Internal medicine journal
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Internal medicine journal · Nov 2020
Real-world direct oral anticoagulant experience in atrial fibrillation: falls risk and low dose anticoagulation are predictive of both bleeding and stroke risk.
Clinical trials have demonstrated that direct oral anticoagulants (DOAC) are non-inferior to vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation (AF) with comparable safety outcomes; however, real-world Australian data are limited. ⋯ DOAC use in real-world Australian practice is safe and effective, consistent with international data. Low dose anticoagulation and falls risk are associated with increased bleeding and thrombotic risk demonstrating overlapping risk factors. Careful individualised patient risk assessment is still required as low dose anticoagulation is not without risks.
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Internal medicine journal · Nov 2020
Poor initiation of smoking cessation therapies in hospitalised patients with chronic obstructive pulmonary disease is associated with low levels of formal training among hospital doctors and under-utilisation of nursing-led interventions.
Smoking cessation intervention is a key component in the management of chronic obstructive pulmonary disease (COPD). ⋯ Our study highlights the real-life challenges in tackling nicotine dependence in hospitals: under-utilisation of evidence-based pharmacotherapies, limited access to formal training for doctors and poor uptake of nurse-led smoking cessation services. Granting limited prescribing rights for specialised nurses may help hospital clinicians to alleviate gaps in current clinical practice.
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Internal medicine journal · Nov 2020
Promoting ethics across the healthcare sector: what can codes achieve?
Over the course of the twentieth century, numerous national and international ethics 'codes' have been developed. While such codes serve important substantive and symbolic functions, they can also pose challenges. ⋯ We emphasise the importance of accountability in the development and maintenance of national and international codes and argue that, despite all their challenges, codes provide an important common language among otherwise disparate and sometimes adversarial groups, and provide visible and explicit sets of standards that may be invoked by community members to criticise and hold powerful bodies to account. This is particularly important for practitioners and researchers who belong to organisations that are signatories to codes, who can use these codes to both guide and justify ethical behaviour in the face of competing organisational, professional and political imperatives.
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Cannabis has been used as a medicine for millennia. Prohibition in the mid-20th century precluded early scientific investigation. 'Cannabis' describes three separate forms - herbal cannabis, 'hemp' products, pharmaceutical-grade regulated cannabinoid-based medical products (CBMP). In Australia, CBMP became available for prescription in November 2016. ⋯ CBMP are well tolerated with few serious adverse events. Additional clinical benefits are promising in many other resistant chronic conditions. Pharmaceutical grade prescribed CBMP has proven clinical benefits and provides another clinical option in the physician's pharmacopeia.