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Internal Medicine Journal

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https://read.qxmd.com/read/30724433/driving-with-cardiac-devices-in-australia-does-a-review-of-recent-evidence-prompt-a-change-in-guidelines
#1
REVIEW
Samuel W Lovibond, Justin A Mariani, Morris Odell
Australian Driving Guidelines for patients with pacemakers and implanted cardioverter defibrillators are in line with many around the world, with some minor differences. Some aspects of these guidelines lack contemporary evidence in key decision making areas and make broad recommendations regarding groups with heterogeneous populations. Additionally, more recent studies suggest lower rates of adverse events in some patients with these devices than previously thought. Through a systematic literature review, along with discussion of current guidelines, we combine new evidence with well established risk assessment tools to ask the following questions: Given the heterogeneity of patient risk within the defibrillator population, should guidelines allow for further individualisation of risk and subsequent licensing restrictions? Could some patients with primary prevention automated cardioverter defibrillators could be able to hold a commercial driving license? This article is protected by copyright...
February 6, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30719826/changing-ethnic-and-clinical-trends-and-factors-associated-with-successful-home-haemodialysis-at-auckland-district-health-board
#2
Junaid Y Beig, David J Semple
BACKGROUND: The health and diversity of the population in New Zealand is changing under the influence of many socio-economic factors. This may have shifted the landscape of home haemodialysis (HHD). AIMS: This study examines the demographic and clinical changes, determinants of HHD training and technique outcome, and mortality between 2008 and 2015 at Auckland District Health Board, NZ. MATERIALS AND METHODS: We compared 3 incident cohorts of HHD patients between 2008 and 2015...
February 5, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30719802/is-there-a-role-for-proton-pump-inhibitor-prophylaxis-in-haematology-patients
#3
REVIEW
Emma Leitinger, Lisa Hui, Andrew Grigg
While proton pump inhibitors (PPIs) are widely prescribed as prophylaxis in selected haematology inpatient and outpatients , an informal survey of haematology units around Australia found wide variations in the specific indications for their use. This is consistent with a literature review which showed a paucity of robust evidence to support their use, specifically in chemotherapy-induced mucositis, thrombocytopenia or administration of high dose glucocorticosteroids in the absence of additional risk factors...
February 5, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30697929/use-of-a-three-tiered-clinical-decision-rule-to-quantify-unnecessary-radiological-investigation-of-suspected-pulmonary-embolism
#4
Lauren H Lim, Annabelle Gl Hayes, Dylan J Toh
BACKGROUND: Clinical decision rules for suspected pulmonary embolism are proposed to identify patients suitable for discharge without radiological investigation. Their use varies between institutions. AIMS: To quantify unnecessary radiological investigations for suspected pulmonary embolism (PE) as defined by a newly proposed three-tiered clinical decision rule incorporating the Revised Geneva Score, Pulmonary Embolism Rule-Out Criteria and D-dimer. To quantify missed diagnosis of PE if the proposed clinical decision rule were followed...
January 30, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30693656/predictors-of-acute-hospital-mortality-and-length-of-stay-in-patients-with-new-onset-atrial-fibrillation-a-first-hand-experience-from-a-met-response-provider
#5
Paul M Thein, Julia Ong, Tim M Crozier, Arthur Nasis, Sam Mirzaee, Sean X Tan, Ralph Junckerstorff
BACKGROUND: Atrial fibrillation(AF) occurs frequently following cardiothoracic surgery and treatment decisions are informed by evidence-based clinical guidelines. Outside this setting there is little data to guide clinical management. Our aim was to describe the characteristics, management and outcomes of hospitalised adult patients with new-onset AF. METHODS: The medical emergency team(MET) database was utilised to identify patients who had a 'MET call' activated for tachycardia between 2015 and 2016...
