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Internal Medicine Journal

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https://www.readbyqxmd.com/read/28516725/the-need-for-better-preventative-strategies-for-inflammatory-bowel-disease-patients-at-risk-of-herpes-zoster-virus
#1
William Bye, Miles Sparrow, Susie Connor, Jane Andrews, Katie Ellard, Watson Ng, Georgia Hume, Sally Antoniades, Alissa Walsh
BACKGROUND: Immunosuppressed IBD patients have an increased risk of HZV infection. The existing live-attenuated HZV vaccine is contraindicated in some of these patients and can only be used with caution in others. AIMS: To describe characteristics of IBD patients suffering HZV to enable implementation of risk mitigation strategies for those at highest risk. METHODS: Gastroenterologists completed a proforma for IBD patients who experienced HZV infection: IBD phenotype, details of HZV infection, immunosuppression and any change to treatment upon diagnosis of HZV...
May 17, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28509435/inpatient-iron-deficiency-detection-and-management-how-do-general-physicians-and-gastroenterologists-perform-in-a-tertiary-care-hospital
#2
Muhammad Waqas Fazal, Jane Andrews, Josephine Thomas, Eliana Saffouri
BACKGROUND: Iron deficiency (ID) is often an indicator of underlying pathology. Early detection and treatment avoids long term morbidity, and allows for prompt iron repletion avoiding ID anaemia (IDA) and need for blood transfusion. AIM: We aimed to evaluate the management of ID in two internal medicine units [General Medical (GM) & Gastroenterology (GE)] in a large metropolitan hospital and compare it to international guidelines.(3,4) METHOD: All consecutive inpatient admissions under GM & GE units were retrospectively reviewed until 40 patients in each service were identified with anaemia and/or microcytic hypochromic blood counts...
May 16, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28509402/a-combined-hands-on-teaching-program-and-clinical-pathway-focused-on-pleural-ultrasound-and-procedure-supervision-transforms-pleural-procedure-outcomes
#3
Timothy Edwards, Alistair Cook, Matthew Salamonsen, Farzad Bashirzadeh, David Fielding
INTRODUCTION: Management of pleural effusions is a common diagnostic and management problem. We reviewed the outcomes from pleural procedures after the instigation of pleural effusion management guidelines focusing on pleural ultrasound and a hands-on teaching program followed with procedure supervision that enabled many operators to perform such procedures. METHODS: A retrospective analysis of all procedures performed for pleural effusions on medical patients. Outcomes were assessed prior to the instigation of pleural effusion management guidelines (pleural pathway) and hands-on teaching (January 2010 to June 2011) and following these interventions (January 2012 to June 2013)...
May 16, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28509399/association-of-renin-angiotensin-antagonists-with-adverse-perioperative-events-in-patients-undergoing-elective-orthopaedic-surgery-a-case-control-study
#4
Amith Zainudheen, Ian A Scott, Xenia Caney
BACKGROUND: Renin angiotensin antagonists (RAAs) may block protective vasopressor responses during surgery. Evidence linking RAAs with intraoperative hypotension and perioperative adverse events is conflicting. METHODS: Retrospective case-control study of 258 consecutive patients who underwent elective total knee or hip replacement between January 1(st) 2013 and August 31(st) 2016, and who were chronically prescribed a single blood pressure lowering agent up to the time of surgery...
May 16, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28485885/hospital-occupancy-and-discharge-strategies-a-simulation-based-study
#5
S Qin, C Thompson, T Bogomolov, D Ward, P Hakendorf
BACKGROUND: Increasing demand for hospital services has resulted in more arrivals to emergency department (ED), increased admissions, and, quite often, access block and ED congestion, along with patients' dissatisfaction. Cost constraints limit an increase in the number of hospital beds, so alternative solutions need to be explored. AIMS: The aims of this study were to propose and test different discharge strategies which, potentially, could reduce occupancy rates in the hospital, thereby improving patient flow and minimising frequency and duration of congestion episodes...
May 9, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28485821/the-role-of-telehealth-in-perioperative-medicine-for-regional-and-rural-patients-in-queensland
#6
Alec Tam, Amy Leung, Cara O'Callaghan, Narelle Fagermo
BACKGROUND: Australians living in regional, rural, and remote areas face a myriad of complexities resulting in a trend to poorer health outcomes. Telehealth is being utilised as an alternative mode of service delivery to overcome such barriers. However, there is limited published information concerning the use of telehealth in perioperative medicine. AIMS: The purpose of this study was to review the performance of the telehealth pre-operative assessment service at Mater Hospital Brisbane to determine last-minute cancellation rates secondary to medical reasons...
