Polypharmacy is here, but needs careful use
Elderly patients are frequently admitted to hospital as the result of polypharmacy. Medications are reviewed and many are able to be stopped.
The list of medications that can cause problems is long. Anticholinergics, antispasmodics, antidepressants and anti-parkinonsian medications are frequent offenders. So too are sedatives and narcotics.
Unfortunately for the GP when patients return after hospital discharge they reportedly find life intolerable due to pain and/or severe insomnia. Despite the warnings medication is often restarted and the cycle begins again.
Dr Tien Khoo, staff physician at Ballina District Hospital, sees this cycle all too frequently. In this article he recommends the "7 step medication review" plan to break or at least slow the cycle.
Concurrent with the evolution of modern medicine practitioners are increasingly caught up in a career that is rife with guidelines and recommendations. Though well-meaning, many of theses are led by specialist groups and institutions that focus (understandably) on a particular condition. Things are then left to the astute clinician involved in the decision-making process of clinical management, often followed by safe prescribing.
The commencement and continuation of medication on the basis of primum non nocere (‘first do no harm’) requires careful consideration of the information at hand. Ideally, information that feeds into our clinical reasoning processes should involve core components of the clinical history, examination, investigation results, intended benefit and most importantly, patient preferences. In addition, I suggest reflecting on the available evidence and the patient’s time horizon.
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- Written by: Dr Tien K Khoo
Rising costs spark NRMX closure
The Northern Rivers Medical Exchange (NRMX) has closed due to the rising cost of insuring medical data transportation.
The Exchange started five years ago as a free service from the Northern Rivers General Practice Network for North Coast health practitioners. The Exchange used secure email to send documents between NRMX users.
The service underwent extensive penetration testing by the Brisbane security firm YellIT prior to its general release and no major vulnerabilities were uncovered.
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Shakespeare steps the global stage
Associate Professor Tom Shakespeare, Radiation Oncologist with North Coast Cancer Institute Lismore, has introduced 10,000 international colleagues to the ground-breaking work in prostate cancer treatment being undertaken in local facilities operated by the Northern NSW Local Health District (NNSWLHD).
A/Prof Shakespeare presented two papers at the American Society for Radiation Oncology’s (ASTRO) recent annual meeting in Chicago.
The gathering heard A/Prof Shakespeare speak on world-first programs that are improving healthcare for regional patients.
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GPs still facing mental health deluge
“Keeping a person healthy is no small charge. Keeping a nation healthy is a near Herculean task. Yet that is exactly what general practitioners (GPs) do.”
So begins the introduction by RACGP President Dr Harry Nespolon to General Practice: Health of the Nation, the latest annual report on the state of general practice in Australia.
The College, which represents 90 per cent of the general practice profession, commissioned research involving more than 1100 RACGP Fellows (of 37,000 in 6500 accredited practices in Australia) as well as drawing on information in the MABEL (Medicine in Australia: Balancing Employment and Life) Survey and a range of government publications.
Each year the release of the report generates media interest but this year’s has been something of a blockbuster, attracting widespread coverage for the statistic that 65% of patients raise psychological issues with their GP.
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Cloudy days ahead
These days, wherever you go, those not looking at a smartphone are the ones who stand out.
It’s almost 13 years since Steve Jobs popularised the internet communicator. It’s a phone, an internet browser and an iPod but these days it’s all this and so much more. These devices, along with tablets and laptops, have changed the way we live and work. Keeping in touch with family and friends, shopping, education and entertainment have changed immeasurably in just over a decade.
Some even rely on their phone for medical care.
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- Written by: David Guest
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