GP Voice

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Acute knee injuries – importance of history taking and simple examination

June 15, 2018 Dr Chee L Khoo

Someone once said “If at the end of taking the history, you do not have the diagnosis, take the history again”. This is particularly relevant when we come to knee injuries. In 90% of the time, when I see someone with a knee injury, I have a fair idea what I am looking for in the examination before I even touch the patient.…

Prescribing antibiotics for influenza – are you one of them?

June 15, 2018, Dr Chee L Khoo

The most recent stats tell us that antibiotics prescription for viral URTIs have come down. It certainly gives us that warm and fuzzy feel good feeling that finally, the message is getting through in primary care. Well, are antibiotic prescription rates for influenza infections really coming down? How come I still come across many of patients being prescribed antibiotics for the “flu” after they were seen on the weekend.…

More GLP1 injectables coming onto the market – are you ready for them?

June 15, 2018, Dr Chee L Khoo 

Insulin secretion is augmented by incretins following oral glucose intake. In healthy individuals, incretins are responsible for 70% of insulin secretion. However, in patients with type 2 diabetes (T2D), the incretin effect is significantly blunted thereby affecting glucose control. Glucagon like peptide 1 (GLP1) and gastric inhibitory peptide (GIP)s are the most studied of the incretins.…

Weight gain with anti-depressants – is it real?

June 15, 2018, Dr Chee L Khoo

In primary care, we have to battle with the increasing incidence of obesity amongst our patients. We also have to battle with the patients with depression where anti-depressants are increasingly being prescribed. Obesity is associated with depression, which is particularly common in patients with severe obesity. Antidepressant treatment may also add on to our patients’ weight.…

Insurance Claims Made Easy (with help from some friends)

Don’t we all hate the paperwork and the hassle of insurance claims – workers compensation, CTP or similar. And to have to chase after the unpaid invoices months after the case have closed. Since, January this year (I think), there have been some positive changes to the whole NSW Workcover system. Is it just me? I don’t recall being notified about the changes.…

A smart vaccine fridge is no match against the bean counters

June 1, 2018, Dr Chee L Khoo

Imagine if your vaccine fridge sends you a message if the fridge temperature veered outside its set range of 2-8 degrees Celsius. You would say “now that’s technology”. And imagine you could do all that for a little more than A$100. Well, that’s exactly how my vaccine fridge at the practice is “wired” up to do.…

Smart intraocular pressure sensors – coming to a centre near you

June 1, 2018, Dr Chee L Khoo

Source: SENSIMED

We are all familiar with 24-hour BP monitor. We are also familiar with 24-hour Holter monitor and continuous glucose monitoring. We now have 24-hour intraocular pressure monitor. It doesn’t actually monitor intraocular pressure but the effects of it (a bit later). A recent study has now confirmed the association between the intraocular pressure monitoring and progression of glaucoma in older adults.…

ACL tears – do they all need reconstruction?

June 1, 2018, Dr Chee L Khoo

Yikes, I must have torn my ACL!

For patients with anterior cruciate ligament (ACL) tears, it used to be that conservative treatment is tried first and if the knee joint is symptomatic and/or unstable, then surgery can be considered. But have you noticed that patients are now routinely heading for surgery without a trial of conservative treatment and irrespective of what future demands on their joints may be?…

Different types of type 2 diabetes – the more the merrier?

June 1, 2018, Dr Chee L Khoo

     What? So many different types of T2D!

Have you noticed that your patients with type 2 diabetes (T2D) are a heterogeneous group? Some T2D patients are more insulin resistant than others. Some T2D patients are more insulin deficient than others. These tend to be the younger T2D. Some patients are obese and some are not.…

Hepatitis C treatment in general practice – my first case

May 15, 2018, Dr Chee L Khoo

Kylie was known to have chronic hepatitis c infection for many years. She had been busy for the last 2-3 years being pregnant. We talked about anti-viral treatment as soon as she finished with breast feeding her last baby. She had heard about these wonder drugs curing her hepatitis C infection.

When Kylie was ready, we went through the motions:

Pre-treatment Asssessment – the 6 Cs

  1. Complications of liver disease
  • Co-factors for liver disease progression
  • Signs of liver disease
  • Presence of cirrhosis -consider Fibroscan for any patient with hepatitis C.

Opioids or codeine not recommended? What do we do with patients with severe back and leg pains?

May 1, 2018 Dr Chee L Khoo

Chronic, persistent low back, lower extremity pain, and radicular pain may be secondary to disc herniation, disc disruption, disc degeneration, facet joint disease, spinal stenosis, or post lumbar surgery syndrome resulting in disc-related pain with or without radiculitis. The specificity and sensitivity of the symptoms and signs are low and therefore, not as reliable as we think in getting to the precise diagnosis.…

Smoking, alcohol, hot tea and oesophageal cancer – how are they related?

May1, 2018, Dr Chee L Khoo

We all know that smoking and alcohol are associated with increased risk of oesophageal cancer. A recent large study from China looked at 456,155 people and found 1731 esophageal cancers over 9.2 years. They noticed that there was an interaction of hot tea with smoking. Smokers who drank burning hot tea daily had double the risk of oesophageal cancer compared with non-smokers who only occasionally drank tea.…

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