Georga Cooke

Queensland University of Technology, School of Counselling and Psychology, Graduate Student

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Papers by Georga Cooke

Australian General Practice Training Distribution

The fellowship comprised of an immersion experience in a primary health care policy research cent... more The fellowship comprised of an immersion experience in a primary health care policy research centre for 4 weeks. In addition to what is presented in this document, I also attended two conferences, a policy briefing, a journal launch and the other activities undertaken by the Robert Graham Center. I gratefully acknowledge and thank both the organisation and staff of the Robert Graham Center. In particular, I wish to thank Stephen Petterson and Sean Finnegan for their guidance and technical expertise, Andrew Bazemore for his mentorship, and Kim Epperson for making me feel welcome from the moment I arrived. My experience in Washington DC would not have been as fulfilling without the sensible advice and hospitality of all staff at the Center. I would also like to extend my gratitude to previous recipients of the Fellowship who were generous with their time and advice, especially Rachel Lee and Danielle Butler. I deeply appreciate the flexibility given by my employers in Australia, who had the foresight to understand the growth that this experience would bring. Finally, the view expressed within the report are my own and do not necessarily reflect the view or policies of my employers and the organisations with which I am affiliated.

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Registrar medical educators--experiences in the Australian General Practice Training Program 2005-11

PubMed, Jun 1, 2012

Background: Increasingly, regional training providers employ general practice registrars within t... more Background: Increasingly, regional training providers employ general practice registrars within their medical education teams. Until recently, only anecdotal evidence has been available about registrar medical educators. Methods: We surveyed current and past registrar medical educators working in the Australian General Practice Training Program from 2005 to 2011, examining demographics, motivations, roles and responsibilities, attitudes and future career intentions. Results: Of 45 known registrar medical educators, 30 responded to our survey. Most were female (83%) and motivated by a desired career in medical education or were seeking diversity. Registrar educators undertook the full scope of educational activities and demonstrated a willingness to become more involved in policy, research and creating resources for registrars. Discussion: The role of registrar medical educators appears to fill a need both for the individual registrar and for the Australian General Practice Training Program program as a whole.

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A is for aphorism -- 'give me a child until they are seven and I will show you the man

PubMed, Oct 1, 2013

This aphorism is true for some, but not most. Child development is about both continuity and chan... more This aphorism is true for some, but not most. Child development is about both continuity and change. Experiences in early childhood shape cognitions and new experiences are integrated into familiar models of relationships. For example, children who have experienced rejection from parents will often assume rejection from others, not initiate positive contacts, isolate themselves, and consequently experience rejection from peers. But they may also experience a caring and supportive teacher who assists them in making lifelong friends who change their perceptions and expectations. So, early experience matters and early family life plays an important role in child development outcomes.

A is for aphorism--'nothing is sometimes a good remedy

PubMed, Jul 1, 2013

We live in a different era of medicine than that of the great Hippocrates. Our patients are bette... more We live in a different era of medicine than that of the great Hippocrates. Our patients are better informed, with ready access to a plethora of medical information, and enter the consultation with expectations of being offered therapies for all their ailments. But is it still true, over 2000 years after Hippocrates, that 'nothing is sometimes a good remedy'?

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A is for aphorism - if many treatments are used for a disease, all are insufficient

PubMed, Dec 1, 2012

The aphorism, 'If many treatments are used for a disease, all are insufficient' seems self eviden... more The aphorism, 'If many treatments are used for a disease, all are insufficient' seems self evident. If any treatments were beneficial ('sufficient' in the aphorism), there would be no need to search for new treatments and therefore the presence of many available treatments might be a marker for none of them being effective.

Silence is golden

Medical Education, Jul 10, 2018

Graves offers reflections on the mechanisms through which duration and setting of rural training ... more

A is for aphorism - is it true that 'a careful history will lead to the diagnosis 80% of the time'?

PubMed, Jul 1, 2012

Medicine is an uncertain pursuit. As medical students and junior doctors, we often try to manage ... more Medicine is an uncertain pursuit. As medical students and junior doctors, we often try to manage this by collecting golden rules as we progress through our education. And there are many occasions when a 'third voice' joins us during a consultation - the voice of a professor, clinical tutor or colleague, that enters our head spouting a pearl of wisdom, such as, 'a woman of childbearing age is pregnant until proven otherwise' or 'when you hear hoof beats, think horses not zebras'.

