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Background: Gallbladder polyps are increasingly being identified due to the widespread use of abdominal ultrasound imaging. They are concerning lesions due to their potential malignant risk. It is hoped that managing them correctly will play a role in improving poor survival rates of gallbladder cancer. Awareness of these lesions is lacking. Management continues to be guided by expert opinion and observational studies and a number of consensus statements exist. Objective: This paper reviews and summarises the current literature and provides an approach for general practitioners based on the available guidance. Discussion: Although minor variation exists between consensus statements, the risk of malignancy for gallbladder polyps is still largely dictated by size, with those ≤5 mm generally considered to pose little risk and not requiring follow-up, whereas those ≥10 mm considered at greater risk and requiring referral for cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: Reducing weight stigma in healthcare is critical to supporting and improving the health of people living with overweight or obesity and decreasing the risk of adverse patient outcomes. We were invited as stigma researchers to participate in an online workshop alongside community members, healthcare professionals and policymakers to codesign guidance for reducing weight stigma in healthcare. This workshop prompted us to reflect on why and how weight stigma should be addressed in healthcare, and to provide recommendations for healthcare professionals and policymakers to reduce weight stigma in healthcare. Objective: This paper presents our reflections and recommendations for addressing weight stigma in healthcare following the codesign workshop. Discussion: Recommendations include targeting individual healthcare professionals and involving clear, practical guidelines and training that leverage the notions of 'do no harm', improving practice and recognising biases. Importantly, such strategies must be couched in broader structural approaches to weight stigma reduction. [ABSTRACT FROM AUTHOR]

The importance of providing institutional assistance to adult learners with visual impairment throughout the COVID-19 pandemic cannot be overemphasised. This paper examined the experiences of adult learners with visual impairment, whose studies were significantly affected by the implementation of lockdown and social distancing that led to their dropping out from one university in Eswatini. Using phenomenological design, three adult learners with visual impairment, who dropped out of the university, were chosen to participate in the study. Adult learners responded to a semi-structured interview guide during the individual conversations. The data were analysed using qualitative thematic analysis. Ethical considerations such as informed consent and anonymity were observed. The findings revealed the themes of social isolation, personal challenges, and lack of institutional assistance. Adult learners with visual impairment reported that there was no support received from the institution. Furthermore, adult learners indicated that some lecturers excluded them by not communicating and providing suitable materials for their condition. The participants acknowledged the awareness of using technology during the COVID-19 pandemic; however, they stated the lack of devices, inadequate technology skills, and their reliance on sighted adult learners and peers to read the content for them. This paper suggests that lecturers at this university in Eswatini be trained on how to teach and support adult learners with visual impairment, and the institution should consider developing a comprehensive education policy to cater to all different adult learners. Comprehensiveness has always been a challenge for adult learners with disabilities generally, but the pandemic has escalated it. [ABSTRACT FROM AUTHOR]

We ask for suffrage that we may stand side by side with our fathers, husbands, brothers, and sons, working with them ... for a noble political life for the country's wealth. Not for a man's place do we ask, but for the fullness of women's. (The Argus, 1891, p. 9) In the late nineteenth century, adult and public learning pedagogy were the key instruments utilised in the campaign to achieve Victorian Women's Suffrage. The democratic process of changing state government legislation on franchise demanded multiple pedagogical methods. Through the actions of Bessie Harrison Lee (1860-1950), this international women's culture (McLean & Baroud, 2020, p. 506). Part of this culture featured Australian women adopting the petition as a political instrument. The petition had already had a long history in Britain, used by groups with little political influence. Ian Fletcher's conception of the British Empire as "a set of relations, rather than the sum of their parts, as frameworks structuring political, economic and cultural exchanges between metropole and colonies" is useful in understanding how political ideas travelled to and were adapted in the Australian context (Fletcher, Levine & Mayall, 2012, p. xiv). This paper argues that new ways of knowing were made possible by Lee, who, empowered by the evangelical faith (her cultural capital) spoke out confidently in public spaces such as town halls, outside public bars, and on the front doorsteps of women's homes in both cities and rural towns. These spaces were the places of learning, or as Bourdieu described, the field. Also, the meeting places of the WCTU, whether private lounge rooms or church halls, enabled women to support each other in the political process of debate, addressing community issues, and devising strategic plans to improve the lives of women. Through critical discourse analysis of newspaper reports, WCTU's publication The White Ribbon, the Victorian Alliance publication Alliance Record, and Lee's autobiography, this paper identifies these learning spaces. It also explores the community of practice in WCTU meetings, doorknocking, pamphleteering and the physical act of collecting signatures for the 1891 'Victorian Monster Petition'. The language and actions used to enact democratic activity that involves women in ways of saying, doing, and being full citizens are unlocked; however, the WCTU was exclusionary of Indigenous and non-Anglo-Celtic ancestry. Therefore, their learning spaces were complicit in the Great Silence (Stanner, 1968). [ABSTRACT FROM AUTHOR]

