The Gillard Government today announced a new hotline for women concerned about their breast implants.The new service has been set up following concerns from France over PIP breast implants.  While there is no evidence of increased rupture rates here in Australia, support is available for women who want more information.

Women who have had breast implants and are concerned should ring the Breast Implant Information Line on Ph: 1800 217 257 or contact their surgeon directly for clinical advice. For women who require further follow up, clinical and radiological investigations will be covered under the usual Medicare arrangements.

“Australian women can be reassured that our experts advise that on the basis of current data available there is no evidence of increased rupture rates for PIP implants in Australia,” Acting Minister for Health and Ageing Nicola Roxon said.

“The Breast Implant Information Line will operate 24 hours a day from today, to provide advice and support. This government service will also register women’s contact details so follow up information can be provided if necessary.”

Parliamentary Secretary for Health Catherine King said the TGA had only received 37 reports of ruptured PIP implants since 2000, representing 0.4% of PIP implants and was well within the international evidence of implant rupture rates.

“These figures remain within the expected risk of rupture but given concerns in Europe regarding this product, we recommend that women see their surgeons if they are concerned or require further advice.”

“Obviously the TGA will continue to keep a close watch on this situation and further information will be provided if more information becomes available.”

The TGA is contacting all Australian surgeons who have used the PIP implants to ask that they provide a clinical evaluation to their patients.

For all media enquiries please contact the Minister’s Office on 0409 945 476.

The 24 hours Breast Implant Information Line, Ph: 1800 217 257

For full TGA advice please visit http://www.tga.gov.au/safety/alerts-device-breast-implants-120104.htm

New guidelines for the prevention, detection and management of chronic heart failure in Australia
To download the Guidelines click here or alternatively we have a small number of hard copy versions available.

Addendum to the 2006 guidelines for the management of acute coronary syndromes
To download the guidelines click here or alternatively we have a small number of hard copy versions available.

Please contact Julia Thompson on 8752 4928 for more information or to receive a copy.

Download the PDF for offline viewing below.

Downloads

• September 2011 | September flyers 2011

Situation update
There is increasing influenza activity in parts of NSW and elsewhere in Australia, and there have been reports of admissions of pregnant women to intensive care in NSW. Because of the possibility of another severe influenza season in 2011, it is important to increase uptake of the seasonal influenza vaccine now, particularly among high risk groups like pregnant women. Below is the release from NSW Health:

• Influenza update for Obstetrician and Maternity Services 21 July 2011
• Mothersafe Factsheet Influenza May 2011
• www.mothersafe.org.au
• NSW Public Health

Over recent months, CSGPN has received feedback from many practice managers seeking more support of their management role and more opportunities for skills development and training. CSGPN has taken this information on board and has been working on strategies to more effectively engage practice managers within CSGPN’s support areas. One strategy discussed is the establishment of a Central Sydney Practice Manager Network.

The view is that a Central Sydney Practice Manager Network would provide an opportunity for practice managers within the CSGPN area to interact with one another and share ideas about contemporary practice management issues. CSGPN, with assistance from AAPM, would like to support its practice managers and help facilitate this group. In doing so, CSGPN would be willing to organise and host the 1st meeting of the proposed network at our facilities in Ashfield.

CSGPN is therefore seeking expressions of interest from practice managers or highly motivated practice staff who would like to be involved in the establishment of this group. If you are interested, please complete this Expression of Interest form and fax back to 9799 0944 or email Gabby with your name and practice details.

View the articles online or download the PDF for offline viewing below.

Downloads

• June 2011 | June flyers 2011

• Practices with an expiry date before 30th of March 2012- will be accredited using the 3rd Edition Standards
• Practices with an expiry date between 1st April 2012 and 31st July 2012- will have a choice to use either the 3rd or 4th Edition Standards for accreditation
• Practices with an expiry date after 1st of August 2012- will be accredited using the new 4th Edition Standards

RACGP is currently running free educational sessions via teleconference about the new features of 4th Edition Standards to assist practices with the transition. Information on dates and how to access the teleconference can be found on the RACGP Standards Website. If you are unsure about your practice’s expiry date, contact your accrediting body, AGPAL or GPA Plus.

The RPAH Thyroid Clinic has developed a new GP referral flowchart and clinic process for antenatal women. The flowchart identifies “red light” areas for which referral to the clinic is recommended.

The following items were removed from PBS listing (effective 1st April):
Zuclopenthixol decanoate (Clopixol® depot 200mg/mL)
Flupenthixol decanoate (Fluanxol® depot 20mg/mL & 40mg/2mL)
Note: The flupenthixol decanoate concentrated depot (100mg/mL) is still PBS listed.

These items are long acting injections for the treatment of psychosis.

Lundbeck Australia, the supplier, has advised that this is a result of ongoing pricing negotiations and likely to be a temporary arrangement.

