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					                                                                                                                               Issue 144     November 2007


  In Focus this Issue                                    Consensus Planning 2008-2010
  Medical Director......................2                On 11th October 2007, the ESDGP held its triennial planning
                                                         event focussing on those strategies that would build on and
  A View from Kings X...............3                    enhance the existing divisional capacity to deliver to
  Women's Health ......................4                 members and the community.

  Mental Health ...........................5             All divisional staff, GP Program Advisors and Members of
                                                         the Board were invited to participate. The main outcomes
  EDQUM .....................................6           from the workshop that will inform our strategic plan for
  HMR............................................7       2008-2010 were:-                                                               A/Prof Eugen Molodysky
                                                                                                                                                         Chair
  Practice Support ......................8                  •   to establish and support a Community Education Program
                                                            •   to engage GPs in community education events/initiatives
  Immunisation.............................9
                                                            •   to increase participation in CPD activities
  NPS .............................................9        •   to involve younger GPs and GP Registrars in CPD activities
  Adolescent Health.................10                      •   to establish and support Community Clinical Schools
  Aged Care ...............................11               •   to engage and support GP Registrars as Teachers

  IT ...............................................12      •   to develop and support a Doctors Health Program
                                                            •   to establish a database of GPs for GPs (a list of GPs willing to
  Advertisements ................13-15                          see their colleagues)
  Book Review...........................15                  •   to enhance and support the Adolescent Health Program
  CPD Events.............................16                 •   to establish a database of Adolescent Friendly GPs
                                                            •   to enhance the Aged Care Program
                                                            •   to recruit and support GPs for care of the aged
                                                            •   to enhance the Women’s Health Program
                                                            •   to promote and support a holistic approach to women’s health
                                                            •   to enhance the Mental Health Program
                                                            •   to recruit and support GPs and psychologists
Suite 103, Level 1, 35 Spring Street                     The final strategic plan will include further input from the ESDGP management
Bondi Junction, NSW 2022                                 and staff following an operations review and planning meeting.
Tel: 02 9389 0874
Fax: 02 9387 4175
Email: esdgp@esdgp.org.au
Web: www.esdgp.org.au
ABN: 84 063 189 042                                       General Practitioners and Climate Change
                                                          GPs interested in learning more about or becoming involved in Doctors for the Environment
                                                          Australia are encouraged to visit their website. www.dea.org.au. Doctors for the Environment
                                                          Australia is an independent group acting as a focus for the increasing number of doctors
                      All contributions to the            interested in further information and action in regards to climate change The DEA believes that
                      newsletter are the views            climate change is relevant to general practitioners because a hotter climate will cause issues and
                      of the author and not               changes relating to patients and will mean a challenge to the health of communities.
                      necessarily those of the
                      Eastern Sydney Division
                      of General Practice
Cert No QEC22235                                                                                  Visit our Website at www.esdgp.org.au
 In Focus                                                                                                                              MEDICAL DIRECTOR
Rotavirus Vaccine
There have been several enquiries recently about Rotavirus                                       to 6 months of age regardless of how
vaccine.                                                                                         the vaccine is funded. Rotarix® is
According to the Department of Health and Ageing at                                              given as 2 oral doses - at 2 months
http://www.health.gov.au/internet/wcms/publishing.nsf/Con                                        and 4 months of age while RotaTeq®:
tent/rotavirus_vaccine.htm Rotavirus gastroenteritis is a                                        is given as 3 oral doses - at 2 months,
highly infectious virus causing severe diarrhoea. About 42                                       4 months, and 6 months of age.
per cent of cases are babies under 12 months and 92 per                                          Both vaccines received funding this
cent of cases are children under 5 years of age. In children                                     year from July 1. In other words,
under 5 years, Rotavirus results in 10,000 hospitalisations,                                     babies born from 1 May 2007 may
                                                                                                                                                                    Dr Jonathan Bentley
22,000 emergency department visits and 115,000 GP visits                                         receive free vaccination between 2 to                                  Medical Director
every year.                                                                                      6 months of age.
Currently there are 2 brands available in Australia for                                          The ESDGP has a range of immunisation resources available
Rotavirus vaccination - Rotarix® from GlaxoSmithKline and                                        to assist members. Please contact ESDGP for more
RotaTeq® from CSL Limited.                                                                       information on 9389 0874.
Both brands are registered by the Therapeutic Goods
Administration (TGA), but only for use in babies between 2




 Self Managed Super Funds
 Representing approximately 25% of all super assets in Australia, self- managed super funds (SMSFs) hold over $200 billion of
 assets in over 300,000 self-managed super funds.
 “Like other super funds, SMSFs are a way of investing funds, which cannot be accessed until retirement,” says * Rod Dunn
 from RetireInvest Bondi.
 “But SMSFs also have their own special set of rules.”
 In a SMSF:
 • There are less than five members
 • All members are trustees of the fund
 • If using a corporate trustee, all members must be directors of the corporate trustee
 • Members cannot be employed by one another unless they are related
 • Trustees cannot receive payment for their service as trustee.
 “You should have at least $200,000 in super for a SMSF to be cost-effective,” says Rod. This is because fixed costs associated
 with a SMSF such as administration and auditing, will be similar no matter how much you have invested.
 It’s also important to make sure you have the time and inclination to set-up and run your own super fund.
 “As the trustee of a SMSF, you are responsible for its administration, management and compliance.”
 “Significant penalties (including jail) can apply if you breach your compliance obligations,” warns Rod.
 So while the responsibility ultimately lies with you, it’s a good idea to seek professional assistance.
 RetireInvest can assist you in formulating and documenting the strategy for a SMSF. For further information, contact
 Rod Dunn from RetireInvest Bondi on 9369 3200.

 * Rod Dunn is an Authorised Representative of RetireInvest Pty Limited (ABN 23 001 774 125), Australian Financial Services Licence 238429. This editorial does not consider your personal
 circumstances and is general advice only. You should not act on any recommendation without considering your personal needs, circumstances and objectives. RetireInvest recommends you
 obtain professional financial advice specific to your circumstances.




                                                                  National Food Safety Week 2007 will be held 12-19 November 2007
                                                                  – the week after Melbourne Cup.

  As this year is the 10th anniversary of the Food Safety Information Council, the theme will be Back to Basics focusing on the main food safety
  messages – Clean, Cook, Chill and Separate. Got to http://www.foodsafety.asn.au/foodsafetyweek/index.cfm for more information. If you are
  organising an event or activity to promote food safety let us know so we can let others know. Email the details to foodsafety@ozemail.com.au