Background: Cardiac implantable electronic devices (CIEDs) are a core component in the management of heart rhythm disorders. The complexity of devices, the information gathered and therapy delivered by CIEDs continues to advance at pace. Objective: The aim of this paper is to provide an update on advances in CIED technology and how this applies to managing patients with CIEDs in general practice. Discussion: In recent years, there have been notable advances in CIED technology. These include widespread magnetic resonance imaging compatibility and automated algorithms to assist in the clinical management of patients. There is the ability for clinicians and pacemaker clinics to monitor devices remotely, avoiding in-clinic visits. Options are now available for leadless pacemakers and subcutaneous defibrillators as an alternative to indwelling leads and associated infection and vascular issues. Techniques have been developed to allow leads to capture the native conduction system, providing physiological cardiac activation (conduction system pacing) for treatment and prevention of heart failure. [ABSTRACT FROM AUTHOR]

Background Interest in using primary care data for research is growing with increasing recognition of its potential for improving healthcare. Many issues exist, some inherent in the data and others external. Objective This paper explores the main issues associated with the use of primary care data for research and proposed solutions to address them. Discussion Issues related to the use of primary care data for research are complex. Government reimbursement system administrative data have limitations as they lack clinical detail. General practice electronic medical record data are more suitable; however, challenges include variable data quality and interoperability. There are concerns from general practices and the public about data access and use. Strategies to address these issues include incorporating bestpractice principles, implementing standards and data quality frameworks, creating partnerships between data custodians and ensuring robust governance systems exist. Leadership and the will of key stakeholders to reform, with governmental support in implementing required actions, must be prioritised [ABSTRACT FROM AUTHOR]

Background Obstructive sleep apnoea (OSA) is a highly prevalent condition associated with significant adverse health consequences affecting multiple organ systems. As the first point of contact for most patients with OSA, general practitioners (GPs) have an important role in the diagnosis of this common sleep disorder. Objective The aim of this paper is to improve awareness of common risk factors for and clinical presentation of OSA in primary care to improve patient health outcomes. We seek to understand how screening tools, such as the OSA50 questionnaire and the Epworth Sleepiness Scale, can help GPs identify patients who are at high risk for OSA with significant daytime sleepiness. Discussion Patients at high risk of symptomatic moderate-severe OSA should proceed to further investigation with sleep study testing. Referral to a sleep physician should be considered for patients with complex presentations or other suspected sleep disorders, commercial drivers, and those who fail to comply with or respond to initial OSA treatments. [ABSTRACT FROM AUTHOR]

Background There are a variety of medical and surgical treatment options available today for the management of lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Objective The aim of this paper is to highlight the various treatment options available for the management of bladder outlet obstruction secondary to BPH and discuss the benefits and potential drawbacks of each. Discussion Lifestyle and dietary modification and medical therapies, such as an alpha-1 blocker as monotherapy, should be considered as first-line when initially counselling a patient for LUTS secondary to bladder outlet obstruction due to BPH. If bothersome LUTS persist despite medical management, or if medical management is not suitable or preferable, then surgical interventions can be considered. The mainstay of surgical intervention has traditionally been transurethral resection of the prostate (TURP); however, the treatment landscape is rapidly evolving with the development of minimally invasive procedures. [ABSTRACT FROM AUTHOR]

