Internal medicine journal
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Pancreatic cancer remains a fearsome disease. New insights into the molecular pathogenesis may influence choice of treatment modalities and provide avenues for novel therapeutic strategies for testing in the clinic. The survival rate of patients with all stages of disease is poor and clinical trials are appropriate alternatives for treatment and should be considered. ⋯ These patients may benefit from palliative bypass of biliary or duodenal obstruction if symptomatic. Pain associated with local tumour infiltration may be palliated with radiation, with or without chemotherapy, or with coeliac nerve blocks or local neurosurgical procedures. Chemotherapy with gemcitabine has modest objective response rates but has been shown to improve symptoms.
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Internal medicine journal · Aug 2004
Rate of nosocomial transmission of vancomycin-resistant enterococci from isolated patients.
To evaluate an isolation policy for patients colonised with vancomycin-resistant enterococci (VRE), we instituted active surveillance for transmission to uncolonised patients. Surveillance rectal swabs were taken and pulsed-field gel electrophoresis was performed on positive isolates. VRE transmission with an identical genotype occurred in 5 patients, giving a transmission rate of 3.7 per 1000 patient days, or 1 patient per ward each week. The present study provides a baseline for -assessment of VRE transmission and will be useful in evaluation of the effectiveness of infection control interventions.
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Internal medicine journal · Aug 2004
ReviewTowards more effective use of decision support in clinical practice: what the guidelines for guidelines don't tell you.
The Brisbane Cardiac Consortium Clinical Support Systems Program used multiple strategies in optimising quality of care of patients with either of two cardiac conditions. One of these strategies was the development and active implementation of decision support systems centred on evidence-based, locally agreed clinical practice guidelines. Our experience in undertaking this task highlighted numerous operational challenges for which solutions were difficult to extract from existing published literature. In the present article we provide a methodology grounded in both theory and real-world experience that may assist others in developing and implementing systems of guideline-based decision support.
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Internal medicine journal · Aug 2004
Improving the implementation of community-acquired pneumonia guidelines.
Best practice guidelines define the essential elements of care. They can improve the treatment of patients with community-acquired pneumonia (CAP). Although guidelines advocating these elements are readily avail-able, the care received by patients with CAP remains heterogeneous. In the present report, the use of a -computer-based assistant to decision-making was -successfully developed and tested, improving the application of well-known guidelines.