Australian Doctor Australian Doctor 27th October 2017 | Page 2

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GP model identifies dementia early

The five-point GP model is more sensitive, says Dr Disler.
RACHEL WORSLEY DEMENTIA screening led by GPs can identify patients early and enhance access to specialist services, Victorian researchers say.
Their trial, carried out by 38 GPs in seven practices in Bendigo, showed that screening tools could be integrated into practice software and used in routine care to identify patients suitable for further investigation.
GPs screened 972 patients over three years using General Practitioner Assessment of Cognition( GPCOG) and geriatric depression tools.
Based on the GP-rated scores, 20 % of patients were referred for specialist cognitive assessment by a geriatrician.
Of these, 16 % were identified as having dementia, 43 % with mild cognitive impairment, 16 % with pseudodementia
and 26 % with age-related cognitive changes.
Presenting their findings at the Alzheimer’ s Australia National Dementia Conference in Melbourne, the researchers said their trial had shown that a GP-based model of dementia detection was feasible and could markedly improve referrals for cognitive changes.
Early identification of mild cognitive impairment would
allow GPs to offer lifestyle changes that could reduce the likelihood of patients developing dementia, said lead researcher Dr Rebecca Disler( PhD), senior lecturer in chronic disease management at Melbourne University.
“ If you know someone who is in that early phase, you can start addressing those broader risk factors— such as exercise, smoking, heart health, nutrition and sleep
— which are key modifiable risk factors within cognitive change,” she said.
Dr Disler said the five-point GPCOG test was a reliable tool designed for use in primary care and took only four minutes to complete.
It had also proved to be a more sensitive test for mild cognitive impairment than the“ blunt instrument” of the Mini- Mental State Examination.

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Antibiotic resistance kills 1600

MICHAEL WOODHEAD ABOUT 1600 people are dying every year from the effects of antibiotic resistance and the death toll will exceed those from cancers by 2050, academics warn.
Professor Chris Del Mar and colleagues at Bond University, Queensland said Australia was on the verge of an antibiotic resistance crisis unless a national strategy to curb GPs prescribing antimicrobials was introduced.
“ This crisis is not directly obvious to GPs working in the community. Yet GPs contribute to most of the antibiotic tonnage consumed by humans in Australia,” they wrote in the Medical Journal of Australia.
Without effective antibiotic prophylaxis, routine medical interventions such as major surgery and chemotherapy would become too dangerous to perform, they warned.
A multipronged strategy was needed that will include PBS restrictions on the prescribing of antibiotics for respiratory tract infections, audits of GP prescribing and practice visits from independent advisers, the researchers suggested.
But the strategy would also need to address the diagnostic uncertainty that GPs face with common infections, perhaps with better access to nearpatient diagnostic tests.
Simple changes, such as removing‘ no repeat’ defaults from practice software, could achieve significant and rapid reductions in antibiotic use.
Better surveillance figures were needed for communitybased antibiotic resistance rates, which could come from sentinel GP practices, they said.
Any strategy to avert antibiotic resistance in the community would require a range of interventions that produced step-by-step changes. Medical Journal of Australia 2017; online.
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