Developing the guidelines for preventive care - two decades of experience.

BACKGROUND: The Royal Australian College of General Practitioners Guidelines for preventive activities in general practice (the 'red book') are now more than 20 years old. Therefore it is an important juncture to reflect on their appropriateness and implementation, and how they can be improved in future editions. OBJECTIVE: This review analyses the guidelines and their development against criteria identified by the AGREE collaboration to ensure the quality and applicability for use in Australian general practice. DISCUSSION: The 'red book' is widely accepted as supporting the provision of preventive care and is now a key element of the quality system in Australian general practice. This independent guideline has rigor, relevance and applicability to general practice. However, its impact on practice could be improved by broader consultation and by using a wider range of means for dissemination and implementation. This needs to be informed by more rigorous evaluation of its implementation and impact on practice.

Screening for chronic kidney disease in Australia: a pilot study in the community and workplace.

The pilot program Kidney Evaluation for You (KEY) was conducted in Australia to screen for chronic kidney disease (CKD). Targeting people at high risk (those with diabetes, hypertension, a first-degree relative with kidney failure, or age >50 years), KEY aimed to establish community-based screening protocols, assess efficacy in promoting changes in risk-factor management, and explore participant CKD awareness. KEY offered free cardiovascular and kidney checks using point-of-care testing for on-site pathology measurements (estimated glomerular filtration rate, hemoglobin A1c, cholesterol, hemoglobin, albuminuria), lifestyle assessment, and exit interviews. Participants were telephoned at 3 months to ascertain whether KEY advice had been followed. Community and health professional support was strong; 99% of participants rated involvement as beneficial. Of 402 high-risk individuals recruited, findings were suggestive of CKD in 20.4%. Of these, 69% had hypertension, 30% diabetes, and 40% elevated total cholesterol. All participants with CKD stage 3b or higher were aged >61 years. Overall, 58% of participants were referred to their primary care providers for further action; of these, 82% saw their doctors in the next 3 months and 94% discussed KEY results. Follow-up telephone contact was successful for 82% of participants. A change in management occurred for 67%. Thus, the KEY approach to early detection of CKD and selected referral of participants was largely successful.

Teaching medical students using role play: twelve tips for successful role plays.

Engaging students in role play promotes active learning. Planned and structured role plays can be used to deliver components of the curriculum in clinical rotations of a medical programme. Role plays are most effective if learning objectives are defined, and the cases are challenging. All students should be involved and ground rules should be set. Allow adequate time for the role play, feedback and reflection. Let the students enjoy themselves. This paper provides 12 tips to create a meaningful learning experience for students using role play.