Students seeking clinical experience in countries with a high prevalence of HIV will be at risk of percutaneous injury and subsequent HIV infection. African clinical placements will involve contact with patients affected by HIV/AIDS. The prevalence of HIV may be greater than 20% of the general population. The prevalence of HIV amongst inpatients may be greater than 60%. Preparation of a student should include: appropriate education; effective immunisation; understanding how to evaluate an 'at risk' exposure; immediate availability of PEP. The risks of acquiring HIV sexually may be higher than through clinical work. (non-author abstract)

General practitioners' concerns about medicolegal issues have been shown to influence the practice of medicine. This research looks at GPs' beliefs about medicolegal issues and how medicolegal concerns affect their practice. A descriptive comparative design was used. A cross sectional self report survey was sent to 1239 GPs, 566 responded (46% response rate). Responses were considered as a group, and then comparisons were made between those who had experienced a medicolegal matter and those who had not. This data was sourced from surveys and medicolegal insurer records. General practitioners with previous medicolegal experiences were more likely than their colleagues to report believing the law required them to make perfect decisions and that medicolegal factors made them consider early retirement from medicine. They were also less likely to believe that inadequate communication is a factor in most complaints. More than half the GPs reported having made practice changes due to medicolegal concerns in the following areas: test ordering (73%); specialist referrals (66%); systems to track test results (70%); and communication of risk to patients (68%). Other changes were reported less frequently. This study found that GPs' concerns about medicolegal matters impact on their practise of medicine. While greater awareness of medicolegal issues may lead to positive impacts, the negative impact of their concerns is that some changes arise from anxiety about medicolegal matters rather than from the exercise of good clinical judgment.

General practice divisions were promoted in the 1990s to provide support for general practitioners. Membership patterns are not well understood and may have implications for research and health services development. Within a postal questionnaire conducted in 1999, we determined self reported membership of divisions. We obtained a 60% response rate (n = 296) from a random sample drawn from all New South Wales GPs. The majority of GPs (n = 204, 69%) belonged to one division. Thirty respondents (10%) did not belong to any division. Fifty-nine GPs (20%) belonged to two or more divisions, women GPs (n = 27, 31%) significantly more than men (n = 32, 16%) (P = 0.002), and GPs with city or metropolitan area practices (n = 52, 24%) were significantly more likely than rural or remote GPs (n = 7, 9%) (P = 0.005) to belong to two or more divisions. If divisions are used as the unit of randomisation for interventional research, there is risk of contamination in study design. Articles reporting such trials should acknowledge this.

General practitioners' satisfaction with previous referral of patients may influence their future specialist referral patterns. A postal survey of 123 GPs assessing satisfaction with discharge planning and communication from operating surgeons for patients following carotid endarterectomy. General practitioners' views of quality indicators for patient referral also were assessed. General practitioners were significantly more likely to be 'very satisfied' with the level of communication from the operating surgeon (83%) than the discharge planning (65%), (p < 0.001). The most highly ranked quality indicator for use in referring a patient for carotid endarterectomy was the 30 day postoperative complication rate per surgeon (n = 69, 56% 'very useful'). Over one-third (35%) remembered seeing the relevant guidelines for GPs. General practitioners value information about surgeon performance when making referral decisions. They are less satisfied with discharge planning than other aspects of care.

Bibliotherapy can be used to treat mild to moderate depression or subthreshold depressive symptoms, as a sole or supplementary therapy. Bibliotherapy is a form of guided self-help. The patient works through a structured book, independently from the doctor. The role of the doctor is to support and motivate the patient as they continue through the book and to help clarify any questions or concerns the patient may have. Relevant books can be purchased or often borrowed from a library, with limited cost and good accessibility from a patient perspective. Patients need to have a reading age above 12 years and have a positive attitude toward self-help. Bibliotherapy has NHMRC Level 1 evidence of efficacy and no serious adverse effects have been reported. This article forms part of a series on non-drug treatments, which summarise the indications, considerations and the evidence, and where clinicians and patients can find further information.