The deletion of PBS listing will have significant impact on patients who currently obtain these depots from their local pharmacy and may not have the means or the inclination to pay private prescription prices. Private prescription pricing may vary between pharmacies however is approximately $30 for zuclopenthixol decanoate (Clopixol® depot) x 5 ampoules.

Many of the patients who have these medications have them administered at the local CHC and we are developing systems to ensure patients continue to receive this medication.

Some patients may receive this medication through their GP. It is important for patients who are prescribed this medication to continue to have it. The Sydney and Sydney South West LHN are prepared to help resolve any issues. For example if the barrier is that the patient will not pay then the LHN can be contacted and we may provide a supply of the medication to the GP.

Please contact Paul Clenaghan on 9378 1209 for any problems in the Central Sydney GP Network.

The TGA is advising health professionals not to administer a second or subsequent dose of Pneumovax 23 vaccine pending the outcome of a review of an apparent increased rate of injection site reactions following administration of the second dose.

Health practitioners are advised not to administer Pneumovax 23 vaccine to patients who have previously received a dose of Pneumovax 23 until a review of this matter by the TGA and ATAGI is completed.

Consumers are advised not to seek revaccination with Pneumovax 23 if they have previously received this vaccine until further advice is provided by the TGA and ATAGI.

Consumers who believe they may have suffered an adverse reaction to Pneumovax 23 are advised to see their medical practitioner for review.

Further information from TGA.

The Fetal Medicine Unit has informed us of new staff appointments and up-coming additions to First Trimester Screening as well as referral protocols for Fetal Echocardiography.

Downloads

• new staff appointments and up-coming additions to First Trimester Screening
• referral protocols for Fetal Echocardiography

The Infants Home Child & Family Services together with the University of NSW are conducting the Changing Life Trajectories Research Project.

The project will offer free parenting education and support to assist isolated mothers in parenting their newborn. The program will include 10 sessions, 4 individual home visits and 6 parent education groups. The program aims to increase maternal responsiveness, increase knowledge and confidence in parenting, decrease social isolation, increase connectedness and use of services.

Further information is outlined in the Information Sheet or contact Nicole Bechard on ph 9799 4844 or nbechard@theinfantshome.org.au.

Download

• April 2011 | April flyers 2011

The Fetal Medicine Department has introduced a new paging system to assist GPs in contacting the Fetal Medicine Department for urgent matters.

Contact RPA Hospital on ph 9515 6111 Pager # 81668

The paging system is to be used to access urgent ultrasound bookings, urgent ultrasound reports, second opinions or if advice is required from a Fetal Medicine Specialist. The service will operate between Monday & Friday from 7.00am-3.30pm. If the pager is not answered please contact the Department on 9515 6042.

 

 

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• March 2011 | March 2011 flyers

The Chief Medical Officer has advised that there is new evidence suggesting a small increased risk of intussusception in infants following rotavirus vaccination. On the basis of the overall risk benefit balance, it is recommend that young infants continue to be offered vaccination against rotavirus and that their parents and carers are made aware of the rare risk of intussusception and how to be alert for the signs and symptoms of the condition.

Communication resources have been developed by NSW Health and a distribution strategy is being implemented to advise parents and providers:

1. NSW Health will be faxing the Chief Medical Officer’s letter and provider fact-sheet directly to all providers, General Practice NSW and Public Health Units. All documents (including a Parent Fact-sheet) will be available via the NSW Health website
2. The Australian Government will be mailing hard copies of the documents directly to providers over the next few weeks
3. The TGA website will have updated information and revised Product Information (PI) for the two rotavirus vaccines (Rotarix® and RotaTeq®)

Release documents

• Chief Medical Officer letter
• Summary factsheet for providers
• Information for Immunisation Providers February 2011
• Information for Parents February 2011
• Report of TGA’s investigation

Queries should be referred to the Immunise Australia website or to the Immunise Australia Information Line on 1800 671 811 (between 8:30am – 5.00pm Eastern Australian Time).

From Monday 7th February 2011, the Early Pregnancy Assessment Service ( EPAS) at RPAH will be offering outpatient medical management of miscarriage.

This outpatient option will be offered to women who are diagnosed as having a missed/incomplete miscarriage and have no contraindications to such management.

• Guidelines for Medical Management of Miscarriage
• Patient Information : Medical Management of Miscarriage

This information is also located under “Pregnancy Assessment” in the ANSC section of the website.

The Missenden Psychiatric Unit at Royal Prince Alfred Hospital has relocated with 38 Beds, to:

Level 6
the QE II Building
57-59 Missenden Road
Camperdown NSW 2050

Telephone numbers remain the same, contact 9515 6111 for assistance.

The RPAH Antenatal Thyroid Clinic has re-developed their GP Referral Form for use when referring women to the clinic. The form can be be downloaded from under the title ” Forms” in the ANSC section of our website and faxed through to the clinic. The clinic will contact the woman with her appointment time.

