Australian Family Physician November 2006 - Pelvic pain
Vol 35, (11) 833 - 928
The theme for the November issue of AFP is
pelvic pain. This month's articles include dysmenorrhoea, ectopic
pregnancy, pelvic inflammatory disease, endometriosis, routine pelvic
examination, abortion and Australian law and giant cell arteritis.
With patient understanding
Jenni Parsons
A recent sojourn as a locum in a beachside resort town with a large population of young people who work hard and play hard (and holiday makers who just played hard) provided a few interesting lessons. I realised that I have well and truly crossed that invisible boundary that divides the young from the middle aged. It is not a particular age, or the number of grey hairs, or the number of wrinkles that puts you over the line.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
GP of the Year awards 2006
GP of the Year, Registrar of the Year and Practice of the Year winners.
Irritable bowel syndrome in Australian general practice
Janice Charles, Christopher Harrison
Irritable colon, spastic colon syndrome, mucous colitis,
splenic flexure syndrome and functional diarrhoea were included with irritable bowel syndrome (IBS), however these related conditions accounted for only 3% of total IBS problems managed.
Dysmenorrhoea
Sue Reddish
Menstruation has dual significance for women. From one perspective it defines the start and end of reproductive potential, an affirmation of womanhood. On the other, just as the ancients observed taboos of menstruation, many women (and men) today are still influenced by outdated negative messages.
Pelvic pain in the female adolescent patient
Sonia Grover
Many causes of pelvic pain in adolescent women are similar to adult women. However, there are some specific problems that relate to obstructive congenital anomalies, and acute pelvic pain, caused by ovarian torsion, is also more common in this age group.
Ectopic pregnancy - Risk factors and diagnosis
George Condous
Ectopic pregnancy is still the most common cause of first trimester maternal deaths, accounting for 73% of early pregnancy mortalities.
Pelvic inflammatory disease
Linda Dayan
Pelvic inflammatory disease (PID) is a treatable condition with serious long term sequelae. The recognition and diagnosis of PID can be challenging due to the wide spectrum of disease and clinical presentation.
Endometriosis - An update
David O'Callaghan
Endometriosis is one of the major causes of pelvic pain and subfertility in women.
Primary dysmenorrhoea - Evidence for complementary medicine
Carolyn Ee, Marie Pirotta
Primary dysmenorrhoea is the occurrence of painful menstrual cramps in the absence of pelvic pathology. This review discusses alternative approaches to the
management of this debilitating condiditon.
Melanoma with cutaneous melanoma secondaries
Anthony Dixon
Mr HG presented in 2002 with a large black lesion on his left loin. It had been present for many years but had recently changed. Nearby, two similar lesions were apparently separated by normal skin.
Routine pelvic examination for asymptomatic women - Exploring the evidence
Rebecca Anne Stewart, Jill Thistlethwaite
A routine pelvic examination is often performed as part of a 'well woman' check, in combination with a Pap test, sexually transmitted infection screening, or before commencing the contraceptive pill or hormone therapy. This check is also done at the woman's request, on the understanding that it may screen for ovarian cancer and other pathology.
Chronic disease prevention in general practice - Applying the family history
Gabrielle Reid, Jon Emery
The family history has a potentially important role in general practice for risk prediction and tailored disease prevention
for several common chronic diseases.
Cutaneous endometriosis - Surgical presentations of a gynaecological condition
David T Chiang, Wan T Teh
Endometriosis is a common gynaecological condition; cutaneous endometriosis is a subtype of endometriosis. Although cutaneous endometriosis involving the abdominal wall is not common, preoperative diagnosis of cutaneous endometriosis can be easily mistaken for a suture granuloma, lipoma, abscess, cyst or hernia. We report two common surgical presentations of this gynaecological condition.
Polymyalgia rheumatica and giant cell arteritis - An ophthalmic emergency
Shane R Durkin, Paul A Athanasiov, John L Crompton
The occurrence of giant cell arteritis (GCA) in the setting of polymyalgia rheumatica (PMR) is not uncommon. It is imperative to recognise the symptoms and signs of GCA in this setting as the treatment of PMR with low dose corticosteroids will not protect the patient against the blinding consequences of GCA.
Masked giant cell arteritis
Peter Pak Moon Cheung, Griffith Richards
Giant cell arteritis (GCA) is the most common vasculitis in the western world and often presents as a diagnostic problem for general practitioners. Prompt diagnosis and treatment is important to prevent potential irreversible complications, with a favourable outcome.
Clinical challenge
Jenni Parsons
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is
in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and
Continuing Professional Development Program and has been allocated 4 CPD points per issue. Answers to this clinical
challenge will be published next month, and are available immediately following successful completion online.
Beyond vertical integration - Community based medical education
Emma Margaret Kennedy
The term 'vertical integration' is used broadly in medical education, sometimes when discussing community based
medical education (CBME). This article examines the relevance of the term 'vertical integration' and provides an
alternative perspective on the complexities of facilitating the CBME process. The principles of learner centredness,
patient centredness and flexibility are fundamental to learning in the diverse contexts of 'community'.
Abortion and the law in Australia
Sara Bird
The legal test for when an abortion is not 'unlawful' - and therefore permitted - is different in each state and territory. This article describes the current legal position in Australia with respect to abortion, but does not attempt to discuss the complex ethical issues surrounding abortion.
Climate change and human health - What can GPs do?
Grant Blashki, Colin D Butler, Suzie Brown
In recent months articles in the most respected peer reviewed medical journals in Australia, the USA and Britain have called for urgent action to reduce climate change. The chief scientist of the United Kingdom has described climate change as 'the most severe problem that we are facing today - more serious even than the threat of terrorism'. Yet, many of you will wonder if this is really such an urgent issue, and - even if it is - what on earth has it got to do with general practice?
The appointment book and the story
Mark Stroud
Dear diary, It is the start of the day as I glance at my consulting schedule. The appointment times are neat and ordered. Lunch is reserved and the finishing time is precisely defined. The day is usually not as ordered. It is subject to all the peculiarities and surprises inherent in working with people, for people, in a service profession.
Dosing frequencies in general practice - Whose decision and why?
Deborah C Saltman, Geoffrey P Sayer, Natalie A O'Dea
Little is known about patient preference for dosing frequency (daily, weekly or monthly). Patient preferences and attitudes among women over 60 years of age were studied. Condition, medication experience and perceived control were assessed against preference.
General practitioners' referral letters - Do they meet the expectations of gastroenterologists and rheumatologists?
Sia Peng Ong, Lie-Teng Lim, Les Barnsley, Robert Read
To solicit the views of gastroenterologists and rheumatologists on the importance of various aspects of general practitioners' referral letters, and to assess GPs' letters based on these views.
Patients with dementia and their carers in general practice
C Bridges-Webb, B Giles, C Speechly, Y Zurynski, N Hiramanek,
In 2004, 6.5% of Australians over 65 years of age were estimated to have dementia and the prevalence of dementia is rising as a result of our aging population. There is evidence to show that carer wellbeing is important for the wellbeing of the patient. Increasing burden of care may lead to depression, anxiety, and more frequent physical illness in the carer, and earlier
institutionalisation of patients.
Patient perception of their weight, attempts to lose weight and their diabetes status
Janice Charles, Helena Britt, Stephanie Knox
Patients' self perception of weight status is a factor to be considered before an attempt is made by the clinician to initiate weight loss behaviour.