In this episode of The Good GP, host Dr Tim Koh is joined once again by Dr Linny Kimly Phuong, a paediatric infectious diseases physician, researcher, and academic tutor, to discuss Pneumococcal Disease. Being the subject of her PhD, Dr Phuong brings her extensive knowledge and experience on this topic.

Dr Phuong outlines the different clinical manifestations of Pneumococcal Disease, dividing them into invasive and non-invasive categories. Non-invasive diseases include otitis media and sinusitis, while invasive diseases can result in conditions like complicated pneumonia, meningitis, bacteremia, bone and joint infections, endocarditis, and peritonitis.

Discussing the significance of the strep pneumoniae bacteria, which is commonly found in the nasopharynx of healthy individuals. Dr Phuong explains the switch from carriage to disease manifestation and highlights the risk factors for invasive Pneumococcal Disease, including extremes of age, immunocompromise, chronic health conditions, and certain lifestyle factors.

They then turn to pneumococcal vaccines, and the differences between conjugate and polysaccharide vaccines, their valencies, and their impact on clinical practice. Dr Phuong emphasises the importance of vaccination in reducing morbidity and mortality related to Pneumococcal Disease, particularly in young children and older adults.

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com

Mentioned in this episode:

Get 10% Off Lyrebird Health

Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

Lyrebird Health

In this episode of The Good GP, Dr Tim Koh is joined by Dr Linny Kimly Phuong, a paediatric infectious diseases physician, researcher, and academic tutor, to discuss Kawasaki disease.

They began by explaining Kawasaki disease as an inflammatory vasculitis with potential long-term cardiac consequences. Dr Phuong notes that one child is diagnosed with Kawasaki disease every day. While the disease is more common in children under the age of five, it can present at any age and across all ethnic groups, with a higher incidence in children of Asian ethnicity.

They discussed the clinical picture of Kawasaki disease, commonly remembered by the mnemonic "CRASH and burn." This includes Conjunctivitis, Rash, Adenopathy, Strawberry tongue, and Hand/feet changes—all accompanying a prolonged fever. Dr Phuong emphasises the importance of recognising these symptoms even if they do not manifest simultaneously.

They move onto diagnosis, highlighting the absence of diagnostic tests and the reliance on clinical evaluation supported by laboratory tests such as full blood count, inflammatory markers, and liver function tests. Dr Phuong also elaborates on differential diagnoses, including both infectious (e.g., scarlet fever, adenovirus) and non-infectious conditions (e.g., drug hypersensitivity, systemic juvenile idiopathic arthritis).

Finally, outlining the long-term clinical impact of Kawasaki disease, emphasising the importance of treatment with intravenous immunoglobulin and low-dose aspirin to reduce the risk of coronary artery aneurysms. Highlighting the necessity for long-term cardiology follow-up due to the potential for severe complications like coronary artery stenosis and myocardial infarction.

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at Talking HealthTech.

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com

Mentioned in this episode:

Get 10% Off Lyrebird Health

Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

Lyrebird Health

In this episode, Dr Krystyna de Lange hosts Associate Professor Dr Alireza Ahmadvand, a practising GP with a special interest in gastroenterology at the Princess Alexandra Hospital in Brisbane, to discuss disorders of gut-brain interaction (DGBI).

Dr Ahmadvand elaborates on what DGBIs are and provides the latest insights into the pathophysiology, mentioning conditions such as irritable bowel syndrome and functional dyspepsia. He explains the diagnostic criteria and the importance of recognising these conditions in general practice, and highlights the role of GPs in identifying and ruling out structural abnormalities before considering a DGBI diagnosis.

They also covered the multifactorial nature of these disorders, including the impact of psychological and psychosocial factors, such as stress, anxiety, and depression, and the interactions between gut microbiome and gut function. Dr Ahmadvand outlines when GPs should consider DGBIs and what red flags to watch for, emphasising the importance of comprehensive evaluations and specialist collaboration.

For management, Dr Ahmadvand advocates for a multidisciplinary approach involving dietitians, psychologists, exercise physiologists, and gastroenterologists to provide holistic care. Pharmacological treatments, diet modifications, and psychological interventions, such as Cognitive Behaviour Therapy, are also mentioned as part of a comprehensive management plan.

Lastly, Dr Ahmadvand points GPs towards the Rome Foundation's criteria, the Gastroenterological Society of Australia, and patient-focused platforms like Gut Foundation Australia and the IBS Network. He also encourages keeping alongside of the latest research through journals like Neurogastroenterology and Motility.

