Monash Minute is a collection of short articles and headlines about Monash Health which may be useful for primary health providers. 
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October 2021 Update from Monash Health GP Liaison

Please forward this newsletter to GPs in your practice or email us at to subscribe to this newsletter.
GPs are warmly invited to attend 
Monash Health Grand Rounds

Would you like to:
  • attend our virtual Grand Round? 
  • update your medical knowledge from the comfort of your consult room? 
  • choose when to attend?
  • pose a question to the expert presenters?  

If you are interested in attending please email Monash GP Liaison Unit indicating your interest. We will send you a weekly email detailing the Grand Round topic and an invitation to attend the session.

Recent Medical Grand Round topics have included;

•    COVID19   update
•    “Home Sweet Home” - The GEM@Home program at Monash Health
•    New options in the management of osteoporosis
•    Palliative Care is Everyone's Business

There is no charge for Grand Round sessions.

To further information on the GP Liaison Unit please contact: 
P: 9554 9374

New Eligibility Criteria for Chronic Pain Management Clinic Services

DHHS State-wide eligibility criteria for chronic pain management services changed on 1 May 2021. Health services are now required to assess all new referrals for this specialty against the new referral criteria which can be found at   

From 1 September, 2021, the new criteria will be implemented at Monash Health and there will be a significant shift in eligibility criteria for entry to the Pain Management Clinic. To ensure your patients are not adversely impacted, please take some time to understand the changes and ensure your referrals meet the new criteria. See Monash Health Referral Guideline here -

What does it mean for my patients?

The most significant criteria change is that patients must be at a point of being:
•    willing to explore living well with pain and 
•    willing to learn how to self-manage ongoing pain.

Patients accepted into the Pain Management Clinic will be supported under a bio-psychosocial model, including an education program, rehabilitation, psychological and physical strategies for managing pain.

What does this mean for me as a referrer?

This focus on self-management means that referrers:
•  need to be convinced that patients are ready and willing to take on a self-management rather than  a medical model to chronic pain management,
•  must now provide evidence that management strategies are in place. For this we recommend the use of the:
              - Pain Self-Efficacy Questionnaire (PSEQ) or the 
              - Pain Readiness for Change questionnaire

Alternative options for your patients could include:
•    investigations and specialist opinions regarding potential pathology and management
•    Allied Health options 
•    Private Pain Specialists
•    Work Safe and TAC eligible patients can use Network Pain Management Services (

If you have any queries about Monash Health’s Pain Clinic, please contact
T: 9265 1401
GP eReferrals – efficient, cost saving and secure 
Specialist Consulting Services

Monash Health and Monash Children’s Hospital invite you to use our completely free eReferrals system via HealthLink! More than 470 GP practices are using eReferrals with overwhelmingly positive feedback from 10,000 successful referrals received in the past 6 months.

Our first specialised Maternity eReferral form was successfully launched in mid-January and we have developed and deployed a number of other Specialty forms. To guide you through the information required for a successful referral, state-wide referral criteria and Monash Health guidelines have been included in our new service-specific eReferral forms.  

To enhance your referral experience, we are continuing to refine and improve the system. We value your involvement and expertise, and your feedback would be very helpful in the ongoing development of eReferrals.

Please contact the GP Liaisons Unit via email to tell us about your experience here.

How do I make a referral?
efer to the GP eReferral website here

For further information on how to make a referral:

To register for HealthLink please contact HealthLink Technical Support:
P: 1800 125 036
Head and Neck Cancer Service
A specialist, integrated care service

Head and neck cancer is the 7th most commonly diagnosed cancer in Australia, with 5168 new cases diagnosed in 2020.
Monash Health utilises an integrated team of experts in the care of head and neck cancer patients. Specialities include ENT surgery, plastics and reconstructive surgery, maxillofacial surgery, radiation oncology, medical oncology, specialist radiology, pathology, dietetics, speech pathology, social work, palliative care and, a cancer nurse specialist.
All Monash head and neck cancer patients are discussed at the weekly multidisciplinary meeting at which all relevant treatment options are considered to ensure safe and quality cancer care.
Specialist care is provided across the four Monash Health hospital campuses (Monash Medical Centre, Clayton; Dandenong and Casey and at Radiotherapy services at Peter Mac Cancer Centre (PMCC)  Moorabbin and Parkville

Who to refer:  
Head and neck malignancy -
  • Oral cavity (tongue, palate and mandible)
  • Oropharynx (Tonsil, Base of tongue, soft palate)
  • Throat (larynx, hypopharynx)
  • Nasal Cavity and Sinuses
  • Nasopharynx
  • Salivary glands
  • Thyroid and parathyroid tumours
  • Paragangliomas and Skull base tumours
  • Unknown primary cancer of the head and neck
  • Skin related head and neck cancer
  • Suspicious Lesions of the Oral Cavity
  • New suspicious solid mass, or cystic lumps of the head and neck present for more than four weeks
  • New suspicious solid mass, or cysitic neck lumps in patients with a previous head/neck malignancy
  • Benign lumps of the thyroid
  • Salivary glands tumours (Parotid and submandibular)
  • Paediatric head and neck lumps
How to refer:

