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

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• September 2010 | September 2010 flyers

Our Aboriginal Health Advisory Group is in need of your expertise!

Kim Toole would like to invite interested GPs, practice nurses and practice managers to join the Aboriginal Health Advisory Group. The group will inform and support the work of CSGPN project officers to ensure quality in all our activities concerned with Aboriginal health.

The Aboriginal Health Program involves a range of activities to:
• increase access to mainstream primary care services by Aboriginal people;
• improve the capacity of general practice to deliver culturally sensitive primary care services;
• increase the uptake of Aboriginal specific MBS items, including Aboriginal health checks and follow up items;
• support mainstream primary care services to encourage Aboriginal Australians to self-identify;
• increase awareness and understanding of Closing the Gap measures relevant to mainstream primary care; and
• foster collaboration and support between the mainstream primary care and the Aboriginal health sectors.

The Advisory Group will provide perspectives from a broad range of local GPs, practice nurses, practice managers, Aboriginal health service representatives and Aboriginal community members to assist us in setting priorities and developing, implementing and evaluating our Aboriginal health activities.

If you have enthusiasm for, or experience in Aboriginal health, we would love to hear from you. You would be very welcome to attend an initial meeting with no obligation to be committed to the group. Meetings present a great opportunity for good networking, fruitful discussion and great food!

The inaugural meeting is planned for Tuesday 21 September at 6.30pm. If you would like further information or are interested in attending the meeting, please phone Kim Toole on 8752 4924.

 

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Around one in five people, usually women, who develop the eating disorder would die as a result, says Associate Professor Susan Byrne from the University of WA’s School of Psychology.

She said many treatments had emerged over the years, from different models of counselling and therapy along with acute hospital care, though there was little evidence to show which approach was best.

“Currently, there are a whole range of treatments and we don’t have any evidence that one is any better than the other,” Dr Byrne said on Friday.

“... We’re really trying to gather some evidence so we can say to people, with confidence, that we have evidence that this or that treatment is helpful.”

Dr Byrne is seeking around 200 adult volunteers who have an eating disorder and who are based in Sydney, Adelaide or Perth.

Participants will receive ten months of free treatment - in one of three different front-line therapies developed independently and used by some to tackle anorexia in different parts of the world.

The research will compare Enhanced Cognitive Behaviour Therapy, developed at Oxford University; Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), developed at London’s Maudsley Hospital; and New Zealand’s Specialist Support Clinical Management for Anorexia Nervosa.

Dr Byrne said each treatment focused on restoring a normal eating pattern and healthy weight “so that the person with anorexia nervosa can become physically and mentally well again”.

Fifteen per cent of Australian women will suffer from an eating disorder during their lifetime, with around four per cent of these cases classed as anorexia.

The cause remains unknown though anorexia has the highest mortality rate of any psychiatric disorder, with 15 to 20 per cent of sufferers dying after 15 years.

“It’s not really are rare as people tend to think,” Dr Byrne said.

Those seeking to join the research can call the UWA’s School of Psychology on 08 6488 7428 or email: treatmenttrial@psy.uwa.edu.au

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On Wednesday 25 August a workshop will be held at Balmain Town Hall from 6:30pm to explore a range of different mental health services that could be offered at Callan Park.

Mental Health Master Plan Workshop

If you are unable to attend the workshop, comments on the website regarding the newer proposals put forward are very welcome. A document outlining these proposals should be available after the workshop next Wednesday.

Download Central Express here.

When children arrive from overseas, it is often difficult to know which vaccinations they have had. This WHO website will enable you to review vaccinations country by country:

WHO overseas vaccinations

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

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• August 2010 | August 2010 flyers

Seasonal flu vaccination for young children can be resumed - see updated advice from the Chief Medical Officer dated 30 July 2010 here on Department of Health website.

The locations of ten new headspace centres have been announced by the Federal Government and headspace. The new centres are part of the $78 million funding package for headspace announced in the May Federal Budget. The first raft of those centres will be located in areas of high need.

New headspace sites

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Release of the work and your mental health brochure for General Practitioners

Recently we relocated our webhosting to a new site in Ultimo to provide a faster loading time to members. If you find any issues that need attention on the website, please contact .(JavaScript must be enabled to view this email address) on 8752 4927.

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• 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).

