Aust Prescr
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Long-term treatment with warfarin is recommended for patients with atrial fibrillation at risk of stroke and those with recurrent venous thrombosis or prosthetic heart valves. Patient education before commencing warfarin - regarding signs and symptoms of bleeding, the impact of diet, potential drug interactions and the actions to take if a dose is missed - is pivotal to successful use. ⋯ Regular monitoring of the anticoagulant effect is required. Evidence suggests that patients who self-monitor using point-of-care testing have better outcomes than other patients.
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Diagnostic imaging is often not indicated in chronic abdominal pain. In particular, undifferentiated abdominal pain is rarely an indication for a CT scan. CT scanning is overused even when imaging is required. ⋯ Alarm symptoms, including anaemia, blood in the stool, waking at night with gastrointestinal symptoms, and weight loss, should be investigated. The most appropriate modality depends on the symptoms. Clinical information on request forms for CT scans should be specific and include the suspected condition as this helps the radiologist to determine an appropriate imaging protocol.
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Current therapies for Alzheimer's disease do not modify the course of disease and are not universally beneficial. Clinical trials of drugs targeting amyloid and tau in established Alzheimer's disease have been unsuccessful as it is thought that treating established disease may be too late. ⋯ Mixed pathologies predominate in the older population. The associations between biomarkers, neuropathology and clinical syndromes are weaker in older people and this is likely to pose a greater challenge in identifying effective therapies.