Aust Fam Physician
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Review Case Reports
Chronic pelvic pain in women: assessment and management.
Chronic pelvic pain (CPP) is a common condition that poses diagnostic and management challenges for doctors and their patients. ⋯ Chronic pelvic pain may be due to one or several aetiologies, while in some women no specific cause is identified. All women should be advised that even though limited medical knowledge sometimes precludes the assignation of a definite cause and cure, the pain can be managed, and psychological support can be provided. A multidisciplinary approach can be beneficial.
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The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of the consultations in general practice involving a patient presentation of abdominal pain. This provides a backdrop against which the articles in this issue of the Australian Family Physician can be further considered.
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Benzodiazepine dependency can occur as a result of treatment for anxiety disorders or sleep disturbance. While benzodiazepine withdrawal can be challenging, cessation of use can be even more difficult if there are other comorbidities such as oestrogen deficiency with vasomotor symptoms and anxiety disorders. ⋯ Some patients may have common medical presentations and coexisting drug dependence. It is often difficult to separate these two issues. In the case of benzodiazepine dependence, gradual withdrawal over time and nonpharmacological treatment of the symptoms of withdrawal such as anxiety or insomnia is effective. Better outcomes are achieved where the GP discusses and plans strategies well in advance with the patient. Treatment often involves multiple interventions from various health professionals. General practitioners are ideally placed to coordinate such treatment.
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Aging populations with greater rates of cognitive decline demand increased attention to the issues of end of life decision making and advance care planning (ACP). Legislatures have passed statutes that recognise the necessity for both substitute decision making and the declaration in advance of wishes relating to health care. ⋯ Advance care planning provides patients, relatives and doctors with greater confidence about the future. There is good evidence that patients desire to discuss end of life care, and GPs are in a good position to engage their patients in considering the issues. They have a responsibility to confirm the decision making capacity of patients who write advance health directive documents, to inform and educate their patients about future health care, and to keep the ACP conversation going.