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Objective: To estimate the resource implications associated with health care assessments for patients with chronic disease and those aged 75-years and over., Setting: A four doctor general practice on the NSW Central Coast., Method: Examination of eligible patients according to health assessment guidelines, and development of health care plans where appropriate. Economic modelling of time and monetary resource requirements for these activities and the follow up management of identified health care issues., Results: Eighty-four patients (80.8%) had a total of 181 additional health care issues identified--73 were geriatric specific, 32 preventive, 63 general medical and 13 of a support services nature. The assessments required a total of 61.5 hours (mean: 36 mins)--GP: 42 hours (mean: 24 mins); nurse: 20 hours (mean: 11 mins)--at a total cost to Medicare of $15,075 (mean: $145). Modelling of the resource requirements estimate a time requirement of 117.5 hours for the GP (mean: 1.1 hours), 57 hours for specialists (mean: 33 mins) and 140 hours for allied health providers (mean: 1.3 hours). The costs to the community are $11,511 for the GP (mean: $111), $18,791 for specialists (mean: $181) and $6688 for allied health care professionals (mean: $64)., Conclusion: Health assessments of an 'at risk' population in general practice may be worthwhile. However, the resource requirements of all members of the health care system may be so high as to make it unsustainable.

The Greater Murray Clinical School (GMCS) was founded with two main aims in mind one, to provide a community-based learning environment offering diversified clinical educational experiences, and two, by doing so, to help address the doctor shortage for Australians living in rural and remote areas. The GMCS is a community-orientated and community-based clinical school, which has replaced the typical discipline-based curriculum with a longitudinal, patient-centred one. Students are attached to patients--called "the longitudinal patient"--whom they follow through all stages of their care. They share with patients their experience of illness and disease, their varying care needs, and how these are addressed by different service providers. The philosophy of the course, its implementation and our initial experiences are described.

Objective: To determine the impact of personal provider continuity on continuity of care as measured by the comprehensiveness of care score., Design: Retrospective cross sectional analysis of medical records., Setting: The setting was a four doctor practice on the New South Wales Central Coast of Australia., Method: The subjects were 131 male and 123 female patients with a mean age of 42.7 years (SD 25.9) median age of 42 years and an age range of 1-95 years. The main outcome measures were a comprehensiveness score for each patient in the personal provider continuity and discontinuity of care group over a two year period., Results: The overall comprehensiveness scores in the personal provider continuity group was 7.38 (95% CI: 7.04-7.71) compared to 6.03 (95% CI: 5.7-6.35) for those in the discontinuity group (p < 0.000). A linear regression model revealed that 15.8% of the total variance of the comprehensiveness score is explained by the two independent variables 'modified continuity index' (13.6%) and 'age' (2.2%). Nonrelated independent variables are gender, number of visits and number of years attending the practice., Conclusion: Personal doctoring significantly improves continuity of care as measured by the comprehensiveness of care score, and this observation is essentially age independent. These findings clearly suggest that patients should be encouraged to find and stay with one doctor, and that practices should develop systems to enable patients access to their usual provider. Both strategies, combined with the awareness of potential gaps in our service provision, will increase the likelihood of achieving increased continuity of care.

Older patients with chronic health problems are a common presentation in general practice. The Central Coast Division of General Practice identified 'care of the elderly' as one of the priorities for local membership. This is the first in a series of articles based on the 'Geriatric Attachment Programme', which was jointly developed between the Division of General Practice and the Department of Geriatric Medicine, Central Coast Health. The recent introduction of the Health Assessment and Health Care Plans for the elderly into the Medical Benefit Schedule encourages preventive and anticipatory care. Doing this successfully requires a structured approach. This series will offer a practical guidance approach to enable readers to achieve this goal. In this article we provide an overview of the issues important to the care of the elderly. Subsequent articles deal with specific issues in detail.

