4 AUGUST 2023
The country ’ s leading independent medical publication
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FOUR IN THIS ISSUE
Paediatric burns HOW TO TREAT , PAGE 19
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Mark Butler interview
NEWS REVIEW , PAGE 56
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Professor Simon Willcock
The ADHD epidemic
GUEST EDITORIAL , PAGE 14
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What makes a ‘ top doc ’? NEWS , PAGE 9 |
CVD guidelines revamp
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But risk categories now ‘ puzzling ’, says leading GP
Rachel Fieldhouse GPs now have access to revamped CVD prevention guidelines and a risk calculator , with the outdated Framingham-based risk equation
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officially consigned to the scrap heap .
The new Australian CVD Risk Calculator — developed by the National Heart Foundation of Australia and endorsed by the RACGP — is a recalibrated version of the contemporary PREDICT-1 ° algorithm based on a New Zealand primary cohort study .
“ It is from a population more relevant to Australia , and we think it is more
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predictive and hopefully more valuable ,” Heart Foundation chief medical adviser Professor Garry Jennings said .
In addition to traditional risk variables , the calculator now takes into account recent use of antihypertensives , lipid-lowering drugs or antithrombotics , as well as AF diagnosis and postcode as measures of socioeconomic status .
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A sub-equation specific to patients with type 2 diabetes has also been added , which allows GPs to factor in HbA1c , time since diabetes diagnosis , eGFR , urinary albumin-to-creatinine ratio , recent insulin use and BMI .
In addition , the CVD risk categories have been adjusted with new ranges :
• Low ( less than 5 % risk over five years )
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• Intermediate ( 5-10 % risk over five years )
• High ( ≥10 % risk over five years ).
For the first time , risk estimates from the calculator can be adjusted using reclassification factors , including chronic kidney disease , severe mental illness , family history of premature CVD , ethnicity and — in a PAGE 3
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AAP IMAGE
How futile was Dr Teo ’ s surgery on Patient A ?
NEWS , PAGE 5
The ‘ hidden curriculum ’ affecting GP numbers
Sarah Simpkins THE RACGP and ACRRM have failed to fill training positions , and a generation of GPs is nearing retirement — so it is no surprise that alarm bells are ringing for the GP workforce .
The dean of a major medical school says one of the big issues is that general practice is still losing ground to hospital specialties at the university level .
“ If you are in a busy , high-volume practice that does not have capacity for an additional consulting room or two for a student , what you have is a student sat in a corner , watching someone else do something and
maybe asking a question or two ,” said Professor Richard Murray , the dean of medicine and dentistry at James Cook University , Queensland .
“ That is not a high-quality teaching or training experience , and it
‘ General practice is losing ground to hospital specialties .’
impacts students , junior doctors and the training GPs themselves .” He said the Australian government was spending PAGE 3
NEW PBS LISTING FOR SEVERE
ASTHMA 1
Extrafine * Trimbow is the only 3-in-1 option for adults with asthma who prefer a pMDI 1 , 2
* Mass median aerodynamic diameter particle size < 2 μm . 2
Trimbow 200 is indicated for the maintenance treatment of asthma , in adults not adequately controlled with a maintenance combination of a high dose of ICS / LABA , and who experienced ≥1 exacerbations in the previous year . 2
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Please review Product Information before prescribing . Product Information is available by scanning the QR code .
PBS Information : Authority required ( STREAMLINED ). Severe Asthma ( 200 / 6 / 10 mcg presentation only ). Criteria Apply . Refer to PBS Schedule for full information .
NEW HIGH
STRENGTH 2 Abbreviations : ICS , inhaled corticosteroid ; LABA , long-acting beta2-agonist ; PBS , Pharmaceutical Benefits Scheme ;
pMDI , pressurised metered dose inhaler . References : 1 . Pharmaceutical Benefits Scheme ( PBS ). Available at : https :// www . pbs . gov . au . 2 . Approved Trimbow Product Information . Chiesi Australia Pty Ltd , Suite 3 , 22 Gillman Street , Hawthorn East , VIC . 3123 , Australia . Tel : + 61 3 9077 4486 ; Fax : + 61 3 8672 0792 ; Email : medicalaffairs . au @ chiesi . com ; Website : www . chiesi . com . au . Copyright © Chiesi 2022 . All rights reserved . Date of preparation : December 2022 . AU-TRI-2200167 . CHIE00042c .
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