Internal medicine journal
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Internal medicine journal · Mar 2014
Randomized Controlled Trial Multicenter StudyAdherence and outcomes of patients prescribed dabigatran (Pradaxa) in routine clinical practice.
To explore and detail clinical experiences of dabigatran, a novel anticoagulant, after it became available in New Zealand in July 2011. ⋯ A high rate of discontinuation of dabigatran, mainly due to GI symptoms, was observed. There does not appear to be any specific predictor of dabigatran tolerance. When prescribed according to guidelines, rates of serious adverse events associated with dabigatran appear to be low.
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Internal medicine journal · Mar 2014
Randomized Controlled TrialExamining patients' preferences for participation in clinical decision-making: the experience in a Latin American chronic obstructive pulmonary disease and cancer outpatient population.
It is generally accepted that patients prefer to be told the truth by their physicians; however, the practice of partial truth-telling is frequent with an existing 'norm of nondisclosure.' Our primary objective was to determine what patients wanted to be told about their illness, and whether there might be differences between patients with either cancer or advanced chronic obstructive pulmonary disease (COPD). A second objective was to determine how these patients envisioned their participation, or lack thereof, in the treatment decision-making process. ⋯ While they considered the role of their families relevant and wanted information to be shared so that family members might participate in decision-making, they did not want their families to have a right to withhold information, make final decisions.
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Internal medicine journal · Mar 2014
Randomized Controlled TrialMedical practitioners' knowledge and self-reported practices of substitute decision making and implementation of advance care plans.
Advance care planning (ACP) provides patients with the ability to make their decisions known about how they would like to be treated if they lose capacity. Medical practitioners have a key role to play in providing information on ACP to their patients. This research explores their knowledge and attitudes to advance care planning and how this affects their practice. ⋯ Respect for patient wishes expressed in advance directives is reassuringly high. The findings suggest significant misunderstanding by medical practitioners of terminologies and systems around substitute decision-making for incompetent persons. Further education and standardisation of terminologies and systems across different jurisdictions would assist in addressing these issues. Low response rate, relating to only one legal jurisdiction, means results may not be generalisable.
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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.
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Internal medicine journal · Jun 2013
Randomized Controlled TrialHyperuricaemia and gout in New Zealand rural and urban Māori and non-Māori communities.
There are few current data on the prevalence of hyperuricaemia and gout in New Zealand, particularly among the indigenous Māori population. ⋯ Gout and hyperuricaemia were more prevalent in Māori, and participants with gout were more likely to have comorbidities. There was not a higher overall adjusted cardiovascular disease risk in Māori participants with gout. Despite the high prevalence of gout, management remains suboptimal.