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Internal Medicine Journal

Jonathon Schubert, Anuk Kruavit, Sumit Mehra, Sanji Wasgewatta, Anne B Chang, Subhash Heraganahally
BACKGROUND AND OBJECTIVE: Poor lung function is a predictor of future all-cause mortality. In Australia, respiratory diseases are particularly prevalent among the Indigenous population, especially in remote communities. However, there are little published pulmonary function tests (PFT) data of remote-based adult Indigenous patients. We aimed to evaluate the severity of airflow obstruction and other PFT abnormalities of adults referred to specialist respiratory clinics in remote Indigenous communities...
September 21, 2018: Internal Medicine Journal
Kenneth Sim, Bernard Yan, Richard Dowling, Steven Bush, Peter Mitchell
BACKGROUND: The benefits of endovascular clot retrieval (ECR) for anterior circulation stroke with large ischemic cores remain uncertain. In spite of recent pooled analysis of randomized controlled studies, conclusions regarding the fate of large ischemic cores cannot be reached given the small number of included patients. METHODS: This was a single centre retrospective study of patients treated with ECR in the period 2012 to 2017. The inclusion criteria were anterior circulation stroke with symptom onset less than 6 hours, baseline CT perfusion and 90 day clinical follow up defined by the Modified Rankin Score (mRS)...
September 19, 2018: Internal Medicine Journal
Christine Semira, Hui-Li Wong, Kathryn Field, Margaret Lee, Belinda Lee, Louise Nott, Jeremy Shapiro, Rachel Wong, Jeanne Tie, Ben Tran, Gary Richardson, Allan Zimet, Lara Lipton, Babak Tamjid, Matthew Burge, Brigette Ma, Julie Johns, Michael Harold, Peter Gibbs
BACKGROUND: Emerging evidence on the optimal use of chemotherapy and biologics in patients with metastatic colorectal cancer (mCRC) should impact management in routine care. Recent studies have demonstrated benefits for initial triplet chemotherapy (FOLFOXIRI) and for initial treatment with an epidermal growth factor receptor inhibitor (EGFRi) in patients with a RAS wild type tumour and a left-sided primary. AIM: To explore evolving patterns of mCRC care over time in Australia...
September 19, 2018: Internal Medicine Journal
A P Douglas, K A Thursky, L J Worth, S J Harrison, R J Hicks, M A Slavin
BACKGROUND: Despite FDG-PET/CT being funded only for staging and restaging of some malignancies in Australia, there is evidence of benefit of FDG-PET/CT for infection indications such as pyrexia of unknown origin (PUO), prolonged neutropenic fever (NF) and prosthetic device infection. AIMS: To evaluate the current knowledge, utilisation of and gaps in access to FDG-PET/CT for infectious indications by Australasian infectious diseases (ID) physicians and microbiologists...
September 19, 2018: Internal Medicine Journal
Ria Arnold, Tim J Pianta, Bruce A Pussell, Zoltan Endre, Matthew C Kiernan, Arun V Krishnan
In Australia approximately 1.7million adults have evidence of chronic kidney disease (CKD). This complex disease can result in a multitude of complications, including hyperkalaemia which common and well recognised. . The advent of new therapeutics aimed at lowering serum potassium have raised the possibility of optimising potassium control to enable greater use of renin-angiotensin-aldosterone system inhibitors in the management of CKD. Recent studies suggest that hyperkalaemia also has implications for peripheral neuropathy in CKD, a complication that substantially contributes to patient morbidity...
September 19, 2018: Internal Medicine Journal
Rajesh Bhatia, Sern Wei Yeoh, Karl Vaz, Corrie Studd, Jarrad Wilson, Sally Bell, Petr Otahal, Alison Venn
BACKGROUND: High inflammatory bowel disease (IBD) rates have been reported in Australasia, but no state-wide studies have yet been performed. AIMS: This study estimates the one-year incidence and point prevalence of IBD in the state of Tasmania, Australia. It also reports clinical outcomes after twelve months of diagnosis in an incident cohort. METHODS: A prospective, population-based study was performed collecting prevalent and incident state-wide cases from 1st June 2013 to 31st May 2014...