Funded by the Social Sciences and Research Council of Canada (SSHRC) grant, this national study examines arts-based adult education organizations involved in dance, music, drama, and visual arts with a philosophical perspective aligned with a multiliteracies theoretical framework. Multiliteracies considers how cultural and linguistic diversity must be fostered to encourage adults to thrive in all learning environments and recognizes that multimodality provides an expanded way to engage in literacy practices. Utilizing Carey Jewitt's four theoretical tenets to characterize multimodality serves to structure the analytical framework for the findings and discussion of this paper. Multiple case studies and constructivist grounded theory were used for the methodology. Some of the sites discussed in this paper include an art gallery; an immigration museum; and a chamber music organization that offers interactive performances. Participants included adult educators and learners who had options around face-to-face interviews; observations; document analysis of lesson plans or exemplars; or secondary data analysis of original film footage shot in these spaces. This research has found that arts-based approaches can infuse the work of adult educators to engage adult learners in inclusive pedagogy and active citizenship. [ABSTRACT FROM AUTHOR]

Background Exercise is widely understood to improve health outcomes in children and adolescents and to contribute to the prevention and management of many chronic conditions. Australian children are not currently meeting the recommended physical activity guidelines, and these habits are likely to extend into adulthood without intervention. Objective The aim of this paper is to provide general practitioners (GPs) with the tools to perform a basic exercise assessment with children and adolescents and an understanding of the core principles of exercise prescription for general and special paediatric populations. Discussion GPs are limited by time often precluding the assessment of exercise levels in children and adolescents unless it is immediately relevant to their presentation. This article discusses simple methods of assessing physical activity, the importance of appropriately prescribed exercise and its benefits for physical, psychological and social health and wellbeing. [ABSTRACT FROM AUTHOR]

Background Most Australian adults are insufficiently physically active, creating an economic and moral imperative to support exercise care in general practice. Objective To provide an overview of exercise care in general practice to support sustained solutions for patients living with chronic disease. Discussion Exercise care should be considered a fundamental component of high-quality consultations, including assessing, advocating and monitoring for physical activity. Exercise levels and cardiorespiratory fitness can be considered ‘vital signs’ for tracking over time. Modest gains in physical activity levels have clinical benefits, warranting approaches that engage patients in any amount of time in exercise. Resources are available to support general practitioners (GPs) to incorporate exercise care into routine consultations. GPs can print or save the links provided in this paper and use platforms such as GoShare to connect patients to the resources. Over 15 exercise-specific clinical practice guides are available through The Royal Australian College of General Practitioners’ Handbook of non-drug interventions. [ABSTRACT FROM AUTHOR]

Background Endometriosis is a chronic inflammatory condition defined as endometrial-like tissue proliferating outside the uterus. It is a common yet frequently under-recognised condition affecting one in nine Australian women. Objective This paper aims to provide a summary of the recommendations for the diagnosis and management of endometriosis-associated pain and infertility from the most recent evidence-based guidelines on endometriosis by the European Society of Human Reproduction and Embryology, the Royal Australian College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence. Discussion Effective management of endometriosis requires prompt diagnosis to enable early multidisciplinary intervention that aligns with patient needs and priorities. Assessment includes a thorough history, pelvic examination where appropriate and referral for transvaginal ultrasound and/or magnetic resonance imaging. If endometriosis is suspected based on clinical symptoms but imaging is negative or empirical treatment is ineffective, individuals should be referred to a gynaecologist for further assessment and consideration of laparoscopy. Management options include hormonal and surgical therapies. [ABSTRACT FROM AUTHOR]

Deployed surgical teams work together to perform time-critical damage control resuscitation However, the team often includes members who have never worked together or in the field A successful team can rapidly acquire knowledge of their clinical environment and each other In this paper, we explain how Immediate Action Drills (IADs) for the operating theatre department (OTD) can be used to orient individual clinicians to the field and how collective training in these drills can maximise the safety and efficiency of the surgical team [ABSTRACT FROM AUTHOR]

The underlying mechanism of MCS is not understood, as a result, there are no accepted diagnostic tests. This situation has had a major effect on the acceptance of MCS as a clinical entity. The lack of diagnostic tools has discouraged clinicians to address the problem in their patients. This paper reviews the current approaches to MCS, with particular attention to the role of adaptive immunity. Immunoglobulin free light chains (FLCs), specific to conjugated chemical haptens, may be involved. The production of FLCs can be elicited by chemical concentrations far below those required for a T cell response. Crosslinking of FLCs on mast cells by conjugated haptens, in the respiratory mucosa, releasing mediators and cytokines, produces local inflammation. Over time, repeated mast cell activation may sensitise neural pathways, lowering the threshold for activation, both peripherally, and subsequently in the central nervous system (CNS). As a result, there may be increasing prominence of CNS-based symptoms. If assays can be developed for FLCs specific to hapten-protein conjugates, then specific chemicals eliciting symptoms can be identified in individual patients. Also, there would be wider acceptance of MCS as a significant clinical problem. [ABSTRACT FROM AUTHOR]

