Craig Hassed – författare

Geriatric Medicine - General Practice: The Integrative Approach Series details the medical and consulting knowledge required of a General Practitioner when managing older patients. The world’s population is ageing rapidly, particularly in developed countries, where life expectancy is over 80 years for women and just under 80 years for men in many countries. Rapid ageing is occurring in less developed countries too, with the number of people aged over 65 years increasing dramatically in many countries. Consequently, much of general practice now involves care of older people in a range of settings—community, residential and acute-care facilities. It is easy to form the impression that ageing normally involves disease, disability and dependency, but while these are more common with increasing age, they are far from inevitable. Most 90-year-olds are not demented, maintain excellent mobility, are independent in personal, domestic and most community activities of daily living and live in their own home.

Herb-Drug Interactions - General Practice: The Integrative Approach Series provides an introduction to herb–drug interactions. Complementary medicines such as herbal medicines are available through a variety of channels such as supermarkets, pharmacies, health-food stores, clinic rooms, internet sites and mail order companies. Many people self-select their products and do not receive professional advice about their safe and appropriate use. When using a complementary medicine, many do not discuss its use with their medical practitioner, either in the community or in the hospital setting. As more people take herbal medicines, the pressure increases on healthcare professionals such as doctors, pharmacists, naturopaths and herbalists to be well informed about the subject, and on researchers to fill the gaps in our current knowledge.

Women''s Health - General Practice: The Integrative Approach Series covers Breast Disease, Gynaecology and Menopause and details the medical and consulting knowledge required of a General Practitioner.

There are approximately 400,000 consultations for breast symptoms each year in general practice in Australia. The vast majority of these will be due to hormonal or benign breast changes.The general practitioner is the first port of call for the effective investigation of these symptoms and, importantly, to exclude or confirm breast cancer. For the thousands of women who are diagnosed with breast cancer each year, whether through mammographic screening or as a result of the investigation of a breast change, the GP provides information, treatment, surveillance and support throughout the patient’s journey, as a member of the patient’s treatment team.

Gynaecology is a large part of any general practice, and the conditions described are part of a general practitioner’s everyday experience. While General Practitioners owe their female patients effective care in their own right, society also benefits when women are healthy and happy in their daily lives. Women are central to the mental, physi cal, nutritional, educational and, frequently, economic health of their families and communities. By managing the woman’s care effectively, we also benefit the health of her children, her partner and, often, her parents.

The menopause transition can be a time of great change and disturbance for some women. Symptoms such as hot flushes, night sweats, mood swings and vaginal dryness can greatly affect quality of life and, in most Western countries, around a quarter to a third of such affected women will seek medical attention.

Neurology - General Practice: The Integrative Approach discusses common neurological symptoms and disorders encountered in general practice such as headache, funny turns, motor weakness, disturbances of vision. It also covers some of the less-common classic neurological problems that are seen in general practice such as abnormal movements and difficulty with movement and multiple sclerosis.

Gastroenterology - General Practice: The Integrative Approach Series offers advice for diagnosing and formulating a management plan for patients with gastrointestinal problems keeping in mind not just the gut symptoms, but the lifestyle factors affecting gut function, and the systemic and nutritional consequences of gut dysfunction.

Cardiology - General Practice: The Integrative Approach Series, explores the basic elements of assessing the cardiovascular system and then describes the major cardiovascular conditions presenting in the primary healthcare setting. Lifestyle and complementary therapy recommendations are made, where they can be supported by evidence.

Mind Body Medicine - General Practice: The Integrative Approach Series. The main premise of MBM is that the mind (intelligence) governs or regulates the body. Although mind is non-physical—and therefore MBM is in essence a metaphysical explanation for physical phenomena—mind uses the body to execute its purposes. More particularly, the mind, powered by consciousness, thinks and feels through the agency of the brain. Mind, brain and body are inseparable. Mind and intelligence make themselves evident by observable results in the physical world. A practical way of expressing this principle is to say that psychological states such as chronic stress, depression, anxiety and fear produce profound and clinically relevant effects upon the body. These effects have implications for health and illness. Psychological states and social context can have both positive and negative effects that manifest on many different levels, all the way from muscle tension to genetic expression. Over time the cumulative effects of negative mental and emotional states can take a heavy toll on the body. Conversely, research also suggests that psychosocial interventions can play an important part in ameliorating these negative effects and can assist in promoting healing.

