Best Practice Software

Bp Launches Connect + Evolve Software Roadshow

For the first time in Best Practice Software’s history, the Product management team and Bp specialists will be travelling to Brisbane, Sydney and Melbourne to showcase their brand-new software innovation roadshow” Best Practice Connect and Evolve.

To entice Bp users, Best Practice will be offering all successful Practices 1,000 SMS credits, a Bp Sports Bag and most importantly, the chance to help shape the future of Best Practice Software.

Chief Operating Officer Mr Craig Hodges says he is excited for the roadshow to commence in the coming weeks.

Connect + Evolve (C+E) will feature an exciting design-led user think tank and software innovation roadshow, where our product experts will be engaging face-to-face with real users of Bp software products to gauge their thoughts, opinions, feedback (good and bad), and ideas for our products in their life. It is a fantastic opportunity for users to help guide the future direction of our software products,

We’ve publicly invited healthcare industry experts knowledgeable in using Best Practice products – including Practice Managers, General Practitioners, Nurses, Specialists and Allied Health professionals. Though we’ve launched the roadshow event in Australia, it’s our hope that we’ll embed C+E into our product design and development culture, and of course take the concept to our New Zealand market in the future. Mr Hodges said.

Bp advises users to secure their spot early in this fantastic opportunity to influence Bp’s product direction and software functionality enhancements into the future, as registrations are limited to 50 attendees per city.

Click here to register your interest today or for further information please phone the team on 1300 40 1111.

Roadshow dates: Brisbane: Tuesday, 1st May | Sydney: Thursday, 3rd May | Melbourne: Friday, 11th May

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View from a Doctor’s Desk – Dr Lisa Surman

Coffee and Cancer? Keep Drinking Your Daily Coffee but Not Too Hot

A Californian judge has ruled that coffee companies must put a cancer warning on coffee products because acrylamide, chemical produced in the roasting process is a carcinogen under California law. Companies, including Starbucks, failed to show that the risk posed by acrylamide in coffee was insignificant. (Of interest, no warning is required on calorie-dense, nutrient poor fast foods and drinks which are linked to obesity. Obesity has convincing evidence linked to increased risk of cancer of the oesophagus, pancreas, bowel, breast, endometrium and kidney and probable evidence of links to gall bladder cancer and many metabolic and cardiovascular consequences).

No new study or evidence has been published or produced regarding the cancer risk of coffee.

Acrylamide is formed when certain foods, particularly plant-based foods that are rich in carbohydrates and low in protein, are cooked at high temperatures such as frying, roasting or baking, the major foods contributing to exposure are potato chips and crisps, cereal-based products such as biscuits and pastries and coffee.

Food Standards Australia does advise that we reduce our exposure to acrylamide. There is no direct evidence that it causes cancer in humans, but evidence that it can cause cancer in Laboratory animals. International food regulators are working to reduce acrylamide levels with new farming and processing techniques such as lower cooking temperatures, enzymes to reduce formation and raw materials with lower reducing sugar levels. Reducing acrylamide in some products such as coffee is difficult without changing the taste. The amount of acrylamide varies dramatically in the same foods depending on several factors including cooking temperature and time. This is the reason the Joint WHO Committee on Food Additives (JECFA) experts do not issue recommendations on how much of any specific food containing the substance is safe to consume. For further information on strategies to reduce exposure see or food safety/acrylamide.

The International Agency for Research on Cancer (IARC) announced in 2016 that there is no conclusive evidence to show coffee increases cancer risk (reversing a 1991 conclusion when the carcinogenicity of coffee was first tested, classifying the drink then as being possibly carcinogenic to humans) after reviewing over 1000 human and animal studies. Concluding that it is unlikely that coffee has any substantial effect on the risk of developing cancers of the pancreas, bladder, prostate or breast and suggesting a protective effect against the development of liver and endometrial cancers.

Drinking coffee (moderate amounts have been defined as drinking three to four cups per day) outside pregnancy, is more likely to benefit our health rather than harm, according to the results published in the BMJ of a study undertaken by the University of Southampton in 2017. The research involved a meta-analysis of observational and interventional studies examining the associations between coffee consumption and any health outcome in any adult population in all countries and all settings. Drinking coffee beyond the amounts given was not associated with harm, but the benefits were less pronounced.

