Internal medicine journal
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Internal medicine journal · Aug 2019
Subclinical hypothyroidism during pregnancy: the Melbourne public hospitals consensus.
Interest in potential adverse outcomes associated with maternal subclinical hypothyroidism (normal free T4, elevated thyroid-stimulating hormone (TSH)) has increased significantly over recent years. In turn, the frequency of maternal thyroid function testing has risen, despite universal thyroid function screening not being recommended, leading to a marked increase in referrals to obstetric endocrinology clinics. In 2017 the American Thyroid Association revised their diagnostic and management guidelines. Although welcome, these new guidelines contain recommendations that may cause confusion in clinical practice. ⋯ Fewer women will be classified as having subclinical hypothyroidism during pregnancy, which is likely to lead to reductions in emotional stress, hospital visits, repeated blood tests and financial costs. Uniform clinical practice will occur across Melbourne.
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Internal medicine journal · Aug 2019
Seasonality of hip fracture and vitamin D deficiency persists in a sub-tropical climate.
Both hip fractures and vitamin D (25-hydroxyvitamin D (25-OHD)) deficiency are more common in winter in regions with temperate climates, but few data exist for a sub-tropical climate. In a South East Queensland tertiary hospital over a 7-year period, there were significantly more hip fractures in winter than the other three seasons (analysis of variance P = 0.003), with associated higher frequency of 25-OHD deficiency - 42.5% in winter compared to 28.5% in summer, odds ratio 1.86 (95% confidence interval 1.35-2.56), P = 0.0001. Seasonality of hip fracture and 25-OHD deficiency occurs even in a sub-tropical climate.
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Internal medicine journal · Aug 2019
Introduction of portable bedside echocardiography to acute general medicine.
We reviewed the medical records of all patients who underwent portable bedside echocardiography under general medicine over a 15-month period. The mean age of patients was 67 years (range 16-95) (n = 201). Indications for scanning included syncope (27%), murmur (17%) and dyspnoea (14%); findings included valve abnormalities (46%), left ventricular hypertrophy (26%) and dilated left ventricle (15%). Bedside echocardiography is a useful extension of the physical examination but is operator-dependent, and its routine use in general medicine will depend on the availability of training, group reporting sessions and quality assurance.
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Internal medicine journal · Aug 2019
Multicenter Study Comparative StudyThe Victorian Comprehensive Cancer Centre lung cancer clinical audit: collecting the UK National Lung Cancer Audit data from hospitals in Australia.
Clinical audit may improve practice in cancer service provision. The UK National Lung Cancer Audit (NLCA) collects data for all new cases of thoracic cancers. ⋯ Lung cancer care at participating hospitals appeared to be comparable with the UK in 2013. In future, prospective data collection should be harmonised across sites and correlated with survival outcomes. One area of concern was a lack of documented access to specialist nursing services.