Treatment for recurrent vulvovaginal candidiasis (thrush)

The Cochrane library, Jan 10, 2022

Recurrent vulvovaginal candidiasis (RVVC) affects up to 5% of women. No comprehensive systematic ... more Recurrent vulvovaginal candidiasis (RVVC) affects up to 5% of women. No comprehensive systematic review of treatments for RVVC has been published. The primary objective was to assess the effectiveness and safety of pharmacological and non-pharmacological treatments for RVVC. The secondary objective was to assess patient preference of treatment options. We conducted electronic searches of bibliographic databases, including CENTRAL, MEDLINE, Embase, and CINAHL (search date 6 October 2021). We also handsearched reference lists of identified trials and contacted authors of identified trials, experts in RVVC, and manufacturers of products for vulvovaginal candidiasis. We considered all published and unpublished randomised controlled trials evaluating RVVC treatments for at least six months, in women with four or more symptomatic episodes of vulvovaginal candidiasis in the past year. We excluded women with immunosuppressive disorders or taking immunosuppressant medication. We included women with diabetes mellitus and pregnant women. Diagnosis of RVVC must have been confirmed by presence of symptoms and a positive culture and/or microscopy. We included all drug and non-drug therapies and partner treatment, assessing the following primary outcomes: • number of clinical recurrences per participant per year (recurrence defined as clinical signs and positive culture/microscopy); • proportion of participants with at least one clinical recurrence during the treatment and follow-up period; and • adverse events. Two authors independently reviewed titles and abstracts to identify eligible trials. Duplicate data extraction was completed independently by two authors. We assessed risk of bias as described in the Cochrane Handbook for Systematic Reviews of Interventions. We used the fixed-effects model for pooling and expressed the results as risk ratio (RR) with 95% confidence intervals (CI). Where important statistical heterogeneity was present we either did not pool data (I2 > 70%) or used a random-effects model (I2 40-70%). We used the GRADE tool to assess overall certainty of the evidence for the pooled primary outcomes. Studies: Twenty-three studies involving 2212 women aged 17 to 67 years met the inclusion criteria. Most studies excluded pregnant women and women with diabetes or immunosuppression. The predominant species found on culture at study entry was Candida albicans. Overall, the included studies were small (<100 participants). Six studies compared antifungal treatment with placebo (607 participants); four studies compared oral versus topical antifungals (543 participants); one study compared different oral antifungals (45 participants); two studies compared different dosing regimens for antifungals (100 participants); one study compared two different dosing regimens of the same topical agent (23 participants); one study compared short versus longer treatment duration (26 participants); two studies assessed the effect of partner treatment (98 participants); one study compared a complementary treatment (Lactobacillus vaginal tablets and probiotic oral tablets) with placebo (34 participants); three studies compared complementary medicine with antifungals (354 participants); two studies compared 'dermasilk' briefs with cotton briefs (130 participants); one study examined Lactobacillus vaccination versus heliotherapy versus ciclopyroxolamine (90 participants); one study compared CAM treatments to an antifungal treatment combined with CAM treatments (68 participants). We did not find any studies comparing different topical antifungals. Nine studies reported industry funding, three were funded by an independent source and eleven did not report their funding source. Risk of bias: Overall, the risk of bias was high or unclear due to insufficient blinding of allocation and participants and poor reporting. Primary outcomes: Meta-analyses comparing drug treatments (oral and topical) with placebo or no treatment showed there may be a clinically relevant reduction in clinical recurrence at 6 months (RR 0.36, 95% CI 0.21 to 0.63; number needed to treat for an additional beneficial outcome (NNTB) = 2; participants = 607; studies = 6; I² = 82%; low-certainty evidence) and 12 months (RR 0.80, 95% CI 0.72 to 0.89; NNTB = 6; participants = 585; studies = 6; I² = 21%; low-certainty evidence). No study reported on the number of clinical recurrences per participant per year. We are very uncertain whether oral drug treatment compared to topical treatment increases the risk of clinical recurrence at 6 months (RR 1.66, 95% CI 0.83 to 3.31; participants = 206; studies = 3; I² = 0%; very low-certainty evidence) and reduces the risk of clinical recurrence at 12 months (RR 0.95, 95% CI 0.71 to 1.27; participants = 206; studies = 3; I² = 10%; very low-certainty evidence). No study reported on the number of clinical recurrences per participant per year. Adverse events were scarce across both treatment and control groups in both comparisons.…