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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

Up to 800 000 patients received their first dose of pneumococcal vaccine in 2005 and these patients are now due for their 5 year booster. Act now to identify and vaccinate all eligible patients aged over 70years before winter. The National Pneumococcal Vaccination Program for Older Australians commenced in January 2005 and provides free pneumococcal polysaccharide vaccine (Pneumovax23®) to adults aged 65 years or older. People aged 65 years or over should discuss vaccination with their doctor or health care provider.

Adults aged 65 years or over are at higher risk of contracting pneumococcal disease than the rest of the population, with the majority of deaths from this disease occurring in this age group.

2 doses of vaccine are given, with the second dose given 5 years after the first dose. For technical information or information about vaccines, refer to the Pneumococcal section of the Australian Immunisation Handbook 9th Edition 2008 (NHMRC).
Reference:
www.racgp.org.au/ff/21

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May 2010 May 2010 Flyers

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• April 2010 | April 2010 flyers

How to do it

Using your iPhone, iPod Touch or iPad browse to our website using Safari.

1. When the page loads, click on the plus symbol “+” at the bottom of the screen.
2. A window will pop up, click the option to Add to Home Screen.
3. Type in a short name for the button - CSGPN

Our icon should now appear in your Apps screen giving you a direct link to load our site.

Done!

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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

Dianne Deschamps Phone: 8752 4923

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• Gay friendly GPs

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The most recently updated breastfeeding guidelines made available from SSWAHS.

• SSWAHS Breastfeeding Guidelines

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• 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.

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• 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.

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• December 2009 | December 2009 flyers

Developed by Sydney South West Area Mental Health Service, consumer medication brochure series on Antipsychotic Medications, Benzodiazepine, Bipolar, Clozapine and Depression is now available on our website as PDF’s for you to download.

Consumer Medication Brochure Series

• CMB Antipsychotic Medications
• CMB Benzodiazepine
• CMB Bipolar
• CMB Clozapine
• CMB Depression

For more information regarding our Mental Health project, please contact Karen Frost on 8752 4910.

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• Central Viewpoint November issue 2009 | November Flyers

This article shows how Memorial Hermann serves a metro area of more than five million people, providing everything from air ambulance services to a chemical dependency treatment centre.

Apple - iPhone in Health Care Business.

If you have any comments or suggestions on the use of technology in the Healthcare system in Australia, please use the contact form on our website to let us know your thoughts.

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• H1N1 Flu Clinic Vaccination Guide

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• 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.

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• 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

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• August 2009 | August 2009 Flyers

Personal Protection Equipment from CSGPN on Vimeo.

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• CSGPN Pandemic Preparedness Workshop presentation.

Information

If you require any information regarding the PPE kits or the above demonstration, please contact Beba Ostrugnaj Phone: 8752 4909.

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• GP update 9
• Oseltamivir suspension

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• July 2009 | July 2009 Flyers

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• 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.

The Melancholia Study Team is pictured (from left to right): David Gilfillan, Tania Perich, Iain MacMillan, Bianca Blanch, Gordon Parker, Vijaya Manicavasagar, Dusan Hadzi-Pavlovic, Alex Apler.

The Black Dog Institute is offering immediate free specialist psychiatric and psychological consultations for up to 300 people experiencing melancholic depression as an inducement to participate in a 12-week trial. The reality is that currently people are waiting up to three to six months when they are referred to see a mood disorder specialist, according to the Black Dog Institute. The “queue jumping” trial announced 17 February 2009, will allow people to receive free treatment and make a valuable contribution to a study that is designed to measure best treatments for melancholic depression. Professor Parker, Executive Director of the Black Dog Institute, has also given an undertaking that if the participants have not improved following the 12-week trial, the Institute will offer ongoing free management for their condition.

Black Dog Institute
Hospital Road
Prince of Wales Hospital
Randwick NSW 2031

Business Hours: MON-FRI 9am-5pm
Reception/Deliveries/General Information: 9382 4530
Community/Consumer Enquiries: 9382 4523
Clinics: 9382 2991
Fax: 9382 8208
Email: blackdog@unsw.edu.au

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.

NSW Mental Health Act 2007 involuntary schedule of a mental health patient form. Please click on the following links for Schedule 1 - medical certificate as to examination or observation of person:

• Medical Director template
• Best Practice template
• How to import templates from CSGPN website Handout : Medical Director or Best Practice

For further information please contact:
Project Officer: Karen Frost
Phone: 8752 4910