Aust Fam Physician
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The strategy of whether to continue anticoagulation and antiplatelet agents during surgery depends on an evaluation of the thromboembolic risk and haemorrhagic risk of the individual patients. Procedures that carry a significant risk of bleeding may require temporary cessation of the medication. ⋯ Generally, patients at high risk of thromboembolism should be considered for a more aggressive perioperative management strategy with bridging therapy. Current recommendations for dual antiplatelet treatment range from 4 weeks in patients undergoing elective stenting with bare metal stents, up to 12 months in patients with drug-eluting stents or patients undergoing coronary stenting for acute coronary syndrome. If a patient is to undergo high-bleeding-risk surgery and an antiplatelet effect is not desired, clopidogrel, prasugrel and ticagrelor should be discontinued 5-7 days before the procedure. Early, effective communication between general practitioners and specialists is useful in managing high-risk patients on anticoagulation/antiplatelet agents during the perioperative periods.
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Despite a paucity of evidence to guide teaching about medical professionalism and ethical issues, there is a widespread consensus that medical students should learn about these issues on clinical placements. Exploring the confidence of general practitioners (GPs) in teaching various topics will identify areas for further discussion, support and/or training. ⋯ Further training for GP teachers may be particularly useful in the important areas of impairment and lapses in colleagues, and cross-cultural issues. Uncertainty about the scope of doctors' social and political responsibilities may limit GP confidence in teaching in these areas.
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The internet has become an integral part of our everyday lives, affecting the way we work and communicate. It has also changed the way patients obtain health information. This study measures the extent to which general practice patients use the internet to obtain health information, particularly in relation to the problem(s) they bring to the general practitioner (GP), and whether this differs by patient age, sex, socioeconomic status, rurality and English-speaking background status (ESB). ⋯ Of 2944 patients, 63.4% accessed the internet in the previous month; 28.1% had sought health information online; and 17.1% had obtained information related to problems managed by the GP at that visit. Internet use and online health information seeking was inversely related to age for patients aged 15 years or older. The most socioeconomically advantaged patients were significantly more likely than the most disadvantaged to have obtained health information online. Patient sex, ESB status and rurality did not influence internet use or online health information seeking.
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Optimal diabetes management involves frequent monitoring and achievement of outcome targets. A primary care diabetes clinic that provides a 'one-stop shop' may facilitate more regular review and improve patient care. ⋯ A comprehensive diabetes clinic may improve management in the ACCHS setting. The clinic promotes regular checks and higher vaccination rates, although insufficient evidence exists to show that this translates to better clinical outcomes. This model may be transferrable to other primary care settings.