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Background: GPs can play a central role in the care of patients with persistent somatic symptoms (PSS). To date, little is known about these patients' experiences relating to their coordination of care. Aim: To explore the experiences of patients with PSS relating to coordination of care — in particular by their GP — during their illness trajectory. Design and setting: This qualitative study was carried out from January to April 2019 in the Netherlands as part of a multicentre prospective cohort study on the course of PSS (PROSPECTS). Method: Thematic content analysis of 15 interviews. Results: Three themes were identified: care fragmentation during the diagnostic trajectory; transition from the search for a cure to coping; and reframing to coping: GPs' role in facilitating supportive care. Patients experienced a lack of collaboration from healthcare workers during the diagnostic trajectory. Guidance by their GP in a process of shared decision making was positively valued by patients. Moving the focus from searching for a cure to coping with symptoms was described as a 'personal endeavour', made even more challenging by the ongoing uncertainty experienced by patients. When reframing to coping, the extent to which patients felt aligned with their GP played an important role in whether their supportive care request was met. Conclusion: Patients experienced difficulties when navigating the diagnostic trajectory and shifting to coping. The findings of this study underline the importance of collaboration between GPs and other healthcare professionals during the diagnostic trajectory. The authors recommend that GPs provide proactive guidance and are sensitive to patients who shift to coping by providing them with supportive care in a process of shared decision making. [ABSTRACT FROM AUTHOR]

Consider repeat CXR or referral for high-risk patients who have persistent symptoms or signs for 6 weeks even if initial CXR was normal. Further investigation is recommended in patients with clinically suspected lung cancer even if the CXR is normalUSAmerican Academy of Family PhysiciansArrange blood tests (CBC, alkaline phosphatase, hepatic transaminase, calcium levels, electrolytes, urea and creatinine) and CXR. These guidelines, along with the US guidance,[17] also advocate follow-up investigation with CT if symptoms persist or are unexplained following the CXR. If CXR is negative but symptoms persist, arrange CT. [Extracted from the article]

GP empathy is likely to be an important component of the doctor-patient relationship and may contribute to reduced mortality with continuity of GP care. Relational continuity of GP care, defined as a patient seeing the same doctor repeatedly, is a means towards the end of better reciprocal doctor-patient relationships. Fundamental new insights into this relationship include that, with continuity of care, both patients and GPs change,[6] SP , sp [13] SP , sp [14] with doctors becoming more responsive, and patients more trusting of the GP. [Extracted from the article]

Background: National guidelines in England recommend prompt chest X-ray (within 14 days) in patients presenting in general practice with unexplained symptoms of possible lung cancer, including persistent cough, shortness of breath, or weight loss.Aim: To examine time to chest X-ray in symptomatic patients in English general practice before lung cancer diagnosis, and explore demographical variation.Design and Setting: Retrospective cohort study using routinely collected general practice, cancer registry, and imaging data from England.Method: Patients with lung cancer who presented symptomatically in general practice in the year pre-diagnosis and who had a pre-diagnostic chest X-ray were included. Time from presentation to chest X-ray (presentation-test interval) was determined and intervals classified based on national guideline recommendations as concordant (≤14 days) or non-concordant (>14 days). Variation in intervals was examined by age, sex, smoking status, and deprivation.Results: In a cohort of 2102 patients with lung cancer, the median presentation-test interval was 49 (interquartile range [IQR] 5-172) days. Of these, 727 (35%) patients had presentation-test intervals of ≤14 days (median 1 [IQR 0-6] day) and 1375 (65%) had presentation-test intervals of >14 days (median 128 [IQR 52-231] days). Intervals were longer among patients who smoke (equivalent to 63% longer than non-smokers; P<0.001), older patients (equivalent to 7% longer for every 10 years from age 27; P = 0.013), and females (equivalent to 12% longer than males; P = 0.016).Conclusion: In symptomatic primary care patients who underwent chest X-ray before lung cancer diagnosis, only 35% were tested within the timeframe recommended by national guidelines. Patients who smoke, older patients, and females experienced longer intervals. These findings could help guide initiatives aimed at improving timely lung cancer diagnosis. [ABSTRACT FROM AUTHOR]