January 28, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30693633/conflicts-of-interest-new-thinking-new-processes
#6
Paul A Komesaroff, Ian Kerridge, Wendy Lipworth
Although the concept of "conflict of interest" (COI) arises in many contexts in health care it is often poorly understood, and commonly accepted definitions are often circular, self-contradictory and unable to provide procedural guidance. To overcome such confusion and imprecision we offer a reformulation of COI that carefully defines interests, clarifies their scope and articulates a simple, non-punitive approach to managing them. We define an "interest" as "a commitment, goal, obligation or duty related to a particular social role or practice"...
January 28, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30693626/prevalence-and-health-care-usage-of-knee-pain-in-south-australia-sa-a-population-based-study
#7
Charlotte Blacketer, Tiffany Gill, Anne Taylor, Catherine Hill
BACKGROUND: It is known that South Australia (SA) has the highest rate of knee arthroscopy use of any state in Australia, however Level 1 evidence demonstrates that knee arthroscopy in patients with uncomplicated knee osteoarthritis confers no benefit. In SA, which patients are presenting with knee pain and what treatments are they receiving? AIMS: To determine the prevalence, persistence and treatment modalities of knee pain in SA. METHODS: This study analysed data from the North-West Adelaide Health Study (1999-2015), a longitudinal, population based cohort study of people aged 18 years and over (n=4060), initially randomly selected from the north-west region of Adelaide, SA...
January 28, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30693625/the-biggest-decision-of-them-all-death-and-assisted-dying-capacity-assessments-and-undue-influence-screening
#8
Carmelle Peisah, Linda Sheahan, Ben White
Arguably, deciding the timing and manner of one's death is the biggest decision of all. With the Victorian Voluntary Assisted Dying Act commencing in 2019, assessing capacity to choose Voluntary Assisted Dying (VAD) becomes a critical issue for clinicians in Victoria, and elsewhere with ongoing efforts to change the law across Australia and in New Zealand. We consider how capacity assessment and undue influence screening can be approached for VAD, the role and risks of supported decision-making, and argue for the importance of training to ensure health care professionals are educated about their role...
January 28, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30693623/patterns-of-immunotherapy-use-and-management-of-toxicities-in-regional-and-tertiary-settings
#9
Brett Hamilton, Kay Xu, Florian Honeyball, Bavanthi Balakrishnar, Rob Zielinski
BACKGROUND: The introduction of the CTLA-4 and PD-1 immune checkpoint inhibitors and their subsequent listing on the PBS for use in metastatic melanomas, renal cell carcinomas and non-small cell lung cancers has resulted in routine use of these agents in oncology practices, including in regional areas. Although immunotherapeutic agents generally have a favourable toxicity profile compared to chemotherapy, they can provoke immune-related adverse effects (irAEs) caused by an unregulated and hyperstimulated immune response...
January 28, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30667165/comparison-between-gallium-68-citrate-pet-ct-and-gallium-67-citrate-scintigraphy-for-infection-imaging
#10
Tatiana Segard, Laurence Mja Morandeau, Marina L Dunne, James O Robinson, Ronan J Murray, Elizabeth A Geelhoed, Roslyn J Francis
BACKGROUND: Preliminary studies have reported promising results for the utility of Ga-68 citrate PET-CT for infection imaging. This technique offers reduced radiation dose to patients, shorter time between injection and imaging and reduced time for image acquisition compared to the 'gold standard' nuclear imaging technique: Ga-67 citrate scintigraphy. AIMS: To compare the two imaging modalities to ascertain whether Ga-68 citrate PET-CT is of equivalent diagnostic efficacy for bone and joint infection or pyrexia of unknown origin (PUO) and to assess image quality and reporter confidence...
January 22, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30667144/resource-use-and-outcomes-in-patients-with-dialysis-dependent-chronic-kidney-disease-admitted-to-intensive-care
#11
Paul Secombe, Pei-Ying Chiang, Basant Pawar
BACKGROUND: Central Australia (CA) has a high prevalence of haemodialysis-dependent-chronic kidney-disease (CKD5D). CKD5D is associated with an increased need for critical care services. AIMS: To describe the demographic features, critical care resource use, and outcomes of patients with CKD5D requiring intensive care admission in CA. METHODS: Retrospective matched cohort database study. Patients with CKD5D who required admission for critical illness between 1 July 2015 and 30 June 2016 were identified using the Centre for Outcome and Resource Evaluation Outcome Measurement and Evaluation Tool (CORE COMET) and matched with patients without CKD5D...