Coffee is one of the most consumed beverages worldwide. Roasted coffee is a complex mix of over 1000 bioactive compounds, some with potential antioxidant, anti-inflammatory, anti-fibrinolytic or anticancer effects, The key active ingredients include caffeine, chlorogenic acids, the diterpenes, cafestol and kahweol. The existing research has involved the associations between coffee as an exposure and a range of outcomes including all-cause mortality, cancer and diseases of the metabolic, cardiovascular, neurologic, musculoskeletal, gastrointestinal and liver systems and pregnancy.

Consumption of coffee was associated with a lower risk of specific cancers including prostate, endometrial, melanoma, non-melanoma skin cancer and liver cancer.

Coffee consumption also had beneficial associations with metabolic conditions such as type 2 diabetes, gout, gallstones, metabolic syndrome, hepatic fibrosis and cirrhosis and chronic liver disease. There also appeared to be a beneficial association between coffee consumption and Parkinson’s disease, depression and Alzheimer’s disease.

Overall, there was no consistent evidence of harmful associations between coffee drinking and health outcomes except in pregnancy, where high caffeine intake was associated with low birth weight, preterm birth and pregnancy loss. Pregnancy recommendations are to limit caffeine intake to under 200 mg per day (one mug of filter coffee is 140mg, one mug of instant coffee 100mg, one mug of tea provides 75mg, one can of cola 40mg) . There was also a small increase in risk of fracture in women, but there was some discrepancy in the evidence suggesting further research is needed.

Decaffeinated coffee is compositionally similar to caffeinated coffee. The review found consuming decaffeinated coffee provided the cardiovascular, reduction in risk of type 2 diabetes, reduced lung cancer risk and endometrial cancer. There were no harmful associations between decaffeinated coffee and any health outcome.

There is evidence that cancer can be initiated by constant irritation of body surfaces (like skin and the lining of the mouth and oesophagus) Extremely hot water can provide this irritation (drinking beverages above 65 degrees). A recent evidence review by IARC concluded that drinking hot beverages above 65 degrees C probably causes oesophageal cancer in humans, but the relative contribution on oesophageal cancer rates requires further research.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

BMJ article BMJ 2017:359:j5024. re cancer myth:coffee,tea,hot beverages and cancer,


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Tips for a Mindful and Healthier Easter – View from a Doctor’s Desk – Dr Lisa Surman

Easter has traditionally been a time for family gatherings and abundant food, particularly high fat and high sugar offerings such as hot cross buns and Easter eggs. The abundance of food related advertisements encourage us to believe that Easter is about eating as much as possible, particularly chocolate.

Mindfulness is about being fully conscious in the moment without making judgement; and being aware of what you are eating. A start may be about being aware of portion sizes, deciding to eat a treat and indulging away from the distractions of screens, books or talking.

Look at the food and enjoy the texture, smell and taste, the muscles used to raise the food to your mouth, the texture and taste as you chew slowly. Don’t grab and eat, try to sit down and enjoy the seasonal treats. The studies show this to be a way of feeling more satisfied with the portion you have eaten, reducing the chance of over-eating and increasing enjoyment in a guilt-free way.

Plan some non-chocolate Easter treats such as an outing to the pool, the park or a bike ride.

Be aware of controlled portion sizes – try to avoid planning to “eat all you want” and avoid planning to “eat no chocolate”. Don’t skip nutritious meals for chocolate. Try fruit dipped in chocolate, chocolate drizzled popcorn or roast nuts, banana muffins with chocolate chips and hot chocolate drinks to make a little chocolate go a long way.

Dark chocolate can provide small health benefits as cocoa is rich in antioxidants. The darker the chocolate the higher the percentage cocoa and potential benefit. Unfortunately, large amounts of chocolate contain large amounts of fats, sugar and calories. Chocolate also contains small amounts of essential nutrients such as protein, vitamin E, calcium, phosphorus, magnesium, iron and copper.

Start Easter morning with a healthy and filling breakfast, swapping chocolate eggs for poached, boiled or scrambled eggs to provide low-fat protein to reduce craving;s and add in some vegetables such as tomatoes and mushrooms on wholegrain toast . LiveLighter, a programme developed in Western Australia to encourage healthier lifestyles is highlighting the benefits of eggs and features several recipes to try out and enjoy across the weekend.

Balance any extra intake with active fun and play. Some examples of walking equivalents are 6 mini Cadbury eggs (19g) requires an average woman to walk for 19 minutes and an average man 17 minutes. A Lindt gold bunny (100g) requires 112 minutes for a woman and 99 minutes for a man.