May 9, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28485067/chemotherapy-related-cardiotoxicity-are-australian-practitioners-missing-the-point
#7
Rachel Conyers, Ben Costello, Anne Tripaydonis, Charlotte Burns, Louise Ludlow, Peter Lange, Paul Ekert, Francoise Mechinaud, Michael Cheung, Michelle Martin, David Elliot
BACKGROUND: It has long been established that cardiotoxicity occurs as a result of exposure to certain chemotherapeutics, particularly anthracyclines. Historically, clinicians equate cardiotoxicity with a poor prognosis, in a small percentage of patients and deem long-term surveillance as optional. Emerging evidence suggests that anthracycline cardiotoxicity (ACT) is a life-long risk with an incidence approaching 20%. METHODS: Participants were identified via the Haematology-Oncology (HO) database at the Royal Children's Hospital, Melbourne...
May 9, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28485058/survey-of-practices-around-pharmaceutical-company-funding-for-continuing-professional-development-among-medical-oncologists-and-trainees-in-australia
#8
Yeh Chen Lee, René Kroon, Bogda Koczwara, Ian Haines, Kay Francis, Michael Millward, Richard Kefford, Ian Olver, Linda Mileshkin
BACKGROUND: Completion of continuing professional development (CPD) is mandatory for Medical Oncologists and Trainees (MO&T). Pharmaceutical companies may fund some CPD activities, but there is increasing debate about the potential for conflicts of interest (COI). AIM: We aimed to assess current practices around funding to attend CPD activities. METHODS: An electronic survey was distributed to Australian MO&T. The survey asked questions about current practices, institutional policies and perceptions about attending CPD funded by pharmaceutical companies...
May 9, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28485026/giant-cell-arteritis-beyond-temporal-artery-biopsy-and-steroids
#9
REVIEW
Jem V Ninan, Susan Lester, Catherine L Hill
Giant cell arteritis is the commonest primary vasculitis of the elderly. The acute complications of untreated Giant cell arteritis such as vision loss or occasionally stroke can be devastating. The diagnosis is however not altogether straightforward due to variable sensitivities of the temporal artery biopsy as a reference diagnostic test. In this review, we discuss the increasing role of imaging in the diagnosis of Giant cell arteritis. Glucocorticoid treatment is the backbone of therapy but it is associated with significant adverse effects...
May 9, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28444883/approaches-for-optimising-intravenous-iron-dosing-in-pregnancy-a-retrospective-cohort-study
#10
Luke E Grzeskowiak, Alaa Qassim, Bill Jeffries, Rosalie M Grivell
AIMS: To examine the relationship between dose of intravenous iron administered during pregnancy according to different maternal body weight measures and subsequent treatment response. METHODS: Retrospective cohort study of pregnant women with confirmed iron deficiency anaemia who received intravenous iron polymaltose at a tertiary teaching hospital in Australia from January 1(st) , 2014 to January 31(st) , 2016. Diagnosis of anaemia and/or iron deficiency, infusion dosage characteristics, and haematological parameters were collected from paper-based case notes and electronic records...
April 26, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28444872/saving-costs-through-a-coordinated-care-model-for-patients-with-hepatocellular-cancer
#11
Tsai-Wing Ow, Lucy Ralton, Edmund Tse
BACKGROUND: In keeping with recent trends, patients with hepatocellular cancer have had their care managed by a dedicated Nurse Coordinator at our tertiary Australian hospital since 2010. To date, there is little data to justify the cost-effectiveness of this approach. AIMS: The aim of this study is to quantify the potential cost saved through the employment of a Nurse Coordinator into the management of patients with hepatocellular carcinoma at a single tertiary-level Australian hospital...
April 26, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28444819/antenatal-maternal-hepatitis-b-care-is-a-predictor-of-timely-perinatal-administration-of-hepatitis-b-immunoglobulin
#12
Suong Tt Le, Lukas Sahhar, Stephanie Spring, William Sievert, Anouk T Dev
BACKGROUND: Mother-to-child transmission (MTCT) of hepatitis B virus continues to occur despite universal recommendations for neonatal immune prophylaxis therapy (IPT) and infant vaccination. AIM: To characterise the risk factors for failure to provide timely IPT and completion of the infant hepatitis B vaccination schedule for children born to mothers with Chronic Hepatitis B (CHB). METHODS: We conducted a retrospective cohort study to assess compliance with universal guidelines for neonatal IPT for children born to CHB mothers at Monash Health, Australia from 2008 to 2013...
April 26, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28422454/childhood-maltreatment-and-adulthood-poor-sleep-quality-a-longitudinal-study
#13
Amanuel Alemu Abajobir, Steve Kisely, Gail Williams, Lane Strathearn, Jake Moses Najman
BACKGROUND: Available evidence from cross-sectional studies suggests that childhood maltreatment may be associated with a range of sleep disorders. However, these studies have not controlled for potential individual, familial and environmental level confounders. AIM: To determine the association between childhood maltreatment and lower sleep quality, after adjusting for potential confounders. METHODS: Data for the present study are from a pre-birth cohort study of 3778 young adults (52...
