Internal medicine journal
-
Internal medicine journal · Dec 2020
Ethics of information-gathering interventions in innovative practice.
Innovative practice involves medical interventions that deviate from standard practice in significant ways. For many patients, innovative practice offers the best chance of successful treatment. Because little is known about most innovative treatments, clinicians who engage in innovative practice might consider including extra procedures, such as scans or blood draws, to gather information about the innovation. ⋯ As a result, clinicians may assume that information-gathering interventions are ethically inappropriate and should not be used in innovative practice. This assumption can lead to seriously negative consequences, such as increasing the likelihood that harmful or ineffective innovations will be adopted and creating new barriers to the development of genuinely beneficial treatments. We argue that health care institutions need to promote the responsible use of information-gathering interventions as an adjunct to innovative practice, and that these interventions are not clinical research and should not be subject to research oversight.
-
Internal medicine journal · Dec 2020
Randomized Controlled TrialClinical efficacy and plausibility of a smartphone-based integrated online real-time diabetes care system via glucose and diet data management: a pilot study.
Smartphones have become novel healthcare tools for patients with diabetes. However, it is uncertain whether the smartphone application support system helps in glycaemic control in patients with type 2 diabetes. ⋯ The smartphone-based integrated online real-time diabetes care system through glucose and diet data management showed clinical plausibility in glucose control in real clinical practice.
-
Internal medicine journal · Dec 2020
ReviewClinical leadership development in Australian healthcare: a systematic review.
Despite clear priority and high costs of leadership capability programmes in healthcare, and significant investments into improving clinical leadership, there remains a prominent gap around evidence of effectiveness or impact on patient outcomes in Australia. We aimed to conduct a systematic review on postgraduate clinical leadership programmes to gather learnings on the processes, theoretical underpinnings, and impact of such programmes for medical and other health professionals. ⋯ Four studies met criteria. Findings revealed that currently, little value is placed on formal evaluations and peer-reviewed publication including assessment of individual, organisational or system level impacts of clinical leadership development programmes, with limited evidence available on effective approaches to clinical leadership development in the Australian healthcare system.
-
Internal medicine journal · Dec 2020
Rapid response team trigger modifications: are we using them safely?
Rapid response teams (RRT) were first proposed as a means of reducing inpatient morbidity and mortality. Modifying RRT activation triggers poses a potential risk for delayed recognition of a deteriorating patient. Trigger modifications have not been validated for safety. ⋯ Trigger modifications are associated with increased hospital LOS and increased rate of in-hospital death and do not reduce the number of recurrent events. For patients in whom escalation of care is not appropriate, the presence of multiple trigger modifications at the time of an RRT activation may be a useful trigger for conversations around goals of care.