Clinical medicine (London, England)
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Chronic kidney disease (CKD) is a global health problem affecting up to 14% of the adult population in developed countries. On the basis of current guidelines, patients with CKD will often fulfil criteria for both short-term and long-term anticoagulation. Paradoxically, patients with CKD are not only at a higher risk of thrombosis, they are also at increased risk of bleeding. ⋯ As such, the decision on whether to anticoagulate or not, and if so with what agent, poses significant challenges. A solid understanding of the condition in question and the available treatments is required to make an informed judgement call. An in-depth appreciation of the advantages and disadvantages of the currently available anticoagulants is a key element in the decision-making process.
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We live in an era of increased societal awareness of sexual harassment and frequent reporting by patients of inappropriate conduct. In this article, we reflect on traditional teaching of physical examination involving full exposure and intimate examinations, and whether this is still necessary, or appropriate, in clinical practice today. We discuss the balance between appropriate physical examination and inappropriate patient exposure resulting in perceived or actual harassment. We argue that ethical values and societal values change with time, and there is an onus on medical educators to reflect societal sensitivities in their teaching.
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The number of frail patients reaching end-stage kidney disease is increasing. They have a high level of comorbidity and symptom burden which need to be considered when making management plans. For those who choose renal replacement therapy, it is important to establish goals and ceilings of care and to provide holistic care focusing on optimising quality of life. Advance care planning is the process of documenting the patient's preferences for their treatment in the event they lose capacity to make decisions about their treatment.