April 19, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28422448/the-benefits-of-clinical-facilitators-on-improving-stroke-care-in-acute-hospitals-a-new-program-for-australia
#14
Tara Purvis, Karen Moss, Linda Francis, Karen Borschmann, Monique F Kilkenny, Sonia Denisenko, Christopher F Bladin, Dominique A Cadilhac
BACKGROUND: Care gaps for stroke lead to preventable disability and deaths. The Victorian State Government implemented a program of employing clinical Facilitators on a fixed-term basis for up to three years (2008-2011) in eight hospitals to improve stroke care. The Facilitators were to establish stroke units where absent, implement evidence-based management protocols and provide staff education within an agreed work plan. The aim of this study was to determine if the Facilitator role was associated with improved stroke care, and to describe factors supporting or mitigating enhancements to care...
April 19, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28422404/the-use-of-resuscitation-plans-at-a-tertiary-australian-hospital-room-for-improvement
#15
Roger J Smith, John D Santamaria, Jennifer A Holmes, Espedito E Faraone, Patricia N Hurune, David A Reid
OBJECTIVES: To evaluate the introduction of a document for recording the resuscitation plans of patients at a tertiary hospital. The 'Acute Resuscitation Plan' (ARP) was introduced in September 2014, superseding the 'Not for Cardiopulmonary Resuscitation (CPR)' form. Unlike the Not for CPR form, the ARP was relevant to patients with and without resuscitation limits. DESIGN: Retrospective audit of the records of all admissions to the hospital from January-June 2014 (Not for CPR period) and January-June 2015 (ARP period)...
April 19, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28401688/goals-of-patient-care-system-change-with-video-based-education-increases-rates-of-advance-cardiopulmonary-resuscitation-decision-making-and-discussions-in-hospitalised-rehabilitation-patients
#16
Claire Johnson, Jeffrey Chong, Anne Wilkinson, Barbara Hayes, Sonia Tait, Nicholas Waldron
BACKGROUND: Advance CPR discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR. AIM: To assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients. METHODS: A pre-post study tested two interventions: i) standard ward-based education forums with CPR content; and ii) a combined, two-pronged strategy with 'Goals of Patient Care' (GoPC) system change and structured video-based workshop; against usual practice (ie no formal training)...
April 12, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28401682/guideline-based-intervention-to-reduce-telemetry-rates-in-a-large-tertiary-centre
#17
Satish Ramkumar, Edward H Tsoi, Ajay Raghunath, Floyd F Dias, Christopher Li Wai Suen, Andrew H Tsoi, Darren R Mansfield
BACKGROUND: Inappropriate cardiac telemetry use is associated with reduced patient flow and increased health care costs. AIM: To evaluate the outcomes of guideline-based application of cardiac telemetry. METHODS: Phase I involved a prospective audit(03-09/2011) of telemetry use at a tertiary hospital. Data was collected on indication for telemetry and clinical outcomes. Phase II prospectively included patients > 18yrs under general medicine requiring ward based telemetry...
April 12, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28401645/body-composition-and-micronutrient-deficiencies-in-patients-with-an-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#18
Charith Horadagoda, Timothy Dinihan, Mary Roberts, Kristina Kairaitis
Chronic obstructive pulmonary disease (COPD) is a multisystem disorder. Abnormal body composition (BC) and low serum micronutrient levels contribute significantly to morbidity associated with acute exacerbations of COPD (AECOPD). The BC and serum levels of selected micronutrients were recorded in prospective, consecutive patients admitted to hospital with an AECOPD in Western Sydney. 94 patients were enrolled, 43% female, the average age was 69.8 ± 8.2years(SD). Admission spirometry revealed a mean spirometric ratio of 0...
April 12, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28401639/targeting-ldl-cholesterol-with-pcsk9-inhibitors
#19
REVIEW
Daniel J Scherer, Adam Nelson, Peter J Psaltis, Stephen J Nicholls
Over the last quarter century, clinical trials have consistently demonstrated that lowering levels of low-density lipoprotein cholesterol (LDL-C) with statins reduce the rate of major adverse cardiovascular events. However, the findings that many patients continue to experience events or harbour inappropriately high LDL-C levels despite intensive statin therapy and the clinical reality of statin intolerance suggests that additional therapeutic strategies are required in order to achieve more effective reductions in cardiovascular risk...
April 12, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28370833/infectious-complications-in-indigenous-renal-transplant-recipients-in-western-australia
#20
Peter Boan, Ramyasuda Swaminathan, Ashley Irish
BACKGROUND: Infectious complications remain a significant risk following renal transplantation. AIMS: To examine the burden and pattern of infection following renal transplantation in Aboriginal and Torres Strait Islanders (ATSI) compared to non-ATSI. METHODS: Retrospective cohort study of 141 consecutive adult renal transplant recipients in Western Australia between 2005 and 2011. We determined baseline serological status for relevant organisms, the number of patients with specific infections and infectious admission in the first year post transplantation and the rate of infectious death during follow up...
April 3, 2017: Internal Medicine Journal
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