Background: Most patients diagnosed with lung cancer present with symptoms. It is not known if the proportions of patients presenting with each symptom has changed over time. Identifying trends in lung cancer's presenting symptoms is important for medical education and early-diagnosis initiatives.Aim: To identify the first reported symptom of possible lung cancer (index symptom), and to test whether the percentages of patients with each index symptom changed during 2000-2017.Design and Setting: This was a serial, cross-sectional, observational study using UK Clinical Practice Research Datalink (CPRD) data with cancer registry linkage.Method: The index symptom was identified for patients with an incident diagnosis of lung cancer in annual cohorts between 1 January 2000 and 31 December 2017. Searches were constrained to symptoms in National Institute for Health and Care Excellence (NICE) suspected-cancer referral guidelines, and to the year before diagnosis. Generalised linear models (with a binomial function) were used to test if the percentages of patients with each index symptom varied during 2000-2017.Results: The percentage of patients with an index symptom of cough (odds ratio [OR] 1.01; 95% confidence interval [CI] = 1.00 to 1.02 per year; P<0.0001) or dyspnoea (OR 1.05; CI = 1.05 to 1.06 per year; P<0.0001) increased. The percentages of patients with other index symptoms decreased, notably haemoptysis (OR 0.93; CI = 0.92 to 0.95; P<0.0001) and appetite loss (OR 0.94; CI = 0.90 to 0.97; P<0.0001).Conclusion: During 2000-2017, the proportions of lung cancer patients with an index symptom of cough or dyspnoea increased, while the proportion of those with the index symptom haemoptysis decreased. This trend has implications for medical education and symptom awareness campaigns. [ABSTRACT FROM AUTHOR]

Background: Primary care guidelines for the management of persistent, often 'medically unexplained', physical symptoms encourage GPs to discuss with patients how these symptoms relate to negative emotions. However, many GPs experience difficulties in reaching a shared understanding with patients.Aim: To explore how patients with persistent symptoms describe their negative emotions in relation to their physical symptoms in primary care consultations, in order to help GPs recognise the patient's starting points in such discussions.Design and Setting: A qualitative analysis of 47 audiorecorded extended primary care consultations with 15 patients with persistent physical symptoms.Method: The types of relationships patients described between their physical symptoms and their negative emotions were categorised using content analysis. In a secondary analysis, the study explored whether patients made transitions between the types of relations they described through the course of the consultations.Results: All patients talked spontaneously about their negative emotions. Three main categories of relations between these emotions and physical symptoms were identified: separated (negation of a link between the two); connected (symptom and emotion are distinct entities that are connected); and inseparable (symptom and emotion are combined within a single entity). Some patients showed a transition between categories of relations during the intervention.Conclusion: Patients describe different types of relations between physical symptoms and negative emotions in consultations. Physical symptoms can be attributed to emotions when patients introduce this link themselves, but this link tends to be denied when introduced by the GP. Awareness of the ways patients discuss these relations could help GPs to better understand the patient's view and, in this way, collaboratively move towards constructive explanations and symptom management strategies. [ABSTRACT FROM AUTHOR]

Background: It is currently not known when in the consultation GPs label symptoms as medically unexplained and what triggers this.Aim: To establish the moment in primary care consultations when a GP labels symptoms as medically unexplained and to explore what triggers them to do so.Design and Setting: This was a qualitative study. Data were collected in the Netherlands in 2015.Method: GPs' consultations were video-recorded. GPs stated whether the consultation was about medically unexplained symptoms (MUS). The GP was asked to reflect on the video-recorded consultation and to indicate the moment when they labelled symptoms as MUS. Qualitative interviewing and analysis were performed to explore the triggers GPs perceived that caused them to label the symptoms as MUS.Results: A total of 43 of the 393 video-recorded consultations (11%) were labelled as MUS. The mean time until GPs labelled symptoms as medically unexplained was about 4 minutes for newly presented symptoms and 2 minutes for symptoms for which the patients had already visited the GP before. GPs were triggered to label symptoms as MUS in the consultation by: the way patients presented their symptoms; the symptoms not fitting into a specific pattern; patients attributing the symptoms to a psychosocial context; and a discrepancy between symptom presentation and objective findings.Conclusion: Most GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation. GPs are triggered to label symptoms as medically unexplained by patients' symptom presentation, symptom patterns, and symptom attribution. This suggests that non-analytical reasoning was a central component in their thought process. [ABSTRACT FROM AUTHOR]