Cancer - General Practice: The Integrative Approach Series. Integrative cancer care requires a comprehensive and well-coordinated team or virtual team approach. The general practitioner with an integrative philosophy is well placed to coordinate appropriate screening, prevention, case finding and treatment services for patients at all stages of their journey. The cancer journey begins with awareness of risk factors and preventive strategies, and continues through diagnosis of the type and stage of cancer, decisions about conventional treatment and adjunctive therapies. Ideally, the integrative approach to cancer management improves a patient’s sense of self-control, reduces anxiety and aims to maximise the body’s potential to heal.

Psychiatry and Psychological Medicine - General Practice: The Integrative Approach Series. The most common psychiatric disorders presenting to General Practitioners are depression, anxiety, adjustment disorders, and alcohol abuse and dependence. The prognoses of anxiety, depression and psychotic disorders are all improved by early detection and intervention, and so the GP’s role is pivotal in improving the level of functioning and quality of life of their patients. The GP is uniquely positioned to assess psychiatric symptoms, because they will have often seen a patient over an extended timeframe and so will have access to information about the patient and their premorbid functioning.

Men''s Health - General Practice: The Integrative Approach Series. This chapter discusses men’s health including erectile dysfunction, testicular cancer, prostate disease and also deals with the difficulty faced by GPs of getting male patients to present for a regular check-up.

Integrative Medicine - General Practice the Integrative Approach Series. This chapter introduces the concept of integrative medicine and the healthcare revolution. The emergence of evidence-based medicine and, more recently, evidence-based complementary medicine is challenging many previously held notions of best practice. As evidence emerges, many Western medical therapies are being confirmed as correct, or challenged as ineffective or harmful. Similarly, many complementary therapies are being confirmed as correct, while others are being found ineffective or harmful. Such is the inevitable evolution of healthcare. It is also important that evidence-based healthcare at very level be considered a ‘work-in-progress’, whether it is in the discovery of the genetic basis of disease, the development of previously untested technology or the clinical application of a treatment. The nature of scientific research is such that new information becomes available at a great rate, and that knowledge often changes the status quo. It is in the GP’s consulting room that patients ideally have the opportunity to explore what is likely to be the best option for their healthcare. We see the gamut of health concerns, from a person wanting a check-up and interested in doing more to maintain good health, to a patient who is symptomatic and wanting a diagnosis and treatment, or a patient with an established diagnosis who is looking for either a cure or a way of optimising their wellbeing as they live with their illness.

Immune System - General Practice: The Integrative Approach Series. The human immune system is extremely complex, with intricate multidirectional connections between our gastrointestinal, psychological, endocrinological and other systems, and communication via various neuro transmitters, cytokines and other immune system messengers. This chapter presents a simplified view of the principles of immunology, with specific focus on some of the most recently researched complementary therapies known to improve immune system health. A comprehensive listing of further resources and references is listed at the end of the chapter.

Endocrinology - General Practice the Integrative Approach Series. Endocrine problems are important in the general practice setting, for a range of reasons. First, they are common enough to occur regularly, either as new cases or in patients managing a chronic illness. Secondly, they can cause serious and life-threatening complications if not diagnosed and treated. Thirdly, they often present a challenging diagnostic problem because of their often slow onset and their capacity to produce non-specific symptoms such as weakness, tiredness or weight change, particularly in the early stages. This chapter explores the endocrinological disorders including Pituitary disorders, Thyroid disorders and Adrenal gland disorders that are important for a GP to know about and to manage. The common model of managing endocrine problems is as a shared-care model with an endocrinologist.

Weight Problems and Eating Disorders - General Practice: The Integrative Approach. This chapter discusses anorexia and bulimia-like disorders. These eating disorders are characterised by the use of inappropriate behaviours to control body weight and feelings, as evidenced by low body weight, high body weight, extreme weight-control behaviours such as vomiting and starvation, excessive exercise and binge eating.

