Internal medicine journal
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Internal medicine journal · Nov 2020
Promoting ethics across the healthcare sector: what can codes achieve?
Over the course of the twentieth century, numerous national and international ethics 'codes' have been developed. While such codes serve important substantive and symbolic functions, they can also pose challenges. ⋯ We emphasise the importance of accountability in the development and maintenance of national and international codes and argue that, despite all their challenges, codes provide an important common language among otherwise disparate and sometimes adversarial groups, and provide visible and explicit sets of standards that may be invoked by community members to criticise and hold powerful bodies to account. This is particularly important for practitioners and researchers who belong to organisations that are signatories to codes, who can use these codes to both guide and justify ethical behaviour in the face of competing organisational, professional and political imperatives.
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Internal medicine journal · Nov 2020
Effectiveness of epoprostenol in the management of pulmonary arterial hypertension: findings of an Australian retrospective chart review.
Pulmonary arterial hypertension (PAH) is a progressively fatal disease. Parenteral prostanoids, including intravenous (IV) epoprostenol, are the most effective therapies for PAH. As epoprostenol requires continuous infusion, therapy is challenging and use is managed by specialist units. ⋯ Epoprostenol therapy was associated with impressive survival rates and durable improvements in functional outcomes. Epoprostenol therapy is challenging; however, it is manageable by the majority of patients with most experiencing positive, sustainable outcomes.
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Internal medicine journal · Nov 2020
Real-world direct oral anticoagulant experience in atrial fibrillation: falls risk and low dose anticoagulation are predictive of both bleeding and stroke risk.
Clinical trials have demonstrated that direct oral anticoagulants (DOAC) are non-inferior to vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation (AF) with comparable safety outcomes; however, real-world Australian data are limited. ⋯ DOAC use in real-world Australian practice is safe and effective, consistent with international data. Low dose anticoagulation and falls risk are associated with increased bleeding and thrombotic risk demonstrating overlapping risk factors. Careful individualised patient risk assessment is still required as low dose anticoagulation is not without risks.
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Internal medicine journal · Nov 2020
Role of digital technology in delivering 'healthy futures' and 'healthy cities'.
Digital health technologies and services play a critical role in the delivery of safe and efficient healthcare and better health outcomes. Interoperability of these technologies and services, as well as digital inclusion for communities are important enablers of a modern, connected health system. The ongoing development of these factors is an aspiration of Australia's National Digital Health Strategy (NDHS). ⋯ All of these pillars have interdependent features, and many play a role in enabling communities to live healthier and happier lives supported by better connected healthcare services as well as access to information in a timely and efficient manner at the point of care. A 'Communities of Excellence' programme has supported regional communities to connect health services to My Health Record, increase digital health tools use and provide digital health literacy support to consumers. The aims of this programme are to allow the benefits of improved interoperability and better connected care to flow to people and their clinicians, test innovation that could go on to be scaled nationally, and close the health inequity gap experienced by people in rural and remote communities.