Links & Resources:

Rome Iv Diagnostic Criteria For Fgids

• https://theromefoundation.org/rome-iv/rome-iv-criteria/
• https://theromefoundation.org/resources/rome-iv-criteria-booklet/ (downloadable booklet in PDF)

Patient Education Material

Irritable Bowel Syndrome (IBS)

• https://dietitiansaustralia.org.au/health-advice/irritable-bowel-syndrome-ibs
• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/irritable-bowel-syndrome-ibs
• https://www.healthdirect.gov.au/irritable-bowel-syndrome-ibs

Resources From The Australian Journal Of General Practice

The lived experience of irritable bowel syndrome: A focus on dietary management

• https://www1.racgp.org.au/ajgp/2022/june/the-lived-experience-of-irritable-bowel-syndrome

Research Instruments/Projects

Valid Instrument for Evaluating Symptoms in the Clinical Setting - Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS)

In this episode, Dr Sean Stevens hosts a discussion on the topic of public hospital virtual clinics with three distinguished guests: Dr Morgan Rayner, a new fellow GP, Associate Professor Joanna Lawrence, a paediatrician at the Royal Children's Hospital in Melbourne and Director of the Victorian Virtual Specialist Clinic (VVSC), and Dr Dominic Mallon, an immunologist at Fiona Stanley in Perth and founder of the Virtual Immunology Clinic.

They explore the origins, purposes, and operational models of the Victorian Virtual Specialist Clinic and the Virtual Immunology Clinic. Associate Professor Joanna Lawrence discusses how the VVSC was established to enable GPs to access specialist expertise more swiftly, to reduce wait times for patients and enhance the ability of community physicians to manage patient care efficiently. Dr Dominic Mallon shares insights into the Virtual Immunology Clinic, how it has successfully reduced patient wait times and facilitated timely access to specialist care, especially in rural areas.

Dr Morgan Rayner also provides a first-hand account of using virtual consult services as a junior registrar, discussing the benefits of building relationships with specialists and improving patient care through timely consultations.

The VVSC is available to any GP working in Victoria. The collab-consult model is a free 20-minute case conference with a specialist (with or without the patient). The collab-consult enables GPs to access timely expert advice to support managing their patients in the community. CPD can be claimed for participating in a case conference. Booking is easy through https://vvsc.org.au/ or email VVSC@nh.org.au.

The Virtual Immunology Clinic is available to any GP in WA who is in or very near the Fiona Stanley Hospital Catchment area for public hospital outpatients services (South Metro, South West, Great Southern)

The link to register, log in and refer is: South Metropolitan Health Service - SMHS Online Services Portal https://smhs.health.wa.gov.au/Our-services/SMHS-Online-Services-Portal

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com

Mentioned in this episode:

Get 10% Off Lyrebird Health

Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

Lyrebird Health

In this episode of The Good GP, Karin Sekhon speaks with Professor Jayashri Kulkarni, a renowned psychiatrist, about premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).

Professor Kulkarni explains the distinctions between PMS and PMDD, emphasising that PMS is more prevalent and generally involves physical symptoms like bloating and headaches, while PMDD affects a smaller percentage of women and includes severe psychological symptoms such as major depression, anxiety, and brain fog. She talks about the genetic and environmental factors contributing to PMDD, highlighting a specific gene complex that may be activated by trauma.

Discussing the primary pharmacological treatments for PMDD, Professor Kulkarni advises starting with hormonal treatments like the combined oral contraceptive pill; she recommends the pill "Zoely" for its balanced hormone levels. She also elaborates on the use of SSRIs like sertraline for additional support and gives a stepped approach to treatment, including the possible need for hormone replacement therapy (HRT) or menstrual suppression in complex cases.

They also touched on the potential role of complementary therapies and the importance of holistic care, involving psychological support and lifestyle modifications. Professor Kulkarni provides guidance on when GPs should consider referring patients to specialists and emphasises the collaborative role of GPs in managing PMDD effectively.

If you want to learn more about this topic, consider the HER Centre Australia's online short course on Women's Mental Health: https://www.monash.edu/medicine/translational/psychiatry/short-courses/womens-mental-health

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com

Mentioned in this episode:

Get 10% Off Lyrebird Health

Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

Lyrebird Health

Join The Good GP host Dr Krystyna de Lange in an episode with Dr Rebecca Starkie as they discuss the topic of cervical screening and the self-collection method in Australia.

