Cancer in the family. Part 2.
Kefford R. Tucker K. Friedlander M. Kirk J.
Westmead Hospital, Sydney.
This second article follows on from 'Cancer in the family--guidelines for general practice' (AFP, May, 1997). It reviews the current knowledge for bowel cancer, breast-ovarian cancer and melanoma, from a genetic perspective.
Preparing for a tropical expedition.
This article reviews the medical preparations made for a 3 month expedition, The Northwest Patrol' which crossed remote Papua New Guinea in 1995-1996. It includes a variety of tips about some of the common medical problems encountered on tropical expeditions.
How do general practitioners manage rectal bleeding?
Sladden MJ. Thomson AN.
Division of Community and Rural Health, University of Tasmania.
OBJECTIVE: To determine how general practitioners (GPs) in northern Tasmania manage rectal bleeding in terms of examination, referral, and patient investigation and estimate the value of early diagnosis of colorectal cancer (CRC). METHOD: Self reported postal questionnaire survey sent to 100 randomly selected GPs in northern Tasmania. RESULTS: Sixty-eight per cent of GPs responded. The clinical action proposed by GPs varied considerably according to patient age and type of rectal bleeding. The proportion of GPs who would refer a patient to a specialist varied from 15 to 100% depending on the specific scenario. Responses were not consistent with the available consensus guidelines and evidence. Most GPs believed that early diagnosis of CRC through screening and the early detection of rectal bleeding improved outcomes. However, fewer than half the respondents believed that there were clear guidelines about the management of a patient with rectal bleeding, emphasising the need for evidence-based guidelines which are effectively disseminated and clinically evaluated. Rural GPs indicated that distance from specialist investigation and referral centres would influence patient management. CONCLUSIONS: There is a wide variation in the way GPs manage rectal bleeding and inconsistent knowledge about the existence of guidelines for managing rectal bleeding. Evidence-based education about the management of this common clinical problem, which is effectively disseminated and clinically evaluated, would seem appropriate.