Medical Benefit Schedule changes

The November 2010 Medicare Benefits Schedule is now available and can be downloaded at: http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Downloads-201011

The following is a summary of changes for this November’s release found at:
http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-20101015-November_2010_MBS

Please be aware that there is an update to the SSWAHS Sentinel Event form.

This form can be used by GPs to report incidents experienced by their patients related to services provided by SSWAHS.

An incident or injury includes: critical incidents and near misses; post-discharge problems, including post-operative complications and medication issues; problems encountered with accessing services for patients in SSWAHS; and communication problems. Please attach additional information if space below is insufficient.

Please send report to SSWAHS Clinical Governance Unit either by:

• Facsimile: 9828 5914
• Email: Cassandra.chan@sswahs.nsw.gov.au
• Postal address: SSWAHS, Locked Bag 7017, Liverpool BC, NSW 1781

This form can be completed and submitted online on the Sydney South West Area Health Service website: http://www.sswahs.nsw.gov.au/pdf/GP_incident/Incident_Notification.pdf (right click to download).

For further information please contact Ms Cassandra Chan on 02 9828 5714.

RPA Women and Babies have decided to change the timing of the vaginal GBS screen to 36 weeks according to college guidelines. This will be a vaginal/anal swab. The transition will be starting from 5th October 2010.

Downloads

• College guidelines for Screening & Treatment for GBS in Pregnancy
• Collection of a genital swab for detection of GBS ( will be used in clinics )

 

The September issue of Central Viewpoint newsletter is now available online to download.

Download

• September 2010 | September 2010 flyers

The August issue of Central Viewpoint newsletter is now available online to download.

Download

• August 2010 | August 2010 flyers

Download

• July 2010 | July 2010 flyers

The Woolcock Institute is offering a new research-based treatment program for adolescents with Insomnia. Treatment includes 4 group-based cognitive behavioural sessions over 7 weeks. The effect of treatment is measured on sleep and mood after treatment and 3 months later. Young persons must be high-school aged and attend an initial assessment with a psychologist to determine whether the program will be helpful for them. Young people may self refer. Medicare rebates available if referred by GPs.

For further information, or to refer a young person, contact Dr Delwyn Bartlett 9114 0460 or go to http://www.woolcock.org.au (click on adolescent sleep).

By completing this Agreement, you are authorised to receive the General Practice Immunisation Incentives practice report (GPII020A) from the Australian Childhood Immunisation Register (ACIR). This agreement is made by either ‘an individual immunisation provider’ or ‘a medical practice’ and outlines your obligations under section 46E of the Health Insurance Act 1973 regarding the use and storage of the information contained in the report. The GPII020A report is available to practices the children included incentives Program (PIP) and identifies the children included in your practice’s GPII outcomes payment calculation. The order form is on the CSGPN web site to find under immunisation.

If you have any question about the form and support with data cleaning please call Marlen 8752 4918.

Reference: www.medicareaustralia.com.au

Download GP Fax Bulletin.

May 2010 May 2010 Flyers

Downloads

• April 2010 | April 2010 flyers

Details

Time for a fresh perspective on your career as a GP? Then why not try rural locum work.

There are now more opportunities for urban doctors to experience life in a country practice thanks to the Federal Government’s new Rural GP Locum Program. Rural locum work is a great way to expand your skills while practising a more diverse and challenging range of medicine including Aboriginal health. You will also be supporting rural doctors who need a short-term break. The level of commitment required is flexible, and can be as little as two days a year up to two or three weeks depending upon your availability.

For locums who choose to make an ongoing commitment to a particular town, there is the chance to become a much-loved member of that community.

Support includes assistance with travel, accommodation and provider numbers.

Register

To register to become part of the locum pool, visit www.ruralgplocum.org.au

More information

To find out more, contact Suzanne Riley from the NSW Rural Doctors Network on 02 4924 8065.

For more information on Sexual Health, please contact the following staff:

Vijay Ramanathan Phone: 8752 4915
Julie McLean-Murray Phone: 8752 4905

Download

• Gay friendly GPs

Download

The most recently updated breastfeeding guidelines made available from SSWAHS.

• SSWAHS Breastfeeding Guidelines

Downloads

• March 2010 | March 2010 flyers

Australia’s Clinical Practice Guidelines Portal has been developed to help Australian clinicians and policy-makers access high quality, evidence-based clinical practice guidelines via a single entry point.

You will find links to clinical practice guidelines developed for use in Australian health care settings. Each guideline on this portal has been assessed according to rigorous selection criteria to help you find the type of guideline you are looking for.

The site provides direct links to guidelines or to guideline developer websites. The majority of guidelines linked to are free, however in a few instances payment is required.

http://www.clinicalguidelines.gov.au/

ME/CFS can lead to isolation and loneliness. With this in mind, an Inner West support group is beginning in 2010 for sufferers of Myalgic Encephalomyelitis (“ME”)/Chronic Fatigue Syndrome (“CFS”).