 2                                                                                                              Visit our Website at www.esdgp.org.au
 In Focus                                                                                            A VIEW FROM KINGS X
Point of care testing
Now that we are two weeks into an election campaign, it is                  strain caused by patients
poignant to consider the findings of a coroner's inquest in                 being discharged too early by
Tweed Heads which has discovered yet another preventable                    emergency         departments
death caused by failures in the health system. A 67-year-                   means that much of the
old woman Charlotte Trushnig died from self-inflicted burns                 pressure of seriously unwell
after six suicide attempts in as many weeks. She had                        patients falls back on families
explained that she needed somebody to live with her at                      and general practitioners.
home because she felt otherwise that she would hurt                         Coupled with this is the
herself. This woman was sent home by cab from the                           paucity of information which
hospital emergency department having been assessed as                       is provided to general                    Dr Raymond Seidler
low risk by triage staff. Soon after she drank bleach and set               practitioners by hospital                            Kings X
herself alight with methylated spirits. She died a few hours                emergency         departments
later in hospital. It appears that the prevailing hospital                  when such often complex, elderly patients are flicked back
culture is to remove patients from the emergency                            into the community.
department as soon as possible due to a lack of beds and                    When we consider the mental health area, an extra level of
this patent was discharged home.                                            complexity prevails. Recently I had occasion to request a
The investigating magistrate, Jeff Linden found in his                      crisis team for a seriously unwell patient in the inner city. I
inquest that this was another example of NSW Health’s                       was told that the two psychiatric nurses were held up
inability and/or failure to deal with individual cases in an                attending to another patient and would be unavailable for
appropriate manner.                                                         a few hours. It was suggested that I call the local police to
In addition we have had recent evidence of a public hospital                have my patient transported to the local psychiatric
system in crisis with teaching hospitals running beyond                     hospital. This was not an easy solution to a difficult
capacity into the ‘danger zone’. Public hospitals Australia                 problem, as the police must remain with the patient until he
wide are continually under pressure with less than two                      is fully admitted and this takes two officers directly off
thirds of urgent emergency department patients seen                         regular duties. Surely, in 2007, with an election campaign
within clinically appropriate times.                                        in full swing and reports coming thick and fast about public
                                                                            hospital systemic failure, we should have comprehensive
NSW bed occupancy is sitting at 97%. It is now well                         funding of all emergency services with an appropriate,
acknowledged that any bed occupancy level over 85% is in                    integrated communication network with GPs in the
the danger zone.                                                            community. At this late stage in the election campaign,
It seems extraordinary that neither political party in this                 surely it’s time for Minister Tony Abbott and Shadow
current election campaign has produced a coherent policy                    Minister Nicola Roxon to offer more than the little they
to deal with the obvious constraints on the creaking public                 have proffered so far to give us hope that things will
health system. GPs working at the coal face know just how                   change after November 24. Perhaps GPs need to become
hard it is to have a patient assessed, triaged and                          more politically active as we watch the system degenerate
appropriately treated in emergency centres. The increased                   irreparably.



                      Professional Development Day for GPs working
                           with Aboriginal Clients – BBIs & STIs
                   Date: Saturday 1 December 2007
                   Time: 9.00am – 5.00pm
                   Venue: Mercure Sydney, 818-820 George Street, SYDNEY NSW, Ph: 02 9217 6666
                   The program has been developed by the AH&MRC & ASHM and will include the following:

                      ÷ An overview of the epidemiology of BBI and STIs with specific emphasis on rates among Aboriginal people.
                      ÷ The testing principles, pathogenesis, natural history and treatment of HIV, hepatitis B and C and common viral and
                        bacterial Sexually Transmissible Infections.

                     This activity has been approved by ACRRM and the RACGP QA&CPD Program, Allocated 12(Category 2) QA& CPD points


                                                                   This is a FREE course
                                     A limited number of travel scholarships are available to attend this course
                                          Contact Hiba Jebeile on 8204 0725 or hiba.jebeile@ashm.org.au for further details.

                    Please fax completed flyer to 02 9212 2382 OR register online at www.ashm.org.au/courses
                                          Registrations close: Friday 16 November 2007
                                                                                                                                             3
  In Focus                                                                                 WOMEN’S HEALTH
Recently OPD staff at the RHW were given a brief update on      develop immunity to HPV
the interpretation of mid stream specimen of urine (MSU)        16 & 18 (the types
results, weight gain and thyroid screening in pregnancy by      responsible for over 70%
Dr Kenneth Chen, Physician Registrar at the RHW. Kenneth        of cervical cancer) Gardasil
recommended:                                                    protects against HPV 16
• that dip sticks on urine specimens are very unreliable and    &18 as well as 6 &11
  suggested and that routine MSUs be performed on all           (responsible for genital warts) Cervarix protects against HPV
  pregnant women at booking                                     16-18 only.
• that the optimum time to take the MSU was in the              Gardasil is registered for use in females aged 9-26 and males
  morning and to discard the first specimen                     aged 9-15. There is no evidence of any benefit for women
• if a specimen was reported as contaminated, ask your          aged over 26 and it is not registered for that use. Women over
  patient to wash carefully before providing the repeat the     26yrs are advised to continue to have regular pap smears.
  specimen                                                      Dr Campion noted that in the 20-26 there is some small
• the MSU should be repeated at monthly intervals for           benefit depending on life style…”however the vaccination
  women who have a history of recurrent UTI’s (> 2 in the       is free, will not harm them and who knows in a few years
  pregnancy)                                                    that studies may show there to be a weak benefit”….
• Women with a history of pyelonephritis or a strong family     Dr Sen also mentioned an alarming statistic that in NSW
  history of renal disease may need to be referred to the       25% of thirteen year olds are sexually active. Dr Campion
  RHW physician and offered a renal scan and a monthly          also mentioned that the suggestion that this vaccination
  MSU.                                                          could lead to greater promiscuity had not been helpful.
He suggested treating when:                                     Finally, an exciting research project from the RHW is looking
• WCC> 10/5 per litre is significant                            into the understanding of the effects of SSRIs and SNRIs on
• WCC> 10/2 per litre with symptoms is significant              the newborn infant.
Antibiotics of choice include: amoxicillin, augmentin and       SSRIs and SNRIs (such as Venlafaxine) are important drugs in
keflex depending on sensitivity.                                the treatment of depression. Untreated depression,
White cells and pyreamia is unusual and the MSU should be       especially of the new mother, has significant social and
repeated and not ignored.                                       personal ramifications for both the women and her family.
                                                                Existing research involving newborn infants have so far
Streptococcus B in the urine should be treated, some
                                                                been limited to small series of case-reports.
obstetricians do offer antibiotic cover in labour for these
women.                                                          As SSRIs and Venlafaxine affect neurotransmitter function,
                                                                there is a possibility that the function of the developing
Recommended weight gain during pregnancy is as follows:*
                                                                nervous system may be affected in some way that is not
• BMI of 20-25 weight gain in pregnancy of 11-16 kg is          currently predictable. Our study will provide an important
  considered OK and during the 2-3rd trimester the weight       contribution towards an understanding of the effects of
  gain of 0.4 kg per week is acceptable depending on parity     these important medications on the newborn infant. We
• BMI of 25-30 up to 11.5 kg                                    would like your help to recruit participants to help us
• BMI 30 or greater women are referred to the High Risk         investigate the effects of antidepressants on newborn
  Clinic as well as a dietician and the weight gain in these    infants. We are looking to recruit 3 (three) groups of
  women should be 7kg or no weight gain at all.                 pregnant women delivering either at the Royal Hospital for
* data source American Society of O&G.
                                                                Women or the Prince of Wales Private Hospital who fall into
                                                                one of the following categories;
A brief look at thyroid function tests. He suggested that if
                                                                1.Clinically depressed pregnant women on SSRIs or Efexor
a woman has a low BMI and is pregnant it is worth
                                                                2.Pregnant women who have symptoms of depression and
investigating and recommended TSH and FT4 - after 20
weeks of pregnancy due to the suppression of TSH in the           are currently NOT on any antidepressant medication, or
early stages of pregnancy.                                      3.Pregnant women with no symptoms of depression.
Hypothyroidism may have long term effects on IQ and             For further information or to refer potential participants
developmental delay. Women with newly diagnosed                 please contact Julia Eve from the Department of Newborn
thyroid disease should be referred to the physicians for        Care, Royal Hospital for Women, Randwick on either
assessment; however most will return to the shared care         9382-6179 or Julia.eve@sesiahs.health.nsw.gov.au
program for your management.                                    Don’t forget the RHW O&G update on Saturday Nov 10th
Recently a question was raised by a local GP who wanted         lunch at 12pm and the meeting starts at 1pm
to know what the benefits were of giving Gardasil /Cervarix
vaccination in prevention of cervical cancer in the older         Deb Blackwood, Program Officer, Women’s Health
women ie > 26 yrs and I approached Dr Mike Campion and            Phone: 93890874 Ext 207
Dr Rahul Sen for their advice.                                    or email dblackwood@esdgp.org.au
Dr Mike Campion said that there is no doubt about the
efficacy of the vaccine in the group 18 - 23yrs, the research
                                                                  Dr Maria Opacic, GP Advisor, Women’s Health
suggesting that within this group almost 100% of women            email mopacic@medemail.com.au

