Internal medicine journal
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Internal medicine journal · Sep 2014
ReviewThiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders.
Wernicke encephalopathy is an acute, reversible neuropsychiatric emergency due to thiamine deficiency. Urgent and adequate thiamine replacement is necessary to avoid death or progression to Korsakoff syndrome with largely irreversible brain damage. ⋯ Currently, different dose recommendations are being made. We present recommendations for the assessment and treatment of Wernicke encephalopathy based on literature review and our clinical experience.
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Internal medicine journal · Sep 2014
Randomized Controlled TrialEffect of a patient-directed discharge letter on patient understanding of their hospitalisation.
Poor patient understanding of their diagnosis and treatment plan can adversely impact clinical outcome following hospital discharge. Discharge summaries are primarily written for the doctor rather than the patient. We determined patient understanding of the reasons for hospitalisation, in-hospital tests, treatments and post-discharge recommendations, and whether a brief patient-directed discharge letter (PADDLE) delivered during a brief discussion prior to discharge would improve understanding. ⋯ A simple patient-directed letter delivered during a brief discussion improves patient understanding of their hospitalisation and post-discharge recommendations, which is otherwise limited. Further evaluation of this brief and well-received intervention is indicated, with the goal of improving patient understanding, satisfaction and clinical outcomes.
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Internal medicine journal · Sep 2014
Rapid rule out of myocardial infarction with the use of copeptin as a biomarker for cardiac injury.
Copeptin is a non-specific marker of an endogenous stress response. A dual biomarker marker approach involving the simultaneous use of troponin and copeptin assays may assist early exclusion of acute coronary syndrome in Australian emergency departments. The utility and limitations of this approach are discussed.
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Internal medicine journal · Sep 2014
Comparative StudyThe undivided patient: a retrospective cohort analysis of specialty referrals made from inpatient general medical units comparing regional to metropolitan practice.
In an era of growing subspecialisation there has been significant research into the role, determinants and outcomes of outpatient referrals but very little on inpatient specialty referrals from general medical units. ⋯ This preliminary study suggests that patients admitted to rural hospital general medical units have fewer active conditions with fewer specialty referrals made per admission, compared with a comparator metropolitan hospital general medical unit. Further research is required to investigate the reasons for such differences and implications for policy and practice.
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Internal medicine journal · Sep 2014
Dilemmas in the compassionate supply of investigational cancer drugs.
In Australia, patients who want to access medicines that are not yet approved have only two options: to enroll in a clinical trial if they are eligible, or obtain their medicine through 'compassionate supply', which is provided at the discretion of the manufacturer. In this article, we explore ethical issues associated with the provision of oncology medicines that are still in development, either prior to regulatory approval or government reimbursement.