Image-guided EBUS bronchoscopy system for lung-cancer staging.

The staging of the central-chest lymph nodes is a major step in the management of lung-cancer patients. For this purpose, the physician uses a device that integrates videobronchoscopy and an endobronchial ultrasound (EBUS) probe. To biopsy a lymph node, the physician first uses videobronchoscopy to navigate through the airways and then invokes EBUS to localize and biopsy the node.

Decreasing Rates of Acute Kidney Injury After Percutaneous Coronary Interventions Through Education and Standardized Order Sets in a Large Tertiary Teaching Center.

Acute kidney injury (AKI) is a common complication of percutaneous coronary interventions (PCI), and it is associated with increased morbidity, mortality, and healthcare costs. Post-PCI AKI is a major quality outcome measured by the National Cardiovascular Data Registry for hospitals that perform PCI. We report the experience of a large, tertiary center with high standardized, post-PCI AKI rates in which we implemented multilevel interventions that included: (1) a multidisciplinary education module for all personnel involved in care of patients undergoing cardiac angiography, (2) a standardized electronic medical record based preprocedure hydration protocol order set for patients undergoing cardiac angiography, and (3) a hydration task list to be completed by the care team the evening before the procedure or prior to admission.

Optimal route planning for image-guided EBUS bronchoscopy.

The staging of the central-chest lymph nodes is a major lung-cancer management procedure. To perform a staging procedure, the physician first uses a patient's 3D X-ray computed-tomography (CT) chest scan to interactively plan airway routes leading to selected target lymph nodes. Next, using an integrated EBUS bronchoscope (EBUS = endobronchial ultrasound), the physician uses videobronchoscopy to navigate through the airways toward a target node's general vicinity and then invokes EBUS to localize the node for biopsy.

Efficient Bronchoscopic Video Summarization.

Bronchoscopy enables many minimally invasive chest procedures for diseases such as lung cancer and asthma. Guided by the bronchoscope's video stream, a physician can navigate the complex three-dimensional (3-D) airway tree to collect tissue samples or administer a disease treatment. Unfortunately, physicians currently discard procedural video because of the overwhelming amount of data generated.

'If this…, then…' - Resource allocation in a finite world.

Background: Tasks in general practice can be divided into three areas: acute care, planned secondary and tertiary prevention, and primary prevention. There is some evidence that the demands placed on practitioners by the second and third areas can decrease the time available for the first.

Objective: To assess the work load of general practitioners and the evidence around benefit for effort, and suggest some strategies for making the most of available time.

Are they safe in there? - patient safety and trainees in the practice.

Background: Due to the projected increase of medical graduates and general practice registrars, a rapid increase in new trainers and practices is required. The resulting mix of relatively inexperienced trainers and trainees makes the examination of the important question of patient safety even more pertinent.

Objective: To describe practical techniques that look beyond the door of the closed consulting room to detect unconscious incompetence in trainees.

Why haven't I changed that? Therapeutic inertia in general practice.

Background: There are multiple gaps between evidence and practice in our health system. The relatively new concept of 'therapeutic inertia' is useful to understand why these gaps persist. It is defined as 'failure of healthcare providers to initiate or intensify therapy when indicated' and 'recognition of the problem, but failure to act'.

Asthma Cycle of Care attendance - overcoming therapeutic inertia using an asthma clinic.

Background: The prevalence of asthma is high in Australia. Despite national guidelines recommending the use of an Asthma Action Plan only 22.5% of people with asthma had a plan in 2004-2005.

AFP in a changing environment.

As Australian general practice evolves, the role of Australian Family Physician needs to be continually re-evaluated. AFP aims to provide relevant, evidence based, clearly articulated information to Australian GPs that is applicable to the varied geographic and social contexts in which they work and to all their roles as clinician, researcher, educator and practice team member, to assist them in providing the highest quality patient care. In this viewpoint article, one of our Editorial Board members, Dr Patrick Byrnes, outlines his views about the evolution of AFP in the context of the current and future general practice environment.

A cardiovascular risk clinic using home BP monitoring.

Background: Hypertension is the most common chronic condition managed in general practice, but blood pressure (BP) control is often suboptimal. Home blood pressure (HBP) monitoring can be more accurate than office based BP (OBP) monitoring, with HBP readings approximately 10/5 mmHg lower than OBP in the same patients.

Methods: Hypertensive patients from a single general practice were invited to a cardiovascular risk review clinic using HBP monitoring.

Management of skin cancer in Australia--a comparison of general practice and skin cancer clinics.

Background: Skin cancer is common in Australia and its increasing incidence has been matched by an increase in specifically focused skin cancer clinics staffed by general practitioners. This study compares the management of skin cancer in general practice with that of skin cancer clinic networks.

Methods: Analysis of billing data relating to management of skin cancer from 1 July 2005 to 30 June 2006 in three Queensland general practices (metropolitan, provincial, and rural) representing 23 100 patients and 23 doctors.

Cervical screening in general practice - strategies for improving participation.

Background: National cervical screening rates have plateaued at around 60%. Each method of recruitment has an upper limit to uptake and the benefits of multiple strategies are additive. There is debate about reallocating Pap testing to nurses in general practice.

An audit of influenza vaccination rates.

Background: Influenza immunisation confers benefits for the elderly. We attempted to increase the uptake of influenza vaccination in those aged 65 years and over in one general practice in Queensland.

Method: We used four strategies: a computer search for the target population; telephone recruitment and booking by our receptionist; removal of cost by bulk billing; and using nurse led immunisation.