Background Institutions are established patterns of recurrent social relationships playing a fundamental part in all our lives. The family is the best-known institution, but other 'total' institutions serve as organisations directly affecting the lives of many individuals in the healthcare sector. Objective This paper examines the sociological theory of institutionalisation as applied to individuals admitted to aged-care facilities, where the complete life-rounds of inmates occur within clearly defined limits. The study provides a framework to enable general practitioners, nurses and healthcare professionals to better appreciate the processes involved as individuals adapt to their new environment. Discussion Sociology provides valuable insights for healthcare providers in understanding how individuals adapt to their loss of independent living and find themselves subjected to intimate regulation in the total institution. The biopsychosocial model of healthcare delivery is better understood when we as health professionals have greater insights to appreciate the competing processes at work. [ABSTRACT FROM AUTHOR]

During my 20-year career as a specialist language and literacy educator, I have found that inclusive and experiential classroom pedagogies stimulate and engage learners of all ages and demographics. What is more, these same methods can be effectively implemented to support individuals with diverse learning needs. This article discusses the 8 Ways of Aboriginal Learning (NSW Department of Education, n.d.) as a pedagogical approach for engaging and supporting learners with diverse needs and, using a case study example, demonstrates how the holistic integration of different strategies enhances learning opportunities for all students. Whether you see yourself as an educator, teacher, trainer, mentor or supervisor, and regardless of whether you 'teach' in a standard classroom, workplace settings (e.g. office building, health clinic), or a communitybased learning centre, the ideas and approaches presented in this paper will help you construct learning opportunities that will support student success and make lesson planning and preparation more effective and time-efficient. [ABSTRACT FROM AUTHOR]

The article is an editorial from the Australian Journal of Adult Learning, discussing various topics related to adult learning education. It mentions changes in Ministerial portfolios in the Federal Albanese Government and highlights the Labor government's commitment to adult and lifelong learning. The journal includes four refereed papers on topics such as academic advising for adult learners, Bessie Harrison Lee's fight for suffrage, adult community education in the theatre and arts, and perceptions of adult learning for visually impaired individuals during the pandemic. The article also includes book reviews and emphasizes the importance of pedagogy, policy, and practice in adult education. [Extracted from the article]

This article explores the crucial roles of high-demand amino acids (HDAA), particularly glycine and histidine, in metabolic health beyond their traditional function in protein synthesis. Highlighting the significance of both protein and non-protein amino acids, it delves into their diverse metabolic functions and their impact on overall well-being. The concept of high-demand amino acids (HDAA) is introduced, emphasizing the disproportionate rates of utilization and excretion of certain amino acids, thus defining their pivotal role in metabolism. Glycine emerges as a prime example of an amino acid with limited endogenous production despite being classified as nonessential, particularly critical for the synthesis of structural proteins like collagen. Histidine, an essential amino acid, demonstrates skewed demands due to its involvement in haemoglobin synthesis and antioxidant activity, posing implications for conditions such as anaemia and prolonged fatigue. The paper underscores the necessity for dietary supplementation strategies to address deficiencies in glycine and histidine, essential for maintaining metabolic equilibrium. Furthermore, insights into the metabolic interplay of these amino acids offer promising therapeutic avenues for optimizing health and enhancing overall well-being. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses the articles in the issue on topics including exploring humanities in medicine, expanding content in medical school curriculums, and humanities' relevance in general practice.

