Internal medicine journal
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Internal medicine journal · Apr 2014
Multicenter StudyCare of the dying cancer patient in the emergency department: findings from a National survey of Australian emergency department clinicians.
Patients with cancer are presenting to emergency departments (ED) for end-of-life care with increasing frequency. Little is known about this experience for patients and ED clinicians in Australia. ⋯ Our findings provide important new insights into a growing area of care for ED. Barriers and enablers to optimal care of the dying patient in ED were identified, and especially the reported high occurrence of futile care, likely a result of these barriers, is detrimental to both optimal patient care and allocation of valuable healthcare resources.
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Internal medicine journal · Apr 2014
Comparative StudySuboptimal management of unfractionated heparin compared with low-molecular-weight heparin in the management of pulmonary embolism.
Both low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) have been shown to be equivalent in efficacy and safety profiles for the management of pulmonary embolism (PE). ⋯ PE was predominantly managed with LMWH. UFH was suboptimally managed when used, although there was no impact on mortality rate.
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Internal medicine journal · Apr 2014
Emergency department lengths of stay: characteristics favouring a delay to the admission decision as distinct from a delay while awaiting an inpatient bed.
A prolonged stay for a patient within the emergency department (ED) can adversely affect the outcome of their ensuing hospital admission. ⋯ Outside of working hours, patients presenting to ED have longer triage-to-admit times while patients for admission have shorter boarding times. ED congestion delays admission decisions only slightly and prolongs patients' boarding times to a greater extent. Strategies to reduce the time patients spend in ED should differ depending on whether a decision to admit the patient has been reached.
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Internal medicine journal · Apr 2014
Long-term tolerance and efficacy of adjunctive exenatide therapy on glycaemic control and bodyweight in type 2 diabetes: a retrospective study from a specialist diabetes outpatient clinic.
Weight gain and hypoglycaemia are common adverse effects associated with anti-diabetic treatments. ⋯ Exenatide is effective in reducing HbA1c and weight, regardless of concurrent insulin, and in a specialist diabetes outpatient clinic, is recommended for use in clinical practice.
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Internal medicine journal · Mar 2014
Randomized Controlled TrialMedical practitioners' knowledge and self-reported practices of substitute decision making and implementation of advance care plans.
Advance care planning (ACP) provides patients with the ability to make their decisions known about how they would like to be treated if they lose capacity. Medical practitioners have a key role to play in providing information on ACP to their patients. This research explores their knowledge and attitudes to advance care planning and how this affects their practice. ⋯ Respect for patient wishes expressed in advance directives is reassuringly high. The findings suggest significant misunderstanding by medical practitioners of terminologies and systems around substitute decision-making for incompetent persons. Further education and standardisation of terminologies and systems across different jurisdictions would assist in addressing these issues. Low response rate, relating to only one legal jurisdiction, means results may not be generalisable.