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Internal Medicine Journal

Siah Kim, Joshua R Lewis, Louise A Baur, Petra Macaskill, Jonathan C Craig
BACKGROUND: Few studies have focused on the prevalence of obesity and hypertension among young people (ages 15 to 24).. AIM: To characterise the prevalence of obesity and systolic hypertension in young people aged 15 to 24 years across Australia.. METHODS: Using data from the 2011-2012 Australian Health Survey, a national cross-sectional population-based survey, we included 2 163 young people aged 15 to 24 years. Risk factors were estimated using multinomial logistic regression...
October 20, 2016: Internal Medicine Journal
Kim Robyn Kennedy, Assoc Prof Kirsten Auret
BACKGROUND: Febrile neutropenia is a life-threatening complication of chemotherapy. The widely dispersed population of Australia creates challenges for rural patients in accessing healthcare services. Cancer treatment is particularly burdensome with patients being forced to relocate to the city for treatment, or to endure long and repeated journeys to the city. This study aimed to assess the safety of chemotherapy in a rural centre with a General Physician-led model, by analysing febrile neutropenia in Albany Hospital, a regional cancer centre in Western Australia...
October 18, 2016: Internal Medicine Journal
J Trotman, J Trinh, Y L Kwan, J A Estell, J Fletcher, K Archer, K Lee, K Foo, J Curnow, A Bianchi, L Wignall, E Verner, R Gasiorowski, E Siedlecka, I Cunningham
BACKGROUND: Multidisciplinary Team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings. AIMS: We aimed to develop a process for formal peer review of patients with haematologic malignancies, and to audit any resulting changes made to the management recommendations of the treating physician. METHODS: A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings...
October 18, 2016: Internal Medicine Journal
Sanka Amadoru, Kwang Lim, Mark Tacey, Craig Aboltins
AIMS: To explore differences in presentation and outcomes between younger and older patients with bacterial spinal infections. METHODS: Clinical, microbiological and radiological information was collected for patients at a single metropolitan hospital with spinal infections (spondylodiscitis, vertebral osteomyelitis, septic discitis, facet joint septic arthritis, and spinal epidural abscess) between January 2008 and January 2015. Patients were excluded if under 18 years of age, or if clinical and imaging findings were inconsistent with the diagnosis...
October 18, 2016: Internal Medicine Journal
Ronelle E Welton, David J Williams, Danny Liew
BACKGROUND: This study provides the first contemporary epidemiological insight into venomous injuries based on demographics and geography in Australia in the timeframe 2000-2013. METHODS: Analysis of national hospitalisation and mortality data to examine the incidence of injury and death due to envenoming in Australia. Rates were calculated using the intercensal population for all Australian age groups. RESULTS: Over the study period, deaths were due to an anaphylactic event (0...
October 17, 2016: Internal Medicine Journal
Emilia Ip, Adrian M J Pokorny, Stephen Della-Fiorentina, Philip Beale, Victoria Bray, Belinda E Kiely, Prunella Blinman
BACKGROUND: Octogenarians represent a growing population reviewed in medical oncology clinics, yet there is a paucity of data on how chemotherapy is tolerated in this age group. AIM: To describe the use of palliative first-line chemotherapy in patients 80 years and over, and factors associated with its use. METHODS: We identified all new patients aged 80 years or older diagnosed with incurable advanced solid organ cancer, and seen in one of three Sydney medical oncology outpatient clinics between January 2009 and December 2013...
October 17, 2016: Internal Medicine Journal
S M Wijayaratna, T Cundy, P L Drury, S Sehgal, S A Wijayaratna, F Wu
BACKGROUND/AIMS: Lower limb (LL) cellulitis related hospitalisations are prevalent in type 2 diabetes (T2DM) subjects. We assess its costs and factors associated with length of stay and readmissions. METHODS: A retrospective case-control study at an urban hospital servicing a multi-ethnic population in New Zealand, where 7% of the adult population is estimated to have diabetes. Admissions with LL cellulitis in 2008-2013 were identified using coding records. Subsequent hospitalisations after 1 month with the same diagnosis were classified as readmissions...