Background: Acute gastroenteritis is a common childhood illness. Most cases are caused by rotavirus infection., Objective: This article discusses the classic presentation of gastroenteritis in children, which includes a short history of vomiting followed by diarrhoea., Discussion: Dehydration is the main problem in children with gastroenteritis, and severe dehydration is a medical emergency. Mild to moderately dehydrated children can be safely treated at home with oral rehydration therapy, however parents require careful explanation of the disease, its course and potential complications. Early reintroduction of usual foods (breast milk, formula or solids) has been shown to shorten the illness. Babies may need to be reviewed within 8 hours and older children within a day.

Background: Diabetes is a common chronic health problem in general practice. The quality of care for patients with diabetes has been shown to depend on many factors involving the patient and the general practitioner (GP) as well as the care environment., Objective: To measure the benefits of general practice based diabetes clinics that integrate all patient care needs in the one place at the one time., Methods: General practice based diabetes clinics were conducted in the rooms of 23 practices involving 54 GPs. The clinic team consisted of a diabetes educator, a dietitian and the usual GP. The clinic was conducted in accordance with the NSW Clinical Management of Diabetes Guidelines., Results: Follow up after 12 months showed a significant drop in the number of patients with very poorly controlled diabetes (HbA1c > 3% of normal range). Management of co-morbidities (hypertension, hyperlipidaemia, microalbuminuria) improved and complication screening for active/high risk feet and diabetic retinopathy were performed., Conclusions: This coordinated and integrated approach to the management of diabetes improved glycaemic control of the poorly controlled patient with diabetes and improved GPs' management of complication risk factors.

Background: Pertussis is an uncommon but serious illness, mainly affecting children under the age of 5 years., Objective: Affected children usually contract the disease from older children or adults in whom the disease presents in an atypical way, their coughing being attributed to other aliments. This article discusses the epidemiology, clinical course and management of pertussis. Prophylaxis is also discussed., Discussion: Pertussis presents as a hacking, mostly nocturnal cough, before becoming constant and occurring in paroxysms. Even though children appear sick, they classically are afebrile. Erythromycin is the treatment of choice for affected children and their immediate family. Achieving a 90% vaccination coverage would eradicate pertussis, but booster vaccinations later in life have been proposed since the protection of vaccination wanes rapidly over a period of 6-10 years.

Objective: The aim of this study is to assess general practice registrars' (GPRs) learning needs in relation to their procedural skills development and compare these with the learning opportunities offered by their general practice supervisors (GPSs)., Method: A 43 item questionnaire was designed to assess the procedural skills development needs of GPRs. The questionnaire was administered to GPSs and GPRs., Results: GPRs can expect to consolidate their skills in the areas of joint injections. ENT procedures and some small surgical procedures. They are unlikely to gain experience in the areas of proctology, the use of the microscope as a diagnostic tool, cardiac stress testing, hearing assessment and some less frequently needed procedures. Respondents identified spinal mobilisation manipulation, flexible sigmoidoscopy, colposcopy and fine needle aspiration biopsy as procedures they would like to see performed in general practice., Conclusion: GPRs are keen to enhance their procedural skills in a wide range of areas. They cannot necessarily expect that their general practice attachment will provide the opportunities to develop all skills desired. The Royal Australian College of General Practitioners (RACGP) Training Program needs to provide registrars with a list of core skills that are expected of every general practitioner (GP). To ensure this objective is achieved, innovative learning opportunities for GPSs and GPRs in the domain of psychomotor competencies need to be developed.

The decrease in morbidity due to tuberculosis and the increasing number on non-infected persons strongly suggest a review of the conventional tuberculosis monitoring procedures in hospital staff. A study at Luebeck university on the risk of tuberculosis infection among medical personnel showed that tuberculin tests in non-infected persons and chest x-rays only if exposed to patients in the infectious stage of tuberculosis will suffice and comply with the Federal regulations governing health protection of medical and paramedical staff.

A case of Ewing's sarcoma metastazing from the pelvis into the heart is presented. Fainting as a result of circulatory obstruction within the right heart was the leading symptom. Open-heart surgery was performed to excise the tumor from the right atrium and the inferior vena cava. Postoperative angiography showed the tumor coming up out of the right iliac vein and growing along the wall of the inferior vena cava.