The LiveLighter website and recipes gives some examples of meal equivalents with their recipe guide for a 100g bunny the same number of kilojoules are contained in:

– a LiveLighter Steak sandwich with caramelised onions

– a healthy quick chicken pizza

– one serve of LiveLonger’s spaghetti Bolognaise

– 2 egg omelette with a slice of toast

– 2 cheese and salad sandwiches

Wishing you a happy ” and healthy ” Easter!

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

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When Should I get my Flu Vaccination? View from Dr Surman’s Desk

Flu Shot

The RACGP president Dr Bastian Seidel is advising us not to get the flu vaccination too early in the season, as protection during the flu season will be less effective. He made the media announcement in response to many pharmacies this week launching campaigns that encouraged people to get their flu shots as early as possible. 

Protection from vaccination is known to reduce over time and recent evidence demonstrated this to be by 6-11% per month and those over 65 years particularly have been shown to lose vaccine-induced immunity at an even faster rate. The flu season is usually between June to September, with a peak in August. The community is strongly advised to have the vaccine closer to the start of the flu season, closer to May.

The vaccine usually provides about a 60% protection from the circulating flu strains during the winter. The flu strains contained in the vaccine are chosen after assessing the circulating strains in the opposite hemisphere winters and the predictions can be poor as a result of the complicated possibilities, the nature of the influenza virus and perhaps the modern ease and frequency of travel across continents by large numbers of people. The vaccine strain can change in the 6 months between being chosen for the next winter and manufacture and distribution. The egg-grown H3N2 vaccine virus strain also changed during vaccine production for the 2017 vaccine in Australia.

There are several flu types circulating every year, the different strains posing different threats to the various age groups in the community. The different strains can be easily distinguished by laboratory tests, but not by clinical symptoms. The types of circulating virus strains are published at the end of winter from national Influenza Centres and data is reported to FluNet internationally. The WHO FluNet Summary provides real-time data on the current global circulation of influenza viruses and the vaccine effectiveness for the past season is also provided. The WHO network provides early detection of new influenza subtypes with the potential to cause a pandemic and monitors antigenic and genetic changes occurring in recently circulating influenza A and B viruses to assist the WHO in formulating the twice yearly recommendations on the most appropriate compositions of influenza vaccines. The information is available on the World Health Organisation website here.

Worldwide, influenza A and influenza B accounted for similar proportions of infections in the northern hemisphere winter of 2018.

The UK season had “Aussie flu”, influenza A ( subtype H3N2) in circulation, particularly causing serious illness and death in the elderly. The vaccine effectiveness was estimated as 39.8% for all ages , but gave no effectiveness in those older than 65 years. The Influenza B, Yamagata lineage was also circulating in similar numbers and caused significant illness in the UK and was not included in the vaccine. Children are most susceptible to the Influenza B viral strains

The Aussie Flu (AH3N2) was most prevalent last season in the USA and also caused most complications in the elderly. The US vaccine all-age effectiveness last winter was 32% for H3N2 and 10% for Influenza B Yamagata.

During the 2017 season, only 27% of all Australians were vaccinated at all, with 6% of children being vaccinated. The vaccine provided 33% protection ( 5-19% for H3N2 and 37% against H1N1 ). There were 1,100 deaths from flu-related causes – 90% were aged 65 years and over. Australia recorded 221,853 flu infections to November 2017, significantly more than other years.

This year two new vaccines are funded and recommended for those over 65 years, hoping to provide better protection than that given to the US and UK populations of over 65 year olds for winter 2018. Both contain 3 strains only for influenza A, not influenza B. The seasonal flu vaccine now contains four strains to cover all the relevant subtypes present, but protection against H3N2 infection appears to be poorer than the other strains. The benefits of better protection against the most common three flu strains appear to outweigh the potential loss of protection against the missing B strain for the elderly.

Fluzone High Dose ( contains 4 times the flu antigen. This vaccine increases antibody response, particularly against the H3N2 strain which causes more problems for older people, particularly with a complicating pneumonia.

Fluad, This vaccine contains an adjuvant to boost the immune response. It has been used overseas for some years and observational data indicates less hospitalisations and less pneumonia infections associated.

The new vaccines are not live, do not cause flu and both give more local side-effects such as painful injection sites or fever. There are no head-to-head comparisons of effectiveness and studies suggest similar results.