September 19, 2018: Internal Medicine Journal
J Trotman, C Y Cheah, P Marlton, S Opat
Outcomes with follicular lymphoma (FL) have improved in the modern era and median survival is now beyond 15 years. Therapeutic decisions need to consider this increased survival as well as recent clinical trial data and emerging treatments. In this context, we present here current approaches to front-line management of FL in Australia. Treatment choices depend on the disease stage, tumour burden, the patient's age, symptoms, comorbidities and preferences. Only about 10-15% of patients with FL are diagnosed with early stage disease...
September 19, 2018: Internal Medicine Journal
Amrish Krishnan, Yogeshni Chandra, Joji Malani, Shilpanjali Jesudason, Shaundeep Sen, Angus G Ritchie
BACKGROUND: Chronic kidney disease is now a leading cause of death in Fiji. The country lacks even basic statistics about the incidence of end stage kidney disease (ESKD) and presents significant challenges to conducting clinical research. AIM: To estimate the incidence and characteristics of ESKD in Fijian adults. METHODS: A retrospective cohort study was conducted of patients admitted to Colonial War Memorial Hospital in Suva, Fiji in 2012...
September 19, 2018: Internal Medicine Journal
Conceição Santos, Saurabh Gupta, Melissa Baraket, Peter J Collett, Wei Xuan, Jonathan P Williamson
BACKGROUND: Intercostal chest catheter (ICC) insertion is a common hospital procedure with attendant risks including life-threatening complications such as pneumothorax and visceral damage. OBJECTIVE: To investigate the effect of a quality improvement initiative on complications associated with inpatient thoracostomy tube insertion. METHODS: Following an audit of ICC complications in inpatients over a 2 year period we implemented a comprehensive quality improvement (QI) program...
September 19, 2018: Internal Medicine Journal
Chanakya Sharma, Helen Keen
INTRODUCTION: Biologic disease modifying anti rheumatic drugs (bDMARDs) have significantly improved the prognosis for patients with Rheumatoid Arthritis (RA). However, due to their immunosuppressive nature, concerns remain about the potential for infection in patients receiving these medications. AIMS: The aim of this review is to evaluate the incidence of serious infections (SI) in a Western Australian cohort of patients with RA who are receiving bDMARDs. The role of confounders including age, gender, co-morbidities and use of glucocorticoids was also evaluated...
September 19, 2018: Internal Medicine Journal
Ying Hui Lum, Scott McKenzie, Martin Brown, Christian Hamilton-Craig
BACKGROUND: The clinical use of cardiac magnetic resonance (CMR) use in Australian heart failure patients has limited evidence. We examined how CMR, compared to routine echocardiography, affects diagnosis and management of patients with heart failure (HF). METHODS: Single-center retrospective study of HF patients newly referred to the Advanced Heart Failure & Transplant unit at The Prince Charles Hospital, Brisbane. Between January 2010 to December 2014, all patients clinically referred for both CMR and echocardiography in the workup of HF were analyzed...
August 28, 2018: Internal Medicine Journal
Eleanor Rye, Andrea Lee, Arun Narayan, A Robert Denniss, Clara Chow, Pramesh Kovoor, Gopal Sivagangabalan
BACKGROUND: Internationally a growing number of studies have identified race related disparities in the presentation, treatment and outcomes of patients with ST-Elevation Myocardial Infarction (STEMI). With a large migrant population Australia presents a unique microcosm in which to study the impact of migrant status and ethnicity in STEMI patients. AIM & METHODS: We conducted a retrospective observational study utilising data from a clinician-initiated registry to investigate if first-generation migrants differed in presentation, treatment or outcomes following STEMI compared with the Australian-born population...
August 27, 2018: Internal Medicine Journal
Joanna M Z Mills, Andrzej S Januszewski, Bruce G Robinson, Caroline L Traill, Alicia J Jenkins, Anthony C Keech
BACKGROUND: There is a global concern that physician-researchers are "a dying breed." Recent studies of clinical career choices of Australian medical students and doctors have signalled the rising age of medical graduates, generational shifts in work-life attitudes, and increased proportion of female graduates. There are scant data regarding Australian physician-researchers. AIMS: To develop and utilise a questionnaire determining respondent characteristics and 'push and pull' factors for medical graduates to incorporate research into their careers...
