Internal medicine journal
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Internal medicine journal · Oct 2013
ReviewRenal transplantation in indigenous Australians of the Northern Territory: closing the gap.
Chronic kidney disease causes high morbidity and mortality among Indigenous Australians of the Northern Territory (NT). Studies have shown chronic kidney disease rates of 4-10 times higher in indigenous than non-indigenous Australians and prevalent dialysis rates of 700-1200 per million population. For most patients with end-stage renal failure, renal transplantation provides the optimal treatment for people with end-stage renal disease. ⋯ Available options to avoid relocation include peritoneal dialysis, home haemodialysis and community health centre dialysis, but the acceptance rates for these are low, hence renal transplantation would provide the best option. There is evidence of identified barriers to renal transplantation for indigenous people of the NT. This review explores published data on why rates of renal transplantation in indigenous people of the NT are low and the reasons for poor outcomes highlighting possible areas of improvement.
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Internal medicine journal · Oct 2013
Clinical utility of sequential venous blood gas measurement in the assessment of ventilatory status during physiological stress.
Venous blood gases (VBG) are commonly utilised, particularly in the emergency setting, to assess and monitor patients at risk of ventilatory failure with limited evidence regarding their clinical utility in the assessment of ventilatory status over time. ⋯ Sequential VBG provide an unpredictable means for assessing pCO2 in patients undergoing flexible bronchoscopy. Previously noted poor agreement between arterial and venous pCO2 worsens following physiological stress, with sequential VBG likely to underestimate changes in ventilatory status in patients with acute respiratory compromise, suggesting limited utility as a means for monitoring changes in ventilation.
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Internal medicine journal · Oct 2013
Observational StudyCharacteristics and prognosis of Asian patients with type 2 diabetes from a multi-racial Australian community: the Fremantle Diabetes Study.
Asian migrants represent an expanding proportion of the Australian population and are from a region with an increasing diabetes burden. There are few data detailing the characteristics and outcome of type 2 diabetes in Asian Australians. ⋯ The phenotype of type 2 diabetes in a relatively small group of well-characterised Asian Australians differed from that in AC patients from the same urban community. Their favourable cardiovascular prognosis may reflect a healthy migrant effect.
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Internal medicine journal · Oct 2013
Impact of emergency access targets on admissions to general medicine: a retrospective cohort study.
Emergency access targets have been implemented Australia-wide following recent retrospective cohort studies linking emergency department (ED) overcrowding and excess mortality. ⋯ Implementation of a 4-h access target has been associated with changes to the characteristics of patients admitted to GM, including higher proportions of younger patients, with fewer comorbid conditions and lower clinical urgency at presentation, although the latter may be explained by a coincidental change in the way that ED patients were triaged, as well as a greater number of these patients presenting to ED overall.
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Internal medicine journal · Oct 2013
Computed tomography in patients with abdominal pain and diarrhoea: does the benefit outweigh the drawbacks?
The role of computed tomography (CT) in the evaluation of abdominal pain is well established. However, concern exists in regard to procedure-related radiation levels, contrast-medium toxicity and costs. We sought to determine whether the use of abdominal CT caused major changes in the management of patients who had abdominal pain and diarrhoea. ⋯ When management changed, the changes resulted from findings unrelated to diarrhoea. Despite its defined role in the assessment of abdominal pain, CT of patients that also had diarrhoea seldom caused a major change in management. The probability of CT causing such a change does not outweigh the cost, radiation risk or potential for contrast-induced nephropathy.