Internal medicine journal
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Internal medicine journal · Jan 2015
Multicenter StudyFactors relating to consent for organ donation: prospective data on potential organ donors.
Obtaining family consent to organ donation is a significant obstacle to improving further Australian deceased organ donation rates. Currently, neither the consent rates for donors eligible to donate after circulatory death, nor factors that influence decision to decline or consent to donation in general are known in Australia. ⋯ Despite a small sample size, these findings describe current consent and donation rates and associated factors and may assist in improving conversations about organ donation.
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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.
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Internal medicine journal · Oct 2014
Multicenter StudyPrevalence and predictors of advance directives in Australia.
Advance care planning is regarded as integral to better patient outcomes, yet little is known about the prevalence of advance directives (AD) in Australia. ⋯ Despite efforts to improve uptake of advance care planning (including AD), barriers remain. One likely trigger for completing an AD and advance care planning is undertaking a wider future planning process (e.g. making a will or financial enduring power of attorney). This presents opportunities to increase advance care planning, but steps are needed to ensure that planning, which occurs outside the health system, is sufficiently informed and supported by health information so that it is useful in the clinical setting. Variations by state could also suggest that redesign of regulatory frameworks (such as a user-friendly and well-publicised form backed by statute) may help improve uptake of AD.
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Internal medicine journal · Jul 2014
Multicenter Study Comparative Study Observational StudyComparison of not for resuscitation (NFR) forms across five Victorian health services.
Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation. ⋯ NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two-stage process of documentation. Stage 1 facilitates discussion of patient-specific goals of care and consideration of limitations of treatment. Stage 2 serves to communicate a NFR order. Decisions to withhold resuscitation are inherently complex but could be aided by separating the decision-making process from the communication of the decision, resulting in improved end-of-life care.
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Internal medicine journal · May 2014
Multicenter StudySpontaneous pneumothorax; a multicentre retrospective analysis of emergency treatment, complications and outcomes.
Spontaneous pneumothorax can be managed initially by observation, aspiration or chest drain insertion. ⋯ Pneumothorax drainage is associated with substantial morbidity including prolonged air leak. As PSP appears to be well tolerated in younger people even with large pneumothoraces, conservative treatment in this subgroup may be a viable option to improve patient outcomes, but this needs to be confirmed in a clinical trial.