Internal medicine journal
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Internal medicine journal · Jul 2024
The cascade of care for hepatitis C in Victoria, Australia: a data linkage cohort study.
Highly effective hepatitis C therapies are available in Australia. However, people living with hepatitis C face various barriers to accessing care and treatment. ⋯ Despite an enabling policy environment and subsidised therapy, many people in this cohort were not treated. Increased measures may be needed to engage people in care, including those who acquired hepatitis C more than 10 years ago.
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Internal medicine journal · Jul 2024
Clinical practice guidelines: Their utility, dissemination and monitoring at Colonial War Memorial Hospital: A mixed methods study from Fiji.
Clinical practice guidelines (CPGs) improve patient care by standardising medical practice. However, little is known about their applicability in low-resource settings. Since 2010, Fiji has introduced guidelines to increase the application of evidence-based practice. ⋯ Most physicians found CPGs to be valuable for improving the consistency of care. In low-resource settings, dissemination of guidelines should be paired with CME to improve their uptake. Increased monitoring of guideline use appears necessary.
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Internal medicine journal · Jul 2024
Medical negligence under pressure: obligations of clinicians and healthcare services in the setting of resource limitations.
Healthcare provision takes place in a variety of contexts, with variations of resources available to practitioners and their patients. Effects from the COVID-19 pandemic superimposed on existing system demands have driven increasing concern about resource limitations, particularly in rural and remote settings. This article explores the legal liability of medical practitioners and healthcare services with respect to actions in negligence arising from harm to patients suffered, either partly or wholly, as a result of resource limitations.
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Internal medicine journal · Jul 2024
Oral corticosteroid stewardship: key insights from the Australasian Severe Asthma Registry.
People with severe asthma remain at risk of toxicity from maintenance oral corticosteroid (OCS) use and/or frequent OCS burst therapy. Cumulative exposures above 500-1000 mg prednisolone are associated with adverse effects, and recently OCS stewardship principles were promulgated to guide OCS prescription. ⋯ A large national asthma registry identifies exposure to toxic cumulative doses of OCS in more than a third of participants, with further subsequent cumulative dose escalation over 2 years. Steroid-sparing strategies were often not employed, highlighting the need for implementation of OCS stewardship initiatives.
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Internal medicine journal · Jul 2024
Medical oncologist perceptions and willingness to participate in voluntary assisted dying in South Australia.
This study surveyed South Australian medical oncologists to capture their perceptions, willingness to participate and perceived barriers and motivations to participation in voluntary assisted dying (VAD) activities. Approximately 70% of surveyed medical oncologists reported familiarity with VAD legislation. ⋯ The top barriers to participation were lack of time and uncertainty given no prior experience. These results demonstrate both a low rate of conscientious objection and a low rate of willingness to participate at the point of VAD implementation in South Australia, and identify barriers to participation that are largely logistical.