Diagnosis of pelvic inflammatory disease and barriers to conducting pelvic examinations in Australian general practice: findings from an online survey

Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination. METHODS: An online survey investigating Australian GPs' chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis. RESULTS: Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6-8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1-6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1-4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2-3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance. CONCLUSION: Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID

Identifying and Preventing Gray Corruption in Australian Politics

Corruption – “grand” or “gray” – is an international problem, and government is a high-risk domain. Research in the field has tended to focus on the more serious and damaging area of grand corruption, including clearly illegal acts such as bribery and embezzlement. However, there is also a growing body of research concerned with more minor and ambiguous areas of alleged misconduct – or “gray” corruption. These include gifts and benefits, misuse of entitlements, influence peddling through donations, excessive and wasteful expenditures, lies and false promises, cronyism, nepotism, and sinecures. Government in Australia presents as an instructive case of scandal and controversy in these areas, with a record of partial and unsatisfactory attempts to manage the challenge. A crisis point was reached during the recent Abbott-led federal government (September 2013 to September 2015), although the problem reached back to previous federal governments and crossed over into state and local government. The issues coalesced around the federal “expenses scandal” of 2014/2015, leading to a major review of parliamentarians’ entitlements, released in 2016. The present paper reviews these issues, drawing primarily on media accounts, focusing on the period of the Abbott government and the aftermath of the entitlements inquiry up to mid-2017. The chapter highlights key lessons for corruption prevention beyond Australia, including the need for much tighter rules and much better enforcement to ensure comprehensive integrity in government