January 22, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30667141/the-impact-of-universal-immunohistochemistry-on-lynch-syndrome-diagnosis-in-an-australian-colorectal-cancer-cohort
#12
Zoe Loh, David S Williams, Lucinda Salmon, Eryn Dow, Thomas John
BACKGROUND: Current guidelines recommend a step-wise screening algorithm for all colorectal carcinomas (CRC) to identify patients with Lynch Syndrome (LS). AIM: We describe the frequencies of mismatch repair deficiency (dMMR), BRAFV600E mutations and MLH1 methylation in resected CRCs, and evaluate the impact of universal screening on LS detection. METHODS: Retrospectively, 1171 consecutive cases of resected CRC were identified between 2010 and 2017 from a large multi-centre pathology service...
January 22, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30667130/immediate-cephalosporin-allergy
#13
Carlo Yuson, Kimti Kumar, Adriana Le, Aida Ahmadie, Tatjana Banovic, Robert Heddle, Frank Kette, William Smith, Pravin Hissaria
BACKGROUND: Patients who suffer from acute IgE-mediated allergy to a cephalosporin antibiotic are frequently assumed to be at high risk of allergy to other cephalosporins and penicillins. OBJECTIVE: To define cross-reactivity patterns in patients with confirmed allergy to a cephalosporin. METHODS: Subjects presenting with a history of immediate allergy to a cephalosporin-family antibiotic between March 2009 to July 2017 were investigated with specific IgE (sIgE) testing to penicillin, amoxicillin and cefaclor, followed by skin prick testing (SPT), intradermal testing (IDT) and drug provocation testing (DPT) with a panel of penicillins and cephalosporins...
January 22, 2019: Internal Medicine Journal
https://read.qxmd.com/read/30582273/the-use-of-biologic-agents-in-the-management-of-uveitis
#14
REVIEW
Amruta Trivedi, Constance Katelaris
The uveitides are a heterogenous group of ocular inflammatory disorders that account for the third highest cause of blindness worldwide1 , responsible for 5-10% of visual impairment globally2 . Up to 35% of patients with uveitis can suffer significant vision loss. To prevent irreversible structural damage and blindness, it is important that the diagnosis and commencement of appropriate therapy occurs promptly. Management includes topical and systemic corticosteroid therapy and conventional immunomodulatory agents, including methotrexate (MTX), azathioprine (AZA), mycophenolate mofetil (MMF), and cyclosporin (CsA)...
December 23, 2018: Internal Medicine Journal
https://read.qxmd.com/read/30582260/association-between-socio-economic-status-and-incident-atrial-fibrillation
#15
Satish Ramkumar, Ayame Ochi, Hong Yang, Nitesh Nerlekar, Nicholas D'Elia, Elizabeth L Potter, Isabella C Murray, Nishee Nattraj, Ying Wang, Thomas H Marwick
BACKGROUND: Low socio-economic status is associated with cardiovascular diseases, and an association with atrial fibrillation(AF) could guide screening. We investigated if indices of disadvantage(IAD), education/occupation(IEO) and economic resources(IER) were associated with incident AF, independent of risk factors and cardiac function. METHODS: We studied community-based participants aged ≥65 years with AF risk factors(n=379, age 70±4 years, 45% men). The CHARGE-AF score (a well validated AF risk score) was used to assess 5-year risk of developing AF...
December 23, 2018: Internal Medicine Journal
https://read.qxmd.com/read/30561089/protocol-for-psychosocial-screening-of-adolescents-and-young-adults-with-chronic-illness
#16
Helen d'Emden, Brett McDermott, Kellee Poulson, Greg McGahan
BACKGROUND: One in five adolescents and young adults (AYAs) have a chronic health condition necessitating on-going engagement with health care systems. Despite increasing prevalence there remains limited understanding of the burden of illness they experience. Living with a chronic illness can challenge healthy adolescent development, with the unique health and developmental issues affecting AYAs requiring different responses from the health care system. METHODS: In a dedicated health service for AYA's aged 15-25 years with chronic health conditions, (13-25 years for those with substance use issues) we detail a protocol where demographics, general health, disease-specific indicators and comprehensive psychosocial variables will be collected...
