Dementia is common and undiagnosed in primary care. Screening instruments alone have insufficient specificity to establish a valid diagnosis of dementia when used in a comprehensive screening program; these results may not be generalized to older adults presenting with cognitive complaints. Multiple health system and patient-level factors present barriers to this formal assessment and thus render the current standard of care for dementia diagnosis impractical in primary care settings.

No abstract

BACKGROUND: Discussions of end-of-life care should be held prior to acute, disabling events. Many barriers to having such discussions during primary care exist. These barriers include time constraints, communication difficulties, and perhaps physicians' anxiety that patients might react negatively to such discussions.

State-by-state contributions of energy and water use to the carbon footprint of satellite HD appear to vary significantly. Performing emissions planning and target setting at the state level may be more appropriate in the Australian context. What is known about the topic? Healthcare provision carries a significant environmental footprint. In particular, conventional HD uses substantial amounts of electricity and water. In the UK, provision of HD and peritoneal dialysis was found to have an annual per-patient carbon footprint of 7.1t CO2-eq. What does this paper add? This is the first carbon-footprinting study of HD in Australia. In Victoria, the annual per-patient carbon footprint of satellite conventional HD is 10.2t CO2-eq. Notably, the contributions of electricity and water consumption to the carbon footprint varies significantly throughout Australia when local factors are taken into account. What are the implications for practitioners? We recommend that healthcare providers consider local factors when planning emissions reduction strategies, and target setting should be performed at the state, as opposed to national, level. There is a need for more comprehensive and current emissions data to enable healthcare providers to do so.