Australian Journal of General Practice最新文献

Background: Chronic pelvic pain is a debilitating but common syndrome that is a burden both for patients and health systems. Pelvic congestion syndrome (PCS) contributes to 30-40% of patients presenting with chronic pelvic pain where no other cause is identified. However, PCS is poorly understood, underdiagnosed and undertreated, with the average time to diagnosis being reported as up to four years after initial presentation.

Objective: This article describes the pathophysiology of PCS and outlines the symptomatology, the most efficient diagnostic pathway and the optimal treatment methods for practitioners encountering patients presenting with PCS.

Discussion: The aetiology of PCS is multifactorial and it is thought to be caused by both hormonal and anatomical dysfunction. Patients with PCS present with a cluster of symptoms related to pelvic venous congestion, including pelvic pain worse on standing, irritable bowel symptoms, dyspareunia, vulval varicosities and lower limb venous pathology. Transvaginal ultrasound is a non-invasive and sensitive test for PCS. Ovarian vein embolisation is a safe, minimally invasive and efficacious treatment for PCS.

Background: The consultation is the vehicle by which general practitioners (GPs) 'ply their trade'. Consultation skills comprise the range of skills that underpin the effective and safe doctor-patient encounter and include communication skills, relationship building, data gathering, identifying the patient agenda, shared decision making, time management and follow-up. Development of consultation skills is a fundamental element of Australian general practice training.

Objective: We build upon a previous article and discuss a number of additional practical tips to support new (and not so new) registrars to navigate the general practice consultation safely and effectively.

Discussion: We address consultation tips across a range of aspects of the consultation, including preparation, building rapport, patient-centred care, data gathering, managing uncertainty, management planning, follow-up and time management.

Background: Chronic respiratory disorders in the adult Aboriginal and Torres Strait Islander population are common, but there is a sparsity of literature detailing an approach to clinical management.

Objective: This paper describes a clinical approach to chronic respiratory disorders for clinicians working with Aboriginal and Torres Strait Islander people, particularly in the remote Australian context.

Discussion: There are significant differences in the way chronic respiratory diseases manifest in Aboriginal and Torres Strait Islander people compared with non-Indigenous Australians. Chronic obstructive pulmonary disease (COPD), bronchiectasis and asthma often overlap in clinical features, and can be present concurrently. Restrictive impairment on spirometry is common. The presence of bronchodilator response might indicate asthma, but can also be observed in patients with asthma/COPD/bronchiectasis overlap. Because the management of each of these conditions differs, accurate diagnosis and disease severity classification are important, particularly in the prescribing of guideline-recommended inhaled pharmacotherapy.

Background: Dysphagia, characterised by a difficulty in swallowing, stems from various causes and is frequently encountered in general practice. The rise in dysphagia in Australia's ageing population necessitates proper management to prevent complications. Recognising and managing dysphagia improves outcomes and quality of life, and reduces secondary complications.

Objective: This article assists physicians through the work-up and management of dysphagia.

Discussion: Dysphagia, resulting from upper aerodigestive tract disruptions, can be categorised anatomically (oropharyngeal, oesophageal) or by pathophysiology (motility, obstructive). It imposes a substantial community disease burden with high morbidity and mortality rates. Dysphagia might lead to aspiration, malnutrition and poor mental health. A holistic approach involving primary and tertiary specialists, allied health, family and carers is vital. Depending on the aetiology, dysphagia is often treated conservatively in the community; however, complex cases often require a multifaceted approach and integration of multiple specialties.