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
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
Multicenter StudyUsing periodic point-prevalence surveys to assess appropriateness of antimicrobial prescribing in Australian private hospitals.
Appropriateness of antimicrobial use is a measure of key importance in evaluating safety and quality of prescribing but has been difficult to define and assess on a wide scale. Published work is limited and has generally focused on tertiary public hospitals, whereas the private sector provides a significant proportion of care in many countries. Information on prescribing in the private hospital context is needed to identify where intervention might be required. An antimicrobial prescribing survey tool was utilised to assess the appropriateness of antimicrobial prescribing among large private hospitals in Australia. ⋯ This study provides important data on antimicrobial prescribing patterns in Australian private hospitals. Results can be used to target areas for improvement, with documentation of indication and surgical antibiotic prophylaxis requiring initial attention.
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Internal medicine journal · Mar 2014
Randomized Controlled Trial Multicenter StudyAdherence and outcomes of patients prescribed dabigatran (Pradaxa) in routine clinical practice.
To explore and detail clinical experiences of dabigatran, a novel anticoagulant, after it became available in New Zealand in July 2011. ⋯ A high rate of discontinuation of dabigatran, mainly due to GI symptoms, was observed. There does not appear to be any specific predictor of dabigatran tolerance. When prescribed according to guidelines, rates of serious adverse events associated with dabigatran appear to be low.