Aust Fam Physician
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Warfarin management can be difficult; many factors can impact on INR control with some factors being unique to the Australian indigenous setting. ⋯ INR control was below the cited benchmark for TTR of 60%. However, this may be better than expected in this clinical setting. The small number of patients included in the audit means that any discussion of the causes of better and poorer control must be treated with caution.
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Randomized Controlled Trial
Promoting patient centred palliative care through case conferencing.
What are the characteristics of case conferences between general practitioners and specialised palliative care services (SPCS)? ⋯ Case conferencing involving SPCS, the GP, other health professionals and the patient can be an efficient part of routine care.
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In recent years, four specific strategies have emerged which have proven clinical benefit in treating acute stroke. These are the administration of tissue plasminogen activator (tPA), aspirin, management in a stroke care unit (SCU) and the use of hemicraniectomy in patients with severe cerebral oedema. ⋯ Although tPA has been shown to be remarkably clinically effective, less than 5% of eligible stroke patients receive this therapy. The main obstacle is its very narrow therapeutic time window of 3 hours. This necessitates the immediate recognition of stroke and rapid transfer to hospital. Computerised tomography is mandatory to rule out cerebral haemorrhage. Starting aspirin within 48 hours of stroke onset in patients with ischaemic stroke results in a significant reduction in mortality and morbidity. Management in a SCU is the most useful intervention with significant reductions in mortality and morbidity for all stroke subtypes. The management of stroke is changing, and the role of the GP is crucial in facilitating the rapid transfer of patients to a SCU together with subsequent risk factor control and community support.