If you would like to meet with others with this condition in a social setting, please contact Katherine on 0415 702 891. Carers also welcome.

Meeting Dates

The new Inner West Support Group at Marrickville Council will meet on Saturdays, every six weeks starting in February 2010.

The dates for 2010 are:

Saturday 6 February
Saturday 20 March
Saturday 1 May
Saturday 3 July
Saturday 21 August
Saturday 2 October
Saturday 20 November

Information

For more information contact Katherine on 0415 702 891 or email: .(JavaScript must be enabled to view this email address) or visit the MS/CFS Society of NSW website:

http://www.me-cfs.org.au

Advice to GPs on new Antenatal Shared Care (ANSC) advice.

Downloads

• February 2010 | February 2010 flyers

To be able to book to deliver at RPA Women and Babies the patient must live in the suburbs covered by the RPA Antenatal Clinic available on the websites detailed below.

Some pateients requiring complex or specialised care who may live in Suburbs not covered by RPA Antenatal Clinic may be referred to RPA by their doctor. A letter of request is to be sent to the Director of Obstetrics and Gynaecology at RPA Women and Babies.

First antenatal visit

Women sometimes have difficulty accessing the Appointment Reception by telephone 9515 7101 as this is a very busy line.

For a patient to make her first Antenatal Visit appointment at RPA Women and Babies, she is required to please book either on-line or by fax:

On-line: www.rpawomenandbabies.com.au

• select ‘Information for Pregnant Women’; select ‘Public Patient Bookings’;
• fill in the ‘First Antenatal Appointment Form’ on-line and click ‘Submit’

This is a new website address to facilitate better access.
   
  or

fax to 9515 3454 with the same on-line form.

The First Antenatal Visit booking form is also available on the CSGPN website www.csgpn.com.au go the Antenatal Section on the home page and click on continue, screen down the page and after program clinical requirements are the links, with the RPA link, then click on departments and then Women & Babies.

A copy of the form is accessible as well as Medical Director and Best Practice templates. 

RPA Women and Babies follow up

Hospital staff will contact the woman via mail with an appointment date.

Booking process

All antenatal patients also need to book their bed for delivery after 20 weeks gestation (usually soon after the obstetric review visit). The woman will need to take her yellow card and registration form to the RPA Medical Centre Suite 210, Level 2, corner Carillon Avenue and Missenden Road.

The Booking Office is open from 7.30am till 5.00pm Monday to Friday.

Dr Robert Ogle
Executive Director
RPA Women & Babies
22 December 2009

Booking process for RPA Women and Babies Antenatal Clinic word document.

Downloads

• December 2009 | December 2009 flyers

Downloads

• Central Viewpoint November issue 2009 | November Flyers

Downloads

• H1N1 Flu Clinic Vaccination Guide

Downloads

• October 2009 | October 2009 Flyers

Please see the following attachments and guidelines for the national H1N1 vaccine roll out.

Timelines

• The vaccine will start to be delivered to those who have pre-ordered from TUESDAY 22 SEPTEMBER. The PROGRAM WILL START ON WEDNESDAY 30 SEPTEMBER
• See press release from Minister Roxon and DoHA
• The product was approved by the TGA for people 10 years of age and older.

Multi Dose Vial Guidelines

You will find the PDF MDV Guidelines as endorsed by ATAGI. These will also be available via the NSW Health H1N1 Vaccination website shortly.

IMPORTANT NOTE

• CSL tested the MDV and found that using the blunt drawing up needles produced “coring” (bits of bung in the vaccine) and jeopardised the integrity of the vial
• Hence a blunt 19G needle can only be used in the mass clinic setting where all doses are being drawn up and administered
• Otherwise 23G needle should be used to draw up the vaccine for individual doses. The VacPacs contain a long 23G needle that could be used for this purpose
• Panvax® will be distributed in packs (of varying sizes) of either 5mL (10 dose) OR 10mL (18 dose) MDV’s.

Vaccine eligibility

The vaccine is available for anyone who wants it over the age of 10.

Patient information sheet

A patient information sheet will be distributed with the vaccine and be available via the NSW Health H1N1 Vaccination website.

Consent form

This is optional as the vaccine is now TGA approved. If you still wish to use one, here is the Consent form PDF version.

Maternity guidelines

Further information will be available via the NSW Health H1N1 Vaccination website in the near future.

Indemnity

Please find a statement from the AMA for its members about indemnity for the H1N1 vaccination program.

Standing order

There will be no standing order developed. Authorised nurse immunisers do not need a standing order as this vaccine is to be regarded as an influenza vaccine (ie covered off in the Authority) and once the vaccine is licensed a PI (Product Information) will be available and included in all vaccine deliveries.

Indigenous communications

AMSs will receive a tailored poster from DoHA. The vaccine will be heavily marketed through Koori Radio.

