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We evaluated a diabetic mini-clinic by assessing adherence to American Diabetes Association guidelines and changes in glycosylated haemoglobin levels. Of 1063 patients, 721 were multiple attenders. Single and multiple attenders showed no significant differences in age, sex, time since diagnosis or body mass index. Female and male multiple attenders showed significant declines in glycosylated haemoglobin levels over the first 12 and 18 months respectively. After 2 years, these levels were similar to those at entry to the clinic. The clinic’s compliance with standard measurement guidelines was high. The diabetic mini-clinic model, which is effective in industrialized countries, was equally effective in this setting.

As we slowly move towards a post-COVID-19 world, it is timely to revisit the ongoing disparity in health outcomes across Australia. Aboriginal and Torres Strait Islander people continue to experience lower life expectancy and higher morbidity than other Australians.1 Closing the Gap began in 2007, aiming to ‘close the health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians … by 2030’.2 However, at the 10-year review in 2018, it was clear that the gap is not closing.2

‘Uncharted waters’ is perhaps an understatement of where we are headed at this time. The situation is fluid, with government regulations for our society changing rapidly.

The importance of physical activity as a core component of the suite of preventive measures central to improving health outcomes has been documented since the Ancient Greek period. Yet, the headline news regarding Australian physical activity trends highlights that only 15% (2.8 million) of people aged ≥18 years meet the minimum activity guidelines for physical activity and muscle strengthening.

Background Legal restrictions on alcohol availability have been used to address violence and injury in the world’s remote Indigenous communities. In Australia, alcohol management plans (AMPs) were implemented by the Queensland Government in 2002. This study reports changes in indicators of alcohol-related violence and injury in selected communities. Methods Design and setting: A longitudinal observational study was conducted in four Aboriginal and Torres Strait Islander (Indigenous) communities in Cape York, far north Queensland. All communities are similarly-isolated from population centres where alcohol is available. Data: For 2000 to 2015 inclusive: 1019 Royal Flying Doctor Service aeromedical trauma retrievals; 5641 Queensland Police Service records of unique assault occurrences, including 2936 involving alcohol; and records for 2741 unique assault victims were examined. Data analysis: Rates (per 1000 population) of trauma retrievals, assault occurrences and assault victims (per 1000 population) were compared across three policy phases. Phase 1: 2000 to 2008. Initial restrictions on possession and consumption of alcohol in ‘restricted areas’ were implemented during 2002–2003. Phase 2: 2009 to 2012. All alcohol was prohibited in three study communities and its legal availability limited in the fourth from 2009. Phase 3: 2013 to 2015. Government reviews of AMP policies in light of legal challenges and community responses characterise this phase. Results Compared with Phase 1, in Phase 2 retrieval rates declined by − 29.4%, assault occurrences by − 34.1% with less than one-third involving alcohol, and assault victims by − 21.1%, reaching historically low levels in 2010–2012. These reductions did not continue consistently. Compared with Phase 1, in Phase 3 retrieval rates, assault occurrence rates and assault victim rates declined by somewhat lesser amounts, − 13.9%, − 15.0% and − 13.4%, respectively. In Phase 3, the proportion of assault occurrences involving alcohol in communities 2, 3 and 4 rose towards pre-2008 levels. Conclusions Early successes of these controversial alcohol restrictions are jeopardised. Indicators of violence and injury appear to be rising once more in some AMP communities. Importantly, rates have not generally exceeded the highest levels seen in Phase 1. Fresh policy action is required with rigorous monitoring to prevent erosion of initial important successes.

Background Indigenous communities in Queensland (Australia) have been subject to Alcohol Management Plans since 2002/03, with significant penalties for breaching restrictions. ‘Sly grog’ and ‘homebrew’ provide access to alcohol despite restrictions. This paper describes how this alcohol is made available and the risks and impacts involved. In affected towns and communities across a large area of rural and remote Queensland, interviews and focus groups documented experiences and views of 255 long-standing community members and service providers. Using an inductive framework, transcribed interviews were analysed to identify supply mechanisms, community and service provider responses and impacts experienced. Results ‘Homebrew’ was reportedly manufactured in just a few localities, in locally-specific forms bringing locally-specific harms. However, ‘sly grog’ sourced from licensed premises located long distances from communities, is a widespread concern across the region. ‘Sly grog’ sellers circumvent retailers’ takeaway liquor license conditions, stockpile alcohol outside restricted areas, send hoax messages to divert enforcement and take extraordinary risks to avoid apprehension. Police face significant challenges to enforce restrictions. On-selling of ‘sly grog’ appears more common in remote communities with total prohibition. Despite different motives for involvement in an illicit trade ‘sly grog’ consumers and sellers receive similar penalties. Conclusions There is a need for: (a) a more sophisticated regional approach to managing takeaway alcohol sales from licensed suppliers, (b) targeted penalties for ‘sly grog’ sellers that reflect its significant community impact, (c) strategies to reduce the demand for alcohol and (d) research to assess the effects of these strategies in reducing harms.