Background: Studies have reported that medically unexplained symptoms (MUS) tend to be associated with increased healthcare use, which is demanding of resources and potentially harmful to patients. This association is often used to justify the funding and study of psychological interventions for MUS, yet no systematic review has specifically examined the efficacy of psychological interventions in reducing healthcare use.Aim: To conduct a systematic review and meta-analysis to evaluate the effectiveness of cognitive behavioural therapies (CBT) for MUS in reducing healthcare use.Design and Setting: Systematic review and meta-analysis.Method: The search from a previous systematic review was updated and expanded. Twenty-two randomised controlled trials reported healthcare use, of which 18 provided data for meta-analysis. Outcomes were healthcare contacts, healthcare costs, medication, and medical investigations.Results: Small reductions in healthcare contacts and medication use were found for CBT compared with active controls, treatment as usual, and waiting list controls, but not for medical investigations or healthcare costs.Conclusion: Cognitive behavioural interventions show weak benefits in reducing healthcare use in people with MUS. The imprecise use of MUS as a diagnostic label may impact on the effectiveness of interventions, and it is likely that the diversity and complexity of these difficulties may necessitate a more targeted approach. [ABSTRACT FROM AUTHOR]

Background: GPs have a central position in the care of patients with medically unexplained symptoms (MUS), but GPs find their care challenging. Currently, little is known about symptom management by GPs in daily practice for patients with MUS.Aim: This study aimed to describe management strategies used by GPs when confronted with patients with MUS in daily practice.Design and Setting: Qualitative study in which videos and transcripts of 39 general practice consultations involving patients with MUS in the region of Nijmegen in the Netherlands in 2015 were analysed.Method: A thematic analysis of management strategies for MUS used by GPs in real-life consultations was performed.Results: The study revealed 105 management strategies in 39 consultations. Nearly half concerned symptom management; the remainder included medication, referrals, additional tests, follow-up consultations, and watchful waiting. Six themes of symptom management strategies emerged from the data: cognitions and emotions, interaction with health professionals, body focus, symptom knowledge, activity level, and external conditions. Advice on symptom management was often non-specific in terms of content, and ambiguous in terms of communication.Conclusion: Symptom management is a considerable part of the care of MUS in general practice. GPs might benefit from support in how to promote symptom management to patients with MUS in specific and unambiguous terms. [ABSTRACT FROM AUTHOR]

Background: Unexplained physical symptoms (UPS) are extremely common among primary care attenders, but little is known about their longer-term outcome.Aim: To investigate the persistence of somatic symptoms at 6 months among a cohort with multiple UPS, and identify prognostic factors associated with worsening symptom scores.Design and Setting: Prospective longitudinal cohort study involving adults attending UK general practice in North and Central London between January and December 2013.Method: Consecutive adults attending nine general practices were screened to identify those with at least three UPS. Eligible participants completed measures of symptom severity (measured using the Patient Health Questionnaire Somatic Symptom Module [PHQ-15]), physical and mental wellbeing, and past health and social history, and were followed up after 6 months. Multivariable linear regression analysis was conducted to identify prognostic factors associated with the primary outcome: somatic symptom severity.Results: Overall, 245/294 (83%) provided 6-month outcome data. Of these, 135/245 (55%) reported still having UPS, 103/245 (42%) had symptoms still under investigation, and only 26/245 (11%) reported complete symptom resolution. Being female, higher baseline somatic symptom severity, poorer physical functioning, experience of childhood physical abuse, and perception of poor financial wellbeing were significantly associated with higher somatic symptom severity scores at 6 months.Conclusion: This study has shown that at 6 months few participants had complete resolution of unexplained somatic symptoms. GPs should be made aware of the likelihood of UPS persisting, and the factors that make this more likely, to inform decision making and care planning. There is a need to develop prognostic tools that can predict the risk of poor outcomes. [ABSTRACT FROM AUTHOR]

Parents' narratives suggest that symptoms can increase and decrease in severity, that symptoms may come and go, and that it is not uncommon to have a period of apparent recovery and then develop symptoms again 6 months later. REFERENCES 1 National Institute for Health and Care Excellence (NICE), COVID-19 rapid guideline: managing the long-term effects of COVID-19. "Long COVID" describes both ongoing symptomatic COVID-19 (5-12 weeks after onset) and post-COVID-19 syndrome (>=12 weeks after onset).[1] Long COVID is also a patient-preferred term[2] so will be used throughout this editorial to describe symptoms lasting >=4 weeks after an acute episode of COVID-19. [Extracted from the article]

