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FODMAP diet may help infant colic
JOCELYN WRIGHT A LOW FODMAP diet may be worth trying for breastfeeding mothers who have colicky babies, a small Australian study suggests.
Researchers from Monash University, Melbourne, who developed the low FOD- MAP diet for IBS, have now assessed its impact in 18 breastfeeding mothers whose babies met the Wessel criteria for colic.
After one week on the diet, their infants’ crying duration fell on average by 52 minutes, while fussing and crying behaviours reduced by 73 minutes.
“ Mothers reported their baby‘ is much more content’ and‘ can be put down without crying’,” the researchers noted.
“ The magnitude and speed of benefits... were impressive and dictate the need for a randomised, controlled study,” they added.
Antibiotic alert
from page 1 Aboriginal health service in NSW says the letters are likely to disproportionately target GPs working full-time in practices that see a high through-put of acute primary care patients.
“ Those are going to be the ones where people come with acute infections where the pressure is on to prescribe antibiotics,” he says, adding this may be the case for many GPs in outer-metropolitan areas in Melbourne and Sydney.
“ It may well be helpful, but I suspect some GPs may feel quite threatened,” he adds.
“ Many Aboriginal communities would have higher rates of prescribing for impetigo, tonsillitis and typhus— accounting for a higher use of antibiotics,” says Dr Senior.
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never filed a complaint against Dr Adams. But the tribunal said it was“ extremely paternalistic” of Dr Adams to complete the documents on his patients’ behalf without informing them.
“ In our view, the forging of a patient’ s signature is a complete antithesis to the requirement for complete candour between doctor and patient.”
In addition, the consent form was not just about consent to Dr Adams’ operation, but to other medical procedures associated with the operation, such as anaesthesia and blood transfusions. This meant anaesthetists, pathologists and hospital pharmacists at the hospital could have been exposed to lawsuits from patients who had not formally consented to those procedures.
The tribunal said they were“ horrified” to find out that Dr Adams had also initially blamed his staff for the forged signatures and“ displayed no discomfiture” for putting their reputations under a cloud during the investigation from AHPRA and the police.
Dr Adams was found guilty of professional misconduct and suspended for six months.
The low FODMAP( Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet recommends avoiding some poorly absorbed carbohydrates that are found in high-lactose dairy, garlic, onions, wheat, as well as certain fruits, beans and processed meats.
Dr Lisa Amir, a Melbourne GP and lactation consultant, said the results looked promising as a proof of concept, but questioned
ATO advises Health Care Homes to get tax advice
GEIR O’ ROURKE THE Australian Tax Office is urging practices in the Health Care Homes trial to seek tax advice, amid fears the chronic care initiative could turn GPs into salaried employees.
The first practices are expected to begin enrolling patients from October for the scheme, which will see chronic care MBS items replaced with monthly lump sum payments. The practices will then use the money to pay GPs for their work in caring for the patient.
Practice owners have raised concerns that taking part will force them to alter all their GP contracts, with all Medicare payments likely to be subject to state payroll taxes.
But the ATO says implementing the model will“ not necessarily” change existing relationships between doctors and their medical practice.
“ The Health Care Home model will not, of itself, create an employer / employee relationship,” the ATO said in a newsletter to participating practices.
The letter was sent out after the Department of Health took the unusual
step of commissioning ATO guidance on the issue to quell the concerns of practice owners.
However, the tax office added that its advice was not definitive, but based on broad business scenarios for sole traders, partnerships, associateships and large corporate practices.
Dr George Somers, whose practice in Emerald, Victoria, is among the first 200 selected for the trial, said the ATO’ s information was useless for independent clinics such as his, which did not fall into any of the categories mentioned.
“ My mind is not set at rest. Only one of the seven GPs at my clinic is an employee and only her patients will be participating in Health Care Homes until I have a better guarantee on this issue,” he said.
“ I just can’ t risk it because if the state revenue office deemed our contracts had varied to allow for bundled payments, it would risk a tax penalty of at least $ 100,000,” he said.
He called on the health department to provide funding for practices to obtain state revenue office rulings so all seven of the GPs at his clinic could participate.
Dr Somers says getting the payments wrong might cost him $ 100,000 in penalities.
After one week of their mothers being on the low FODMAP diet, breastfed infants’ duration of crying fell by an average of 52 minutes. whether the colic had simply run its course.
“ It does look quite substantial, the improvements, but we can’ t say for sure because the babies could’ ve been better a week later anyway,” she told Australian Doctor.
And while the low FOD- MAP diet could be worthwhile trying, she warned that it was very restrictive.
Dr Amir said she advised her patients having trouble with colic to try removing
ANTONY SCHOLEFIELD PEOPLE who develop muscle pains when taking statins should be given an action plan to avoid being taken off the drugs unnecessarily, GPs are being told.
NPS MedicineWise has released a guide to help GPs identify and manage statin-associated muscle symptoms, with a written‘ patient action plan’ that offers several options for responding to muscle pains and weakness.
The guide emphasises many kinds of muscle pain may not be statin related, and provides an algorithm based on CK levels for differing interventions.
Patients whose CK levels are less than five times the upper limit of normal( ULN) may stop statins for 2-4 weeks, while those with CK levels more than five times the ULN are advised to stop statins for 6-8 weeks.
If symptoms improve, patients can resume the statin at a reduced dose or try a different statin.
One of the main messages in the guide is that many people who experience muscle symptoms can keep taking their statin at a lower dose, and up to 90 % are able to tolerate a different statin without problems.
“[ The ] perceived high incidence of statin-associated only certain foods first.
“ I sometimes say to people:‘ is there anything you couldn’ t eat as a child or other people in the family couldn’ t eat?’ as it might be worth eliminating those foods.
“ Sometimes people do find that helpful,” she said.
The FODMAP diet proved acceptable to the breastfeeding mothers, with 16 of the 18 mothers choosing to continue with if for a further four to eight weeks, the authors said.
While it was not yet clear whether there was a causeeffect relationship between FODMAPs and colic symptoms, the authors postulated that the changes in gut microbiota with a low FODMAP diet would also alter the breastmilk microbiota in breastfeeding mothers. Journal of Human Nutrition and Dietetics 2017; online.
Push for action plans to manage statin pain
Many kinds of muscle pain may not be statin related.
muscle symptoms risks compromising adherence to an otherwise highly efficacious and generally well-tolerated class of medicines,” they say.
Perth GP Dr Brett Montgomery said formal guidelines and action plans for muscle pain might help convince statin users that their doctor was not‘ making it up as they go along’.
“ These guidelines back up what I already do, which is reassuring,” he told Australian Doctor.
He said he was sometimes sceptical about patient claims that statins had caused muscle pain, but it was difficult to be sure.
“ I haven’ t done alternative dosing, but I have stopped and started patients on a different statin,” said Dr Montgomery, an associate professor of general practice at the University of WA.
For the NPS guide, see bit. ly / 2tVhLUt
4 | Australian Doctor | 30 June 2017 www. australiandoctor. com. au