There is no data to support the use of different doses, nor multiple doses, with the vaccine given at each site most likely to be the one that has been made available to the Clinic.

No vaccine provides guaranteed protection, but reduces the risk of getting flu.

For very detailed information about influenza, the website is a useful resource and provides the current vaccine recommendations and surveillance report links available and the Australian Immunisation Guidelines for those who are at increased risk from influenza other than those over 65 years, such as pregnant women, those with lung and chronic diseases and with immunodeficiency states.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

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How Do I Avoid a Listeria Infection?


Listeria infection has been in the news recently. However, it’s important to remember that it is is rare, is caused by eating foods contaminated by the bacteria and is not usually transmitted between people.

The overall number of cases reported in Australia each year has been about 65, with between 1 to 14 confirmed cases of listeriosis reported in pregnant women each year for approximately 300 000 births.

Foods associated with infection include unpasteurised milk, dairy products made from unpasteurised milk, soft cheeses including ricotta and fetta, juices, soft serve ice-cream, tofu, tempeh, sushi, seed sprouts, chilled ready-to-eat foods like pre-packed sandwiches, pate and deli meats, pre-cut fruit, oysters, packaged salads, cold ready-to-eat chicken, sashimi, smoked salmon. And, most recently, rockmelon (grown in the Eastern States) due to soil contamination on the skin of the fruit.

Listeria infection can be dangerous to those with weakened immune systems ( the elderly, those with cancer, diabetes, liver and kidney disease) and to pregnant women and their unborn babies. Symptoms range from fatigue, headache, diarrhoea, aches and fever to meningitis and septicaemia. The symptoms occur from as early as a few days to several weeks, usually three weeks. The diagnosis is made using a blood or spinal fluid sample

There are simple guides to avoid infection including advice about food preparation, handling and storage:

– washing hands before preparing food and between raw and ready-to eat foods

– defrosting food in the fridge or microwave

– washing raw fruit and vegetables before eating (due to soil contamination)

– not using the same knives and boards for raw and cooked foods unless washed in soapy water

– cooking all foods of animal origin, including eggs

– storing food covered

– avoiding raw food after their use-by-date

– cleaning the fridge and keeping the temperature below 5 degrees, but the organism can survive and grow at low temperatures

– placing cooked food in the fridge within an hour of cooking

– when reheating food, make sure the centre is piping hot as listeria is killed by cooking food to boiling point

Foods without listeria risk include yoghurt, hard cheeses, cheese spreads and processed cheese, milk, canned and pickled foods, ready-to-eat deli meats and smoked fish heated to above 100 degrees, soft cheeses in cooked products such as pizza, hard ice-cream and gelato.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

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Battling Endometriosis


Endometriosis is a disorder that can cause significant distress, both physically and mentally, in women and is often misunderstood.

Lena Dunham has written a very personal account of her decision to have a hysterectomy at 31 after years of suffering with endometriosis in the recent issue of Vogue (In Her Own Words). She describes battling the disorder for ten years and undergoing nine surgical procedures and how she chose the surgery despite knowing that the surgery does not guarantee that the pain will cease, and is not a cure.

Endometriosis is estimated to affect 176 million women and their families worldwide. It is not related to lifestyle choices and affects physical, mental and social wellbeing, often affecting a woman’s ability to complete education, maintain a career, interferes with relationships, social activities and can affect fertility. Between 1% and 10% of Australian women have the condition.

A general lack of awareness by both women and health care professionals, perhaps due to “normalisation” of symptoms, results in significant delay between experiencing symptoms, diagnosis and treatment (the average is seven years).

Endometriosis is condition where tissue similar to the lining of the womb (endometrium) grows outside the womb, the hormones that usually trigger a period cause bleeding at the sites of endometrial-like tissue and causes pain. The cause of endometriosis is currently unknown, with several theories such as retrograde flow of endometrial tissue out of the womb through the fallopian tubes implanting in the pelvic cavity, genetic predisposition and other gynaecological factors and environmental exposures (such as dioxin and PCBs) all being investigated as contributing. Although endometriosis is associated with inflammation and immunological dysfunction, it has not been proven itself to be an autoimmune disorder. Some studies have linked the presence of endometriosis to the development of ovarian cancer, but the association is not definitive and the absolute risk for a woman with endometriosis is very low. The complicated nature of pain pathways is also involved, explaining why some women have advanced endometriosis with few symptoms and others very little endometriosis and severe symptoms. It is possible to have surgical treatment for endometriosis and ongoing significant pain due to the pathways mis-firing and not progression of the disease. The symptoms of endometriosis include painful periods, painful ovulation, pain during and after sex, fatigue and infertility. Diagnosis can only be made by laparoscopic (keyhole) surgery.