Background: Many GPs find the care of patients with medically unexplained symptoms (MUS) challenging. Patients themselves are often not satisfied with the care they receive.Aim: To explore the problems patients with MUS experience in communication during consultations, with the aim of improving such consultations DESIGN AND SETTING: A qualitative analysis of semi-structured interviews.Method: GP consultations were videorecorded and the GPs were asked immediately afterwards whether MUS were presented. Patients in these MUS consultations were asked to reflect on the consultation in a semi-structured interview while watching a recording of their own consultation.Results: Of the 393 videorecorded consultations, 43 contained MUS. Patients who did identified six categories of problems. First, they reported a mismatch between the GP's and their own agenda. Second, patients indicated that the GP evoked an uncomfortable feeling in them during the consultation. Third, they found that GPs did not provide a specific management plan for their symptoms. Fourth, patients indicated that the GP was not well prepared for the consultation. Fifth, they perceived prejudices in the GP during the consultation. Finally, one patient found that the GP did not acknowledge a limited understanding of the origin of the symptoms.Conclusion: According to patients, GPs can improve their consultations on MUS by making genuine contact with their patients, by paying more attention to the patient's agenda, and by avoiding evoking uncomfortable feelings and displaying prejudices. They should prepare their consultations and focus on the issues that matter to patients, for example, symptom management. GPs should be honest to patients when they do not understand the origin of symptoms. [ABSTRACT FROM AUTHOR]

Background: Most frequent attendance in primary care is temporary. Long-term frequent attendance may be suitable for psychological intervention to address health management and service use.Aim: To explore the feasibility and acceptability of cognitive behaviour therapy (CBT) for long-term frequent attendance in primary care and obtain preliminary evidence regarding clinical and cost effectiveness.Design and Setting: A CBT case series was carried out in five GP practices in the East Midlands.Method: Frequent attenders (FAs) were identified from case notes and invited by their practice for assessment, then offered CBT. Feasibility and acceptability were assessed by CBT session attendance and thematic analysis of semi-structured questionnaires. Clinical and cost effectiveness was assessed by primary care use and clinically important change on a range of health and quality of life instruments.Results: Of 462 FAs invited to interview, 87 (19%) consented to assessment. Thirty-two (7%) undertook CBT over a median of 3 months. Twenty-four (75%) attended at least six sessions. Eighteen FAs (86%, n = 21) reported overall satisfaction with treatment. Patients reported valuing listening without judgement alongside support to develop coping strategies. Thirteen (54%, n = 24), achieved clinically important improvement on the SF-36 Mental-Component Scale at 6-month follow-up and improved quality of life, but no improvement on other outcomes. Primary care use reduced from a median of eight contacts in 3 months at baseline (n = 32) to three contacts in 3 months at 1 year (n = 18).Conclusion: CBT appears feasible and acceptable to a subset of long-term FAs in primary care who halved their primary care use. With improved recruitment strategies, this approach could contribute to decreasing GP workload and merits larger-scale evaluation. [ABSTRACT FROM AUTHOR]

Background Unexplained fatigue is frequently encountered in general practice. Because of the low prior probability of underlying somatic pathology, the positive predictive value of abnormal (blood) test results is limited in such patients. Aim The study objectives were to investigate the relationship between established diagnoses and the occurrence of abnormal blood test results among patients with unexplained fatigue; to survey the effects of the postponement of test ordering on, this relationship; and to explore consultation-related determinants of abnormal test results. Design of study Cluster randomised trial. Setting General practices of 91 GPs in the Netherlands. Method GPs were randomised to immediate or postponed blood-test ordering. Patients with new unexplained fatigue were included. Limited and expanded sets of blood tests were ordered either immediately or after 4 weeks. Diagnoses during the 1-year follow-up period were extracted from medical records. Two-by-two tables were generated. To establish independent determinants of abnormal test results, a multivariate logistic regression model was used. Results Data of 325 patients were analysed (71% women; mean age 41 years). Eight per cent of patients had a somatic illness that was detectable by blood-test ordering. The number of false-positive test results increased in particular in the expanded test set. Patients rarely reconsulted after 4 weeks. Test postponement did not affect the distribution of patients over the two-by-two tables. No independent consultation-related determinants of abnormal test results were found. Conclusion Results support restricting the number of tests ordered because of the increased risk of false-positive test results from expanded test sets. Although the number of reconsulting patients was small, the data do not refute the advice to postpone blood-test ordering for medical reasons in patients with unexplained fatigue in general practice. [ABSTRACT FROM AUTHOR]

