Internal medicine journal
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Internal medicine journal · Aug 2023
Effects of an outpatient exercise programme for Australians with cancer-related fatigue: an unmet need.
Cancer-related fatigue (CRF) is a common debilitating condition. International evidence supports an exercise prescription for CRF. The majority of Australians with cancer do not meet recommended exercise targets. ⋯ The outcomes of this programme contribute to exercise guidelines in Australia. Currently only position statements exist on the subject, but there are no programme guidelines. An exercise prescription is critical to cancer outcomes. This programme is likely to benefit cancer survivors experiencing CRF across private and public hospitals in Australia.
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Internal medicine journal · Aug 2023
Real world decision making in the management of patients presenting with major bleeding on rivaroxaban: The Auckland regional experience.
Rivaroxaban is used increasingly as an oral anticoagulant; however, a specific reversal agent is not currently available in the Australasian setting. There is also variation across international consensus guidelines regarding advice on the management of bleeding. ⋯ There is considerable heterogeneity in the acute clinical management of patients presenting with rivaroxaban-related major bleeding. The use of PCC and dosage administered is inconsistent. TXA was utilised in only approximately one-quarter of all cases. Evidence-based guidance for treating rivaroxaban-related bleeding would improve the management of these patients and potentially improve clinical outcomes.
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Internal medicine journal · Aug 2023
Observational StudyWaiting for Guardianship in a public hospital geriatric inpatient unit: A mixed methods observational case series.
Patients in acute hospital settings waiting for guardianship and financial management (FM) hearings experience extended length of stay (LOS), with known consequences for frail elderly. This, together with universal agreement that substitute decision-making is a last resort measure, an imperative exists to examine guardianship and FM applications made from within hospital for geriatric inpatients. ⋯ This study identifies potential points along pathways towards guardianship in hospital settings, which might be targeted to streamline if not divert some of these applications. Points of intervention include at initiation of applications, with consideration of alternatives to substitute decision-making by addressing patient needs and using supported decision-making, while improving clinician understanding of capacity assessment and guardianship.
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Internal medicine journal · Aug 2023
CommentNoninvasive ventilation in New Zealand: a national prevalence survey.
Home-based noninvasive ventilation (NIV) is an effective treatment for a range of conditions that cause respiratory failure which reduces hospitalisation and mortality and improves quality of life. ⋯ Home-based NIV provision has doubled since the previous survey, reflecting increased burden from OHS and obstructive pathologies and a disproportionate disease burden among Māori and Pacific populations. The large regional variations are concerning and highlight the urgent requirement for national service specifications, education and equipment provision. Further research is needed to address access equity.