The International Organisation, has posted a very useful list of myths and misconceptions:

  1. Endometriosis is difficult to understand. There are many associated myths, taboos, hit-and-miss treatments, lack of awareness, a wide variety of symptoms contributing to a frustrating, painful chronic condition. Health professionals often have poor understanding of the disease and the media present varying understanding of the disease and outcomes, so women receive confusing information
  2. Severe period pain is not normal. If period pain interferes with daily life, such as going to school, work or day-to-day activities it is not normal
  3. No-one is too young to have it, and it is possible to have symptoms after menopause, particularly due to scarring and inflammation effects of the disease
  4. Hormonal treatments do not cure endometriosis. Hormonal treatments temporarily suppress the symptoms while the drugs are being taken. Surgery by an experienced gynaecologist is the only effective medical treatment
  5. Pregnancy does not cure endometriosis. Like hormonal drugs, pregnancy temporarily suppresses the symptoms, but does not eradicate the disease itself.
  6. Endometriosis does not equal infertility. Most women with endometriosis go on to have children. In general, it is believed that the likelihood of fertility problems increases with the severity of the disease and age. There are no statistics available to give a reliable indication of an individual woman’s fertility.
  7. Infertility is not just caused by endometriosis on the tubes, pelvic inflammatory disease damages and blocks fallopian tubes. Tubal endometriosis is much less common and does not always cause infertility. The mechanism by which endometriosis causes infertility remains largely unknown
  8. Hysterectomy does not cure endometriosis
  9. It is a physical, not an emotional disorder. Women with endometriosis may struggle with emotional distress associated and, as a result of, unrelenting pain and infertility
  10. Abortion does not cause endometriosis
  11. Douching does not cause endometriosis

There is no best treatment for endometriosis. Treatments will work differently for individual women. It is important to be aware of the different kinds of treatments and their possible effects, side-effects or complications. Usually a combination of treatments can be used to relieve symptoms.

There are now national support organisations worldwide. The Pelvic Pain Foundation of Australia ( website has links to the Australian Coalition for Endometriosis, the peak consumer and advocacy body representing the needs of girls and women with endometriosis in Australia. There is also a pelvic pain booklet , advice regarding pelvic muscle relaxation, and links to subscribe to the regular newsletter. Endometriosis Australia has a helpful website ( containing a medical Webinar series as an educational reference and possibly has more detailed information regarding the nature of the treatment options.

To read the Lena Dunham article, see

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee,

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Heart Disease in Women: A Timely Reminder

Heart Disease

Valentine’s Day comes with a timely reminder for heart disease in women.

Heart disease is the leading cause of death for women, with three to four times more women dying from heart disease than breast cancer in Australia.

Women having a heart attack can have severe chest pain, but many experience more subtle symptoms such as dizziness, fatigue, nausea, burning sensations similar to heartburn, discomfort in their arms, neck and jaw, shortness of breath, sweating or nausea.

The difference in the nature of heart attack symptoms between men and women often means that women present later to Hospital and, upon arrival at Hospital, recent studies in the US, UK and Australia have demonstrated that women’s symptoms can result in missed diagnoses. Women are referred less for in-hospital treatments such as angioplasty and also are referred less and attend fewer cardiac rehabilitation programmes, with poorer outcomes as a result.

Prior to a heart attack, some diagnostic tests for heart disease indicators are less accurate in women than men, women are less likely to seek help quickly for nonspecific symptoms and some health professionals are less likely to check for heart disease for so-called recent onset nonspecific symptoms.

The National Heart Foundation of Australia has developed several videos and documented personal stories to raise awareness for heart disease in women, the signs, and symptoms of heart disease at

Previously each risk factor was individually measured and treated. It is now recommended that your overall risk be assessed using several measures to determine your personal risk score. Men statistically are at higher risk than women for developing heart disease in middle age, but hormonal changes after menopause and possibly increases in other lifestyle-related risk factors cause a woman’s risk of heart disease to increase over time to probably equal men. There is no single cause of coronary heart disease. Several risk factors cannot be changed, including family history, racial factors and increasing age. The good news is that others can be managed.

