Internal medicine journal
-
Internal medicine journal · Jun 2016
Randomized Controlled Trial Multicenter StudyMulti-site placebo-controlled randomised clinical trial to assess protection following oral immunisation with inactivated non-typeable Haemophilus influenzae in chronic obstructive pulmonary disease.
Previous studies identified factors that modify response to an oral non-typeable Haemophilus influenzae (NTHi) vaccine in chronic obstructive pulmonary disease (COPD): severe COPD, moderate-severe exacerbations as end-point and a threshold prevalence of NTHi in the study population. More data are needed to confirm parameters that influence clinical outcomes. ⋯ Patients aged 40-88 years with moderate to severe COPD and low rates of H. influenzae-positive sputum were not protected against exacerbations by HI-1640V. Further studies are needed to confirm protection in subjects aged <65 years. Older age and low colonisation rates appear to affect adversely response to this vaccine.
-
Internal medicine journal · Jan 2015
Randomized Controlled TrialDoes the availability of therapeutic drug monitoring, computerised dose recommendation and prescribing decision support services promote compliance with national gentamicin prescribing guidelines?
Gentamicin is an aminoglycoside antibiotic that is highly effective in treating Gram-negative infections, but inappropriate use leads to toxicity. In 2010, the Australian Therapeutic Guidelines (Antibiotic) were revised to recommend the use of computerised methods to individualise dosing of gentamicin and optimise therapy, rather than traditional nomogram approaches. ⋯ In comparison with the national guidelines, there was significant under-dosing and monitoring practices were haphazard. Computerised electronic alerts were ineffective in informing users. To improve prescribing practices, we recommend exploring alternative computerised decision support approaches (e.g. pre-written orders) and more pervasive and persuasive implementation strategies.
-
Internal medicine journal · Dec 2014
Randomized Controlled Trial Multicenter StudyMetoclopramide for patients with intractable hiccups: a multicentre, randomised, controlled pilot study.
Limited data exist regarding the efficacy of metoclopramide in the treatment of intractable hiccups. ⋯ Metoclopramide appears to be a promising candidate for the treatment of patients with intractable hiccups, with mild adverse events. However, further clinical trials are required to confirm these results.
-
Internal medicine journal · Sep 2014
Randomized Controlled TrialEffect of hospital-based telephone coaching on glycaemic control and adherence to management guidelines in type 2 diabetes, a randomised controlled trial.
Failure to achieve treatment targets is common among people with type 2 diabetes. Cost-effective treatments are required to delay the onset and slow the progression of diabetes-related complications. ⋯ Telephone coaching improved glycaemic control and adherence to complication screening in people with type 2 diabetes, for the duration of its delivery, but these effects were not maintained on withdrawal of the intervention. Strategies that assist patients to sustain these benefits are required.
-
Internal medicine journal · Sep 2014
Randomized Controlled TrialEffect of a patient-directed discharge letter on patient understanding of their hospitalisation.
Poor patient understanding of their diagnosis and treatment plan can adversely impact clinical outcome following hospital discharge. Discharge summaries are primarily written for the doctor rather than the patient. We determined patient understanding of the reasons for hospitalisation, in-hospital tests, treatments and post-discharge recommendations, and whether a brief patient-directed discharge letter (PADDLE) delivered during a brief discussion prior to discharge would improve understanding. ⋯ A simple patient-directed letter delivered during a brief discussion improves patient understanding of their hospitalisation and post-discharge recommendations, which is otherwise limited. Further evaluation of this brief and well-received intervention is indicated, with the goal of improving patient understanding, satisfaction and clinical outcomes.