Gabbay and May recognised this as the generation of practice-based evidence.[2] By observing GPs in practice, they revealed how primary care clinicians rarely access or use research evidence directly, but instead rely on the development of "mindlines" - guidelines-in-the-head. Developing this full range of knowledge work skills has the potential to reduce treatment burden for patients, while also decreasing the burden of decision making for clinicians. All clinicians in primary and secondary care use generalist skills in whole person medicine everyday. [Extracted from the article]

Jackson, Gabrielle Piatkus, 2019, PB, 368 pp, £14.99, 978-0349424552 Graph It is a truth universally acknowledged, that man is the default human being, and any deviation from that is atypical, abnormal, and deficient. Fourteen years after receiving the diagnoses of endometriosis and adenomyosis, and after suffering pain for many years, the author is shocked to find that little has changed in the understanding or management of these conditions. One in 10 women of reproductive age has endometriosis, yet it is funded at 5% of the funding rate for diabetes, despite affecting the same number of women and costing the economy more. [Extracted from the article]

Their subsequent grief and trauma-related behaviours have helped me find a new level of empathy for my patients. Childhood trauma can impact a whole lifetime, so while I don't have the solutions, I think an understanding about it can help GPs connect better with their patients. [Extracted from the article]

I write as an individual severely impacted by withdrawal after tapering an antidepressant (AD) too quickly in 2017. 2 Guy A, Brown M, Lewis S, Horowitz M. The "patient voice": patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition. [Extracted from the article]

I 'Chronic primary pain has no clear underlying condition or the pain (or its impact) appears to be out of proportion to any observable injury or disease. i '[1] In July 2014, Sir Simon Wessely stated in an article in I The Times i entitled, I Pain may be in the mind i , that: I 'Many of them i [chronic pain patients] I have mental health disorders - anxiety, depression, etc', i and that, I 'patients felt dismissed and denigrated when they were referred to mental health services ... '. i [2] As patient safety campaigners, we are hearing from many people who are developing "unexplained" chronic pain conditions after taking antidepressants (ADs), as prescribed, and sometimes over many years - and this has often led to polypharmacy with other drugs added "for symptoms" along the way, most likely including ADs, benzodiazepines, Z-drugs, opioids, and/or gabapentinoids. [7] Footnotes 1 This article was first posted on BJGP Life on 29 April 2021; https://bjgplife.com/nice REFERENCES 1 Kmietowicz Z. Offer exercise, therapy, acupuncture, or antidepressants for chronic primary pain, says NICE. Chronic pain is debilitating and depressing. [Extracted from the article]

The article notes the comparison between patient-cent red and patient-led care (PLC) with the emphasis on several adverse consequences of PLC. Adverse outcomes of PLC in healthcare system include impact on infrastructure and research, impact on mental health, missed diagnoses, widening of the health gap, and harm through the abrogation of responsibility.

An editorial is presented which offers information on the medically unexplained symptoms (MUS.) Topics discussed include challenges for management of patients with MUS such as challenges of clinical diagnosis, treatment, and follow-up; evaluation of the effectiveness of cognitive behavioural therapies (CBT) in reducing healthcare use among patients with MUS; and concerns related to abstraction and generalisation for understanding patients in general practice.

The article discusses delayed diagnosis of Multiple sclerosis (MS) in males, a neurodegenerative condition that affects functioning of the central nervous system. Topics include questions on several factors to explain sex differences; gendered associations lead to delayed or missed diagnosis; MS in males, allow clinicians to disregard evidence that MS is more prevalent in females; and delayed help-seeking behavior in males as a key social factor influencing when MS is diagnosed.