Urinary tract infections (UTIs) commonly occur in children. An estimated 8% of girls and 2% of boys will have at least one episode by seven years of age. Of these children, 12-30% will experience recurrence within one year. Australian hospital admission records indicate that paediatric UTIs represent 12% of all UTI hospital admissions. The aim of this article is to review the pathogenesis, clinical assessment and management of UTIs, and prevention strategies in children. Clinically, paediatric UTI presentations are challenging because symptoms are vague and variable. Young infants may present with sepsis or fever and lack specific symptoms, whereas older children present with classical features such as dysuria, frequency and loin pain. Early diagnosis with appropriate urine specimen collection techniques, investigations and treatment is necessary for prevention of renal damage and recurrence. Effective, evidence-based investigations and treatment options are available, and physicians should feel confident in identifying and managing paediatric UTIs.

Chronic pain is a large and growing public health concern in Australia. Chronic pain is generally associated with physical, psychological, social and cultural risk factors. Several antidepressants have been efficacious in the management of chronic pain. This article illustrates the use of antidepressants in major chronic neuropathic pain conditions. Knowledge of psychopharmacology is important in the management of chronic pain. The majority of patients with chronic pain have comorbid psychiatric conditions ranging from mild anxiety, depression and adjustment problems, to severe delusional and psychotic disorders. Depression and anxiety are known to enhance the perception of pain. Not all antidepressants have independent analgesic properties. There is now a convincing body of controlled data, as well as extensive longstanding clinical experience, supporting tricyclic antidepressants (TCAs) as analgesics independently of their antidepressant actions.

High infection burden among the residential aged care facility (RACF) population has long been recognised; however, existing infection prevention effort is often limited to infection surveillance activity. There is a scarcity of evidence to guide antimicrobial stewardship in the Australian RACF setting. This review summarises the current trends in antibiotic use and multi-drug resistant (MDR) organisms, challenges related to antibiotic prescribing and areas of suboptimal antibiotic prescribing for further improvement, particularly in the Australian RACF setting. There is widespread antibiotic prescribing in RACF, which may lead to the emergence of antibiotic resistance. Accordingly, there is an immediate need for judicious antibiotic use in this high-risk population to curb the rapid emergence of MDR organisms and other adverse consequences associated with inappropriate antibiotic use, as well as to reduce healthcare costs.

Changes in the demography of Australia have resulted in changes in patterns of primary care delivery. One of these changes is that the proportion of paediatric visits has decreased. The objectives of the article are to examine patient, practice and personal factors that influence a general practitioner's (GP's) decision to refer patients for paediatric specialty care, and investigate referral goals and experience with shared care. A mail survey was sent out to 400 GPs who had referred at least two children to public hospital specialty clinics during 2014. The response rate for the mail survey was 67%. The factors most commonly reported by GPs as 'Somewhat important' or 'Very important' in the decision to refer were whether they had enough knowledge of a specific condition (81%) or did not have experience with similar patients (75%). About one-quarter (26%) of GPs reported that a parental request 'Frequently' or 'Almost always' influenced their referral decision. A similar pro-portion (26%) placed importance on whether they had sufficient time for a specific patient. Understanding the perspectives and determinants of GP referrals for paediatric specialty care is important, especially in the context of changing patterns of primary care delivery.

Although integral to the early detection and treatment of anorexia nervosa, there is a paucity of clear guidance available for general practitioners (GPs). This paper attempts to bridge the gap between the specialist and generalist literature to assist the busy GP feel confident in identifying and managing these patients. On reading this article it is anticipated the GP will feel well equipped to screen for and provide ongoing treatment to patients who pre-sent with eating disorders, particularly anorexia nervosa. This paper provides guidance for the identification and ongoing management of patients with anorexia nervosa, and supporting their carers. People affected by eating disorders, particularly anorexia nervosa, may deny having a problem, minimise their symptoms and resist treatment yet engage partially with their GP throughout the course of their illness. There are well-validated, quick screening tools that the non-specialist can use to identify patients at high risk of having an eating disorder.