Internal medicine journal
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Internal medicine journal · Sep 2016
ReviewThe ABCs of entrustable professional activities: an overview of 'entrustable professional activities' in medical education.
Consultants regularly need to decide whether a trainee can be entrusted to perform a clinical activity independently. 'Entrustable professional activities' (EPA) provide a framework for justifying and better utilising supervisor entrustment decisions for trainee feedback and assessment in the workplace. Since being proposed by Olle ten Cate in 2005, EPA are emerging as an integral part of many international medical curricula, and are being considered by the Royal Australasian College of Physicians in the current review of physician training. EPA are defined as tasks or responsibilities that can be entrusted to a trainee once sufficient competence is reached to allow for unsupervised practice. ⋯ EPA-based assessment is gaining momentum, amongst significant concerns regarding feasibility of implementation. While the optimal process for designing and implementing EPA remains to be determined, it is an assessment strategy where the over-arching goal of optimal patient care remains in clear sight. This review explores the central role of trust in medical training, the case for EPA and potential barriers to implementing EPA-based assessment.
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A core consideration in the care of Indigenous patients at the end of life is their place of death. Dying in community can be of paramount importance to Indigenous people. This paper reports the experiences of the Top End Palliative Care Service with respect to the barriers and solutions in the return of Indigenous patients to community for end-of-life care. These barriers include not only those associated with the significant distances and remoteness in the Northern Territory but, also, spiritual and cultural factors, which often influence healthcare delivery.
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Internal medicine journal · Sep 2016
Endovascular thrombectomy for acute ischaemic stroke: a real-world experience.
Endovascular thrombectomy for acute ischaemic stroke due to proximal vessel occlusions in the anterior cerebral circulation within 6 h of stroke onset is now recognised as highly beneficial. Five randomised controlled trials in 2015 showed significant improvement in functional outcome at 90 days compared with intravenous thrombolysis alone. Liverpool Hospital is a tertiary referral centre with an acute stroke service, including 24/7 intravenous thrombolysis and endovascular thrombectomy. ⋯ This cohort of patients with anterior cerebral circulation occlusions was treated outside the well-resourced situation of clinical trials and good functional outcomes are similar. The study translates endovascular thrombectomy to a 'real-world' situation.
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Internal medicine journal · Sep 2016
Multicenter Study Observational StudyEffectiveness and response predictors of omalizumab in a severe allergic asthma population with a high prevalence of comorbidities: the Australian Xolair Registry.
Severe asthma is a high impact disease. Omalizumab targets the allergic inflammatory pathway; however, effectiveness data in a population with significant comorbidities are limited. ⋯ Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. Symptomatic response to omalizumab was high despite significant comorbid disease. Omalizumab is an effective targeted therapy for severe allergic asthma with comorbidity in a real-life setting.
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Internal medicine journal · Sep 2016
Multicenter StudyInconsistencies and time delays in site-specific research approvals hinder collaborative clinical research in Australia.
The aim of this study was to describe the time and documentation needed to gain ethics and governance approvals in Australian states with and without a centralised ethical review system. ⋯ The benefits of centralised ethics review systems have not been realised due to duplicative, inflexible governance processes. A system that allowed the recognition of prior ethical approval and low-risk applications was more efficient than a central ethics and site-specific governance process.