20 OCTOBER 2016
ANKLE & KNEE IMAGING: NEW PROGRAM ON YOUR IMAGING CHOICES
NPS MedicineWise has this week launched a new health professional program on ankle and knee imaging—developed in conjunction with musculoskeletal experts and in line with RANZCR, Australian Physiotherapy Association and Australian College of Nursing Choosing Wisely Australia® recommendations and RACGP clinical guidance for MRI referral.
Australian data* suggests that about 20% of all the sprains and strains managed by GPs in Australia in 2011–12 were ankle injuries, and about 5% were knee injuries. Ankle ultrasounds are requested in almost 40% of newly presenting cases—despite Australian guidelines not recommending ultrasound to investigate ankle sprains.
The new ankle and knee imaging program provides health professionals with an update on the latest imaging recommendations for the type of acute knee and ankle injuries that are commonly seen in general practice. The program includes key factors to consider when deciding whether to refer for imaging—and, when imaging is indicated, guidance on selecting the most appropriate imaging modality.
The program also emphasises the importance of good physical examination skills, which in combination with patient history can be as good as imaging in diagnosing these injuries.
Dr Andrew Boyden, NPS MedicineWise Medical Adviser says that determining whether an investigation is indicated can be challenging in clinical practice, in both balancing the benefits for appropriate investigation with the potential harms, while also managing patient expectations.
“One factor to consider in balancing the risks and benefits of imaging is that the discovery of incidental findings can lead to unnecessary tests or treatments and their associated risks. Notably, incidental meniscal tears seen on MRI are reasonably common in the general adult population, particularly in older people,” he says.
“Patients can benefit through gaining a better understanding that in the case of strains, imaging is often unlikely to make any difference to management or speed of recovery.”
The program provides an update and refresher on physical examination to diagnose acute ankle and knee injuries such as fracture, ACL tear and meniscal injury and lateral ankle sprain and provides resources to assist GPs provide reassurance to patients that imaging is not always required to investigate ankle and knee injuries. The program outlines:
* Guidelines (Ottawa Rules, RACGP) that promote physical examination and history-taking to identify likely ankle and knee injury
* Indications and considerations following knee and ankle injury which warrant imaging and the imaging modality to request.
* Role of conservative management
* How to talk with patients when they’re expecting/requesting imaging which may not be clinically indicated.
The ankle and knee imaging program includes:
* Educational visits for GPs – register your interest now
* Choosing Wisely Australia campaign – view RANZCR, Australian Physiotherapy Association and Australian College of Nursing recommendations for imaging for acute ankle injury
* An NPS MedicineWise Action Plan to help health professionals have good conversations with patients about the best care for their injury, and to assist patients with self-management of ankle sprains and routine knee injuries
* Health professional publication Medicinewise News: Acute knee pain presentations in middle-aged patients: what role does MRI play?
* Interactive online case study for GPs
* New evidence-based, best practice videos demonstrating physical examination tests and Ottawa Rules for the diagnosis of common acute ankle and knee injuries.
For more information, go to nps.org.au/ankle-knee-imaging
*2014 BEACH study: Evaluation of imaging ordering by general practitioners in Australia 2002–03 to 2011–12.
18 OCTOBER 2016
HANDLE ANTIBIOTICS WITH CARE: ANTIBIOTIC AWARENESS WEEK 2016
NPS MedicineWise is encouraging health professionals and community groups to get involved in Antibiotic Awareness Week 2016.
Antibiotic Awareness Week is an annual, global event that encourages people around the world to use antibiotics responsibly. This year, the week is on from 14 – 20 November with the theme ‘handle antibiotics with care’.
The campaign aim is to raise awareness about the serious public health issue of antibiotic resistance, and create behaviour changes that drive down inappropriate prescribing in Australia by health professionals and the misuse of antibiotics by consumers.
If you’d like to get involved in this year’s campaign, you can:
* Download our Antibiotic Awareness Week campaign toolkit, which contains everything you need to know about the week
* Order a free event kit and host an Antibiotic Awareness Week event at your workplace, clinic, community centre, school or any other venue. Submit a photo of your completed display to @NPSMedicineWise on Twitter using the hashtag #AntibioticResistance for the chance to win a morning tea for your office valued up to $500
* Share the message on social media
* Display posters at your office (order printed posters or download at your convenience)
For more information visit nps.org.au/aaw2016
About the global Antibiotic Awareness Week
NPS MedicineWise is working with organisations around the world to encourage the responsible use of antibiotics across the health sector, agriculture, industry, and communities.
In Australia, Antibiotic Awareness Week 2016 is being coordinated by NPS MedicineWise and the Commission on Safety and Quality in Health Care in conjunction with the Australian Government Department of Health and Department of Agriculture, the Australian Veterinary Association, and state and territory health departments. Antibiotic Awareness Week is also supported in Australia by a number of professional societies and groups.
Globally, Antibiotic Awareness Week is coordinated and supported by the European Centre for Disease Prevention and Control (ECDC), World Health Organization, WHO Western Pacific Region (WPRO), Health Quality and Safety Commission (New Zealand), Centers for Disease Control and Prevention (Canada), Centers for Disease Control (USA) and the Infectious Disease Surveillance Center (Japan).
4 October 2016
Latest edition of Australian Prescriber out now
The latest issue of Australia’s free, national, independent journal of drugs and therapeutics is now available. The journal facilitates debate about complex, controversial or uncertain therapeutic areas. Some of the highlights of the October issue include:
Bacterial skin and soft tissue infections
Bacterial skin infections are common presentations in general practice and emergency departments. Treating the underlying cause of infection is the most important step in management say Vichitra Sukumaran and Sanjaya Senanayake, infectious diseases clinicians from Canberra Hospital.
They write that it is important to have a good understanding of the common clinical manifestations of bacterial skin infections and to know when to consider hospital referral. Understanding when antibiotics are required is important. For example, antibiotics are not usually required for the treatment of boils and carbuncles.
Non-culture methods for detecting infection
Traditional methods for diagnosing infection have relied on laboratories selecting, isolating and then identifying organisms via culture – this can be very time consuming. Microbiologists Evan Bursle and Jennifer Robson examine the increasing use of non-culture techniques and discuss their advantages, including improved turnaround times.
The authors examine a range of tests, including immunoassays and nucleic acid amplification testing, and outline how they are simplifying many difficult diagnoses.
Paediatric dosing errors with oral prednisolone mixture
A medicinal mishap feature examines dosing errors with oral prednisolone mixture in children. Jeff Robinson, Christine McKenzie and Dawson MacLeod from the Victorian Poisons Information Centre report the clinical consequences and the adverse effects that may occur. To reduce dosing errors, the authors suggest that prescribers explain to parents that this medicine is only given once a day, and that pharmacists carefully consider label instructions and reinforce them with verbal counselling.
Other articles in the October 2016 issue of Australian Prescriber include:
* Costs and concerns in cancer care
* Choosing non-oral, long-acting reversible contraception
* A new class of drugs for hypercholesterolaemia: PCSK9 inhibitors – mechanisms of action and clinical applications
* New drugs including a review of idarucizumab for dabigatran reversal.
Australia Prescriber is now fully digital and available at www.nps.org.au/australianprescriber.