Internal medicine journal
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Internal medicine journal · Feb 2015
Characteristics favouring a delayed disposition decision in the emergency department.
The working hours of a hospital affects efficiency of care within the emergency department (ED). Understanding the influences on ED time intervals is crucial for process redesign to improve ED patient flow. ⋯ Extrinsic to the patients themselves and in addition to ED overcrowding, the working hours of the hospital affected efficiency of care within the ED. Not only should the whole of the hospital be involved in improving efficient and safe transit of patients through an ED, but the whole of the day and every day of the week deserve attention.
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Internal medicine journal · Feb 2015
Editorial Comparative StudyChronic kidney disease in disadvantaged populations.
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Internal medicine journal · Jan 2015
Multicenter StudyFactors relating to consent for organ donation: prospective data on potential organ donors.
Obtaining family consent to organ donation is a significant obstacle to improving further Australian deceased organ donation rates. Currently, neither the consent rates for donors eligible to donate after circulatory death, nor factors that influence decision to decline or consent to donation in general are known in Australia. ⋯ Despite a small sample size, these findings describe current consent and donation rates and associated factors and may assist in improving conversations about organ donation.
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Internal medicine journal · Jan 2015
Randomized Controlled TrialDoes the availability of therapeutic drug monitoring, computerised dose recommendation and prescribing decision support services promote compliance with national gentamicin prescribing guidelines?
Gentamicin is an aminoglycoside antibiotic that is highly effective in treating Gram-negative infections, but inappropriate use leads to toxicity. In 2010, the Australian Therapeutic Guidelines (Antibiotic) were revised to recommend the use of computerised methods to individualise dosing of gentamicin and optimise therapy, rather than traditional nomogram approaches. ⋯ In comparison with the national guidelines, there was significant under-dosing and monitoring practices were haphazard. Computerised electronic alerts were ineffective in informing users. To improve prescribing practices, we recommend exploring alternative computerised decision support approaches (e.g. pre-written orders) and more pervasive and persuasive implementation strategies.
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Internal medicine journal · Jan 2015
Echocardiographic and electrocardiographic findings in patients with obesity hypoventilation syndrome.
Obesity is a risk factor for both sleep-related breathing disorders (SRBD), including obesity hypoventilation syndrome (OHS) and cardiovascular diseases (CVD). The development of CVD in patients with SRBD is usually attributed to the fact that most patients are obese in addition to conventional cardiovascular risk factors. ⋯ There appears to be a high prevalence of right ventricular impairment, pulmonary hypertension, left ventricle hypertrophy, diastolic dysfunction and arrhythmias in patients with OHS. These findings would appear to be higher than expected in obese patients without OHS. A larger prospective matched cohort study would be needed to confirm the clinical significance of these findings.