Introduction There is an increasing recognition of the need for deployed intensive care physicians (intensivists) with the changing nature of conflict Required capabilities of military intensivists are determined by the operational context and is different to those of the civilian work environment We sought to identify an operational clinical skillset for military critical care physicians Methods To answer the research question, we performed a literature review to identify existing intensive care competency frameworks and define the scope of practice for a deployed intensivist Quantitative and qualitative research articles of any design were eligible for inclusion if the context included intensive or critical care medicine in a deployed environment Articles were identified on PubMed, Medline, EMBASE, Google Scholar and EBSCO and included in the review if they met inclusion criteria Results Several quantitative studies described battle injury patterns and identified predominant mechanisms of injury Deployed intensivists frequently have to manage patients with non-combat injuries and medical conditions Paediatric patients also require ICU care in a deployed environment with high injury severity and in-hospital mortality We identified a subset of qualitative articles that described the general characteristics of military critical care patients; important considerations related to infections in a deployed environment and ethical and legal decision making Several articles discussed training and equipment considerations (including ICP monitoring, ultrasound and renal replacement therapy) in preparation for potential peer-on-peer conflicts Discussion The reviewed articles allowed us to identify the skills a deployed intensivist requires beyond the baseline civilian clinical skillset We used this information to propose a core operational clinical skillset for deployed intensivists This intends to help individual clinicians and commanders identify training pathways to prepare competent clinicians who are adequately prepared for military deployments [ABSTRACT FROM AUTHOR]

Augmentative and alternative communication (AAC) options are often utilised by people with communication disability (PWCD). A limited range of bilingual AAC systems are currently available, and uptake of these options is impacted by misconceptions among speech-language pathologists and PWCD, and clinician knowledge and skill gaps. To explore literature on AAC use in more than one language for bilingual PWCD. A systematic search of six databases and grey literature was conducted to identify research evidence on bilingualism, AAC, and PWCD. A descriptive synthesis was generated from charted data. A total of 16 articles met the eligibility criteria. This included four qualitative research studies, one participatory action research study, one quasi-experimental study, one case study, one case series, and eight expert opinion papers, primarily focused on the paediatric population and high-technology AAC. Linguistic, social, and ethical bases were identified for the development and use of bilingual AAC systems. Studies found bilingual AAC use was not detrimental to language development, promoted self-identity among users, and increased caregiver involvement in supporting AAC use. However, small sample sizes limit the generalisability of these findings, and considerable barriers exist to developing and implementing bilingual AAC. This review highlights the need for developing AAC that is accessible to PWCD in each of their languages. Further research is needed to co-produce efficient and culturally responsive bilingual AAC systems with PWCD and/or their caregivers and identify effective strategies for supporting implementation. [ABSTRACT FROM AUTHOR]

This paper describes the planning and implementation of a strategy for increasing classroom supports for school-aged children who use augmentative and alternative communication (AAC). Speech and language pathologists (SLPs) in the Tasmanian state education system provide valuable supports to school children and staff, however there are limited resources to meet the need. The 'AAC in Classrooms' project was implemented in order to build the capacity of school staff to learn and utilise AAC in a sustainable way through online learning modules and a community of practice. A multidisciplinary working group involving SLPs and inclusion support staff was formed. The group implemented actions based on survey data gathered from school staff across the state regarding AAC skills, knowledge, and learning needs. The project is entering a monitoring and evaluation phase with early outcome data indicating that the project activities are meeting the ongoing AAC learning needs of school staff in Tasmanian state schools. [ABSTRACT FROM AUTHOR]

Fatigue jeopardises soldiers' lives, and despite caffeine being the approved wakefulness aid in the Australian Defence Force (ADF), its efficacy equals a placebo with unwanted side effects. The US Military uses modafinil as an alternative, but no ADF studies on modafinil exist. This article argues for exploring alternatives, ensuring consent and conducting willingness-to-participate studies before conducting ADF modafinil trials. [ABSTRACT FROM AUTHOR]

Background: The widely-used Dental Anxiety Scale (DAS) has practical and theoretical limitations. The Index of Dental Anxiety and Fear (IDAF-4C) was developed to overcome these shortcomings but requires more psychometric analysis to determine its utility. Purpose: To compare DAS and IDAF-4C validity and reliability among New Zealand Defence Force (NZDF) personnel. Material and methods: A survey of NZDF recruits and officer cadets collected data on dental anxiety using the IDAF-4C, the DAS and a global dental anxiety item. Results: Some 134 individuals completed the questionnaire. Confirmatory factor analysis for the IDAF-4C showed that a single factor explained 72.4% of the variance. The IDAF-4C showed high internal consistency reliability (α = 0.94). Confirmatory factor analysis for the DAS showed that a single factor explained 69.5% of the variance. The DAS showed high internal consistency reliability (α = 0.85). While the IDAF-4C showed a consistent gradient in mean scale scores across response categories of the global dental anxiety question, the gradient for the DAS was less consistent. The IDAF-4C and DAS showed considerable concordance (r = 0.71). Conclusion: The IDAF-4C demonstrated excellent psychometric properties, validity and reliability, and it is a valid and useful instrument for measuring dental anxiety and fear in Defence Force personnel. [ABSTRACT FROM AUTHOR]

