Internal medicine journal
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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 · Feb 2014
Multicenter StudyThe Australia and New Zealand Fontan Registry: description and initial results from the first population-based Fontan registry.
The Fontan procedure is the final in a series of staged palliations for single-ventricle congenital heart disease, which encompasses rare and heterogeneous cardiac lesions. It represents an unusual and novel physiological state characterised by absence of a subpulmonary ventricle. ⋯ The population surviving after the Fontan procedure has been growing in recent decades, especially since survival with hypoplastic left heart syndrome has improved. The Australia and New Zealand Fontan Registry provides population-based data, and only large databases like this will give opportunities for understanding the population and performing prospective trials.
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Internal medicine journal · Nov 2013
Multicenter StudyAdministration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy.
Appropriately timed cessation of chemotherapy is an important aspect of good quality palliative care. There is wide variation in the reported rates of chemotherapy administration within the last 30 days of life. ⋯ Patients who received chemotherapy in the last 30 days of life were more likely to be male and have a shorter duration of palliative care team involvement. In this study, the observed rate of death within 30 days of chemotherapy is within the range of published data. It is recommended that a standard definition be used to benchmark medical oncology centres and individual oncologists, and to allow comparison over time.
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Internal medicine journal · Sep 2013
Multicenter StudyReducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers.
Patient flow is a major problem in hospitals. Delays in accessing inpatient rehabilitation have not been well studied. ⋯ There are opportunities to improve the efficiency of key processes in the acute hospital journey for patients subsequently admitted to inpatient rehabilitation; in particular, reducing the time from acute hospital admission till referral for rehabilitation and from being deemed ready for transfer to rehabilitation till admission.
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Internal medicine journal · Aug 2013
Randomized Controlled Trial Multicenter StudyWhen do we transfuse cryoprecipitate?
The 2001 National Health and Medical Research Council/Australasian Society of Blood Transfusion Clinical Practice Guidelines for cryoprecipitate are being updated, and cryoprecipitate has been incorporated into new Patient Blood Management modules. ⋯ These results highlight discrepancies between guidelines and practice, providing rationale for the update of the guidelines that is currently underway. Cryoprecipitate has attendant risks, and it is appropriate that transfusion be restricted to situations with good evidence or sound principles to underpin use.