The Medical journal of Australia
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Multicenter Study Comparative Study
Unplanned admissions to two Sydney public hospitals after naltrexone implants.
To describe hospital presentations related to the use of naltrexone implants, an unlicensed product used in Australia for treating heroin dependence. ⋯ These severe adverse events challenge the notion that naltrexone implants are a safe procedure and suggest a need for careful case selection and clinical management, and for closer regulatory monitoring to protect this marginalised and vulnerable population.
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To examine policy and implementation issues around multidisciplinary care planning (MDP) as a means of improving outcomes for patients with chronic disease and/or complex care needs. ⋯ While MDP improves many functional outcomes, widespread implementation of MDP in standard practice will require complex and targeted strategies. Devising and testing such strategies is a prerequisite for widespread, routine use of MPD in chronic disease management.
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Successful, "innovative" primary health care (PHC) models exist that have adapted to the specific circumstances of their rural and remote context. A typology of discrete, integrated, comprehensive and outreach rural and remote services exists rather than a "one coat fits all" PHC health service model. ⋯ Service sustainability depends on ensuring that key systemic service requirements are met at the local level in ways that accord with, and are supported by, the broader macro-scale environmental enablers. Based on these principles, these model types are amenable to generalisation and evaluation in other regions.
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Comparative Study
Metformin and lactic acidosis in an Australian community setting: the Fremantle Diabetes Study.
To determine the incidence of lactic acidosis in community-based patients with type 2 diabetes, with special reference to metformin therapy. ⋯ The incidence of lactic acidosis in patients with type 2 diabetes is low but increases with age and duration of diabetes, as cardiovascular and renal causes become more prevalent. Metformin does not increase the risk of lactic acidosis, even when other recognised precipitants are present.
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Comparative Study
Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis.
To investigate current use of Australian snake antivenoms and the frequency and severity of immediate-type hypersensitivity reactions. ⋯ Antivenom was used appropriately, and most commonly for coagulopathy. Hypersensitivity reactions were common, but most were not severe. The discretionary use of premedication was not associated with any reduction in reactions.