Is pulse palpation helpful in detecting atrial fibrillation? A systematic review

PubMed, Feb 1, 2006

Background: Atrial fibrillation in the elderly is common and potentially life threatening. The cl... more Background: Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign of atrial fibrillation is an irregularly irregular pulse. Objective: The objective of this research was to determine the accuracy of pulse palpation to detect atrial fibrillation. Methods: We searched Medline, EMBASE, and the reference lists of review articles for studies that compared pulse palpation with the electrocardiogram (ECG) diagnosis of atrial fibrillation. Two reviewers independently assessed the search results to determine the eligibility of studies, extracted data, and assessed the quality of the studies. Results: We identified 3 studies (2385 patients) that compared pulse palpation with ECG. The estimated sensitivity of pulse palpation ranged from 91% to 100%, while specificity ranged from 70% to 77%. Pooled sensitivity was 94% (95% confidence interval [CI], 84%-97%) and pooled specificity was 72% (95% CI, 69%-75%). The pooled positive likelihood ratio was 3.39, while the pooled negative likelihood ratio was 0.10. Conclusions: Pulse palpation has a high sensitivity but relatively low specificity for atrial fibrillation. It is therefore useful for ruling out atrial fibrillation. It may also be a useful screen to apply opportunistically for previously undetected atrial fibrillation. Assuming a prevalence of 3% for undetected atrial fibrillation in patients older than 65 years, and given the test's sensitivity and specificity, opportunistic pulse palpation in this age group would detect an irregular pulse in 30% of screened patients, requiring further testing with ECG. Among screened patients, 0.2% would have atrial fibrillation undetected with pulse palpation.

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Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry: A Cross-sectional Study of Common Conditions in the United States

PLOS Medicine, Aug 13, 2013

Background: Financial ties between health professionals and industry may unduly influence profess... more Background: Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties. We undertook a cross-sectional study of the most recent publication between 2000 and 2013 from national and international guideline panels making decisions about definitions or diagnostic criteria for common conditions in the United States. We assessed whether proposed changes widened or narrowed disease definitions, rationales offered, mention of potential harms of those changes, and the nature and extent of disclosed ties between members and pharmaceutical or device companies. Of 16 publications on 14 common conditions, ten proposed changes widening and one narrowing definitions. For five, impact was unclear. Widening fell into three categories: creating ''pre-disease''; lowering diagnostic thresholds; and proposing earlier or different diagnostic methods. Rationales included standardising diagnostic criteria and new evidence about risks for people previously considered to not have the disease. No publication included rigorous assessment of potential harms of proposed changes. Among 14 panels with disclosures, the average proportion of members with industry ties was 75%. Twelve were chaired by people with ties. For members with ties, the median number of companies to which they had ties was seven. Companies with ties to the highest proportions of members were active in the relevant therapeutic area. Limitations arise from reliance on only disclosed ties, and exclusion of conditions too broad to enable analysis of single panel publications. For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies.

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General practice registrars’ clinical uncertainty, and in-consultation information- and assistance-seeking

Health Education in Practice: Journal of Research for Professional Learning

Purpose: To explore the association of Australian general practitioner (GP) registrars’ responses... more Purpose: To explore the association of Australian general practitioner (GP) registrars’ responses to uncertainty with their in-consultation information-, advice- and assistance-seeking.Design/methodology/approach: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study in four Australian states. In ReCEnT, GP registrars record details of 60 consecutive consultations, six-monthly, three times during training.Outcome factors in logistic regression models included whether the registrar sought in-consultation information or assistance from (i) their supervisor or (ii) an electronic or paper-based source. Independent variables were the four independent subscales of the Physicians’ Reaction to Uncertainty (PRU) instrument, as well as registrar, practice and consultation variables.Findings: 589 registrars contributed details of 70,412 consultations.On multivariable analysis, scores on the two ‘affective’ PRU subscales ‘anxiety regarding d...

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Growing and retaining general practice research leaders in Australia: How can we do better?