October 17, 2016: Internal Medicine Journal
Gillian E Caughey, Agnes I Vitry, Emmae N Ramsay, Andrew L Gilbert, Sepehr Shakib, Philip Ryan, Adrian Esterman, Robyn A McDermott, Elizabeth E Roughead
BACKGROUND: Little is known about the impact of a general practitioner management plan (GPMP) on health outcomes of patients with diabetes. AIM: To examine the impact of a GPMP on risk of hospitalisation for diabetes. METHODS: A retrospective study using administrative data from the Australian Government Department of Veterans' Affairs was conducted (1st July 2006 to 30th June 2014) of diabetes patients either exposed or unexposed to a GPMP...
October 8, 2016: Internal Medicine Journal
Iain A Kaan, Geoffrey McCaughan, Tracey Jones
OBJECTIVE: To determine the likely current capacity of accredited treatment centres in treating hepatitis C (HCV) patients with Interferon free Direct Acting (DAA) Antiviral agents in Australia. METHOD: Data was collected from 22 centres before the introduction of DAA therapy - 11 sites from the Study 1 survey and an additional 11 sites from the Study 2 survey. The sites were selected based on consensus by viral hepatitis experts, in consultation with the NSW Agency for Clinical Innovation...
September 26, 2016: Internal Medicine Journal
Barry D Hock, Nicholas D McIntosh, Judith L McKenzie, John F Pearson, Jeremy W Simcock, Sean A MacPherson
BACKGROUND AND AIM: Chronic lymphocytic leukemia (CLL) is associated with an increased incidence and aggressiveness of skin cancers, in particular cutaneous squamous cell carcinoma (cSCC), but little is known of cSCC incidence in Australasian CLL patients. In this retrospective study we analysed the incidence of cSCC in patients seen at a tertiary hospital in New Zealand (NZ). METHODS: We retrospectively assessed the clinical history and histology data of CLL patients (n = 371) who were seen at the Haematology Department, Christchurch Hospital, NZ during the period 1996-2015...
September 24, 2016: Internal Medicine Journal
Lironne Wein, Catherine Rowe, Benjamin Brady, Despina Handolias, Lara Lipton, David Pook, Robert Stanley, Ian Haines
BACKGROUND: In recent years there has been a significant increase in the number of cancer treatments that have become available. However, it has remained difficult to choose the most appropriate time to cease active therapy in individual patients. AIM: To determine the proportion of patients being treated with palliative intent who received systemic anticancer treatment in the last 30 days of life. METHODS: This is a retrospective cohort study conducted within the Melbourne Oncology Group at Cabrini Hospital...
September 23, 2016: Internal Medicine Journal
Kate Diana Williamson, Madeleine G Gill, Jane Mary Andrews, Hugh Aj Harley
BACKGROUND: Alcoholic liver disease (ALD) carries a significant cost burden, and often leads to inpatient care. It is unclear whether inpatient care for ALD is any more costly than admission for other reasons. AIMS: To compare the costs and outcomes of inpatient care for ALD to two groups: a control group of matched cases admitted in the same timeframe, and people admitted for other chronic liver diseases (CLD). METHODS: All admissions for ALD and other CLD in a 3-month period were retrospectively identified ...
September 19, 2016: Internal Medicine Journal
Yee-Ming Cheung, Anju Joham, Sharon Marks, Helena Teede
Obesity is a growing epidemic both in Australia and worldwide. Being overweight or obese is known to be adversely associated with multiple cardiovascular risk factors such as type 2 diabetes mellitus, lipid disorders and hypertension. Despite the adverse impact of overweight and obesity, recent observational studies have suggested that in some overweight and obese individuals with established chronic disease, there is a survival advantage which is paradoxically better than individuals of normal weight. A burgeoning area of interest is the existence of this paradox in chronic endocrine disorders, especially with respect to osteoporosis, type 2 diabetes mellitus, as well at the latter's chronic complications: chronic kidney disease and coronary artery disease...
September 19, 2016: Internal Medicine Journal
Carolina X Sandler, Blake A Hamilton, Sarah L Horsfield, Barbara K Bennett, Ute Vollmer-Conna, Chris Tzarimas, Andrew R Lloyd
BACKGROUND: Medically-unexplained chronic fatigue states are prevalent, and challenging to manage. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) are effective in clinical trials. Evaluation of delivery in a standard health care setting is rare. An integrated treatment program with individualised allocation of resources to patients' needs, was developed and implemented though an academic outpatient clinic. It was hypothesised that the program would result in similar responses to those observed in the clinical trials...
