Internal medicine journal
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Internal medicine journal · Apr 2017
Advance Care Planning: is quality end of life care really that simple?
The routine implementation of Advance Care Planning (ACP) is now a prominent feature of policy directed at improving end of life care in Australia. However, while complex ACP interventions may modestly reduce medical care at the end of life and enable more people to die at home or outside of acute hospital settings, existing legal, organisational, cultural and conceptual barriers limit the implementation and utility of ACP. We suggest that meaningful improvements in end of life care will not result from the institutionalisation of ACP but from more significant changes to the design and delivery of care.
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Internal medicine journal · Apr 2017
The genomic potential of the Aspirin in Reducing Events in the Elderly and Statins in Reducing Events in the Elderly studies.
Human genetic studies are continuing to increase in size and scale, but the availability of well-phenotyped longitudinal cohorts remains rare. Significant infrastructure, investment and effort are required to establish and maintain high-quality cohorts with biobanking, genetic consent and repeated clinical data measurements. Australia currently has two such cohorts established by Monash University as part of community-based clinical trials in the elderly. ⋯ Both cohorts involve biobanking and consent for genetic research, with recruitment through a network of general practitioners in the community. A combination of whole-genome and targeted sequencing approaches will allow gene-phenotype relationships to be explored within the context of detailed longitudinal data. Genetic risk factors for late-onset high-burden conditions, such as cardiovascular disease and dementia will be investigated, plus research into other areas, such as healthy ageing and disease resilience will be possible due to unique phenotypes of health.