many of the finer details of the Award when they think that they can get away with it. This is really quite disgusting. The purpose of the Award is so that your rights and entitlements are documented in stone. You shouldn’t have to fight for them.

Don’t let medical and hospital administration get away with labour theft because of your own ignorance of your employment contract and conditions.

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Sunday 22 October, 2006

Caffeine is not a substitute for sleep

Posted in Emergency Dept., Michael Tam, Rants, Wards, Workplace at 21:53 by Michael Tam

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Caffeine is the most widely used stimulant worldwide, and this is certainly true among Australian junior medical officers. Every morning, the wards are frequented by bleary-eyed junior doctors who do not become their cheery selves until the morning “cuppa”.

Juliano and Griffiths (2004) categorised and described a “caffeine-withdrawal syndrome” in a comprehensive review, and even concluded that “there is sufficient empiracal evidence to warrant inclusion of caffeine withdrawal as a disorder in the DSM [Diagnostic and Satistical Manual of Mental Disorders]” (1).

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Monday 16 October, 2006

DMARDs for rheumatoid arthritis

Posted in General Practice, Medicine, Michael Tam, Resources, Wards at 23:33 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

Disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis

An excellent two page summary from the National Prescriber Service [65 Kb]

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Sunday 15 October, 2006

How to start an intravenous glyceryl trinitrate (GTN) infusion

Posted in Emergency, Emergency Dept., Medicine, Michael Tam at 20:20 by Michael Tam

Original article: Michael Tam :: Printer friendly

An understanding of how to start and setup an intravenous infusion of glyceryl trinitrate (GTN) is a rather useful skill. Unfortunately, setting up a GTN infusion is sufficiently complicated that it can’t be worked out in an emergency situation. In a nutshell:

Start with glyceryl trinitrate 5 mcg/min

then

increase infusion rate by 5 mcg/min every 3-5 minutes if needed

when infusion rate is GTN 20 mcg/min or more

increase infusion rate by 10 mcg/min every 3-5 minutes if needed

GTN infusions are not trivial. Call for help. It should best be performed under the supervision of someone who has experience with them (e.g., a medical registrar or emergency medicine registrar).

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Sunday 8 October, 2006

Dealing with borderline personality disorder

Posted in Emergency Dept., General Practice, In The Field, May Su, Psychiatry at 21:31 by May Su

Original article: May Su :: Printer friendly

There is the hypothesis that borderline personality disorder may not be a true personality disorders but rather a form of post traumatic stress disorder. Regardless, a person with borderline personality disorder will present with particular characteristic traits which can be difficult to manage.

Borderline personality disorder

Characterized by: instability of mood, poor self-esteem and self-image, and poor impulse control (1). These mood fluctuations may occur over the space of hours or days, as opposed to the mood fluctuations that occur in bipolar affective disorder. There is often a great fear of abandonment, and higher sensitivity to rejection (or perceived rejection). This can manifest as more unstable interpersonal relationships. The term “splitting” refers to these intense by transient relationships, which can suddenly switch from idealization to contempt.

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