  4                                                                       Visit our Website at www.esdgp.org.au
 In Focus                                                                                     MENTAL HEALTH
New multicultural mental health                                 Courses and training
fact sheets                                                     The Black Dog Institute offers 30 Category 1 QA&CPD
                                                                points in an upcoming course titled:
New Factsheets available via website
http://www.mmha.org.au/find/resources                           Demystifying Depression
                                                                Managing Depression in General Practice
For those who don't have internet access, Multicultural
                                                                Saturday 24th November 2007, Randwick, Sydney
Mental Health Australia (MMHA) contact details are:
                                                                Presenters
Phone: (02) 9840 3333                                           • Dr Howe Synnott, Psychiatrist & Medical Educator,
Fax:   (02) 9840 3388                                             Black Dog Institute
                                                                • Dr Vered Gordon, GP & Medical Educator, Black Dog
Email: admin@mmha.org.au
                                                                  Institute
Information Service:
info@mmha.org.au                                                Learning Outcomes
                                                                • Describe the Black Dog Institute’s model of depression
                                                                • Write a Mental Health Care Plan (item number 2710)
                                                                • Use the psychological tool kit, in association with a
                                                                  problem identification tool (Identifying Your Priorities).
                                                                Program Information
Youth Mental Health                                             Date: Saturday, 24th November 2007
                                                                Time: Registration, 9.15am for 9.30am start, 4.30pm finish
The October MJA Supplement is on Early Intervention in
                                                                (lunch & refreshments served)
Youth Mental Health. The latest information on youth            Venue: Black Dog Institute, Hospital Road, Prince of Wales
mental health is included.                                      Hospital, Randwick NSW 2031
See web link: http://www.mja.com.au/public/information/         Endorsement: Active Learning Module: Category 1
supplements.html or call Natasha at the Division for a copy     attracting 30 QA&CPD points or 7 ACRRM PDP and Better
of any of the articles.                                         Outcomes in Mental Health Care Level 1 for those who
                                                                complete requirements.
                                                                Cost: There is no charge for this workshop
 Natasha Sekelja
                                                                Enquiries: Contact Katherine Dabich, ph: 02 9382 8518, or
 Program Officer, Mental & Adolescent Health                    email: k.dabich@unsw.edu.au
 Phone: 93890874 Ext 204
                                                                To register please email your details to Katherine or
 or email nsekelja@esdgp.org.au
                                                                complete and fax the form enclosed to Fax: 02 9382 8207




                       Dr Surya Krishnan BSc(Med) MBBS(UNSW) FRANZCOG
                Obstetrician and Gynaecologist, Gynaecology Endoscopic Surgeon
 Dr Surya Krishnan is an Obstetrician and Gynaecologist at the Royal Prince Alfred Hospital and Prince of Wales
 Private Hospital, Randwick.
 Dr Krishnan is an Obstetrician who has trained in prestigious centres in Australia and the USA. With his special
 interest in pelvic floor and neural plexus damage during and after pregnancy, Dr Krishnan also contributes his
 expertise to the pelvic floor clinic at RPAH which also provides counselling for pregnant women who have sustained
 prior Traumatic Deliveries, Continence or Pelvic Organ Prolapse sustained after pregnancy.
 Dr Krishnan has a team of continence and pelvic floor physiotherapist in conjunction with urodynamic assessment if
 required. All women under his antenatal care will also benefit from his pelvic floor expertise.
 In addition to Obstetrics, Dr Krishnan also has a special interest in Laparoscopic (Key Hole) surgery for: Endometriosis,
 Pelvic pain, Prolapse and Incontinence, Infertility, Hysterectomy and fibroids
 Dr Surya Krishnan speaks fluent Indonesian and Mandarin
 For further enquires, see your GP or contact 1300 738 680 or 9810 4751
   RPAH Medical Centre                Royal Prince Alfred Hospital                 343 Darling St
   Suite 403, 100 Carillon Ave        Dept Endo-Gynaecology and Pelvic Floor       Balmain 2041
   Newtown 2042                       Missenden Road. Camperdown
   Tel: 1300 738 680                                                               Tel: 02 9810 4751
   Fax: 02 9550 3927                                                               Fax: 02 9810 8032


                                                                                                                             5
        ENHANCED DIVISIONAL QUALITY USE OF MEDICINES (EDQUM)
What is the relationship between food and energy?1
Food that is converted to energy is usually fat, carbohydrate    Food for energy
or protein. Carbohydrates are readily converted into             Energy foods are those with a lot of B-complex vitamins
glucose which is either used immediately as energy or is         including folic acid and biotin. Other nutrients important
converted to glycogen and stored in the liver and muscles.       for energy production are vitamin C, magnesium, zince,
When more energy is needed, the glycogen is released into        copper and co-enzyme Q10.
the bloodstream.
                                                                 The most effective group of “energy foods” are:
There should be a good balance between protein and               wholegrains such as oats, millet, buckwheat, rye and
carbohydrates, but “a good balance” is highly individual         quinoa, corn and barley; dense vegetables such as broccoli,
and varies among people. Individuals have to find their          cauliflower, brussels sprouts, mushrooms, turnips, carrots,
balance through trial and error. For example,                    asparagus, artichokes and spinach; fruit such as avocados,
increase/decrease by small amounts the intake of                 apples, pears, pineapples, berries; fish, seaweed, eggs,
protein/carbohydrate and see how your energy levels              walnuts, brazil nuts, seeds, haricot beans, lima beans,
change and at which point you have consistently more             chickpeas, lentils and soya beans.
energy. It is important to remember that “carbohydrates”
                                                                 The next best group is: buckwheat, wild rice, oatcakes;
refers    to    “good    carbohydrates”   or   “complex
                                                                 potatoes, sweet potatoes, corn, squash, beetroot, peppers,
carbohydrates” such as those found in dense vegetables
                                                                 yam, watercress, salad leaves; peaches, apricots, mangoes,
and wholegrains.
                                                                 papayas and bananas; kidney beans, black beans, split/dried
Too much protein becomes a problem because protein               peas, almonds, chicken, game, turkey, yoghurt, cottage
stimulates the body into an acid state which the body            cheese.
compensates for by releasing calcium from the bones to
                                                                 The least effective “energy foods” are: processed
restore the body to an alkaline state. This can lead to
                                                                 carbohydrates; tomatoes, green peas, zucchini, cucumber;
compromised bone-health and greater risks of osteoporosis.
                                                                 dried fruit, grapes, figs; dairy, beef, lamb and veal.
It should be remembered that animal products including
cheese and milk are sources of protein and should not be         Hidden sugar
relied on as a source of calcium supplementation.                Sugar, despite being a “natural product”, disturbs the
                                                                 process of energy production in the body and plays havoc
Stealing energy                                                  with blood sugar levels. Sometimes it isn’t obvious that food
Certain substances steal energy or interfere with production
                                                                 contains sugar. It is imperative that people read the labels
of energy because they stimulate the production of
                                                                 of all the food they buy and recognise the different forms
adrenaline. If the production of adrenaline is constantly
                                                                 of sugar, such as honey, molasses & fruit. Don’t forget
stimulated by these foods, general fatigue occurs because it
                                                                 alchohol contains sugar too.
interferes with the digestive process and directs the liver to
release glycogen. Although this produces short-term              No easy way out
energy, it also produces long-term fatigue because energy        Unfortunately, there is no easy way to “fix” the problem of
stores are depleted.                                             lack of energy. Diet can play a big part as well as stress
                                                                 reduction, quality sleep and regular exercise. Each person
Substances that cause this are alcohol, caffeine (tea, coffee,
                                                                 needs to find the mix that is right for them, not adopt “the
fizzy drinks), cakes, biscuits and sweets.
                                                                 latest”. Hopefully, a little effort will yield good rewards and
Stress and nicotine also encourage the release of stored         thereby provide motivation.
glucose resulting in short-term energy but long-term             Reference: 1. The Food Doctor, Healing foods for mind and body; V. Edgson, I.
fatigue.                                                         Marber, Great Britain, 1999