Adverse events reporting

In contrast to usual procedures, providers are to be encouraged to report any AEFI of Panvax® directly to ADRAC as soon as possible after the event either by:
–      Electronic reporting
–      Blue Form:
If assistance is required contact your local Public Health Unit (PHU). PHU’s will record serious AEFI information supplied to them onto NDD and undertake any follow up required.

PENS

It’s recommended to write the date of opening onto the MDV; however this cannot be done with “ordinary” pens. CSL has kindly provided AGPN “Panvax® vial friendly” pens. These will be distributed to you via CSGPN as soon as they are received.

Further information

Please contact the Immunisation project office on 8752 4902 for further information.

Downloads

• September 2009 | September 2009 Flyers

From Monday 17 August 2009, all maternity units in Sydney South West Area Health Service (SSWAHS) will be offering vaccination with dTpa (Boostrix) to all mothers during the postnatal stay in hospital.

The objective of this policy is to reduce the risk and incidence of pertussis in newborns. As you will see from the 2 attached documents, this has the support of NSW Health and NCIRS. A brochure outlining the role of this injection will be given to each mother.

As General Practitioners usually take on the overall responsibility for vaccination records for their patients, it would be helpful if you ensure that your pregnant women are aware of this initiative and the implications of the new program.

Also could you please check with your postnatal patients whether they have been given the vaccination and ensure that there is a record of the vaccination being given as well as answer any questions they may have.

Dr Andrew Child AM
Clinical Director, Women’s Health and Neonatology
12 August 2009

Ph:   9515 8416
Fax:  9565 1595
Executive Unit
RPA Women and Babies

• Pertussis fact sheet
• Pertussis vaccination flyer
• Pregnant women info dtpa

Downloads

• August 2009 | August 2009 Flyers

Downloads

• GP update 9
• Oseltamivir suspension

Download

• TGA safety advice regarding GARDASIL HPV vaccine.

Current status

Human cases of a new form of influenza virus have been identified in the United States and Mexico. The virus is a type of influenza A virus that is usually seen in pigs (“swine influenza”).

No cases of swine influenza have been confirmed in New South Wales or Australia. 27.4.2009

The World Health Organisation has declared the swine influenza situation to be a public health event of international significance.

Pandemic alert levels have not been raised by the World Health Organisation or by the Australian Government.

This event is of concern because:
• Swine influenza is derived from an animal influenza virus, which means that humans are likely to have little or no immunity to the virus
• There has been rapid spread to multiple communities overseas
• Swine influenza is affecting unusual age groups (healthy, young adults)
• The swine influenza virus is thought to be sensitive to the latest antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza)

For the most up-to-date information on the number of overseas confirmed cases of swine influenza please see:
• The World Health Organisation website
• and the United States CDC website

New South Wales is performing enhanced surveillance for the new swine influenza virus, by encouraging testing of people presenting with influenza-like illness or pneumonia who have recently returned from affected areas in the United States and Mexico.

NSW Health is working very closely with State and Commonwealth Government agencies to investigate and respond to this situation.

What you can do?

Influenza is spread from person-to-person through coughing or sneezing of infected people. There are many things you can do to prevent getting and spreading influenza:
• Cover your mouth when you cough, and wash your hands regularly.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the garbage bin after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way.
• Try to avoid close contact with sick people.
• Influenza is spread from person-to-person through coughing or sneezing. Stay away from people who are sick.
• If you get sick, stay home from work or school and limit contact with others to avoid infecting them.

For more information, see the swine flu fact sheet.

Advice for recently returned travellers

If you have returned from the United States or Mexico within the last 7 days, and are feeling unwell with any flu-like symptoms, such as cough, fever, headache, joint aches and pains, fatigue, nausea, vomiting or diarrhoea, please contact your local Public Health Unit, or go to your nearest hospital emergency department and tell them that you have recently returned from overseas and may have flu.

Advice for clinicians

Clinicians should consider the possibility of swine influenza A virus (H1N1) infection in patients who have:

a) an influenza-like illness (fever and cough and fatigue) and who have travelled to Mexico or United States of America within the past seven days

or

b) pneumonia and who have travelled to Mexico or United States of America within the past seven days.

If swine flu is suspected, please isolate the patient, notify your local Public Health Unit, safely obtain a viral nose and throat swab for swine influenza testing and send it immediately to ICPMR at Westmead Hospital, or SEALS at Prince of Wales Hospital.

Please see the advice to clinicians from the Chief Medical Officer.

New Australian Alcohol Guidelines - the National Health and Medical Research Council’s (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking Alcohol were released on 6 March 2009.
The key changes include the following revised guidelines:

Guideline 1

For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.

Guideline 2

For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol related injury arising from that occasion.

Guideline 3

3A Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that for this age group, not drinking alcohol is especially important.
3B For young people aged 15–17 years the safest option is to delay the initiation of drinking for as long as possible.

Guideline 4

4A For women who are pregnant or planning a pregnancy, not drinking is the safest option. 
4B For women who are breastfeeding, not drinking is the safest option.