Importance: Since 2001, 3.5 million United States service members deployed overseas in support of the post-9/11 Global War on Terror. While healthy and fit upon deployment, veterans have experienced many complex and often unexplainable illnesses and chronic diseases, with more than 520 000 being diagnosed with cancer. With the implementation of the VA MISSION and PACT Acts, post-911 veterans are increasingly being seen in non-VHA healthcare facilities by non-physician providers. Objective: To assess the readiness of registered and advanced practice nurses to provide knowledgeable and competent healthcare for post-9/11 veterans in the civilian healthcare system. Design, setting and participants: A web-based survey was administered by the HunterSeven Foundation (a Veteran-founded non-profit organisation), with 541 nurse respondents. Primary outcomes and measures: Questions were designed to assess military knowledge, comfort level caring for veterans, self-reported proficiency and prior training of participants. Mean differences were compared using a restricted maximum likelihood, fixed-effects model, with incidence between groups estimated as log-binomial relative risks. Results: Meaningful gaps in clinical knowledge of screening for and treatment of medically related conditions were identified. Our assessment also highlighted a sparseness of knowledge for making care recommendations based on apposite resources. Conclusions and relevance: Cognitive biases among healthcare providers in the civilian sector may lead to missed and/or delayed diagnoses, therefore emphasising the need for additional training focused on caring for post-9/11 veterans. [ABSTRACT FROM AUTHOR]

Melanoma is the most serious form of skin cancer. While classical risk factors are well described, the literature debates whether specific subgroups in the community have an increased risk of developing the condition. These include those who work as aircrew or in the defence forces. While occupational skin cancer is increasingly recognised, it is likely still under-reported. This narrative literature review explores the published literature on melanoma, focusing on aircrew and Defence Force members, as results have potential implications for these workers' selection, protection and surveillance. Many but not all studies show that aircrew and Defence Force members may have an increased risk of melanoma, but gaps in the literature are highlighted. In particular, much of the data reviewed is from several years ago and primarily relates to Northern Hemisphere settings. The importance of exploring the current context in the Australian setting to inform future practice is outlined. [ABSTRACT FROM AUTHOR]

Background: Buruli ulcer (BU) is caused by Mycobacterium ulcerans, an environmental pathogen that causes severe skin and soft-tissue necrosis. In Australia, cases of BU are acquired in endemic regions, which include Victoria and Far North Queensland, but those who have visited these regions can present to health practitioners anywhere. Objective: This article provides Australian general practitioners with an overview of BU, including its epidemiology, transmission, clinical features, diagnosis and management. Discussion: BU can manifest as an ulcer or as a nonulcerated skin lesion, such as a plaque, nodule or oedema. Diagnosis can be achieved with a dedicated Mycobacterium ulcerans polymerase chain reaction (PCR) test performed on a wound swab. Swabs on non-ulcerated disease have a high false negative rate, and a PCR test should be performed on a tissue biopsy to confirm disease. Most cases are managed with prolonged antibiotic therapy - commonly a combination of oral rifampicin and clarithromycin or fluroquinolone (moxifloxacin or ciprofloxac. [ABSTRACT FROM AUTHOR]

Background: Low back pain is one of the most common presentations in general practice. Although there is excellent evidence regarding best management of the condition, in primary care there is often overuse of less effective and expensive options, whereas effective, inexpensive options are underused. After broad consultation and evidence review, the Australian Commission on Safety and Quality in Health Care has developed a clinical care standard in response to this identified gap between best and actual practice. A clinical care standard focuses only on key areas of care where the need for quality improvement is greatest. Objective: We explore the new standard using a typical patient scenario in primary care to highlight evidence-based approaches for challenging aspects of management, such as imaging and pain management. Discussion: General practitioners (GPs) might find the practical GP 'quick guide' resource from the standard useful to support their care of patients with low back pain. [ABSTRACT FROM AUTHOR]