                                      GP WANTED FOR THE CITY
             Friendly Sydney CBD doctor-owned accredited practice seeks replacement GP
                         for retiring male partner. 60% share. Flexible hours.
                      Contact Frances Kavanagh, Practice Manager on 9290 3477




 6                                                                            Visit our Website at www.esdgp.org.au
  In Focus                                                                                        HOME MEDICINES REVIEW

GP TIP                                                                         Recommendations to GP:
HMRs can be initiated at an ordinary visit and the second                      Although Zoloft is a good
visit can be added to another ordinary visit.                                  choice for this patient, she
                                                                               still experiences anxiety so
Both the visit and the HMR Claim MUST BE DOCUMENTED.
                                                                               the dose may be too low.
A second HMR can be done on patients whose medical                             Long-term        use       of
condition has altered. There needs to be DOCUMENTATION                         medication such as Serepax can lead to tolerance and
OF THE REASON WHY otherwise it may be rejected.                                increased risk of falls, so it may be beneficial to change the
                                                                               dosage to intermittent use.
CASE STUDY1
80 year-old female with IHD, angina, GORD,                                     Anxiety and palpitations can be symptoms of
hypothyroidism, osteoporosis, osteoarthritis, depression &                     hyperthyroidism, so thyroid function should be tested and
anxiety. She has a BMI of 19kg/m2 & uses a Zimmer frame.                       if necessary, the dose of Oroxine adjusted. Also,
She drinks several cups of coffee a day, a rum & cola at night                 hyperthyroidism lowers bone density. The use of PPI’s for
and is an ex-smoker.                                                           over one year has been associated with significantly
                                                                               increased risks of hip fracture.
Medications: Transiderm-Nitro 25, GTN spray prn, Zoloft
50mg, paracetamol 500mg 1-2 prn, Fosamax Plus weekly,                          The patient may also need to have vitamin D levels tested.
Caltrate 2 daily, Monic 15mg prn, Serepax 15mg bd & prn,                       For best therapeutic effect, recommended doses of calcium
Oroxine 150mcg mane, Nexium 40mg daily.                                        are 1200mg (600mg bd because the body absorbs calcium
                                                                               less efficiently as the dose increases) and 800IU vitamin D
Patient’s discussion with pharmacist: the patient is                           daily. Since calcium reduces absorption of oroxine, these
concerned about her increasing anxiety and tremor. She has                     medications should be taken at least four hours apart. Also,
also been suffering from headaches & palpitations and has                      calcium carbonate needs an acidic environment to dissolve
had recent falls. She feels restless and has trouble                           in the gut and to be absorbed into the blood stream;
concentrating. She asks about gingko bilboa to help with                       calcium citrate (Citracal) doesn’t require acidity and may be
memory.                                                                        better in this patient. Elderly patients often have reduced
Pharmacist’s recommendations to the patient: to use                            gastric activity anyway and she is on a Nexium, so this
methods of relaxation daily (pharmacist provided some                          should be reviewed for ongoing need.
information on relaxation techniques). They discussed falls                    Perhaps the use of propanolol could be considered here to
prevention strategies as well as benefits of exercise for                      treat the tremor and palpitaitons associated with anxiety.
strength and balance, however this would need to be                            The patient doesn’t appear to have contra-indications (e.g.
supervised. She may also benefit from a home assessment                        airways disease, bradycardia or uncontrolled heart failure).
for falls prevention. The pharmacist also discussed the risks                  Reference: 1. Case study provided by consultant clinical pharmacist as
and benefits of the Serepax. The pharmacist advised her to                     published in Pharmacy News, September 2007.
cut down on caffeine, i.e. coffee and cola. Cola drinks are
associated with lower bone mineral density in older                               Please contact Anita Schwartz for any
women. Finally, the pharmacist checked the storage                                assistance with HMR.
conditions for Oroxine and explained that there was not                           Phone: 93890874 Ext 206 or email
convincing evidence that ginko will help her with dementia                        aschwartz@esdgp.org.au
and cognitive impairment.