If academic research is to really improve primary care, the research community must be integrated and accessible to grass roots GPs, and GPs must be able to know who to contact if they have an idea or want to know more about a particular topic. Along with perceptions of heavy workload there is also a feeling that general practice is not intellectually challenging.[2] This can be shared at times by hospital colleagues, the general public, and even GPs themselves - witness the phrase: "just a GP". The complexity of general practice consultations is well documented but is not always obvious to outsiders.[1] Media representation of general practice is often negative, focusing on what GPs haven't done or occasions when GPs have failed to make an important diagnosis. [Extracted from the article]

For patients, acquiring such a diagnosis comes with the perception that many doctors have little interest in such conditions and show negative attitudes towards patients affected by them. Once the dust settles after the pandemic, our focus will return to patients with complex multimorbidity, those with chronic pain and distress, the "worried well", and older patients with varying degrees of frailty and cognitive decline. Termination of the coronavirus pandemic by vaccination will be heralded as a triumph for science. [Extracted from the article]

I read with interest the barriers to uptake of Improving Access to Psychological Therapies (IAPT), particularly those pertaining to the misconception that depression is part of normal ageing.[1] The misattribution of symptoms as part of the ageing process is what I have since seen described as the "understandability phenomena", which may prevent older people from seeking help when depressed.[2] The manifestation of physical rather than emotional symptoms seen in older adults with depression[2] means that GPs need to be vigilant towards atypical presentations and be mindful that it can be difficult to detect depression in this population. 2017 NHS England, NHS Improvement https://www.rcgp.org.uk/-/media/Files/CIRC/Toolkits-2017/Mental-Health-Toolkit-2017/Top-Tips-for-mental-health-problems-in-older-people.ashx?la=en (accessed 9 Feb 2021). 5 England E, Llanwarne N, Chew-Graham C, Top tips: diagnosis and management of common mental health problems in older people. [Extracted from the article]

This February 2020 edition of the I BJGP i contains topics that are more closely interrelated than first appears, and the relationship is crucial for GPs to recognise. A 2017 UK practice-based study of self-harm showed a 68% rise in incidence in girls aged 13-16 years between 2011-2014.' i "Patients" descriptions of the relation between physical symptoms and negative emotions'[4] - I 'Primary care guidelines for the management of persistent, often "medically unexplained", physical symptoms encourage GPs to discuss with patients how these symptoms relate to negative emotions.' i "Medically unexplained symptoms"[5] - I 'Most GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation.' i Taking into account the recent report on the 2018/2019 Public Health England review of prescribed medicines associated with dependence and withdrawal,[6] the links become clear. 4 Bekhuis E, Gol J, Burton C, Rosmalen J. Patients' descriptions of the relation between physical symptoms and negative emotions: a qualitative analysis of primary care consultations. [Extracted from the article]

We appreciate Martins I et al i 's effort to present an amendment to WONCA's P4 (quaternary prevention) definition. Therefore, WONCA's P4 definition requires clinicians to reflect upon what sort of lens (the clinical gaze) they are using in order to constrain biomedical jurisdiction and to protect patients from being medicalised. [Extracted from the article]

The English poet Elizabeth Jennings has captured, with lucid, lyrical precision, her experiences of illness, both as a surgical and a psychiatric patient.[1] In a series of eight poems called I Sequence in a Hospital i (1964), she evokes the isolation and terror that precedes surgery and, in I Night Sister i , describes the values of the healing art: I ' You have a memory for everyone; None is anonymous and so you cure. I 'How can doctors respectfully show their patients that they understand their particular problems and offer specific advice? 5 Campbell D, Martin Marshall: GPs need to do less, but it's not what patients want to hear The Guardian. [Extracted from the article]

The article presents a guide for improving the care of patients with medically unexplained symptoms (MUS). Topics include MUS as an ongoing working hypothesis, the need for a broad biopsychosocial exploration of symptoms in MUS patients, and the role of doctor-patient communication in the treatment of MUS.

In this article, the author discusses the problems related to medically unexplained symptoms (MUS) in primary care in Great Britain. Topics discussed include the annual cost of MUS to the National Health Service of Great Britain, the exacerbation of the somatic symptoms because of it, and the effect of negative emotions in doctors on the doctor–patient relationship.

The article offers information on the medically unexplained symptoms (MUS). Topics discussed include up to 10 percent of the population has a form of dissociative disorder; mentions childhood issues are more prevalent among people with MUS; and also mentions using trauma or a short dissociation screen could be a useful way to differentiate pathways for management of unexplained somatic disorders in primary care.

The author reflects on effectiveness of self-monitoring of blood glucose among patients with type 2 diabetes. It discusses the importance of effective diagnosis and detection of hypoglycaemia in self-monitoring blood glucose (SMBG). It discusses the decision-making process associated with the reduction of blood glucose.