Alcohol has a complex role in Australian society. Most Australians drink alcohol, generally for enjoyment, relaxation and sociability, and do so at levels that cause few adverse effects. However, a substantial proportion of people drink at levels that increase their risk of alcohol-related harm. For some, alcohol is a cause of significant ill health and hardship. In many countries, including Australia, alcohol is responsible for a considerable burden of death, disease and injury. Alcohol-related harm to health is not limited to drinkers but also affects families, bystanders and the broader community.

NHMRC intends Australian Guidelines to Reduce Health Risks from Drinking Alcohol to establish the evidence base for future policies and community materials on reducing the health risks that arise from drinking alcohol. It is about helping you to help your patients reduce the risks to their health from drinking alcohol.

Of course, how much your patients drink is their choice. But the NHMRC hope these guidelines will help you to help your patients make an informed choice and also help health agencies guide the community in reducing health risks. Click on the following links to view and download the indicated resources:

• Download the Australian Guidelines to Reduce Health Risks from Drinking Alcohol
• Summary of the Guidelines
• Alcohol FAQ
• The Australian standard drink

Alternatively you can view and download the new guidelines, including a summary, FAQs and standard drink guide by clicking on the following link at:
http://www.nhmrc.gov.au/your_health/healthy/alcohol/index.htm

Information and resources relating to the new guidelines will soon be available on www.alcohol.gov.au from late April 2009.

For more information contact:

Project Officer: Karen Frost
Phone: 8752 4910

In coming years more than 21,000 older women with osteoporosis are expected to benefit from the addition of zoledronic acid (Aclasta®) to the PBS. The once-a-year injection will be available for women over 70 years with a bone mineral density score of -3.0 or less.

This is the third treatment option available under the PBS for osteoporosis and recognises the growing number of people, especially older women, with the condition. According to Osteoporosis Australia, someone is admitted to an Australian hospital with an osteoporotic fracture every eight minutes.

The listing of zoledronic acid will add about $20 million to the PBS over the next five years.

Children aged 1-10 years with tyrosinemia will benefit from the listing of amino acid formula with vitamins and minerals without phenylalanine (PKU Anamix Junior LQ® and Lophlex LQ 10®). Tyrosinemia is an inherited disorder of amino acid metabolism that causes liver disease and is treated with a diet low in the amino acid tyrosine.

There are no expected cost implications for the PBS as this medication will be a substitute for other PBS medications.

Restless legs syndrome (RLS) is a neurological disorder characterised by unpleasant sensations in the legs and an uncontrollable urge to move when at rest in an effort to relieve these feelings.

The listing of pramipexole hydrochloride (Sifrol®) on the PBS has been extended to include treatment of severe primary RLS, and is expected to benefit more than 25,000 patients over the next five years. This will add about $18 million to the PBS over the next five years.

A variety of additional treatments for existing medications will now be subsidised through the PBS.

An oral solution of escitalopram oxalate (Lexapro®) will provide an additional treatment method for people with moderate to severe generalised anxiety disorder and social anxiety disorder. There are no expected cost implications for the PBS as this will substitute existing PBS medications.

A new formulation for desmopressin acetate (Minirin Melt®) as a wafer put under the tongue will provide an additional treatment method for primary nocturnal enuresis (bed-wetting). There are no expected cost implications for the PBS as this will substitute other medications.

A new solution concentrate for an in vitro infusion of gemcitabine hydrochloride (Gemcitabine Ebewe®) has been added to the PBS to treat a variety of cancer conditions, including breast cancer, epithelial ovarian cancer, non-small cell lung cancer and bladder cancer. There are no expected cost implications for the PBS as this medication will substitute for different forms of the same strengths of the same medication.

Two additional strengths of oxycodone hydrochloride (OxyContin®) tablets will be added to the PBS for the management of moderate to severe chronic pain that is unresponsive to non-narcotic analgesia. This listing will provide patients with increased convenience. There are no expected cost implications for the PBS as this will substitute for other forms of this PBS medication.

The listing of ziprasidone hydrochloride (Zeldox®) has been extended to include monotherapy, for up to six months, of an episode of acute mania or mixed episodes associated with bipolar I disorder. There are no expected cost implications for the PBS as this will substitute for other PBS medications.

Changes to the Highly Specialised Drugs Program from 1 April 2009 will broaden the subsidised use of filgrastim (Neupogen®) and pegfilgrastim (Neulasta®) to assist some people with chronic lymphocytic leukaemia.

Chronic lymphocytic leukaemia is the most common form of leukaemia in Western countries and occurs primarily in older people, with men twice as likely to develop the condition.

The changes will cover patients being treated with fludarabine and cyclophosphamide who have secondary prophylaxis of neutropenia or prolonged severe neutropenia. This will assist more than 900 patients over the next five years.

Neutropenia is a condition of an abnormally low number of a particular type of white blood cell neutrophil. Treatments such as chemotherapy and radiation therapy can cause neutropenia.

