Health Care Homes fear
Push to inject user choice
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Exercise backed for fibromyalgia
Low-impact aerobics produces benefits in pain .
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YOUR TRAVEL ADVICE IS THE LAST THING ON HIS MIND Up to 98 % of travellers fail to adhere to safe eating and drinking advice whilst abroad 1
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CLARE PAIN AEROBIC exercise may give some benefit to people with fibromyalgia , a Cochrane Review shows .
Activities such as running , cycling , low-impact aerobics and walking produced benefits in pain , stiffness and physical function , as well as health-related quality of life for people diagnosed with fibromyalgia , according to the review of eight randomised trials .
For exercise programs that lasted between six and 24 weeks , there was lowlevel evidence of improvements in pain and physical function , and moderatequality evidence of improvement in quality of life .
However , there was little difference in fatigue and stiffness .
The review found less evidence for the long-term effects of exercise in patients with fibromyalgia , showing only small differences in pain and physical function at between 24 weeks and four years of follow-up .
The studies in the review covered supervised 35 minute exercise sessions provided 2-3 times a week .
Rheumatologist Professor Geoffrey Littlejohn , of Monash University , Melbourne , said the study
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PBS Information : This product is not listed on the National Immunisation Program ( NIP ) or the PBS . validated what he saw in clinical practice .
“ We see exercise as one of the main interventions or strategies for managing chronic pain , including fibromyalgia .
“ Any sort of aerobic exercise is appropriate that suits the patient . Three to five times a week , 30 minutes each time is a good strategy ,” Professor Littlejohn told Australian Doctor .
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MINIMUM PRODUCT INFORMATION . DUKORAL ® Oral Inactivated Cholera Vaccine . INDICATIONS : Cholera caused by serogroup O1 Vibrio cholerae : Active immunisation of adults and children ≥ 2 years of age , who will be visiting areas epidemic or endemic for cholera and who are at high risk of infection . CONTRAINDICATIONS : None known . PRECAUTIONS : Postpone immunisation in cases of acute illness ; Not protective against species other than O1 V . cholera ; Does not necessarily prevent spread of cholera via a vaccinee exposed to V . cholerae bacteria ; Not a sole measure in prevention of cholera outbreaks . Encourage clean hygiene practices ; Subjects infected with HIV ; Pregnancy Category B2 . Use in Lactation : DUKORAL may be administered to lactating women . INTERACTIONS : Avoid food / drink 1 hour ± vaccination ; Buffer may affect other oral vaccines . Administration of encapsulated oral typhoid vaccine should be separated by ≥ 8 hours . ADVERSE EFFECTS : Abdominal discomfort , loose stools , headache , rhinitis , cough or other respiratory symptoms ( see full PI ). DOSAGE & ADMINISTRATION : Dissolve effervescent granules in 150mL water ( pour away 75mL for children 2 – 6 years ), mix DUKORAL suspension with buffer solution and drink . Adults , children > 6 years : 2 doses ; Children 2 – 6 years : 3 doses ; administer doses at intervals ≥ 1 week . Re-start basic immunisation if > 6 weeks elapse between doses . Booster : Adults , children > 6 years : 2 years ; Children 2 – 6 years : after 6 months . PRESENTATION : Whitish oral liquid suspension ( vaccine ) in a single dose glass vial with effervescent granules ( buffer ), in an accompanying sachet . STORAGE : Store at 2˚C to 8˚C . Refrigerate , do not freeze . Based on TGA approved PI dated 9 September 2003 , last amended 6 August , 2015 . REFERENCES : 1 . Kozicki M et al . Int J Epidemiol . 1985 ; 14 ( 1 ): 169 – 172 . 2 . Mattila L et al . J Travel Med 1995 : 1 ; 2 ( 2 ): 77 – 84 . 3 . Steffan R et al . Trav Med Infect Dis . 2003 ; 1:80 – 88 . 4 . NHMRC . The Australian Immunisation Handbook 10th Edition . 2013 . 5 . DUKORAL ® Approved Product Information , August , 2015 . Product Information is available from Seqirus ( Australia ) Pty Ltd . 63 Poplar Road , Parkville , VIC 3052 . ABN 66 120 398 067 . Medical Information : 1800 642 865 . ® DUKORAL is a registered trademark of Valneva Sweden AB . Seqirus™ is a trademark of Seqirus UK Limited or its affiliates . Date of preparation : July 2017 . SEQ / DUKO / 0517 / 0050a . 14259-AD .
Current European guidelines for fibromyalgia recommend regular exercise in addition to patient education and psychological interventions .
They advise that physical activity interventions should be introduced gradually , but do not differentiate between aerobic and strengthening exercise . Cochrane Library 2017 ; online .
Health Care Homes fear
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MBS item descriptors when looking after patients .
Dr Walid Jammal , who signed up his Western Sydney practice for the trial last week , said that GPs needed to embrace the uncertainty .
“ There is no certainty ... but this is what a trial is all about . It ’ s not about being funded to do the same thing we are doing now ; it is about innovation and trying to do things differently .”
According to the terms of the contracts , practices must receive permission from the government to leave the program .
Once they sign , each practice will get a $ 10,000 grant to cover training and start-up costs , but how much ongoing funding they will receive per patient is still unclear .
Dr Bill Coote , a former policy advisor to ex-health minister Sussan Ley , said : “ The Prime Minister himself has called Health Care Homes one of the biggest health reforms since the introduction of Medicare and maybe it ’ s inevitable , maybe it ’ s a good thing .
“ But we need to start getting past the aspirational rhetoric and start looking at the real political and economic implications of it .”
Push to inject user choice
from page 1 for the GP to nominate a particular medical specialist would reduce the opportunity for a patient to benefit from these existing relationships ,” the RACGP said in a submission to the commission . “ The RACGP cautions the Productivity Commission about the unintended consequences of promoting patient choice at the expense of appropriate use of health resources .”
The final Productivity Commission report is expected to be published in October .
See the full report here : bit . ly / 2tvS2p
8 | Australian Doctor | 28 July 2017 www . australiandoctor . com . au