Internal medicine journal
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Internal medicine journal · Jun 2023
Differences in the pattern and cost of hospital care between Indigenous and non-Indigenous Australians with cirrhosis: an exploratory study.
Liver diseases are important contributors to the mortality gap between Indigenous and non-Indigenous Australians. ⋯ Our data highlight the disparities in health service use and patient-reported outcomes, despite having similar clinical profiles. Integration between primary care, Aboriginal Community Controlled Health Organisations and liver specialists is critical for appropriate health service delivery and effective use of resources. Chronic liver disease costs the community dearly.
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Internal medicine journal · Jun 2023
Outcomes of de-prescribing proton pump inhibitors during acute admissions in a general medical unit: a pilot study.
The study describes the feasibility and short-to-medium-term efficacy of an evidence-based proton pump inhibitor (PPI) de-prescribing initiative undertaken as part of routine clinical care during acute admissions in a general medical unit. Of the 44 (median (IQR) age 75.5 (13.75) years; females 25 (57%)) who participated in the study, de-prescription was maintained in 29 (66%) and 27 (61%) patients at 12 and 26 weeks respectively.
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Internal medicine journal · Jun 2023
Quality of acute asthma care: an audit of clinical practice in a Victorian health service.
Gaps in the treatment of patients with acute asthma have been repeatedly described in Australia. We conducted a retrospective audit of acute asthma care at a Victorian tertiary institution. ⋯ The emergency treatment of patients with acute asthma frequently deviated from guidelines and there was significant variation in inpatient treatment. Quality improvement initiatives that incorporate structural changes are required to improve asthma care.
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Internal medicine journal · Jun 2023
Digital health competencies for the next generation of physicians.
As health care continues to change and evolve in a digital society, there is an escalating need for physicians who are skilled and enabled to deliver care using digital health technologies, while remaining able to successfully broker the triadic relationship among patients, computers and themselves. The focus needs to remain firmly on how technology can be leveraged and used to support good medical practice and quality health care, particularly around resolution of longstanding challenges in health care delivery, including equitable access in rural and remote areas, closing the gap on health outcomes and experiences for First Nations peoples and better support in aged care and those living with chronic disease and disability. We propose a set of requisite digital health competencies and recommend that the acquisition and evaluation of these competencies become embedded in physician training curricula and continuing professional development programmes.
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Internal medicine journal · Jun 2023
Self-control, limited willpower and decision fatigue in healthcare settings.
We argue that willpower as well as its depletion may, in some circumstances, adversely impact on clinical decision-making and patient care. This psychological phenomenon has been dubbed ego depletion in social psychology. Willpower and its depletion which is known as 'ego depletion' are well-established and validated theoretical constructs in social psychology and have been studied across a range of experimental contexts. ⋯ We examine willpower and its depletion in the context of three clinical case examples, which include (i) doctor-patient interactions, (ii) willpower and its depletion in relation to challenging interpersonal interactions with clinical and non-clinical work colleagues and (iii) willpower and its depletion in response to working within a challenging and unpredictable clinical environment. In contrast to the more widely recognised external resources (including space, staff allocations and night shifts), a greater understanding of how this important but under-recognised internal resource can be depleted in response to a range of different factors within clinical settings has the potential to inform and improve patient care through a renewed focus on the developing interdisciplinary clinical studies which draw upon contemporary findings from social psychology. Future work aimed at developing evidence-based interventions to help mitigate the negative impact of impaired self-control and decision fatigue within healthcare systems may in turn lead to improved patient care as well as more effective healthcare service and delivery.