Palmbarber4068

Atrial fibrillation is a common cardiac disease of aging. The risk of stroke and bad prognosis increase with age and atrial fibrillation. Compared with younger people, elderly people have higher risks for both thrombosis and bleeding. Stroke prevention with oral anticoagulants is the cornerstone of the management of atrial fibrillation but is often questioned because of the risk of bleeding, furthermore comorbidities, comedications, fall risks, poor compliance. These factors frequently found in frail elderly patients complicate the management of antithrombotic therapy. This article reviews the evidence for the risks and benefits of anticoagulation in the elderly with atrial fibrillation, by comparing the new oral anticoagulants to vitamin K antagonists.Assisted teleconsultation, one of the components of telemedicine, is a form of medical practice set to further develop in the coming years. Interprofessional relationships are being adapted, and the triad patient-care provider-physician is experiencing new challenges. In this article we focus on the competencies and skills required and suggest some clinical practice guidelines for this new form of medical practice based on the pilot phase of our project.The covid-19 outbreak prompted many health care providers to use video consultation for the first time. While it is particularly useful in times of pandemic, a number of patients wish to continue using video consultation as it allows easy access to their physician. However, many physicians may be uncomfortable communicating with new technologies and without performing a traditional physical examination. Training in communication and virtual physical examination in telemedicine appears to be necessary, making it possible to make videoconsultation sustainable into daily practice while guaranteeing quality of care.Teleconsultation is subject to the same rules as face-to-face consultation. However, doctors who wish to integrate it into their activity must be aware of a certain number of requirements linked to this practice such as the need to adapt their working environment, to comply with security rules, to ensure the continuity of medical information or to be aware of good practices and billing possibilities. In this article, we try to answer the frequently asked questions of health professionals who wish to carry out remote consultations in good conditions.There is no specific legal framework in Switzerland for the practice of telemedicine. The doctor carrying out a teleconsultation must therefore respect the general principles of medical practice  provide care online with professional recommendations, provide his patient with clear, appropriate and complete information, and also respect medical confidentiality. The doctor, due in particular to the limitation of the senses and the absence of direct physical examination, must maintain a degree of caution in the practice of remote consultations. He also remains responsible for the medical data exchanged and it is up to him to use a telemedicine solution adapted to the data security and confidentiality standards.During the COVID-19 crisis, telemedicine was at the center of the health management systems in the canton of Geneva. Telemedicine contributed to the triage and follow-up of patients with a suspected or confirmed diagnosis of COVID-19, as well as to the coordination of different healthcare actors in the patient's trajectory. New partnerships and reinforcement of coordination in the Geneva healthcare and social care networks with an unprecedented use of telemedicine tools were able to ensure patient care while preserving frontline healthcare providers. Telemedicine has benefited during this time from a temporary relaxation of measures and regulations governing its practice, encouraging its deployment in a crisis situation. However, for these tools to be effective, they need to become an integral part of our healthcare systems.The COVID-19 pandemic has imposed a reorganization of our health care system leading to an unhoped-for boom in telemedicine, particularly in Geneva. The deployment of HUG@home at the Geneva University Hospitals and of docteur@home in the doctors' offices has allowed health professionals to come together around a single solution thus ensuring continuity of care for patients with chronic diseases but also the triage and follow-up of patients with COVID-19 in compliance with security and confidentiality rules. The ease of use of remote consultation tools is essential for the sustainable anchoring of telemedicine in practice. The supervision of practices, training and the financial valorization of telemedicine are also necessary for the development of quality care.With the rise of life-expectancy, the number of comorbidities can increase and lead to polypharmacy (≥ 5 drugs/day) and excessive polypharmacy (> 9 drugs/day). In order to define suitable therapeutic targets, it is essential to take into account the heterogeneity of this population which can be classified into 3 categories  robust, vulnerable or dependent. In this context, the concept of deprescription, which englobes the process of tapering or stopping drugs, aimed at improving patient outcomes, becomes an important therapeutic tool. In the context of hypertension, this approach seems to be a safe, provided that patients can benefit from regular monitoring. see more It must be considered in vulnerable and dependent patients or patients institutionalized in nursing homes. Although, scientific evidence slowly accumulates, its levels remain moderate. Finally, the deprescribing process, can also be applied in specifics situations in order to prevent adverse events, such as during a heat wave.When should antihypertensive treatments be administered ? The concept of chronotherapy has been attractive for several years, in connection with the importance of circadian variations in blood pressure. The "too" promising results of the Hygia study argue in its favour. Yet experts caution us about the methodology and results of this study. Vesperal administration of routine anti-hypertensive treatments in all patients is not recommended to date, with a non-negligible risk of excessively lowering the nocturnal blood pressure in some patients (increase of ischemic risk in target organ damage) and on the other hand reducing therapeutic adherence by increasing the number of drug doses. Chronotherapy will therefore only be fully effective if patients are willing to adhere to it.