Obesity - General Practice: The Integrative Approach. General Practitioners in primary care are uniquely placed to help in the management of patients in all stages of overweight and obesity, and are able to maintain a therapeutic relationship with patients over many years. General practitioners should take a long-term view of weight problems, which can mean avoiding goals for weight management that are unlikely to be achieved.

Sexual Health - General Practice: The Integrative Approach. Sexual health medicine is generally thought of as primarily concerned with the management of sexually transmissible infections (STIs). While STIs are an important facet, sexual health also includes a wide range of other topics including fertility and contraception, sexuality and gender, sexual problems and various dermatological and gynaecological conditions. Sexual health physicians are also involved with the public health aspects of STIs, particularly the reporting, monitoring and control of infectious diseases.

HIV management in general practice - General Practice: The Integrative Approach. General practitioners have always had a central role in the delivery of healthcare to communities (especially marginalised groups) and they have played a key role here as well. Their skills in chronic disease management, their teamwork, their holistic view of health and their long-term relationships with patients and communities all contribute to the care they can bring to the Human immunodeficiency virus (HIV) infected patient.

Urology - General Practice: The Integrative Approach. Symptoms suggesting urological pathology are common presentations in primary care. These include recurrent urinary tract infections, frequency and urgency of micturition, nocturia and urinary incontinence. Acute presentations to general practitioners or hospital emergency departments often involve pain: acute loin pain, testicular pain and the pain of urinary retention. Some signs may be suspicious for malignancy (e.g. haematuria). In addition, lumps in the scrotum and testes are a frequent cause for patient concern. A systematic approach to these presentations is easily followed, and history and examination will provide the diagnosis in the majority of cases.

Bones - General Practice: The Integrative Approach. Bones are complex organs with many important functions, the most obvious being structural. They provide support for the body and the means by which muscles can insert into fixed structures in order to allow movement. They are also important in hearing, through the transduction of sound via the ear’s ossicles, and they protect other soft organs that are easily damaged, such as the brain, eyes, kidneys, lungs and spleen. Bone marrow, which is largely within the medulla of the long bones, is the centre for production of blood cells (haematopoesis) and an important site for storage of fatty acids. Bones also have important metabolic functions. This chapter describes the following conditions affecting bones: osteoporosis, rickets, osteomalacia, Paget’s disease and bone cancer.

Child health and development - General Practice: The Integrative Approach. While not an extensive overview of paediatric ill health, this chapter addresses a range of common problems presenting in a primary care setting including Screening, Growth monitoring, Atopy, Allergic rhinitis, Asthma, Iron deficiency, Screening for hearing loss, Screening for eye and vision problems, Infantile colic, Enuresis, Dyslexia, Developmental disorders and disabilities, Langauge development, Behaviour and psychological problems, Attention deficit hyperactivity disorder (ADHD), Autism and Autism-Spectrum Disorders, Obesity and Immunisation to illustrate the role of an integrative approach to children and their families that will support family cohesion and rally mutual physical, psychological and social supports underpinning a healthy approach to living.

Substance Misuse - General Practice: The Integrative Approach. We define a drug (substance) as a chemical entity, self administered (non-medically) for its psychoactive effect. The effect usually includes a change in mood, arousal or perception, thinking (cognition) and/or behaviour. It may vary according to which drug is used, the amount used, the route of administration, the mixture of drugs used, the expectations of effect by the user, the setting of use and the personal characteristics of the user such as weight, gender and previous drug experience. Drugs can be classified according to their physiological effects: depressants, opioids, cannabinoids, stimulants and hallucinogens. In this chapter we briefly consider the more important drugs in most of the categories, and for each we consider the drug and its mode of action, use and clinical effects, and current medical and integrative treatments.

Allergies - General Practice: The Integrative Approach. The purpose of this chapter is to introduce you to the basics of allergy, what the practitioner should know in order to plan an effective integrative treatment strategy, and to provide an overview of some therapies that have been used successfully to treat different aspects of allergy. For the patient, an integrative approach usually means making lifestyle changes and being more attentive to what they allow inside their body and their home. For the practitioner, it means becoming more informed about allergy and treatment options in order to make better treatment decisions for each patient.