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                                                                                                                                                        7
 In Focus                                                                                                         PRACTICE SUPPORT
Mumps                                                                            The new schedule would also bring forward the second
NSW Health has issued a health advisory to the community                         dose of MMR vaccine from four years to 18 months because
to be alert for the symptoms of mumps amidst an increase                         this provides better immune protection. Dr Eizenberg said
in the number of cases.                                                          the new handbook was needed to reflect the introduction
                                                                                 of new vaccines against infections such as HPV, varicella and
Director of Communicable Disease for NSW Health, Dr
                                                                                 rotavirus, and to clarify advice on immunisation against
Jeremy McAnulty said there have been 148 reported cases
                                                                                 influenza.
of mumps so far this year compared to 153 in total for 2006.
In 2001, there were just 28 cases reported and only 35 cases                     Other changes in the new schedule include an
in 2003. The majority of the 2007 cases are among men.                           acknowledgement that vaccines can be given in the ventro-
                                                                                 gluteal area, and a new recommendation that there is no
To prevent the spread of mumps, children and young adults
                                                                                 need for a minimum interval between use of dTpa and
should have had two doses of the MMR vaccine. People
                                                                                 other tetanus containing vaccines in adults.
diagnosed with mumps should stay at home for nine days
after the onset of swelling of the salivary glands.                              A draft version of the 9th Immunisation Handbook can be
                                                                                 found: http://web.archive.org/web/20070311102425
Mumps is spread via respiratory droplets or from person to
                                                                                 /immunise.health.gov.au/internet/immunise/publishing.nsf
person via direct contact with infected saliva.
                                                                                 /Content /handbook07
Symptoms begin two to three weeks after exposure to an                           * Note: Nothing has changed in the 9th Edition as compared with Strive for Five.
infectious person. People are infectious for up to nine days                     Bar fridges are still not recommended and purpose built fridges are not
                                                                                 mandatory. The only requirement for general practice accreditation is that
after swelling of the salivary glands begins,” he said.                          practice maintains a robust cold chain management procedure as outlined in
                                                                                 Strive for Five.
Dr McAnulty said people born during or after 1966 who                            Sources: 6minutes.com.au. Monday October 8th 2007. http://www.
have not had two doses of vaccine are more at risk and                           6minutes.com.au/dirplus/images/6minutes/newspluspharma/8_10_2007.pdf
                                                                                 Kirsten Ward - Alliance of NSW Divisions Immunisation Coordinator
should be vaccinated with the MMR (Measles Mumps and
Rubella) vaccine.                                                                Save $$$ For Your Practice
                                                                                 GPA Accreditation plus is offering all Eastern Sydney
Many people in their 20s, 30s and early 40s will not be                          Division of General Practice GPs a “Special” Group Package.
immune, so it’s particularly important they check their                          As part of this “Special” Package, GPA is giving the Division
status with their doctor and get a vaccination. Parents                          the opportunity to register 10 Practices at ONCE and receive
should ensure that their children are vaccinated on time.                        the many benefits of the GPA Accreditation Program.
9th Edition Australian Immunisation Handbook                                     By registering 10 practices together, GPA is able to pass on
The 9th Immunisation Handbook to be released later this                          significant COST SAVINGS, to all practices.
year. two of the major changes planned are a ban* on the
use of bar fridges for vaccine storage and an earlier second                     For expressions of interest please call Candi at the Division
dose of MMR.                                                                     on 9389 0874 ext 203 or email: cmadziar@esdgp.org.au

“The new handbook will include a new and much stronger                           or for further information Samantha Elliott – Division
recommendation against the use of bar fridges for vaccine                        Liaison Officer on 6944 4042 or email:
storage because of temperature instability”, said Dr Peter                       samanthaelliott@gpa.net.au
Eizenberg, a Melbourne GP and NHMRC immunisation
committee member. Speaking at the RACGP annual
                                                                                    Candi Madziar
conference, he said the handbook was the reference
                                                                                    Practice Support, Practice Nurse &
publication on immunisation and thus the recommendation
                                                                                    Immunisation Program Officer
would effectively mean practices would miss out on
                                                                                    Phone: 9389 0874
accreditation if they used bar fridges rather than purpose
                                                                                    Email cmadziar@esdgp.org.au
built vaccine fridges.


 Beating Bowel Cancer through Online Education
 The Royal Australian College of General Practitioners’ (RACGP) and the Cancer Council of Australia have teamed up to deliver bowel cancer screening
 education to general practitioners and their practices across Australia. The new education program will be delivered using the RACGP’s innovative online
 learning platform – www.gplearning.com.au
 The launch of the new learning program coincides with the first phase of the Commonwealth Governments National Bowel Cancer Screening Program
 (NBCSP). The NBCSP relies heavily on general practitioners supporting the program and notifying the register of the referral status of positive cases.
 Medicare Australia is sending a free Faecal Occult Blood Test (FOBT) to 1 million people in Australia who turn 55 or 65 years of age between 1 May 2006
 and 30 June 2008, inviting them to participate in the program. If a test result is positive, the person will be notified and advised to see their general
 practitioner for further assessment
 General practitioners need to be ready to support patients who come in for further tests for more information visit www.cancer.org.au.


 8                                                                                            Visit our Website at www.esdgp.org.au
 In Focus                                                                                      IMMUNISATION

This month’s article focuses on how to manage serious         • apnoea
adverse reactions to vaccines and is derived from the         • any other serious event
Immunise Australia website.                                     that            required
For people who have experienced a serious adverse event         hospitalisation        or
following immunisation, there have been services that aim       emergency medical review
to:                                                             and treatment.

• review people who have had a serious adverse event          Some parents/guardians are reluctant to re-vaccinate
  following immunisation to determine if there is a           children/adolescents after an immunisation adverse event,
  relationship between vaccination and the adverse event;     unless re-vaccination is done under close medical
                                                              supervision. This may include time in hospital.
• work out whether other schedules vaccines should be
  given                                                       A history of
                                                              • anaphylaxis (to a vaccine component) and
• provide a specialised environment in which further
                                                              • encephalopathy (occurring within 7 days) following
  vaccinations can be given, so patients can be closely
                                                                vaccination
  monitored and treated should an adverse event occur.
                                                              are now the ONLY absolute contraindications to re-
Indications for referral to a vaccination serious adverse     vaccination.
events service include:
                                                              All adverse events following immunisation (AEFI) are
• seizure                                                     notifiable and in Sydney, GPs should contact the National
• persistent, inconsolable screaming for 3 or more hours or   Centre for Immunisation Research and Surveillance (NCIRS)
  an unusual distinctive high pitched cry                     on 9845 1433.
• a temperature of 40.5 degrees or more, unexplained by
  any other cause;
                                                                Dr Ankita Roy, GP Advisor, Immunisation
• generalised skin rash within 24 hours
                                                                Email ankitaroy@hotmail.com
• hypotonic hypo-responsive episodes




                                                   N P S
                                        National Prescribing Service Limited
Current NPS audit – management of hypertension                The NCIRS has since confirmed that
(clinical e-audit)                                            families moving from one Australian State
The current and final NPS audit for this PIP year is          or Territory to another will be able to access rotavirus
Management of Hypertension. You can enrol for this audit      vaccination under the National Immunisation Program in
by completing your details on the attached flyer and          their new State, and are updating their advice on how the
returning to NPS before Friday 11th January 2008.             schedule should be completed. NPS is liaising with the
                                                              NCIRS and National Immunisation Committee and will
                                                              provide a statement based on the most recent advice from
New publications / listings                                   these bodies. This will be available on the NPS RADAR
Interstate transfers and rotavirus vaccination of infants     section of the NPS website.
The August NPS RADAR article ‘Rotavirus vaccines (Rotarix
                                                              Varenicline tartrate for smoking cessation
and RotaTeq) for prevention of rotavirus gastroenteritis’
                                                              The PBAC has recently recommended the listing of
stated that since the two rotavirus vaccines were not
                                                              varenicline as a short-term treatment to aid smoking
interchangeable, infants should complete the entire course
                                                              cessation in patients aged 18 years or older on the basis of
of vaccination using the same rotavirus vaccine and that
                                                              an acceptable cost effectiveness compared with bupropion.
families who move to a State or Territory where a different
                                                              An NPS RADAR review of varenicline tartrate will be
vaccine is funded may need to bear the cost of completing
                                                              available in the December 2007 issue.
their child’s vaccination schedule. Both NPS and the
National Centre for Immunisation Research and Surveillance
(NCIRS) have received correspondence from GPs seeking           Sowmya Gandham
clarification of the above.                                     Program Officer, NPS
                                                                Phone: 9389 0874 ext 205
                                                                or email sgandham@esdgp.org.au