The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd – Bertrand Russell

Skin cancer medicine is a core component of Australian general practice and is consistently in the top 10 conditions managed.1 This is not surprising as Australia has the highest incidence of melanoma in the world,2 leaving melanoma the fourth most common cancer in Australia, especially in non-metropolitan locations.3 Across the 20-year period 1995–2014, melanoma incidence in Queensland remained the highest recorded in the world (age-standardised incidence of invasive melanoma 572 per 100,000/annum [2010–2014]).4 Widespread public information campaigns have been effective; currently, approximately half of all new diagnoses of melanoma are initially noticed by the patient, who then approaches their clinician, usually their general practitioner (GP), for advice.5 This is leading to earlier detection, known to improve survival, with the incidence of in situ melanoma rising while the incidence of invasive melanoma is stable or falling in patients aged under 60 years.4 The management of melanoma continues to evolve, with the latest changes for both cutaneous and metastatic melanoma explored by Dixon et al.6,7 GPs are well positioned to play a key part in skin cancer medicine, with diagnostic acumen of similar high sensitivity and accuracy to formal skin cancer doctors.8 Overall management of skin cancer in general practice is of similar quality and effectiveness to that provided by skin cancer clinic networks.9 Similarly, despite patients with cutaneous melanoma having a high risk of recurrence and hence requiring careful follow-up, GP-led follow-up for melanoma has been shown to be as effective as hospital-based care.10

The man who uses intelligence with respect to his diet, his sleeping habits and who exercises properly, is beyond any question of doubt taking the very best preventive medicines provided so freely and abundantly by nature.

You matter because you are you, and you matter to the end of your life. We will do all that we can not only to help you die peacefully, but also to live until you die. – Cicely Saunders

Background Favourable impacts are reported from complex alcohol control strategies, known as ‘Alcohol Management Plans' (AMPs) implemented 14 years ago in 19 Aboriginal and Torres Strait Islander (Indigenous) communities in Queensland (Australia). However, it is not clear that all communities benefited and that positive impacts were sustained. Service providers, key stakeholders and community leaders provided insights about issues and impacts. Methods Participants ( N =382) were recruited from knowledgeable and experienced persons using agency lists and by recommendation across sectors which have a mandate for managing alcohol-related issues and consequences of AMP policies in communities. In semi-structured interviews, participants (51% Indigenous, 55% male and comprised of at least one-third local community residents) were asked whether they believed alcohol controls had been effective and to describe any favourable and unfavourable outcomes experienced or perceived. Inductive techniques were used for thematic analysis of the content of transcribed recorded interviews. Comments reflecting themes were assessed across service sectors, by gender, Indigenous status and remoteness. Results Participants attributed reduced violence and improved community amenity to AMPs, particularly for ‘very remote' communities. Participants' information suggests that these important achievements happened abruptly but may have become undermined over time by: the availability of illicit alcohol and an urgency to consume it; migration to larger centres to seek alcohol; criminalization; substitution of illicit drugs for alcohol; changed drinking behaviours and discrimination. Most issues were more frequently linked with ‘very remote' communities. Conclusion Alcohol restrictions in Queensland's Indigenous communities may have brought favourable changes, a significant achievement after a long period of poorly regulated alcohol availability from the 1980s up to 2002. Subsequently, over the past decade, an urgency to access and consume illicit alcohol appears to have emerged. It is not clear that relaxing restrictions would reverse the harmful impacts of AMPs without significant demand reduction, treatment and diversion efforts.

