By Kilburn, J.

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G. support groups, respite care. Awareness of financial aspects such as benefits. Advice regarding driving. Prospects of going back to work. g. stroke association. Consider patients’ changing needs and environment. Medical review including use of antihypertensives/long term aspirin. g. smoking. Look for symptoms of depression. Post-discharge hospital review. Related evidence • Benefit of lifestyle changes especially smoking cessation. • Organized stroke rehabilitation improves short and long term mortality by 25% and reduces long term disability.

The addition of aspirin reduced it by a further 25%. For GP role Trials for GP thrombolysis: GREAT—the Grampian Region Early Anistreplase Trial of 311 patients receiving therapy a median of 139 minutes earlier than those in hospital reduced infarct size and improved left ventricular function. Mortality at 3 months was improved. When time to reach hospital exceeds 30 minutes, GP thrombolysis is appropriate. The other large studies in this area, 38 PRACTICE QUESTIONS EMIP (European Myocardial Infarction Project 1993 of 5469 patients) and MITI (The Myocardial Infarction Triage and Intervention in Seattle) were both inconclusive for the benefit.

Evaluate how much of the problem lies within each party. Is this an appropriate role for a doctor? Are you looking for morbidity or being a family policeman? • Balance possibility of providing genuine help with that of exacerbating problems and inviting personal danger. • Could disrupt the doctor-patient relationship. • May be time-consuming but further knowledge of the family dynamics may be very useful. Issues regarding the son • Is he your patient and is there mutual respect? PRACTICE QUESTIONS 35 • Is he likely to appreciate or accept advice?

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Answer Plans for the MRCGP by Kilburn, J.
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