                                                                                                                       9
  In Focus                                                                                        ADOLESCENT HEALTH
                                                                            • Young people can be coerced into attending appointments
                                                                              by various others – acknowledge this, ensure you see the
                                                                              patient alone and try to find common ground even if it is
                                                                              “try to get others to stop controlling me”.
                                                                            • Family involvement although desirable is not always
Journal Watch                                                                 possible, and should not be mandatory. Remember the
                                                                              doctrine of the mature minor. You may be able to
“Tips and techniques for engaging and managing                                encourage involvement of the family later on when some
the reluctant, resistant or hostile young person.”                            barriers have been addressed. Clearly document your
McCutcheon et al. From MJA Supplement “Early Intervention in Youth Mental     assessment of capacity for informed consent.
Health” 1 October 2007 Vol 187 Number 7
                                                                            • Confidentiality – always include this discussion along with
A couple of weeks ago I had a young fellow storm out of my
                                                                              explanation of its limits.
room half way through a very unsatisfactory consultation. I
                                                                            • Attendance – this one drives me crazy!! Young people
felt terrible but consoled myself that I really couldn’t have
                                                                              often miss appointments – the article says it is “crucial not
done anything better to save the situation… then this
                                                                              to be punitive in your response to these behaviours. While
article appeared in the latest MJA supplement! Of course
                                                                              a punitive approach might yield short-term satisfaction
now if only I had my time again… I’d like to share a few
                                                                              for the clinician it is likely to make the situation worse,
salient points, particularly to do with engagement, which I
                                                                              result in patient drop-out, and reduce the likelihood of
clearly failed to achieve that time.
                                                                              help-seeking.”
• “Young people usually want to be treated as if they are
                                                                            • The article also gives some good tips on managing
  able to make decisions for themselves, but some struggle
                                                                              reluctant or resistant behaviour, and hostile, angry or
  with asking for assistance, or reject help when it is
                                                                              threatening behaviour.
  offered, even when a situation feels wildly out of
  control.”                                                                 • They referred to a good website: www.orygen.org.au. It
                                                                              has good fact sheets for young people.
• Stigma associated with mental illness can be two sided –
  clinicians’ attitudes if negative or demeaning, even                      Thanks for your interest, and please keep your fingers
  unintended, are picked up by patients, and also patients                  crossed for the outcome of the Headspace funding
  who have had negative previous clinical experiences.                      application, which I can hopefully tell you more about next
                                                                            month.
• Denial and avoidance of distress by drug and alcohol users
  results in a vicious circle of inability to discuss difficulties
                                                                              Dr Karen Spielman
  and worsening problems. Be non-judgemental and
                                                                              GP Advisor, Adolescent Health
  inquisitive – this can help them to find a way of accepting
                                                                              Email karenspi@optusnet.com.au
  responsibility and agreeing to treatment for own benefit.




 10                                                                                    Visit our Website at www.esdgp.org.au
  In Focus                                                                                                AGED CARE
The Importance of CMAs to Residential Aged Care Facilities
                  As we have been promoting all along             diagnosis and this has been
                  to our GPs, the importance of CMAs for          completed within the past 12
                  residents it is now spreading through           months. As you can appreciate,
                  the system. The Aged Care Association           dementia and behaviours are very
                  of Australia (ACAA) is advising ACFs            common within residential care, and services must be able
                  that the residential aged care sector is        to claim for appropriate levels of funding to support the
going through a major change to its funding system.               staffing required to meet the needs of these residents.
A new funding tool - the Aged Care Funding Instrument             This change in structure helps to reinforce our focus on GPs
(ACFI) - will be implemented from 20 March 2008 and it is         completing CMAs in ACFs along with the RMMR and
based on measurable needs. In other words it measures the         contribution to Care Plans and case conferencing. GPs are
need for care, not the care provided. It replaces the             actually completing all the requirements of the CMA
Resident Classification Scale (RCS) that has been in place        however a lot of the time they are not completing the
since 1997 and has been the source of much of the onerous         paperwork and claiming the item number.
documentation requirements that have plagued the aged             Aged care call-out fee rises as at 1 November 2007
care sector over the past 10 years.
                                                                  GPs that are attending ACFs will benefit by an extra $18.00
The accreditation process will continue to assess whether         after an increase in the call-out fee. Any additional increases
outcomes for residents are being delivered appropriately,         to be advised in the next newsletter. See page 12 for more
and that care is being provided as required. Introduction of      information
the ACFI will provide aged care providers with the
                                                                  Allied Health Involvement in Aged Care:
opportunity to review unnecessary and duplicative
                                                                  Also on the agenda for the Aged Care GP Panel is the
documentation in the future.
                                                                  additional funding to engage Allied Health Professionals
The new funding tool is made up of three parts: basic             (AHPs) in ACFs. We ask our members if you know of any
subsidy that covers Activities of Daily Living (ADL's) as well    AHPs that have an interest in Aged Care that we are in the
as two Diagnostic sections: Cognition and Behaviour and           process of creating a database of names and professions so
Complex Health Care. To claim funding in these areas there        that we can use their services in educating GPS, staff and
is a requirement to have evidence of a diagnosis in some          residents of ACFs. The funding does not extend to paying
instances as well as information/history of health related        AHPs for payment of clinical services.
issues. The evidence used to support a claim in these areas,
                                                                  The following allied health professionals are included in the
where a diagnosis, provisional diagnosis or re-confirmation
                                                                  initiative:
of a diagnosis is required, must have been completed within
                                                                  Aboriginal Health Workers             Oral Hygienists
the last 12 months.
                                                                  Aboriginal Mental Health Workers Orthotists/Prosthetics
One of the easiest ways of providing documentary evidence
of these conditions is to utilise the information gathered in     Audiologists                          Osteopaths
the process of completing a Comprehensive Medical                 Chiropractors                         Physiotherapists
Assessment (CMA) – an assessment which can be completed           Counsellors                           Podiatrists
and claimed for each twelve months, as well as when there         Diabetes Educators                    Psychologists
is a significant change to the person's medical condition.        Dietitians/nutritionists              Radiographers
The majority of aged care providers will be approaching           Dental Hygienists                     Registered Nurses,
General Practitioners seeking CMA's for their residents                                                 with specialist roles
leading up to the implementation of the new ACFI funding
                                                                  Exercise Physiologists                Social Workers
tool coming into force in March 2008.
                                                                  Occupational Therapists               Speech Pathologists
We are urging services to liaise with all visiting GP's to
                                                                  If you require any further information or you are currently
discuss ways of sharing information that is routinely
                                                                  seeing patients in ACFs and would like to arrange a visit on
collected as part of the comprehensive assessment carried
                                                                  how to claim aged care item numbers please contact
out which forms the basis of care planning and service
                                                                  Jennifer at the division on 9389 0874 ext 202.
delivery to residents in RACFs.
Without evidence of diagnosis and/or previous history the           Jennifer Dunn, Program Officer, Aged Care
facility will be unable to validate their claims for funding        Phone: 93890874 Ext 202
e.g. the highest claim for behavioural supplement funding           or email jdunn@esdgp.org.au
is only claimable if there is a dementia diagnosis, provisional
                                                                    Dr Erin Crumlin, GP Advisor, Aged Care
dementia diagnosis, psychotic diagnosis or behavioural

                                                                                                                                11
 In Focus                                                                                                              AGED CARE

