Australian journal of general practice
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Practice Guideline
Clinical Oncology Society of Australia position statement on cancer survivorship care.
Cancer survivors often experience long‑term negative consequences of their cancer and cancer treatment. With increasing numbers of survivors and duration of survival, a sustainable model of care is required to better meet the needs of cancer survivors. ⋯ Recommendations include: a systematic, multidisciplinary care approach that optimises self-management and enhances coordinated and integrated survivor-centred care from diagnosis; stratified care pathways based on survivors' needs, capacity to self-manage and anticipated treatment sequelae; a focus of care on wellness, healthy lifestyle, symptom management and prevention of life-altering and life threatening late effects in addition to cancer surveillance; development of a treatment summary and care plan; and equitable, timely access to services, while minimising unnecessary use of healthcare services.
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Data are sparse on how well the absolute risk approach is implemented in primary healthcare. The aim of this study was to quantify absolute cardiovascular disease (CVD) risk, appropriate use of blood pressure (BP)-lowering and lipid-lowering therapy, and clinical target responses in the Busselton baby boomer population. ⋯ These data confirm substantial under treatment of Australian adults who are at high CVD risk. Enhanced implementation of absolute CVD risk assessment and evidence-based treatment in high-risk adults has potential for substantial health gains.
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In a medical negligence claim, courts must consider whether a doctor acted in accordance with the required standard of care. Experts may disagree on what should have been done, particularly in light of knowledge that a patient has been harmed. In Australia, the law gives further guidance on the standard of care, providing that doctors will not have breached their duty if they acted in a manner that, at the time the service was provided, was widely accepted by peer professional opinion as competent professional practice. ⋯ In two recent cases, courts in different states have considered the role of professional guidelines in establishing what was widely accepted as competent professional practice.
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Palpitations are one of the most common presentations to general practice. While they are usually benign, they may be associated with an adverse prognosis. ⋯ Not all palpitations are due to arrhythmia, and because of the transitory nature of palpitations, the work-up will usually be performed between episodes. Direction from history, examination and 12-lead electrocardiography will guide further investigations and will often include an echocardiogram and ambulatory electrocardiographic monitoring. The intensity of ambulatory electrocardiographic monitoring and diagnostic work-up will be dictated by the frequency, nature and severity of symptoms, and will sometimes require incorporation of new technologies and electrophysiology referral. Ultimately, management must be tailored on a case-by-case basis depending on the cause of palpitations and symptom severity.
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Palliative care aims to improve quality of life for patients with life-limiting illnesses. It is often linked to the care of people with cancer; however, patients with non-cancer end-stage conditions also have significant needs. ⋯ The symptom burden and care needs for patients with end-stage, nonmalignant illnesses are similar to those of patients with advanced cancer. These patients benefit from a palliative approach, comprising management of the underlying condition and attention to symptoms, psychosocial needs and carer support. Advance care planning provides an opportunity to prepare for future illness episodes, including provision of end-of-life care. General practitioners are well placed to provide palliative care for patients with advanced non-cancer illnesses.