Exercise as Therapy - General Practice: The Integrative Approach. Physical exercise involves the voluntary movement of the body, incorporating large muscle groups, with the goal of enjoyment, relaxation and physical exertion to improve the body’s structure and function. The different types of exercise are discussed but the avenues for exercise include sport participation, recreational activities such as bushwalking, fitness training such as resistance training, aerobic classes, yoga, Pilates, occupational and recreational work such as gardening, and incidental exercise such as walking to the shops or cycling to work.

Genetic Conditions - General Practice: The Integrative Approach. Genetic conditions are those that are directly or indirectly due to a pathogenic variation in a person’s genome that is present at birth. The variant may be inherited from a parent, or occur for the fi rst time in the family in that person in the production of the egg or sperm or at conception (spontaneous mutation or chromosomal change). This chapter covers Epigenetics, Genetic counselling and genetic services, Genetic testing, Chromosomal conditions, Single gene conditions and Inherited genetic susceptibility.

Managing Pain - General Practice: The Integrative Approach. One of the most common reasons for people presenting to a healthcare practitioner is the presence of pain. Taking an integrative approach to pain management is more, however, than adding in alternative or complementary treatments that merely provide another symptomatic approach to the patient’s treatment. Rather, integrative medicine means taking a holistic approach to the person’s experience of pain, assessing the relative contribution of all aspects of their pain, whether physical, psychological or spiritual, and applying the most appropriate treatment that evidence has demonstrated to be effective in the management of that aspect. Integrative pain management may therefore involve the judicious use of medications, stress reduction techniques, behavioural modification and re-examination of purpose and meaning. Any or all of these approaches may need to be considered as part of the prescription that best addresses the needs as well as the desires of the person in pain.

The Skin - General Practice: The Integrative Approach. This chapter provides a framework to enable a clinician to approach skin conditions from an integrative perspective, using some common conditions as examples. Some skin conditions are covered at greater length, with integrative approaches, while others have been included only briefly, to represent what is common in primary care practice. As in other areas of medicine it is important to ensure that both diagnosis and treatment of skin conditions address causes, rather than suppressing symptoms alone. Skin conditions often have multiple contributing causes, including topical influences, autoimmune or genetic susceptibility, food factors and numerous ancillary triggers.

Sleep Disorders - General Practice: The Integrative Approach. There are many types of sleep disorders, with different aetiologies, presentations and treatments. Generally, sleep disorders can be classified into one of four groups: hypersomnias, parasomnias, insomnia and sleep–wake schedule disorders. Some sleep disorders need to be referred to a specialised sleep disorders clinic for diagnosis and treatment. Other sleep problems can be diagnosed and managed within general practice and will be emphasised in this chapter. In the first part of this chapter we provide a brief introduction to the sleep process. In the second part, we outline sleep disorders such as obstructive sleep apnoea, narcolepsy and sleep-related movement disorders, bruxism and the parasomnias, which require referral to a specialised sleep centre. In the final part we describe the diagnosis and management of the more common but heterogenous sleep disorders of insomnia and sleep–wake schedule disorders.

Respiratory Medicine - General Practice: The Integrative Approach. The human respiratory system is complex and finely tuned. Fortunately, two factors are of enormous benefit to us. First, there is a large reserve of function, greater than many of us are ever going to call upon; and secondly, the respiratory system can tolerate quite a degree of insult before symptoms appear. The predominant symptoms of respiratory problems that present to GPs are breathlessness, cough, sputum, wheeze and chest pain. Diagnosis is the important first step in medical practice, and the classic method of adequate history, appropriate physical examination, thinking about the clinical problem and then considering special investigations will clarify most situations. The four diagnoses that are most prominent and/or important in general practice are: asthma, chronic obstructive pulmonary disease (COPD), lung cancer and infections.

Detoxification - General Practice: The Integrative Approach. In this chapter we examine what toxins are, where they are found and how they can affect body systems to cause illness. We also examine the underlying principles of detoxification protocols. While these are commonly used by doctors with training in environmental medicine and complementary therapies, it is important to remember that the concept of detoxification will continue to be subject to rigorous debate in the field of medicine.

Communicating with Patients - General Practice: The Integrative Approach. This chapter introduces a patient-centred approach to General Practice and how to effectively communicate with patients is also outlined.