Saturday 1 January, 2011

New website: Morsels of Evidence

Posted in Good Websites, May Su, Michael Tam at 10:51 by Michael Tam

Morsels of Evidence is a new website dedicated to providing brief, digestible and clinically relevant articles on contemporaneous published evidence from medical journals to Australian general practitioners working in primary health care.  It is hoped that this will help assist GPs to practice evidence based medicine by translating findings in medical research to clinical practice suggestions.

Each article is prefaced with an “evidence cookie”; an evidence based summary that can be absorbed in a glance.  A more detailed summary follows for those whose appetite for knowledge has been whetted.

The first evidence based morsel will be published next week on 5th January 2011, and further articles will be published on Mondays, Wednesdays, and Fridays.

Morsels of Evidence:


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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Monday 27 November, 2006

Topical corticosteroids

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

Original article by: May Su :: Printer friendly

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 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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“The Creation of The Medicine Box” published

Posted in May Su, Michael Tam, Site News at 14:19 by Michael Tam

This book, “The Creation of The Medicine Box” is a comprehensive documentation of the design, goals, development and construction of this website. It contains a review and analysis of the state of the project after six months from its launch in April 2006.

This report was in addition written and designed as a guidebook to the development of online medical education resources.

“The Medicine Box” represents a significant body of work. We hope that you find both this book and the website worthwhile.

“The Creation of The Medicine Box” has been published as a hard cover publication through It can be purchased here for $US 17.95.

It can also be downloaded as a PDF ebook [4.2 MB].

Tuesday 26 September, 2006

How to manage difficult patients

Posted in Emergency Dept., General Practice, May Su, Psychiatry, Wards at 18:13 by May Su

Original article by: May Su :: Printer friendly

There are many reasons why patient interactions can be frustrating or difficult. Most commonly these can be traced to factors relating to the patient, the physician, or the health care system (1).

The management of a “difficult” patient requires time, good communication and firm limit setting.

“Difficult patients” are common and unavoidable. That being the case, “avoidance” should never be the goal of management. More often than not, these patients have real physical and/or psychological health needs. Try to restrain yourself from the all too easy temptation of categorising “difficult” with “undeserving” or tossing them into the “too hard basket”.

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Wednesday 13 September, 2006

Menopause – a summary of management

Posted in General Practice, May Su, Medicine, Resources at 23:28 by May Su

Original article by: May Su :: Printer friendly


Menopause treatment algorithm

The Jean Hales Foundation for women’s heath. Menopause, a treatment algorithm. (Australian Family Physician 2006, adapted from the Royal Australian College of General Practitioners) [102 Kb]

Menopause usually occurs in women aged between the ages of 45-55 years. In general women in their peri-menopausal years are more likely to seek medical advice than the post-menopausal woman.

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Saturday 29 July, 2006

How to manage workplace conflict

Posted in Emergency Dept., General Practice, May Su, Wards, Workplace at 20:44 by May Su

Original article by: May Su :: Printer friendly

Bullying and other workplace conflict is a common scenario as a medico – from patients, from nurses and from other colleagues. There has been increasing media coverage on this regarding in particular the NHS medical system in the UK, and our own more close to home situation in Queensland (1). In a study of the National Health System (NHS) in Britain released in 2002 specifically of junior doctors, 37% of respondents identified as being bullied in the past year and 84% had experienced one or more bullying behaviours (2).

Bullying should not be accepted passively

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Saturday 10 June, 2006

Beware of serotonin syndrome

Posted in May Su, Medicine, Psychiatry, Surgery, Wards at 10:40 by May Su

Original article by: May Su :: Printer friendly

Serotonin syndrome is a medical emergency. It usually occurs when several serotonergic agents are used simultaneously or concurrently and is due to excess serotonin in the central nervous system.

Serotonin syndrome is a clinical diagnosis and a high index of suspicion is required:

Clinical features of serotonin syndrome (1)


  • confusion
  • agitation
  • hypomania
  • hyperactivity
  • restlessness


  • hyperthermia
  • sweating
  • tachycardia
  • hypertension
  • mydriasis
  • flushing
  • shivering


  • clonus
  • hyperreflexia
  • hypertonia
  • ataxia
  • tremor

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