New malignancies will be seen within 1 week of a referral being received
General Referrals to Monash Access:
P: 1300 342 273
F: (03) 9594 2273

Urgent Referrals to:
 Monash Head and Neck Nurse Consultant
P: (03) 9928 8711
F: (03) 9928 8052
Screening and Managing Latent Tuberculosis Infection (LTBI)

Latent TBI in Australia

Latent tuberculosis infection (LTBI) is a common asymptomatic condition in Australia that is often unrecognised and may progress to life-threatening ‘active’ tuberculosis (TB), sometimes decades after exposure. Active TB in Australia is found predominantly in people born overseas who have migrated to Australia from countries with a high prevalence of TB e.g. people from a refugee background so screening is important! The risk of active disease is about 10% and this drops to about 5%, five years post-arrival. Factors known to increase the risk of active disease include immunosuppressive medications or conditions such as HIV or diabetes. However, sometimes reactivation occurs without a clear trigger.

Screening for LTBI
  • Screen all migrants and refugees who have not been tested before (also consider if there is a history of TB- lifelong positive test)
  • Two diagnostic tests for LTBI are available in Australia: 
      - the tuberculin skin test (TST; also known as the Mantoux test) and 
      - the interferon-gamma release assay (IGRA).
  • Most people with a past history of TB will give a lifelong positive Mantoux and IGRA
  • Some key differences-
    • History of a  Bacillus Calmette–Gu (BCG) vaccination can lead to a false positive Mantoux test 
    • Mantoux is observer-dependent and requires 2 visits to complete the test  
    • Mantoux is preferred in children under 5
  • Importantly, neither test distinguishes between LTBI and active TB disease, so recognising symptoms of active TB is important.
Diagnosing Latent TB
  •  Clinical assessment for symptoms of TB (including fever, cough, weight loss or lymphadenopathy, particularly when present for >3 weeks) and a chest X-ray.
  • Order a Mantoux or IGRA test
  • Latent TB = no symptoms, CXR- normal or abnormal (e.g. old apical scarring) and positive Mantoux or IGRA
  • The IGRA test has an MBS rebate for people who are immunosuppressed and those with a known exposure to active TB
Medical treatment of Latent TB
A word of caution when diagnosing Latent TB: ensure this is differentiated from active TB which, for many refugees, is associated with death. This will avoid traumatising a ‘well’ person who may otherwise leave the consultation being diagnosed with a ‘deadly’ disease. This is especially the case where language is a barrier and health literacy is low. 

Key things to communicate:
  • Latent TB is not the same as TB
  • LTBI means you are not sick and you cannot make others sick
  • LTBI means that you have a 5-10% chance of getting sick with TB in the future
  • One-third of the world's population has LTBI (normalising)
  • We can treat LTBI with medication for 6 months to reduce your risk of progression to active TB (to nearly zero)
Treatment options for Latent TB:
Most patients diagnosed with Latent TB are referred to an Infectious Diseases physician. However, with guidance and specialist support, LTBI can be managed in primary care (particularly for well under 35-year-olds). The standard medical treatment is six to nine months of Isoniazid (300mg) daily. A second option is four months of Rifampicin (fewer side effects but has many drug interactions). For people more susceptible to the side effect of peripheral neuropathy (e.g. being malnourished) you can add Pyridoxine (Vitamin B6) 25mg daily for the treatment period. 

A few important things to consider prior to starting treatment for Latent TB:
  • No symptoms are present to suggest active TB
  • The patient wants to be treated and will comply with the medication for the period of six  months (or 4 months for Rifampicin)
  • Patients understand the side effects (peripheral neuropathy, GI upset) as well as signs/symptoms suggestive of liver toxicity (nausea, vomiting, jaundice, pale stool, dark urine etc)
  • Baseline LFTs are normal
How to contact the Refugee Health Service
P:    9792 8100
F:    9792 7765   
Plastics Reconstruction Update 2021

Proudly presented by Monash Health’s Plastics Reconstruction Unit & North Ward 

Wednesday 27th of October 2021 (0830 – 1600 hrs)

Presented by Professor Michael Leung and other Plastic Reconstructive Specialist’s

Topics include:

•    History and Principles of Plastics Surgery
•    Head and Neck Reconstruction
•    Multidisciplinary Altered Airway Management
•    Breast Reconstruction
•    Hand Trauma
•    Paediatric
•    Cleft Palate

Click here or scan the QR code to register

Please contact Nurse Manager Kaitlin Lamb with any questions or queries 
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