Objective: To assess the impact on patient flow as noted by the National Emergency Access Target (NEAT), with the introduction of a new Paediatric ED (PEM ED) model of care. Methods: This longitudinal observational study was conducted at the Logan Hospital, a 344 bed public hospital in metropolitan Brisbane, which opened a physically separate, dedicated PEM ED on 14 October 2014, incorporating approximately 30% more staff, limited changes in processes and no changes in governance. De-identified data of the entire clientele from the ED Information System were compared 365 days before and after the opening of the PEM ED. Results: Although the number of children presenting to ED increased by 23% (pre 18 142, post 22 391), the median length of stay decreased substantially from 152 min to 138 min, resulting in a 7.75% rise in presentations that met the NEAT target (pre 77.41%, post 85.16%; P < 0.0001). Admission to the ED Short Stay Unit rose by 16.48% (pre 5.38%, post 21.86%; P < 0.0001), whereas final disposition to the inpatient paediatric unit fell by 2.30% (pre 11.43, post 9.13%; P < 0.0001). The clinical presentations were similar pre and post across age, sex, ethnicity, referral and arrival mode, Australasian Triage Scale category, presenting problem and discharge diagnosis. Conclusion: NEAT times improved after changing the PEM ED model of care. Further studies may assist identifying which of the specific features within the new model are most effective for improving patient flow.

Tobacco has been a pervasive part of the human experience since prehistory, with tobacco cultivation in the Americas dating back to 6000 BC.2 The dangers of tobacco smoking were clearly apparent and publicised by the mid-20th century, but formal measures to stop smoking were slow to be introduced or accepted. Looking back from our current understanding, it is hard to believe that around the time when The Royal Australian College of General Practitioners (RACGP) was established, doctors including general practitioners (GPs) were promoting smoking to patients,3 with brand preference among doctors used as a marketing strategy.4 Even a noted GP and past president of the RACGP ‘smoked Temple Bar cigarettes, sometimes while consulting’.5

As noted by Leonardo da Vinci, ‘the human foot is a masterpiece of engineering and a work of art’,2 evolving over eons with a unique design for propulsion and support.3 However, it would seem that overall we do not afford the foot great interest, adopting at an early age footwear that may not be especially supportive and restricting movement.4 When combined with the hard surfaces we regularly tread, strong and mobile feet are not the usual outcome.4

I have always been interested in the apparent dichotomy between the two arms of medical training and practice: the exploration of disease and illness through intellectual discourse versus the practical use of the clinician’s psychomotor skills and techniques to physically interact with the patient. Perhaps there is no real surprise as medicine’s two branches – the less invasive medical methods and the more invasive surgical methods – have been present since before the existence of written language.2 This duality persists in the designation of the primary medical degree in most countries as a combination of a Bachelor of Medicine with a Bachelor of Surgery.

Background In Australia, ‘Alcohol Management Plans’ (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents’ experiences of AMPs in 10 of Queensland’s 15 remote Indigenous communities. Methods This cross-sectional study used a two-stage sampling strategy: N = 1211; 588 (48%) males, 623 (52%) females aged ≥18 years in 10 communities. Seven propositions about ‘favourable’ impacts and seven about ‘unfavourable’ impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18–24, 25–44, 45–64, ≥65 years), residence (≥6 years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability (ρ), item loadings and covariances. Results Slim majorities agreed that: AMPs reduced violence (53%, p = 0.024); community a better place to live (54%, 0.012); and children were safer (56%, p

To assess the impact on patient flow as noted by the National Emergency Access Target (NEAT), with the introduction of a new Paediatric ED (PEM ED) model of care.This longitudinal observational study was conducted at the Logan Hospital, a 344 bed public hospital in metropolitan Brisbane, which opened a physically separate, dedicated PEM ED on 14 October 2014, incorporating approximately 30% more staff, limited changes in processes and no changes in governance. De-identified data of the entire clientele from the ED Information System were compared 365 days before and after the opening of the PEM ED.Although the number of children presenting to ED increased by 23% (pre 18 142, post 22 391), the median length of stay decreased substantially from 152 min to 138 min, resulting in a 7.75% rise in presentations that met the NEAT target (pre 77.41%, post 85.16%; P 0.0001). Admission to the ED Short Stay Unit rose by 16.48% (pre 5.38%, post 21.86%; P 0.0001), whereas final disposition to the inpatient paediatric unit fell by 2.30% (pre 11.43, post 9.13%; P 0.0001). The clinical presentations were similar pre and post across age, sex, ethnicity, referral and arrival mode, Australasian Triage Scale category, presenting problem and discharge diagnosis.NEAT times improved after changing the PEM ED model of care. Further studies may assist identifying which of the specific features within the new model are most effective for improving patient flow.