Today we are joined by ophthalmologist and all round nice guy Dr Russell Phillips to discuss red eye in GP - differentials, causes, approach to history, exam and management.

Approach to the red eye in GP

Conjunctivitis (bacterial, viral, allergic)

Subconjunctival haemorrhage

Herpetic keratitis + dendritic ulcer

Herpes zoster ophthalmicus

Anterior uveitis (iritis)

Scleritis

Episcleritis

Acute closed angle glaucoma

Trauma

Contact lens 

Red eye in neonates

 

Today we are joined by ophthalmologist and all round nice guy Dr Russell Phillips to discuss red eye in GP - differentials, causes, approach to history, exam and management.

Approach to the red eye in GP

Conjunctivitis (bacterial, viral, allergic)

Subconjunctival haemorrhage

Herpetic keratitis + dendritic ulcer

Herpes zoster ophthalmicus

Anterior uveitis (iritis)

Scleritis

Episcleritis

Acute closed angle glaucoma

Trauma

Contact lens 

Red eye in neonates

In this episode we will cover history and examination in eye disorders.  This is a review episode to help give us the foundations to assessing any eye disorder which we will cover more in future episodes.

- History

- Examination - visual acuity, visual fields, eye movements, pupils and swing torch test, torch examination and fluoroscein staining, slit lamp exam, intraocular pressure testing, ophthalmoscopy, amsler grid, ishihara charts

In this episode we will cover history and examination in eye disorders.  This is a review episode to help give us the foundations to assessing any eye disorder which we will cover more in future episodes.

- History

- Examination - visual acuity, visual fields, eye movements, pupils and swing torch test, torch examination and fluoroscein staining, slit lamp exam, intraocular pressure testing, ophthalmoscopy, amsler grid, ishihara charts

1.Key points of medicare 2.What medicare covers and doesn’t cover 3.Detail of certain item numbers: During hours, after hours, emergency, women’s health, procedures, GPMP/TCA, MHCP, health assessments, cycle of care and more, 4.PIP/SIPs and GPRIPs 5.Auditing and 80/20 rule 6.Medicare Safety Net

Key points of medicare,

What medicare covers and doesn’t cover,

Detail of certain item numbers: During hours, after hours, emergency, women’s health, procedures, GPMP/TCA, MHCP, health assessments, cycle of care and more,

PIP/SIPs and GPRIPs,

Auditing and 80/20 rule,

Medicare Safety Net

This episode we will cover clinical lifestyle evidence based medicine in cardiovascular disease.  

What is Lifestyle Medicine (LM)?

Why do we need it?

Chronic disease burden. 

What are the myths and facts about changing peoples lifestyles?

LM in hypertension, size of effect and details - including DASH diet, reduction by weight loss, smoking cessation, diet changes, physical activity, mindfulness and some specific foods

LM in high cholesterol

LM in coronary artery disease

LM in prevention of strok

This episode we will cover clinical lifestyle evidence based medicine in cardiovascular disease.  We will cover:

- What is Lifestyle Medicine (LM)?

- Why do we need it?

- Chronic disease burden 

- What are the myths and facts about changing peoples lifestyles?

- LM in hypertension, size of effect and details - including DASH diet, reduction by weight loss, smoking cessation, diet changes, physical activity, mindfulness and some specific foods

- LM in high cholesterol

- LM in coronary artery disease

- LM in secondary prevention of stroke

 

References:

https://www.heartfoundation.org.au/images/uploads/publications/PRO-167_Hypertension-guideline-2016_WEB.pdf https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf

Salehi-Abargouei A, Maghsoudi Z, Shirani F. Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases – incidence: a systematic review and meta-analysis on observational prospective studies. Nutrition 2013; 29:611–618.

Siervo M, Lara J, Chowdhury S et al. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Br J Nutr 2015;113:1–15.

http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/409499?resultClick=3

CAD - 

http://jamanetwork.com/journals/jama/fullarticle/188274?resultclick=1

http://thelancet.com/journals/lancet/article/PII0140-6736(90)91656-U/abstract?cc=y

Cholesterol-lowering effects of dietary fiber: a meta-analysis - http://ajcn.nutrition.org/content/69/1/30.full Stroke - https://www.ncbi.nlm.nih.gov/pubmed/24029303 Social isolation in disease - 

https://www.ncbi.nlm.nih.gov/pubmed/11292274, 

https://www.ncbi.nlm.nih.gov/pubmed/15760298

Mindfulness - 

https://www.ncbi.nlm.nih.gov/pubmed/24127622

Flaxseed - 

http://www.ncbi.nlm.nih.gov/pubmed/24126178

http://www.racgp.org.au/afp/2016/september/the-changing-face-of-australian-general-practice-across-the-decades/

Today we will cover opioid prescribing guidelines for chronic non-cancer non-palliative care pain in adults.  Enjoy!   Contents: •New codeine laws 2018 •Opioids prescription facts and harms •Evidence for opioids •Types of opioids and equivalence dosing •Side effects – short and long term •Initiating and ongoing presciprtion •Break through pain management •Discontinuing •Aberrant behaviour management and assessment •Follow up consideration •Not  - opioid replacement therapy like methadone and suboxone   References: •Qld health - https://www.health.qld.gov.au/__data/assets/pdf_file/0032/374693/ddu_quick_guide.pdf - great 4 pager •CDC guidelines - https://www.cdc.gov/drugoverdose/prescribing/guideline.html •http://jamanetwork.com/journals/jama/fullarticle/2503508 •SA health - http://www.sahealth.sa.gov.au/wps/wcm/connect/7b1378004ddce5e2965efe6d722e1562/Opioid_prescription_chronic_pain_guidelines_for_SA_GPs_ALL.PDF?MOD=AJPERES&CACHEID=7b1378004ddce5e2965efe6d722e1562 •Hunter integrated pain service NSW guidelines – great 2 pager https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0018/212760/Opioid_treatment_agreement.pdf •Hunter Integrated Pain Service http://www.hnehealth.nsw.gov.au/Pain/Documents/Reconsidering_opioid_therapy_May%202014.pdf •http://www.emrpcc.org.au/wp-content/uploads/2016/05/Opioid-Conversions-May-3-2016-final.pdf •https://www.tga.gov.au/media-release/update-proposal-rescheduling-codeine-products •2009 opioid rotation expert panel review and guidelines - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065110/

Today we will cover opioid prescribing guidelines for chronic non-cancer non-palliative care pain in adults.

Contents:

•New codeine laws 2018

•Opioids prescription facts and harms

•Evidence for opioids

•Types of opioids and equivalence dosing

•Side effects – short and long term

•Initiating and ongoing presciprtion

•Break through pain management

•Discontinuing

•Aberrant behaviour management and assessment

•Follow up