The Medical journal of Australia
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Practice Guideline
Chronic kidney disease and measurement of albuminuria or proteinuria: a position statement.
Optimal detection and subsequent risk stratification of people with chronic kidney disease (CKD) requires simultaneous consideration of both kidney function (glomerular filtration rate [GFR]) and kidney damage (as indicated by albuminuria or proteinuria). Measurement of urinary albuminuria and proteinuria is hindered by a lack of standardisation regarding requesting, sample collection, reporting and interpretation of tests. A multidisciplinary working group was convened with the goal of developing and promoting recommendations that achieve consensus on these issues. ⋯ The working group recommended that adults with one or more risk factors for CKD should be assessed using UACR and estimated GFR every 1-2 years, depending on their risk-factor profile. Recommended testing algorithms and sex-specific cut-points for microalbuminuria and macroalbuminuria are provided. The working group recommended that all pathology laboratories in Australia should implement the relevant recommendations as a vital component of an integrated national approach to detection of CKD.
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To examine trends in mechanism and outcome of major traumatic injury in adults since the implementation of the New South Wales trauma monitoring program, and to identify factors associated with mortality. ⋯ Deaths from major trauma in NSW trauma centres have declined since 2003, and definitive care at a Level 1 trauma centre was associated with a survival benefit. More comprehensive trauma data collection with timely analysis will improve injury surveillance and better inform health policy in NSW.
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Practice Guideline
The role of HbA1c in the diagnosis of diabetes mellitus in Australia.
For many years, the diagnosis of diabetes has been made through the laboratory-based measurement of fasting or random blood glucose levels, or using the oral glucose tolerance test. A glycated haemoglobin (HbA(1c)) level ≥ 6.5% (48 mmol/mol) is now also acceptable for diagnosing diabetes. Caution is needed in interpreting HbA(1c) test results in the presence of conditions affecting red blood cells or their survival time, such as haemoglobinopathies or anaemia.
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To identify a level of iodine supplementation to recommend for pregnant and breastfeeding women in Australia. ⋯ The final level of supplementation we recommend should be based on these calculations and other factors. There will be population subgroups for whom our general recommendation is not appropriate.
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To examine the frequency and causes of snorkelling-related deaths in Australia. ⋯ In the context of the large population sampled, snorkelling-related deaths are rare. Preventive measures for such deaths could include pre-dive medical assessments for people with a history of cardiac or respiratory disease or with a family history of sudden unexpected death; improved training in how to use snorkelling equipment; better matching of skills to health, fitness and water conditions; better supervision and quality training of supervisors in rescue and resuscitation techniques; and avoidance of hyperventilation before breath-hold diving.