The extension of filgrastim and pegfilgrastim of will add about $15.4 million to the PBS over the next five years.

People who have had a stroke and have moderate to severe spasticity of the upper limb will benefit from the extension of botulinum toxin type A (Botox®). According to the National Stroke Foundation, Australians will suffer around 60,000 new and recurrent strokes this year alone.

This treatment will be available as second line therapy when standard management has failed, or as an adjunct to physical therapy. There are no expected cost implications for the PBS as this will replace as existing therapy.

Further information

RADAR (Rational Assessment of Drugs and Research) provides information on new drugs.

Project officers:
Beba Ostrugnaj Phone: 8752 4909
Vijay Ramanathan Phone: 8752 4915
Julie McLean-Murray Phone: 8752 4905

Mood disorders in General Practice - as simple as DSM, SSRI & CBT?

The webcast
In the past decade mental health, and depression in particular, has received a great deal of attention both in the general and medical media. Awareness of depression has markedly increased, attempts have been made to reduce its stigma, and a lot of effort has gone into educating GPs.

No-one would argue that this has not been a positive development. However it has lead on occasions to an oversimplification, where all bad moods are depression, and depression always responds to evidence based treatment with CBT & an SSRI.

Clinical reality in general practice is rather different. We see a wide range of low moods, only some of which are unipolar depression. Many belong to other diagnoses, and many, despite being very significant, struggle to fit neatly any single DSM category. General practice is messy and our patients rarely conform to the neat case studies of typical education modules. And treatments may be evidence based, but the patients to whom we offer them are rarely the same as those carefully selected folk from whom the evidence was gathered.

This talk tries to step back a little and look first at normal mood and its adaptive function, and then go on to take an honest look at the diverse range of mood presentations in GP. In no sense didactic, it is one particular GP’s reflections on how he approaches the manifold uncertainties around treating mood dysfunction. It touches on the difference between the cross sectional, phenomenologically driven approach of some specialist practitioners and the more longitudinal, formulation based approach often found in general practice. It touches on lifestyle, ‘second line’ pharmacological treatments and when to move beyond CBT & explore the meaning of depressive symptoms.

The presenter
Dr Simon Cowap MBBS (Hons) FRACGP is a GP with a long interest in mental health. He is currently practicing at the Brain & Mind Research Institute (BMRI), Camperdown, headspace (youth mental health initiative) in Campbelltown, and in private mental health focused practice in Glebe. He is a level II mental health accredited practitioner, and has both attended and helped design and deliver a number of mental health education initiatives for general practitioners. He has written on general and mental health issues for publications including the Australian Family Physician, Medical Observer, the Australian newspaper and a variety of internet sites. He is currently assisting in the development of the BMRI’s post graduate education programme for GPs intended to commence in 2010. He is interested in the collaborative care of mental health patients and the unique perspective GPs bring to the mental health team.

Accessing and participating in the broadcast
The live broadcast will be a presentation to a small studio audience. The talk will last approximately 30 to 40 mins with 20 minutes for questions. You will be able to watch the live webcast at home on your computer, and the program will allow you to type in questions which the speaker can address during the question time. Access is free to ACPM members and members of the Central Sydney GP Network - co-sponsors of this webcast.

Instructions for viewing
This event is free to financial members of CSGPN, details can be viewed by logging in to the Members section of this website or contact us for further details.

If you are not able to view the live webcast you will be able to access it a few weeks later on the web site by going through the above steps.

For further information please contact: 
Dr Howard Gwynne
email: howard@aya.yale.edu
ph: 0402 827 156

Three Key points for GPs

1. The pertussis epidemic continues in NSW. Babies who are too young to be fully vaccinated are most at risk
2. For a limited time, dTpa vaccine will be provided free for all new parents, grandparents and any other adults who regularly care for infants
3. DTPa (Infanrix-hexa) can be given to babies from 6 weeks of age

Timely immunisation of infants is important because unvaccinated infants are at highest risk of infection and are also at high risk of complications. Because pertussis immunity wanes over time, many older children and adults are susceptible to infection and can be the source of new infections in infants.

For a limited time, FREE dTpa vaccine will be available for all new parents, grandparents and any other adults who will regularly care for infants less than 12 months of age.

GPs should advise all new parents to:
• Vaccinate their baby on time.
• Keep their baby away from anyone with a cough.

For new parents, GPs should:
• Check the immunisation status of new parents and other children and provide catch-up vaccination.
• Offer FREE dTpa vaccine to new parents, grandparents and any other adults who regularly care for infants.
• Consider vaccinating infants at 6 weeks if the opportunity arises. Infanrix-hexa, Prevenar and Rotarix are all licensed for use in infants from 6 weeks of age. The next scheduled vaccines should be given at 4 and 6 months of age.