Dr Starkie, a GP, practice owner, academic, medical educator, and researcher with a specific interest in women's health, shares her expertise on the success of self-collection for cervical screening. With the uptake of self-collection, especially among older women and those in remote areas, we have seen a reduction in barriers to cervical screening and improved access

They delve into the eligibility criteria for self-collection, discussing those who can opt for this method and those who still require clinician-collected samples. Expected changes in guidelines for the cervical screening program are also touched upon, emphasising the upcoming recommendations for test-of-cure processes.

Sharing insights for GPs on how to effectively explain and guide patients through the self-collection process, including the use of instructional resources and addressing possible patient concerns. Dr Starkie offers practical tips for handling abnormal test results and troubleshooting sampling challenges.

Dr Starkie recommended adopting a whole-of-team approach in general practice to support cervical screening efforts, underscoring the importance of involving practice managers, nurses, and reception staff in creating a positive patient experience.

Links & Resources:

• https://acpcc.org.au/practitioners/resource-hub/

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com

Mentioned in this episode:

Get 10% Off Lyrebird Health

Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

Lyrebird Health

In this episode of The Good GP, host Dr Karin Sekhon is joined by Dr Jana Combrinck, an experienced women's health GP working in Perth and the current GP lead of Oasis Fertility Centre. They delve into the GP's role in fertility management.

Dr Combrinck discusses the prevalence of fertility issues, noting that one in six couples of reproductive age in Australia are affected by subfertility. Identifying advanced maternal age as a common cause, along with conditions such as polycystic ovarian syndrome (PCOS), ovulation disorders, and endometriosis. She emphasises the importance of considering male factors, which are responsible in at least 50% of cases.

Giving insights on the process for couples experiencing infertility. Dr Combrinck outlines a systematic approach, which includes taking a thorough history, conducting necessary blood tests, and performing imaging investigations. For male patients, a semen analysis is recommended as the first step.

Dr Combrinck also discusses the medications and supplements that GPs can prescribe to aid in fertility. For PCOS patients, metformin and myoinositol are suggested as first-line treatments. She provides a comprehensive guide on the use of letrozole for ovulation induction, emphasising the need for close monitoring. Supplements like CoQ10 and melatonin are recommended for women with reduced ovarian reserve, and Menivit is suggested for male patients with suboptimal semen analysis.

They also touched on when to refer patients to a fertility specialist. Referral timelines vary based on the age of the female partner and any known fertility-impacting conditions.

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network.

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com.

Mentioned in this episode:

Get 10% Off Lyrebird Health

Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

Lyrebird Health

In this episode of The Good GP podcast, host Dr Karin Sekhon talks to Dr Alex Shivarev, a public health physician from the WA Department of Health, to discuss the emerging public health concern of monkeypox, now also referred to as Mpox. Providing insights for GPs on the epidemiology, transmission, and clinical manifestations of the monkeypox virus, along with the distinction between the clade Ib and clade IIb strains.

Dr Shivarev explained what monkeypox is, its origins, and the different strains that have emerged. Discussing the recent increase in monkeypox cases globally and the response from both international bodies and local health authorities. He also highlighted the differences in transmission routes and the populations most at risk, including gay, bisexual, and other men who have sex with men.

Dr Shivarev mentions the vaccination with the JYNNEOS vaccine, which is available and recommended for eligible individuals. He also provided detailed guidance on the clinical presentation and diagnosis of monkeypox, emphasising the importance of history-taking and examination findings in identifying potential cases.

Lastly, they touched upon the future of monkeypox outbreaks and the potential for control measures to prevent further spread. Dr Shivarev reassures listeners that the risk of a wide-scale outbreak akin to the COVID-19 pandemic is low, given the effective public health measures in place and the community's prior successful response to the 2022 outbreak.

Resources and Links:

• ASHM Mpox Resource Toolkit - https://ashm.org.au/resources/mpox-resource-toolkit/
• Mpox Quick guide for primary health care workers WA - https://www.health.wa.gov.au/~/media/Corp/Documents/Health-for/Infectious-disease/Monkeypox/Monkeypox-quick-guide-for-clinicians.pdf
• Mpox (monkeypox) (health.wa.gov.au) (clinician focus)
• Mpox (monkeypox) (healthywa.wa.gov.au) (consumer focus)

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com

Mentioned in this episode:

Get 10% Off Lyrebird Health

Unlock a 10% discount on Lyrebird Health by using the code GOODGP and discover how this AI scribe can transform your practice by saving you time and ensuring your documentation sounds just like you: www.thegoodgp.com.au/lyrebird

Lyrebird Health