Heart disease risk factors that you can change include:

  • Smoking
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Physical Inactivity
  • Overweight
  • Depression, social isolation and poor social support

It is important for women, particularly at menopausal age, to have their individual risk markers assessed and their overall heart disease risk calculated. Your GP is in an ideal position to arrange the measures, review the risk factors and assist with changes that are recommended to reduce overall scores.

The website provides overviews regarding many factors linked to heart disease and more details about definitions and diagnoses

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

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Sports Supplements: How Safe Are They?


Many people will be spending some time watching the Winter Olympics and may wonder what they could do to improve their own fitness, endurance and muscle power. As such, this is an ideal time to get accurate information on sports supplements.

Many people use sports supplements (available over the counter and online) for varied and complex reasons – to gain muscle mass, lose weight, improve health or performance. Almost 3% of Australian adults reported using a special dietary product in an Australian survey from 2012, with 70% of the supplements being sports and protein beverages or powder. The rate of use in young men aged 19-30 years was 7.8%. The claims are very tempting – better recovery, improved endurance, increased strength. loss of body fat and enhanced immune systems.

Most people believe that government laws prevent companies from making false claims, particularly in writing, and would prevent unsafe products from being available. In Australia, supplements fall under the control of the Therapeutic Goods Administration, the most lightly regulated category of the TGA. There is no requirement that a product must have proof of its benefits to be accepted at this level and sports supplements can be heavily marketed in Sports Magazines, brochures and other communications with very little control over the claims made. The testimonials of successful athletes are part of sponsorship or paid advertising by the manufacturers or simply by word of mouth, which are persuasive arguments to others. Performance is the result of many factors such as talent, training, equipment, diet and mental attitude. In real life an athlete finds in difficult to pinpoint how much each factor contributes to a success.

Just prior to the last Olympics, ASADA released results that found one in five of 67 common Australian supplements analysed contained banned substances such as anabolic drugs or stimulants and, importantly, none of these substances were listed on the ingredient list on the labels.

According to the Australian Anti-Doping Authority as many as one in five products contain banned substances including stimulants and anabolic drugs and warned that any supplement may not be safe to use as a result of these findings. Some contain large amounts of protein or creatine, which may alter blood results in an otherwise healthy person, and long term effects are not known. Taurine is promoted for its ability to improve exercise capacity and performance, but most products do not contain enough for therapeutic benefit and little is known about the long term effects of regular, nor heavy use. Androgenic steroids are often not listed on the ingredient label and can cause androgen deficiency with symptoms such as fatigue, lethargy, low mood, irritability, poor concentration, hair loss, acne, liver damage, breast development in males and reduced sexual desire or performance.

Designer anabolic hormones, also referred to as pro-hormones, natural steroids, testosterone boosters have been available in the legal marketplace for the past ten years. The pro-hormones have also been identified in tests of supplements and not declared on the labels. Despite attempts to improve regulatory efforts, many remain easily available. These products have potential significant side-effects, now seen increasingly in General Practice. Liver damage, hypertension, renal failure, hypogonadism, gynaecomastia and infertility are increasingly being reported, most are reversible on ceasing the supplement, more permanent damage is possible from chronic use, including heart attack and stroke Some products contain “liver protectors” such as milk thistle extract or herbs, none have been demonstrated to have any protective value against oral androgen liver damage.

The Australian pharmacy business is controlled by a number of regulatory and licensing requirements. A prescription is required for some products and importations of controlled substances is prohibited. Online pharmacies generally supply products without prescriptions and may or may not employ pharmacists. All studies and warnings from regulatory agencies emphasise the caution ” buyer beware” many websites operate outside legal requirements and there is no way to check the authenticity of the product and how it will affect you. The TGA does not conduct any regulatory review of internet sites. The TGA’s position assists consumers in having greater confidence in Australian online pharmacy sires rather than those overseas.

The advice given by the Australian Sports Anti-Doping Authority to competitive athletes in relation to the various sports supplements available is to assess whether the specific supplement is safe, effective or necessary and the same advice is relevant to the general public. The advice to athletes is to completely avoid the combined products and “enhancers”. Improvements to health and performance are possible with changes to nutrition, sleep or training and there are professional sports dieticians, exercise scientists and even medical practitioners who can provide useful guides about benefit and harms of various products and chemicals. There remains significant concern about the unlisted and potentially dangerous substances in the supplements that are not listed on the labels.

