Anticoagulation therapy is effective in preventing primary and secondary thromboembolic events due to atrial fibrillation. Warfarin, which was approved by the United States in 1954, was the only long-term oral anticoagulation therapy till the approval of dabigatran in 2010, and of rivaroxaban and other direct factor Xa inhibitors from 2011, forming a group known as novel oral anticoagulants (NOAC). NOAC have fewer food and drug interactions compared to warfarin; hence, the patient will require fewer clinic visits. However, the short half-life of NOAC means that twice-a-day dosing is needed and there is higher risk of a prothrombotic state when doses are missed. Other disadvantages are the lack of long-term data on NOAC, their high cost and the current lack of locally available antidotes.
Administration, Oral ; Anticoagulants ; administration & dosage ; Atrial Fibrillation ; drug therapy ; Cardiology ; methods ; Dabigatran ; administration & dosage ; Family ; Humans ; Professional-Patient Relations ; Rivaroxaban ; administration & dosage ; Stroke ; prevention & control ; Thromboembolism ; prevention & control ; Warfarin ; administration & dosage

Editorial Policies ; Family Practice ; methods ; Humans ; Periodicals as Topic ; Singapore

Female ; Humans ; Hypertension ; diagnosis ; therapy ; Male

Dental surgery is very common, and it is important for our dental colleagues to understand the medical history and chronic medications of our co-managed patients. Antibiotic prophylaxis is currently recommended only for patients at high risk for infective endocarditis when undergoing high-risk dental procedures. Good dental hygiene can prevent more infective endocarditis than prophylactic antibiotic therapy, as transient bacteraemia is common in daily activities such as the brushing and flossing of teeth. Most dental surgeries can generally be performed on patients taking a daily dose of aspirin, but the dentist must be able to assess the risk-benefit ratio of employing local measures of haemostasis versus stopping the antiplatelet therapy. Patients on antiplatelet with recent coronary artery stenting should be referred to their primary cardiologist regarding the cessation of these agents before any surgery.
Angioplasty ; Antibiotic Prophylaxis ; methods ; Aspirin ; therapeutic use ; Dental Care for Chronically Ill ; methods ; Dentists ; Drug Interactions ; Endocarditis ; prevention & control ; Humans ; Hyperlipidemias ; complications ; Macrolides ; adverse effects ; Male ; Mitral Valve Prolapse ; complications ; Myocardial Ischemia ; complications ; Platelet Aggregation Inhibitors ; adverse effects ; Simvastatin ; adverse effects ; Streptococcal Infections ; prevention & control ; Tooth Extraction ; methods ; Viridans Streptococci ; metabolism

Diabetes mellitus is common in our increasingly affluent and ageing population. Although it is an old friend of practising family physicians, there is a need to be familiar with and up to date about the disease. As patients become more informed and receptive to current medical information, family physicians also need to stay current. This article highlights the evidences that have shaped our current treatment targets for type 2 diabetes mellitus.
Diabetes Mellitus, Type 1 ; blood ; therapy ; Diabetes Mellitus, Type 2 ; blood ; therapy ; Family Practice ; methods ; Glycated Hemoglobin A ; metabolism ; Humans ; Physicians, Family

The solitary pulmonary nodule on chest X-ray (CXR) is a common problem in pulmonary medicine. Its presence raises the question of lung cancer. As five-year survival after resection of a solitary bronchogenic carcinoma can be as high as 80%, prompt evaluation is crucial. This should begin with a cancer risk assessment based on clinical and radiographic factors. The risk and benefits of surgery should next be assessed, and together with the patient's preferences, a management plan can be decided upon. Surgery is recommended for patients at high risk of malignancy with a low surgical risk, while careful observation is adopted for patients at low risk of malignancy coupled with a high surgical risk. Further diagnostic tests may be warranted to aid in this decision process. Although CXR is not useful for lung cancer screening, low-dose computed tomography imaging is increasingly recommended for individuals at high risk for lung cancer.
Aged ; Diagnostic Imaging ; methods ; Humans ; Lung Diseases ; diagnosis ; Lung Neoplasms ; diagnosis ; Middle Aged ; Pulmonary Medicine ; methods ; Radiography ; methods ; Radiography, Thoracic ; methods ; Risk Assessment ; methods ; Risk Factors ; Solitary Pulmonary Nodule ; diagnosis

Urinary incontinence is the involuntary loss of urine. There are many types of incontinence and different management options available, ranging from lifestyle modifications, medication to surgical intervention. Untreated urinary incontinence can result in a myriad of problems, including skin irritations, infections, social phobia, major depression and premature institutionalisation of elderly family members. Common barriers to optimal management include the socially embarrassing nature of the condition, which impedes open discussion, as well as the misperceptions that management must be invasive and the condition cannot be adequately managed within the community. We discuss the common types of incontinence encountered in the community and their management in the primary care setting.
Cholinergic Antagonists ; therapeutic use ; Diagnosis, Differential ; Exercise Therapy ; Female ; Humans ; Male ; Medical History Taking ; Primary Health Care ; Urinalysis ; Urinary Incontinence ; diagnosis ; etiology ; therapy

Hypertension is the most common chronic condition seen in primary care. It is a potentially modifiable risk factor for cardiovascular and renal complications. The latest Joint National Committee recommendations in 2014 address common clinical questions from the best available science with regard to managing patients with hypertension. We review some of these recommendations and discuss how they may be applied in our practice.
Aged ; Antihypertensive Agents ; therapeutic use ; Blood Pressure ; Diabetes Mellitus, Type 2 ; complications ; Female ; Guidelines as Topic ; Humans ; Hypertension ; diagnosis ; therapy ; Male ; Patient Education as Topic ; Practice Guidelines as Topic ; Primary Health Care ; methods ; Risk Factors

A clinical diagnosis of asthma is often considered when a child presents with recurrent cough, wheeze and breathlessness. However, there are many other causes of wheeze in a young child. These range from recurrent viral infections to chronic suppurative lung disease, gastro-oesophageal reflux disease and rare structural abnormalities. Arriving at a diagnosis includes taking into consideration the symptomatology, triggers, atopic features, family history, absence of red flags and therapeutic trial, where indicated.
Asthma ; diagnosis ; Child, Preschool ; Cough ; diagnosis ; Diagnosis, Differential ; Humans ; Infant ; Pediatrics ; methods ; Primary Health Care ; methods ; Respiratory Sounds ; diagnosis ; Treatment Outcome