Internal medicine journal
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Internal medicine journal · Mar 2014
Randomized Controlled TrialMedical practitioners' knowledge and self-reported practices of substitute decision making and implementation of advance care plans.
Advance care planning (ACP) provides patients with the ability to make their decisions known about how they would like to be treated if they lose capacity. Medical practitioners have a key role to play in providing information on ACP to their patients. This research explores their knowledge and attitudes to advance care planning and how this affects their practice. ⋯ Respect for patient wishes expressed in advance directives is reassuringly high. The findings suggest significant misunderstanding by medical practitioners of terminologies and systems around substitute decision-making for incompetent persons. Further education and standardisation of terminologies and systems across different jurisdictions would assist in addressing these issues. Low response rate, relating to only one legal jurisdiction, means results may not be generalisable.
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Internal medicine journal · Mar 2014
Fatalities and hospitalisations due to acute poisoning among New Zealand adults.
Acute poisoning accounts for a significant proportion of the total burden of disease worldwide. While the rate of poisoning fatalities in New Zealand is comparable to other industrialised countries, demographic trends in incidence, particularly including socio-economic indicators and substances involved, are less well known. ⋯ The majority of hospitalisations and deaths due to poisoning in New Zealand adults are intentional self-harm episodes. A comprehensive approach to monitoring poisoning, the underlying risks and the implementation of interventions is required to minimise risks.
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Internal medicine journal · Mar 2014
Multicenter StudyUsing periodic point-prevalence surveys to assess appropriateness of antimicrobial prescribing in Australian private hospitals.
Appropriateness of antimicrobial use is a measure of key importance in evaluating safety and quality of prescribing but has been difficult to define and assess on a wide scale. Published work is limited and has generally focused on tertiary public hospitals, whereas the private sector provides a significant proportion of care in many countries. Information on prescribing in the private hospital context is needed to identify where intervention might be required. An antimicrobial prescribing survey tool was utilised to assess the appropriateness of antimicrobial prescribing among large private hospitals in Australia. ⋯ This study provides important data on antimicrobial prescribing patterns in Australian private hospitals. Results can be used to target areas for improvement, with documentation of indication and surgical antibiotic prophylaxis requiring initial attention.
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Internal medicine journal · Mar 2014
Randomized Controlled TrialExamining patients' preferences for participation in clinical decision-making: the experience in a Latin American chronic obstructive pulmonary disease and cancer outpatient population.
It is generally accepted that patients prefer to be told the truth by their physicians; however, the practice of partial truth-telling is frequent with an existing 'norm of nondisclosure.' Our primary objective was to determine what patients wanted to be told about their illness, and whether there might be differences between patients with either cancer or advanced chronic obstructive pulmonary disease (COPD). A second objective was to determine how these patients envisioned their participation, or lack thereof, in the treatment decision-making process. ⋯ While they considered the role of their families relevant and wanted information to be shared so that family members might participate in decision-making, they did not want their families to have a right to withhold information, make final decisions.
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Internal medicine journal · Mar 2014
Randomized Controlled Trial Multicenter StudyAdherence and outcomes of patients prescribed dabigatran (Pradaxa) in routine clinical practice.
To explore and detail clinical experiences of dabigatran, a novel anticoagulant, after it became available in New Zealand in July 2011. ⋯ A high rate of discontinuation of dabigatran, mainly due to GI symptoms, was observed. There does not appear to be any specific predictor of dabigatran tolerance. When prescribed according to guidelines, rates of serious adverse events associated with dabigatran appear to be low.