Internal medicine journal
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Internal medicine journal · Jan 2020
Are general practitioners getting the information they need from hospitals and specialists to provide quality cancer care for Indigenous Australians?
Cancer care involves many different healthcare providers. Delayed or inaccurate communication between specialists and general practitioners (GP) may negatively affect care. ⋯ Deficits in communication and information transfer between specialists and GP may adversely affect patient care. Indigenous Australians are a relatively disadvantaged group that experience poor health outcomes and relatively poor access to care. The low proportion of discharge summaries noting discharge medication regimen is of concern among Indigenous Australians with cancer who have high comorbidity burden and low health literacy. Our findings provide an insight into some of the factors associated with quality of cancer care, and may provide guidance for focus areas for further research and improvement efforts.
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Internal medicine journal · Jan 2020
Comparative StudyIn-hospital morbidity and mortality among patients from residential respite care.
Residential respite is an important support for many community-dwelling older Australians and their caregivers. Respite clients are often very frail with high or specific care needs. Little is known about the comparative outcomes of hospital admission between permanent residential aged care facility (RACF) residents and residential respite residents. ⋯ Although residential respite recipients represent a minority of total residential aged care admissions, they are at high risk of poor outcomes. Prospective identification and timely intervention may improve quality of care for this vulnerable cohort.
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Internal medicine journal · Jan 2020
Case ReportsDoes glyceryl trinitrate cause central sympatholytic effects? Insights from a case of baroreflex failure.
Whether part of the blood pressure lowering effects of glyceryl trinitrate (GTN) is the result of centrally mediated reduction in sympathetic activity is debated. In humans, baroreflex activity potentially obscures the central sympatholytic effects of GTN. We examined this in a routine clinical tilt test in a patient with baroreflex failure secondary to previous neck radiotherapy. With reduced baroreflex function we observed an exaggerated fall in blood pressure and reduced sympathetic activity with GTN, supporting a peripheral vasodilation and central sympatholytic effect.
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Internal medicine journal · Jan 2020
Observational StudyCharacteristics and outcomes of rapid response team activations for hypotension in orthopaedic patients.
Hypotension following orthopaedic surgery has been associated with increased morbidity and mortality. Rapid response teams (RRT) review patients on hospital wards with hypotension. ⋯ Hypotension-related RRT calls in orthopaedic patients are common. Future interventional studies might focus on perioperative fluid therapy and vaso-active medications, as well as withholding of anti-hypertensive medications preoperatively.
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Internal medicine journal · Jan 2020
Observational Study'Cold and lonely': emergency presentations of patients with hypothermia to a large Australian health network.
Extreme heat is a public health priority in Australia with the health effects of cold poorly studied. A record-breaking cold winter prompted an institutional investigation into the epidemiology and outcomes of hypothermic presentations. ⋯ Hypothermia is a marker of clinical and socioeconomic vulnerability. The dominant presentation of the elderly patient with multimorbidity, and few social supports being found indoors, raises broader questions around the social determinants of health.