 2007/08 Budget
 Aged care – improved health services for residents of aged care homes
 The 2007/08 Budget measure Aged care – improved health services for residents of aged care homes will increase
 Medicare rebates for GP attendances in residential aged care facilities from 1 November 2007.
 The fees for the majority of GP services in aged care facilities have a derived fee structure. Derived fees have a base
 component which is the same as for other services of the same length and complexity performed in-surgery, and a
 “call-out” component. The “call-out” component is added to the base fee and paid only once per visit being
 apportioned across all patients seen in that visit.
 For attendances by Vocationally Recognised GPs (VR GPs) in residential aged care facilities the call-out fee will
 increase by $18. For attendances by Other Medical Practitioners (OMPs) the call-out fee will increase by $14.05 for
 standard consultations and by $12.45 for brief, long and prolonged consultations in residential aged care facilities.
 For example, where a VR GP sees one patient in a residential aged care facility for a standard consultation (MBS item
 35) the rebate is currently the fee for MBS item 23 (in-surgery standard consultation) + $22.45 “call-out” component.
 From 1 November 2007 this will be the fee for MBS item 23 + $40.45.
 The measure will also increase the fee for contributions to multidisciplinary care plans for patients with chronic
 conditions and complex care needs in residential aged care (MBS item 731) and in the community (MBS item 729).
 The fees for both items will increase by $17.55 from 1 November 2007.
 These fees will also be indexed in line with indexation of the Medicare Benefits Schedule from 1 November 2007.




 In Focus                                                                                                                                 IT
Medicare Claiming                                                        KEY DETAILS OF TRANSITIONAL SUPPORT
                                                                         PACKAGE
The Australian Government is providing a transitional
                                                                         • applies to general practitioners and specialists only
support package for general practitioners and specialists, to
help them use electronic Medicare claiming and provide                   • a lump sum payment of $750 for metro practices and
greater patient convenience.                                               $1000 for rural practices to assist with setup costs for
                                                                           Medicare Easyclaim and Medicare Online
Practices will receive a lump sum payment of between $750
and $1000 to assist them move to either Medicare Online                  • 18 cents for each bulk bill and patient claim transaction
or Medicare Easyclaim. They will also receive 18 cents for                 made electronically between September 2007 and
each bulk bill and patient claim transaction (except                       December 2009 through either channel (except for
pathology claims) made electronically between September                    pathology claims)
2007 and December 2009.                                                  • payments made quarterly, starting in March 2008 (but
“We recognise there is no ‘one size fits all’ way to claim                 backdated to September 2007)
from Medicare,” said Deputy CEO for Medicare Australia,                  • access to a 90 day pay doctor cheque scheme for
Rona Mellor.                                                               specialists for claims lodged electronically
“This package supports practices in making the choice of                 • a per-practice payment to software vendors to assist them
electronic claiming channel that best suits them and their                 in bringing providers online
patients.”
                                                                         • a tailored arrangement to help pathologists make the
More information is available from                                         transition from Medclaims.
www.medicareaustralia.gov.au or calling 1800 700 199.
                                                                         .
                                                                  Family walk from Queens Park to Bronte Park.
                                                                  • Assemble 10am at Queens Park, cnr Carrington Rd and John St, Waverley
                                                                  • Walk starts at 11am along Carrington Rd, Macpherson St and Bronte Rd
                                                                  • Bring a picnic lunch, hat, sunscreen and water, and have a great family day
                                                                    out. There will be BBQ facilities, safe swimming areas, a children's
                                                                    playground, mini train and access to a cliff walk.
 To register call 0439 995 427 or 0418 271 718
 For more information about events being held in NSW check out the website at: http://www.whiteribbonday.org.au/


 12                                                                                   Visit our Website at www.esdgp.org.au
                                   ADVERTISEMENTS




                         Safe Surgery is the ‘Key’!
Advanced laparoscopic surgeon Dr Chris Berney has been working at Prince of Wales Private
Hospital for nearly 4 years. He is actively involved in the expansion of minimally invasive
surgical techniques in the operating theatres.
Dr Berney values the constant development of new skills in this innovative field for the benefit
of his patients and uses laparoscopic techniques as a priority in his practice whenever possible.
When compared to conventional procedures, laparoscopic or “keyhole” surgery offers many
advantages such as reduced operative trauma, limited pain for the patient, shorter hospital stay
and quicker recovery, return to work within a shorter period of time, minor physical scarring
and therefore reduced risk of long term complications such as incisional hernia.
Some of the many laparoscopic procedures that Dr Berney offers include: various hernia repairs,
cholecystectomy, appendicectomy, small and large bowel resections, gastric surgery, splenectomy,
adrenalectomy, oophorectomy and adjustable gastric banding for morbid obesity.
Dr Berney also performs endocrine surgery (thyroid & parathyroid glands) and endoscopic
procedures such as gastroscopies and colonoscopies.
Dr Berney is committed to delivering high quality service and providing his full attention and
a thorough analysis of individual surgical problems. He is dedicated to find the most appropriate
and less invasive approach in order to minimize the impact of surgery for his patients.
He has appointments at the Prince of Wales Private, Sydney Private and Bankstown-
Lidcombe Hospitals and has a conjoint appointment as a Senior Lecturer with the University
of NSW. Dr Berney also speaks French fluently.
To find out more about Dr Chris Berney’s practice please contact his rooms at:
  Suite 26, Level 7, Prince of Wales Private Hospital
  Barker Street, Randwick NSW 2031
  Tel: (02) 9650 4954 Mob: 0403 492 428
   Suite 102, Bankstown Hospital Medical Centre
   68 Eldridge Road, Bankstown NSW 2200
   Tel: (02) 9709 6508 Mob: 0403 492 428

Or visit his website at: www.safesurgery.com.au




                                                                                                    13
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                                                                                 Hurstville Gosford Canberra
 BONDI DENTURE CLINIC                                                              Wollongong Newcastle
 177 Bondi Road, BONDI 2026                                                      Pregnancy Termination

     A BINSHTOK                                                                  • Private & individual treatment
     DENTAL PROSTHETIST                                                          • Consultation, ultrasound &
     TELEPHONE NO (02) 9389 4929                                                   counselling prior to procedure
 • Established since 1980
 • Medicare registered under chronic medical
                                                                                 • Only a 2 hour visit
   conditions and complex care needs.                                            • 24 hours on call advice
 • Bulk billing available.
 • Veteran affairs provider.                                                     • Mirena/IUD insertion with sedation
 • Willing to see aged care patients. Wheelchair                                   or under local anaesthetic 6-8
   access available . All types of new dentures.                                   weeks post TOP
 • Emergency denture repairs while you wait.
 • Mouthguards.                                                                  • D & C for incomplete miscarriage
                                                                                              Vasectomy also available
 OPEN 7 DAYS
                                                                                                  All Hours 9585 9599


14                                                                                          Visit our Website at www.esdgp.org.au
                      ADVERTISEMENTS                                                               BOOK REVIEW
             !"                                                      ‘ANTONIO’S SEED’ a novel by Merry Watson
          #$! $% & '()!(
   '!" '$! $"'*! #$*' &!$*                                               A review by Erin Pizzey
                  !'"'
                                                                                    ‘Poisoned by his words,
                                                                                    beaten by his criticism,’ is
               !" )                                                            the quote that might well
                                                                                    have been carved on
             !" " $(                                                         Ruth’s tombstone had she
                                                                                    not finally made her
 +, "