December 18, 2018: Internal Medicine Journal
https://read.qxmd.com/read/30561039/subclinical-hypothyroidism-during-pregnancy-the-melbourne-public-hospitals-consensus
#17
Peter Shane Hamblin, Penelope M Sheehan, Carolyn Allan, Christine A Houlihan, Zhong X Lu, Simon P Forehan, Duncan J Topliss, Christopher Gilfillan, Bala Krishnamurthy, Debra Renouf, Shoshana Sztal-Mazer, Suresh Varadarajan
BACKGROUND: Interest in potential adverse outcomes associated with maternal subclinical hypothyroidism (normal Free T4, elevated TSH) has increased significantly over recent years. In turn, the frequency of maternal thyroid function testing has risen, despite universal thyroid function screening not being recommended, leading to a marked increase in referrals to obstetric endocrinology clinics. In 2017 the American Thyroid Association (ATA) revised their diagnostic and management guidelines...
December 18, 2018: Internal Medicine Journal
https://read.qxmd.com/read/30552793/calcitriol-loading-before-total-parathyroidectomy-with-autotransplant-in-patients-with-end-stage-kidney-disease-does-it-prevent-postoperative-hypocalcaemia
#18
David Ferreira, Eswari Vilayur, Michael Gao, Christy Sankoorikal, Cino Bendinelli
BACKGROUND: Hungry bone syndrome (HBS) is one of the most serious complications following parathyroidectomy for severe hyperparathyroidism. There is a lack of literature informing the treatment and risk factors for this condition and the ideal pre-operative strategy for prevention. AIMS: The primary aims of this study were to examine the incidence of HBS with pre-operative calcitriol loading for 10 days and to determine the risk factors for HBS. The secondary aims were to determine the rate of intravenous calcium replacement in those with HBS and to assess whether cinacalcet removal has increased rates of parathyroidectomy in the ESKD population...
December 15, 2018: Internal Medicine Journal
https://read.qxmd.com/read/30548387/the-assessment-incidence-and-factors-associated-with-urinary-incontinence-in-older-aboriginal-australians
#19
Kate Smith, Ailsa Sutherland, Zoë Hyde, Ruth Crawford, Anna Dwyer, Roslyn Malay, Linda Skeaf, Leon Flicker, David Atkinson, Dina LoGiudice
BACKGROUND: Little is known about urinary incontinence in older Aboriginal Australians. AIM: To describe urinary incontinence assessment, prevalence, incidence, and associated conditions in older Aboriginal Australians. METHODS: Wave 1 consisted of 363 Aboriginal participants aged ≥45 years from Western Australia. 289 participants participated in Wave 2,with 184 included at both time points. Urinary incontinence was assessed by self-report, family report and the modified International Consultation on Incontinence Questionnaire (ICIQ)...
December 11, 2018: Internal Medicine Journal
https://read.qxmd.com/read/30548385/early-development-of-the-australia-new-zealand-musculoskeletal-anzmusc-clinical-trials-network
#20
REVIEW
Rachelle Buchbinder, Allison Bourne, Jane Latimer, Ian Harris, Sam Whittle, Bethan Richards, William J Taylor, Ornella Clavisi, Sally Green, Rana S Hinman, Lyn March, Ric Day, Manuela L Ferreira, Laurent Billot, Chris G Maher
The Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network was formed to build capacity and infrastructure for high quality musculoskeletal clinical trials in our region. The purpose of this paper is to describe the steps taken in its formation to help others interested in establishing similar networks. In particular we describe the steps taken to form the collaboration and our progress in achieving our vision and mission. Our aim is to focus on trials of highest importance and quality to provide definitive answers to the most pressing questions in our field...
December 11, 2018: Internal Medicine Journal
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