Who is eligible for the FREE dTpa vaccine?
• Couples who are planning a pregnancy (both parents).
• New parents (mothers should be vaccinated as soon as possible after childbirth).
• Grandparents and other adults who will regularly care for the infant.

Ordering FREE dTpa vaccine for adults
Fax order form to the NSW Vaccine Centre on 1800 041 528. Download:
Pertussis outbreak response order form.
Additional guidelines for ordering free dTpa vaccine

For further information, GPs can call the Public Health Unit at Camperdown on 9515 9420.

From January 2009, the Medicare audit scheme will increase from 0.7% to 4% (500 to 2500 audits per year) of all providers with includes GPs, allied health professionals and specialists. The audits are carried out on claims that consistently produce anomalies in claiming procedures. Medicare acknowledged that the majority of non-compliant audits are not the acts of lawless scoundrels but more an administrative glitch.

For more information about MBS audits, visit the Medicare website and look for the fact sheet titled Increased MBS Compliance Audits Information Sheet or call Lisa Maude on 8752 4902.

Central Sydney GPs will shortly be able to refer eligible patients for free psychological therapy to our selected Access to Allied Psychological Services (ATAPS) providers with expertise in PND
Recent studies show that 1 in 7 women in Australia experience postnatal depression. The aims are to provide better care, support and treatment for expectant mothers, new mothers and their families.

Our current ATAPS and Antenatal Shared Care projects will be combining forces to run this project in our area. Key activities of this project include the following:

• establishing linkages and relationships with local child and maternal health services and primary mental health care services to ensure that women experiencing perinatal depression and their families have the necessary resources available to them;
• as appropriate, promoting the use of other pathways to care for women experiencing perinatal depression and their families;
• ensuring that women experiencing perinatal depression and their families are able to receive treatment under ATAPS; and
• promoting and disseminating materials and resources to GPs and allied health professionals to support professional practice in respect of perinatal depression treatment and support;

Discussions are being held with the key SSWAHS service providers as well as Karitane and Tresillian on how best to ensure this program meets the needs of the most at risk women.

Karen Frost (ATAPS) and Dianne Deschamps (ANSC) are interested in speaking to GPs who care for large numbers of women from Culturally and Linguistically Diverse Backgrounds to see how this initiative would assist the women you care for.

Do not hesitate to contact either Karen Frost on 8752 4910 or Dianne Deschamps on 8752 4923 for further information or advice regarding this program.

This clinic will run on Friday mornings in the Women’s Health Ambulatory Care area on level 5 and will be led by Dr Kirsten Black, a consultant gynaecologist and clinical academic. Access will only be by GP referral or referral from other RPAH specialty units. The clinic is for women with complex medical conditions requiring contraceptive advice and management and for women requiring intrauterine device insertion that is not able to be undertaken in the community setting. Gynaecology appointment forms, presently available on the SSWAHS website and used by GPs for faxing requests for appointments, will be updated to include this new clinic.

Previously Bali was considered rabies free; hence this presents a new risk to Australians visiting Bali.

The Indonesian media have also reported that several people with rabies-like clinical signs and symptoms have died after being bitten by dogs. There is at present no indication that the disease has spread to animals other than dogs. However any animal should be considered to pose a potential risk.

NSW Health recommends that all adults and children visiting Bali should avoid contact with wild and domestic animals, including dogs, cats and monkeys, even if the animal appears well.

“Anyone who is bitten or scratched by an animal in a rabies-affected area, including Bali should immediately wash the wound well with soap and water, apply an antiseptic such as povidone iodine to the wound and see a doctor as soon as possible,” Dr Andrew Marich, Acting Director of NSW Health’s Communicable Diseases Branch, said.

“A course of injections is sometimes needed to prevent rabies infection developing after a bite or scratch,” he said.

NSW Health advises that anyone who has been bitten or scratched by any animal in Bali since 1 August 2008 should see their general practitioner for advice. People bitten or scratched by an animal before this time are not thought to be at risk of rabies.

Rabies is transmitted when viruses in a rabid animal’s saliva get into nerve cells through a wound – usually following a bite or a scratch. While many rabid animals will be sick and may go on to die, some appear well.

Symptoms in humans may include headache, fever, feeling unwell, sensory changes around the site of the bite or scratch, excitability, an aversion to fresh air and water, weakness, delirium, convulsions, and coma.

If rabies infection has occurred, symptoms in humans normally begin within several weeks but sometimes the symptoms begin years after infection. Death usually follows several days after the onset of symptoms.

There is no treatment for rabies once the symptoms have started however treatment of infected people before they develop symptoms can be effective.

The Governor of Bali has temporarily banned the import or export of dogs, cats, monkeys and other animals declaring the island under official quarantine until further notice. Officials are also endeavouring to create a perimeter of vaccinated animals in the areas immediately surrounding those areas in which rabies has been confirmed, aiming to isolate and eventually eliminate the disease.

For a copy of the fact sheet on rabies go to NSW Health Fact Sheet.