 ,--.                                                                        decision.
                                                   

                                             9 9
                                      8
 

                                                                                   From the moment I
  +-/-- 0 +1/--                
 8

                                                                                   opened the book until the
 '' %&*'                                                                      final sentences I felt a
       %*
   '  '                                                                        huge sense of grim
  
  2     
                                                                    foreboding. For those of
    " $##
                                                                                    us who experienced an
     %%  '!3                                                                  abused childhood this powerful novel catalogues
                                                                                    the unending fear that sits in the throats of Ruth
       $$4"&                                                                      and her five children.
   ''"%
       $"                                                                      Antonio comes to Australia full of hatred and
#%$" !$"$                                                                     rejection of everything that is good in life. He is
                                                      : 
;                     betrayed by his first love and then meets Ruth a
       516, 1.71                                                              

                                                                                    warm, loving uncomplicated Australian girl who is
                                   : 
;
#!    *% '"!                                     
                   oblivious to the warning signs of his morbidly
   '
 
      8
                                                                                    jealous nature. Reluctantly Antonio marries her and
                 The program includes talks by a                                    then Ruth becomes his punching bag. His domain is
                 psychologist, physiotherapist and                                  the house, his five children become his slaves and
                                                                                    his wife slowly looses her sense of self until she
                 dietician from the University of
                                                                                    becomes a shadow.
                 New South Wales and Prince of
                                                                                    The author states in the introduction that this story
                 Wales Hospital. The panel of                                       is based on a true story – it is all too horribly
                 experts will also answer                                           accurate. Antonio bullies his sons, he owns his
                 questions at a free forum aimed                                    daughters and he despises his wife and then one
                                                                                    day he makes his big and fatal mistake. He decides
 at older people living in the community.                                           to go back to Italy. During the time he is away his
                                                                                    daughter Natalie gives her mother a present. The
 You are invited, so come along, enjoy a free
                                                                                    mother and children finally spend precious time
 morning tea and learn how to “Train the Brain                                      together and the gift brings Ruth back to life.
 and the Body”                                                                      Now Ruth begins to recreate herself but she is
                                                                                    unaware that her husband is coming back and he is
 RSVP essential! Phone: 9382 3753
                                                                                    no longer the man she knew.
 MEDIA ENQUIRIES:                                                                   There is a breathless impetus and a tight grip on the
 Professor H Brodaty or Daniella Kanareck                                           plot that made me read the book far into the night.
                                                                                    This is a book that tells the story of a survivor. If
 Phone: 9382 3759
                                                                                    you ever wondered what it would be like to live
                                                                                    with a terrorist in the family, then this is the book to
   Enquiries: 1300 136 588             Email: hpday@diabetesnsw.com.au
                                                                                    read. A wonderful, powerful book.

   Diabetes Australia-NSW presents                                                  Erin Pizzey
                                                                                    Founder of the Modern Women's Shelter Movement


                                                                                    Publisher: Jeremiah’s Circle Publishing, Sydney

                                                            2007                    Contact: Les Watson - 0447 717 667
                                                                                    Email: lwatson@jeremiahscircle.com.au
                                                                                    Site: www.jeremiahscircle.com.au


   Saturday, 17 November 2007 8.20am - 5.30pm
   Australian Technology Park, Bay 4, Locomotive Workshop, Eveleigh, Sydney South

                                                                                                                                         15
                                                     CPD Events November 2007
                                      Sat 10th November    Women’s Health         ANSC Intake Meeting
Executive                                                                         Venue: RHW Ground Floor Conference
Chairman                                                                          Room, Barker Street, Randwick
A/Prof Eugen Molodysky,                                                           Time: 10.00am till 12.00pm
Ph: 9365 1333 Fax: 9326 9990
Vice Chairman & Treasurer             Sat 10th November    Women’s Health         O & G Update
Dr David Rockman                                                                  Venue: RHW Lecture Theatre, Women’s
Ph: 9231 3211 Fax:9221 1482
                                                                                  Health Institute, Barker Street,
Secretary
                                                                                  Randwick
Dr Ray Seidler
Ph: 9358 3066 Fax: 9358 3676                                                      Time: 12.00 for 1.00pm till 5.00pm

Board Members                         Tue 13th November    ESDGP/St Vincent’s     Cancer Update
Dr Danny Beran                                             Clinic                 Venue: Conference Room, Level 4
Ph: 9389 3133 Fax: 9371 0620                                                      St Vincent’s Clinic, Darlinghurst.
Dr Barri Phatarfod                                                                Time: 6.00 for 7.30 till 9.00pm
Ph: 9328 4828 Fax: 9328 3638
                                      Wed 21st November ESDGP                     Annual General Meeting
Dr Patrick Tan
Ph: 9232 3323 Fax: 9232 3321
                                                                                  Venue: South Steyne Floating
                                                                                  Restaurant, Harbourside Jetty,
Staff                                                                             Darling Harbour
Kevin Reid
CEO
                                                                                  Time: 7.00 for 7.30pm
Ph: 9389 0874 ext 209
Dr Jonathan Bentley
Medical Director                          Please complete the FAX BACK FORM (enclosed) to secure your place!!!
Ph: 9365 1333 Fax: 9300
Deb Blackwood
Women’s Health
Ph: 9389 0874 ext 207
Arturo Chamorro
IM/IT
Ph: 9389 0874 ext 208
                                                          Division Report. Why use it?
Jennifer Dunn                                             Whilst other results can be received electronically, such as
Programs & CPD Coordinator                                pathology results, specialist reports are still received by mail
Aged Care
Ph: 9389 0874 ext 202
                                                          or faxed, and then either retyped or scanned into the patient
Sowmya Gandham                                            notes.
NPS
Ph: 9389 0874 ext 205                  Direct secure messaging with your selected specialists.
Angie Ho                               With Eastern Sydney Report, you can easily send secure requests electronically
Office Administrator
                                       to your chosen service providers (i.e. Specialists) and have their report sent
Ph: 9389 0874 ext 201
                                       directly to your clinical software eliminating the use of fax or any other non-
Candi Madziar
Practice Nurse CDM & Immunisation      secure exchange methods resulting in low cost and better patient care. This
Ph: 9389 0874 ext 203                  means you will save money on paper, envelopes, stamps and time.
Anita Schwartz
HMR and EDQUM                          First 6 months absolutely free!!
Ph: 9389 0874 ext 206                  If you would like to try this innovative new system free of charge for six months
Natasha Sekelja                        please let me know and we will have you connected as soon as possible. After
Research Associate
Mental & Adolescent Health             the first six months if you are pleased with the system the cost is $35 per month.
Ph: 9389 0874 ext 204
                                       Save money & time
GP Advisors                            This cost is easily offset by the savings you will make in other overheads and if
Dr Erin Crumlin
                                       you are not fully satisfied you can simply discontinue use.
Aged Care
Dr Maria Opacic
Women’s Health
Dr Ankita Roy                                                   To get connected
Immunisation
                                                                   Please call
Dr Karen Spielman
Adolescent Health                                         Arturo on 9389 0874 ext: 208
Newsletter Editor
Dr Claudia Lee

Funded by
The Australian Department of Health                                     Visit our Website at www.esdgp.org.au
and Ageing

				
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