August 27, 2018: Internal Medicine Journal
Y M Cheung, K Van, L Lan, R Barmanray, S Y Qian, W Y Shi, Jla Wong, P S Hamblin, P G Colman, D J Topliss, J T Denholm, M Grossmann
OBJECTIVE: Reports from resource-poor countries have associated thionamide- and para-aminosalicylate sodium (PAS)-based treatment of multidrug-resistant tuberculosis (MDR-TB) with the development of hypothyroidism. We aimed to identify predictors and assess the cumulative proportions of hypothyroidism in patients treated for MDR-TB with these agents in Australia. DESIGN, SETTING AND PARTICIPANTS: Retrospective multi-centre study including MDR-TB patients from five academic centres covering TB services in Victoria, Australia...
August 27, 2018: Internal Medicine Journal
Lena R Quinto, Louisa Sukkar, Martin Gallagher
AIMS: Corticosteroids may hasten recovery in drug-induced acute interstitial nephritis (DI-AIN). However, there is no consensus regarding the effectiveness of corticosteroid as compared to non-corticosteroid therapy. METHODS: We conducted a systematic review of the literature according to Preferred Reporting in Systematic Reviews and Meta-Analysis (PRISMA) guidelines using MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science from inception until November 2017 with predefined search terms...
August 21, 2018: Internal Medicine Journal
John Au, Chris Horwood, Paul Hakendorf, Campbell Thompson
BACKGROUND: Hospital congestion is worsened by fewer patients being discharged on the weekend than on weekdays. Weekend admissions fare worse in hospital than weekday admissions. Understanding the fate of patients discharged on the weekend, or any particular weekday, may help optimise hospital discharge processes. AIM: To determine the effects of weekend and specific weekday discharges on adverse outcomes (mortality and readmission to hospital). METHODS: Electronic records were used to identify unplanned admissions to two large public hospitals across a five-year period...
August 21, 2018: Internal Medicine Journal
Jonathan Wong, Erica M Wood, Philip Crispin, Robert Weinkove, Zoe K McQuilten
BACKGROUND: Acquired hypogammaglobulinaemia secondary to haematological malignancies is associated with increased infection risk. Immunoglobulin (Ig) replacement reduces major infections but not mortality, and is costly. No prospective randomized trials have compared Ig replacement with prophylactic antibiotics. AIMS AND METHODS: To inform trial development, we conducted an online survey of current clinical practice regarding management of secondary hypogrammaglobulinaemia among haematologists in Australia and New Zealand...
August 21, 2018: Internal Medicine Journal
Johannes Nossent, Warren Raymond, Helen Keen, Charles Inderjeeth, David B Preen
OBJECTIVES: Immunoglobulin A vasculitis (IgAV) is a systemic small-vessel vasculitis of unknown aetiology. Although commonest in children, onset in adulthood is not unusual. As Australian data are lacking, we investigated longitudinal hospitalisation rates and characteristics for both adult and paediatric IgAV patients in Western Australia (WA). METHODS: Data was extracted from a state-wide register for all first hospital contacts in WA between 1980 and 2015 for patients with a primary diagnosis of IgAV...
August 8, 2018: Internal Medicine Journal
Penelope Casey, Wendy Cross, Melinda Webb-St Mart, Cathryn Baldwin, Kath Riddell, Peteris Darzins
BACKGROUND: Delirium in hospitalised patients is common, and a risk factor for adverse outcomes. Health services require accurate delirium data to monitor the impact of initiatives designed to improve detection and prevention of delirium. AIM: To determine the extent to which ICD codes represent delirium occurrence. METHODS: A cross-sectional point prevalence survey was used to audit delirium occurrence in 25 inpatient wards of an Australian health service...
August 8, 2018: Internal Medicine Journal
William R Good, Pernille M Christensen, Samantha Herath, Paul Dawkins, Elaine Yap
BACKGROUND: Radial-probe endobronchial ultrasound (radial-EBUS) is becoming an important investigation for peripheral pulmonary lesions (PPLs). A key advantage of radial-EBUS is the favourable risk profile compared with current gold-standard CT-guided biopsy. AIMS: To investigate the diagnostic yield, predictors of positive yield and radial-EBUS safety in a New Zealand institution. We also determined whether molecular analysis was possible on the same tissue samples...
August 8, 2018: Internal Medicine Journal
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