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David Wilkinson

Publications and source records attributed to David Wilkinson.

64 records · Page 4Linked to original sources
PubMed2002

The Professional Development Program of the Australian College of Rural and Remote Medicine.

BACKGROUND: The case for doctors' performance and maintenance of competence are issues of increasing importance for the profession, governments and communities. There is also increasing public expectation that the profession will be pro-active in protecting patients from under performing doctors. The Australian College of Rural and Remote Medicine (ACRRM) positions itself as the arbiter of standards for rural and remote medical practice and has assumed responsibility for providing a mandatory Professional Development Program (PDP) for its Fellows. OBJECTIVE: This paper outlines the steps taken by the ACRRM to design and develop a PDP. DISCUSSION: The PDP aims to enable doctors to participate in a range of continuing education activities that enhance their clinical, management and professional skills. Participation is mandatory but the program is designed to be flexible and responsive to the range of practice characteristics in rural Australia as well as to individual needs. The PDP includes categories on continuing medical education, quality assurance and clinical assessment (with minimum compulsory requirements), practice assessment, educator activities and educational development activities. The PDP will evolve over time to meet the needs of doctors and communities in rural and remote Australia.

Australia↗
PubMed2002

HIV infection.

Explore the source record for details and available documents.

Anti-HIV Agents↗
PubMedDate not supplied

A new solution for an old problem? Effects of a nurse-led, multidisciplinary, home-based intervention on readmission and mortality in patients with chronic atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF), the most common chronic cardiac dysrhythmia, is an important cause of cardiovascular morbidity and mortality. However, there is a paucity of studies examining the potential benefits of optimizing the postdischarge management of patients with chronic AF. RESEARCH OBJECTIVE: To examine the effects of a nurse-led, multidisciplinary, home-based intervention (HBI) on the pattern of recurrent hospitalization and mortality in patients with chronic AF in the presence and absence of chronic heart failure (HF). PATIENT COHORT AND METHODS: Health outcomes in a total of 152 hospitalized patients (53% male) with a mean age of 73 +/- 9 years and a diagnosis of chronic AF who were randomly allocated to either HBI (n = 68) or usual postdischarge care (UC: n = 84) were examined. Specifically, the pattern of unplanned hospitalization and all-cause mortality during 5-year follow-up were compared on the basis of the presence (n = 87) and absence (n = 65) of HF at baseline. RESULTS: Patients with concurrent HF exposed to HBI (n = 37) had fewer readmissions (2.9 vs 3.4/patient), days of associated hospital stay (22.7 vs 30.5: P = NS) and fatal events (51 % vs 66%) relative to UC (n = 50): P = NS for all comparisons. In the absence of HF, morbidity and mortality rates were significantly lower but still substantial during 5-year follow-up. In these patients, HBI was associated with a trend towards prolonged event-free survival (adjusted RR = 0.70; P = .12) and fewer fatal events (29% vs 53%, adjusted RR = 0.49; P = .08). HBI patients (n = 31) also had fewer readmissions (2.1 vs 2.6/patient) and days of associated hospital stay (16.3 vs 20.3/patient), although this did not reach statistical significance. On the basis of these data, it was calculated that a randomized study of an AF-specific HBI would require 250 patients followed for a median of 3 years to detect a 25% variation in recurrent hospital stay relative to UC. CONCLUSIONS: These unique data provide sufficient preliminary evidence to support the hypothesis that the benefits of HBI in relation to the management of HF may extend to "high risk" patients with chronic AF in whom morbidity and mortality rates are also unacceptably high. Further, appropriately powered studies are required to confirm these benefits.

Aftercare↗
PubMedDate not supplied

The role of paracetamol in chronic pain: an evidence-based approach.

Chronic pain is a significant public health burden. Several international guidelines and influential reviews recommend the use of paracetamol (acetaminophen) as the first-line analgesic of choice for the management of chronic pain. These recommendations are based largely on the balance of evidence, which favorably demonstrates the efficacy, safety, and low cost of paracetamol relative to other analgesics.A decade ago, March et al suggested that because of the dangers associated with conventional nonsteroidal antiinflammatory (NSAID) use, particularly in the elderly, they should ideally not be used without an individual n-of-1 trial to show that they are more effective than paracetamol. Today, the results of our investigations into the individualization of pain management options continue to support this suggestion. Based on the data available to date, it still seems prudent to use NSAIDs only in those patients in whom there is good evidence of improved efficacy over paracetamol. In patients with chronic pain, paracetamol can play an important role as an NSAID sparer, with resultant benefits in terms of reduced adverse effects and cost savings.

Acetaminophen↗
PubMedDate not supplied

The effect of link nurses on hospital readmission rates.

This study investigates whether visits to a patient early post-discharge by a member of the ward team (locality link nurse) reduces psychiatric hospital readmission rates for older people and improves the physical and psychological state of the patient. This is a summary of the paper the full version can be accessed at nursingtimes.net.

Aged↗