September 13, 2016: Internal Medicine Journal
Christine Fenton, Aysha Al Ani, Andrew Trinh, Ashish Srinivasan, Geoffrey Hebbard, Kaye Marion
BACKGROUND: In Australia, correspondence is routinely sent to general practitioners following a specialist consultation. Written communication is an important way to enhance patient experiences and understanding, yet most patients do not receive copies of their medical correspondence. AIMS: Determining whether providing clinic correspondence and endoscopy reports to patients leads to improved understanding, satisfaction or anxiety. METHODS: Prospective, randomised controlled study conducted at an Australian tertiary hospital from October 2013 to February 2015...
September 12, 2016: Internal Medicine Journal
Rob Lee, Amin Aminian, Paul Brunton
There is a potential for gastro-oesophageal reflux disease (GORD) to be under diagnosed by physicians. A quick, focused examination, requiring no special equipment, of a patients' dentition can assist in making a more accurate diagnosis where GORD is suspected. Guidance is provided for physicians as to what intra-oral signs are suggestive of intrinsic dental erosion, which is a clinical feature of GORD and its associated conditions. Use of this information will it is suggested improve outcomes for patients where GORD is suspected...
September 8, 2016: Internal Medicine Journal
Kyle White, Ian A Scott, Anne Bernard, Kristy McCulloch, Amanda Vaux, Chris Joyce, Clair M Sullivan
BACKGROUND: The characteristics of mature contemporary rapid response systems (RRS) are unclear. OBJECTIVES: To determine the patient characteristics, processes and outcomes, both in-hospital and post-discharge, of a well established RRS in a tertiary adult hospital. METHODS: Prospective study of consecutive rapid response team (RRT) activations between July 1(st) and November 25(th) 2015. Variables included patient characteristics, timing, location and triggers of RRT activations, interventions undertaken, mortality and readmission status at 28-days post-discharge...
September 7, 2016: Internal Medicine Journal
Matthew W Linger, Mieke L van Driel, Samantha A Hollingworth, Jennifer H Martin
BACKGROUND: Tumour necrosis factor-alpha inhibitors (anti-TNFα) and anakinra are monoclonal antibodies against pro-inflammatory cytokines overexpressed in many systemic inflammatory diseases. In Australia they are registered for the treatment of several rheumatological, gastroenterological and dermatological indications. Despite increasing observational evidence for their use in off-label indications, there is a paucity of outcome research from the Australian hospital sector. AIMS: To describe the off-label use of anti-TNFα and anakinra at a tertiary referral hospital in Queensland, Australia and consideration of a drug register to inform future clinical decision-making...
August 30, 2016: Internal Medicine Journal
Hamish J Farquhar, Ben McGettigan, Peter T Chapman, John L O'Donnell, Chris Frampton, Lisa K Stamp
OBJECTIVE: To determine the incidence of ANCA Associated Vasculitis (AAV) during the 3-year period before (period 1), and the 3 years following (period 2), the earthquake that occurred on 22 February 2011 in Christchurch, New Zealand. METHODS: All ANCA tests performed in the Canterbury region for 3 years before the earthquake (period one, 2007-2010), and for 3 years after the earthquake (period two, 2011-2014) were examined. AAV was defined according to The European Medicines Agency classification algorithm...
August 30, 2016: Internal Medicine Journal
Alberta Y Hoi, Laura Ross, Jessica Day, Russell Rc Buchanan
Antiphospholipid syndrome (APS) is an autoimmune condition, characterized by the persistent presence of antiphospholipid antibodies (aPL) and either thrombosis or obstetric morbidity. The cornerstone of therapy is long-term anticoagulation to reduce morbidity and mortality; however, better understanding of the immunological pathways may direct us to develop future therapeutic strategies. We provide an overview of the current understanding of the immunopathogenesis of this perplexing condition and its associated morbidities and current evidence for some of the immunotherapeutic strategies...
August 30, 2016: Internal Medicine Journal
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