Internal medicine journal
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In Australia, there is a high incidence of melanoma, and until recently, the treatment and median overall survival for advanced metastatic melanoma had not changed in decades. The recognition of BRAF as an important tumour oncogene in melanoma has led to the development of targeted therapies, and in the last few years, we have seen the impact of these therapies, with significant improvement in response rate, duration of disease control and overall survival for patients with BRAF mutation-positive metastatic melanoma. ⋯ The development of checkpoint inhibitors as a tolerable and effective therapy for metastatic melanoma, which has demonstrated improved response rates, duration of control and overall survival for patients, has implications beyond the care of patients with metastatic melanoma as these therapies are being trialled in other malignancies. This article will review the current standard of care and available therapies for metastatic malignant melanoma.
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Internal medicine journal · Oct 2017
Supine awake oximetry as a screening tool for daytime hypercapnia in super-obese patients.
Evidence-based screening tools are required for detection of daytime hypercapnia in high-risk patient populations. ⋯ Awake supine oximetry is an easily performed test that may have novel use in identifying patients at high risk of respiratory failure. Future studies are required to evaluate prospectively its role in screening patients at risk of daytime hypercapnia.
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Internal medicine journal · Oct 2017
Underuse of risk assessment and overuse of computed tomography pulmonary angiography in patients with suspected pulmonary thromboembolism.
Evidence suggests the potential overuse of computed tomography pulmonary angiography (CTPA) in patients with suspected pulmonary thromboembolism (PTE) in the absence of consistent use of pre-test clinical prediction rules and D-dimer assays. ⋯ More than 50% of patients with suspected PTE may be subject to unwarranted use of CTPA in the absence of pre-test clinical prediction rules coupled with D-dimer assays.
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Entry criteria included patients who developed sinusoidal obstruction syndrome (SOS) at a single centre from January 2000 to December 2011. Patients who underwent haemopoietic stem cell transplantation or actinomicyn-based chemotherapy for nephroblastoma were selected. The study group comprised five patients with SOS who were compared with a control group of seven patients without SOS. ⋯ This study demonstrates the existence of an ongoing procoagulant and hypofibrinolytic status in SOS, indicating a possible role for anticoagulant therapy. Moreover, these findings suggest a role for EV CD 144+, either alone or in combination with PAI-1, as a new biomarker for SOS.
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Internal medicine journal · Oct 2017
Assessing the practice of palliative care doctors: what driving advice do they give patients with advanced disease?
There is little research and no clear guidelines for clinicians to follow when instructing patients with advanced disease about driving. ⋯ This is the first survey investigating the practice of Australian doctors in assessing fitness to drive of patients with advanced disease. The survey found wide variability in practice and substantial discordance with current driving guidelines.