For the current Supplement In Sport Fact Sheet from the AIS see for a list of products and the current evidence for benefit or not for individual products such as creatine and simple dietary guides re nutrition and protein intake when training.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software?s Clinical Leadership Advisory Committee

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The Impact of Bullying on Mental Health


We’ve known for years the impact of bullying on mental health, especially in children and young adults.

During consults, patients often spend time talking about medical and social issues currently in the media, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites. These are usually written weekly by a doctor in our practice. We all know that patients often don’t recall some of what is said in a consultation and these articles allow them to revisit the issue at their leisure and share the information with others, without detracting from consultation time.

As we start the new school year parents are concerned about how their children will cope with potential bullying incidents and the impact of bullying on mental health, and our latest article addresses this.

The Children’s Commissioner has released the data of a survey of 1800 Western Australian children finding one in five high school students and one in ten primary school students were afraid of being bullied or being hurt in some way. Relationships with peers and friends and teachers were key issues as were relationships with parents and health issues. Commissioner Pettit said this did not mean those students were in chronic fear, rather that they did not feel safe all the time.

YouthbeyondBlue has launched some resources to guide young people when supporting their friends and has a wide choice of advice about how to open conversations with young people if you are concerned about their behaviour and well being or if you are worried they may be being bullied.

Melbourne App developers and Youthbeyondblue have created The Check-in App for anyone who wants to check in with a friend but is concerned about saying the wrong thing or making the situation worse. The app suggests ways to think about where you might check in, what you might say and how you might support your friend. There is also a section showing you things to consider if your friend denies there is a problem. The app also gives advice on the next steps after you have had your conversation and where to get support and additional links or tips.

The website also suggests ways to start a conversation when someone you know is not acting the way they usually do (such as stressing out or withdrawing), there is a written guide and video examples. It is hard to know what to say to someone you care about who needs some help or support. The four key things that Youthbeyondblue suggests are:

  1. Look out for signs such as not hanging out with usual friends as much, always being down or tired, being more snappy or looking a mess
  2. Listen to your friend’s experiences, don’t rush in with advice. they may not want to talk about it, let them know you are worried and that you are happy to listen when they want to talk or suggest someone else.
  3. Talk about what is going on, simply saying that you have noticed they are not themselves and showing that you are prepared to listen can be very supportive to a friend
  4. Seek help together by encouraging your friend to get some support. It can be family or a local GP or Health Professional. You may even offer to attend the first appointment

If you think your child’s worry is affecting their life, there are many evidence based programs and services effective in reducing anxiety and worry, like Centre for Emotional Health or Brave Online.

The Triple P Parenting programme offers a range of ways to get your positive parenting, either choosing single visit consultations to public seminars, group or private sessions and an online course offering strategies and ideas at

Help for young people is also available at Kidshelpline

If urgent advice is needed, call the beyondblue support service on 1300 224636 or visit

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

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Best Practice Software supports Scouts Australia

Scouts are known for always being prepared and that has extended to being prepared for any medical eventuality at the Australian Venture, from 2nd January at Camp Warrawee, north of Brisbane.

Best Practice Software have been supplying Scouts Australia with their GP medical software Bp Premier for over a decade.

Dr Michael Rice, a Scouts member in Beaudesert Queensland, says using Bp Premier makes healthcare for kids and adults so much simpler.

Best Practice Software has been generous in allowing Scouts to use their software at events for over a decade, where we can have 1000 to 10,000 youth and adults attending.

We are able to load up our attendance database for each event, saving time and improving accuracy. Dr Rice said.

Scout events can run up to a fortnight, with the attendees and most leader volunteers arriving within the space of a few hours prior to the event and with little time to familiarise with software systems.

Clinical Nurse at the PA Hospital Emergency Department and Venturer Scout Leader at Wishart-Chester Scout Group in Toohey Forest District Kelly Jenkins says Best Practice is very intuitive and easy to learn.
We have a range of volunteers including doctors, nurses, various health science students and administrators, and if they have used electronic clinical records in the past, they learn Best Practice’s Bp Premier so quickly that we are productive from day one. Jenkins said.
CEO and founder of Best Practice Software Dr Frank Pyefinch says he is pleased to see Bp support Scouts Australia over many years.

We have been a very proud supporter of Scouts Australia and we are delighted that our medical software has assisted them at many of their major events. Dr Pyefinch said.

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