Australian family physician, 2017

BACKGROUND The aim of this study was to explore the experiences of Australian general practitione... more BACKGROUND The aim of this study was to explore the experiences of Australian general practitioners (GPs) with a Doctor of Philosophy (PhD) about their choice to abandon or pursue an academic career. METHODS A qualitative study of 18 GPs (PhD obtained between 2006 and 2016) was conducted. Semi-structured telephone interviews were transcribed and analysed using concurrent thematic analysis. RESULTS General practice researchers faced insecure career pathways. They often work in isolation, there is a lack of critical mass, and research was often described as a hobby (ie unfunded, done from home). Solutions included expanding academic general practice registrar positions to include advanced research training, building professional networks, mentoring, and better marketing of general practice research. DISCUSSION Focused investment in developing clear and sustainable career pathways is essential to nurture and retain general practice researchers and research leaders. The research culture...

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Silence is golden

Medical education, 2018

Graves offers reflections on the mechanisms through which duration and setting of rural training ... more

A is for aphorism -- 'give me a child until they are seven and I will show you the man

Australian family physician, 2013

A is for aphorism - is it true that 'a careful history will lead to the diagnosis 80% of the time'?

Australian family physician, 2012

Registrar medical educators--experiences in the Australian General Practice Training Program 2005-11

Australian family physician, 2012

Increasingly, regional training providers employ general practice registrars within their medical... more Increasingly, regional training providers employ general practice registrars within their medical education teams. Until recently, only anecdotal evidence has been available about registrar medical educators. We surveyed current and past registrar medical educators working in the Australian General Practice Training Program from 2005 to 2011, examining demographics, motivations, roles and responsibilities, attitudes and future career intentions. Of 45 known registrar medical educators, 30 responded to our survey. Most were female (83%) and motivated by a desired career in medical education or were seeking diversity. Registrar educators undertook the full scope of educational activities and demonstrated a willingness to become more involved in policy, research and creating resources for registrars. The role of registrar medical educators appears to fill a need both for the individual registrar and for the Australian General Practice Training Program program as a whole.

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Is pulse palpation helpful in detecting atrial fibrillation? A systematic review

The Journal of family practice, 2006

Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign... more Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign of atrial fibrillation is an irregularly irregular pulse. The objective of this research was to determine the accuracy of pulse palpation to detect atrial fibrillation. We searched Medline, EMBASE, and the reference lists of review articles for studies that compared pulse palpation with the electrocardiogram (ECG) diagnosis of atrial fibrillation. Two reviewers independently assessed the search results to determine the eligibility of studies, extracted data, and assessed the quality of the studies. We identified 3 studies (2385 patients) that compared pulse palpation with ECG. The estimated sensitivity of pulse palpation ranged from 91% to 100%, while specificity ranged from 70% to 77%. Pooled sensitivity was 94% (95% confidence interval [CI], 84%-97%) and pooled specificity was 72% (95% CI, 69%-75%). The pooled positive likelihood ratio was 3.39, while the pooled negative likelihood ra...

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A is for aphorism--'nothing is sometimes a good remedy

Australian family physician, 2013

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A is for aphorism - if many treatments are used for a disease, all are insufficient

Australian family physician, 2012

The aphorism, 'If many treatments are used for a disease, all are insufficient' seems sel... more The aphorism, 'If many treatments are used for a disease, all are insufficient' seems self evident. If any treatments were beneficial ('sufficient' in the aphorism), there would be no need to search for new treatments and therefore the presence of many available treatments might be a marker for none of them being effective.

Common general practice presentations and publication frequency

Australian family physician

General practitioners see the widest range of conditions of any specialty. It is unclear if the m... more General practitioners see the widest range of conditions of any specialty. It is unclear if the most commonly managed problems in general practice are reflected in the volume of published general practice research, or in guidelines produced for general practice. The 200 most commonly managed problems in general practice were sought from the BEACH database. For the 10 most often managed, we searched Australian Family Physician in MEDLINE (2005-10) for articles and the National Health and Medical Research Council Clinical Practice Guidelines Portal for guidelines, to determine publication frequency. The 10 most commonly managed problems were hypertension, immunisation, upper respiratory tract infection, depression, diabetes, lipid disorder, general check-up, osteoarthritis, back complaint, and prescription request. The top 30 problems accounted for approximately 48% of GP problems managed. To cover 75% of problems managed, GPs need to have knowledge of more than 100 problems. While GP...

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