Internal medicine journal
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Internal medicine journal · May 2020
Impact of supplemental private health insurance on dialysis and outcomes.
The influence of health insurance systems on the treatment of end-stage kidney disease (ESKD) patients ispoorly understood. ⋯ Our findings suggest that supplemental PHI in Australia is associated with lower-risk ESKD treatment attributes and improved health outcomes. A greater understanding of the treatment pathways that deliver these outcomes may inform treatment for the broader ESKD treatment population.
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Internal medicine journal · May 2020
Aeromedical retrievals for gastrointestinal disorders in rural and remote Australia: the need for improved access to specialist advice.
The Royal Flying Doctor Service (RFDS) provides medical care to populations without access to traditional health-care services. From 2014 to 2018 the RFDS conducted 6007 (≈1201/year) aeromedical retrievals for gastrointestinal (GI) disorders. More detailed research is needed to determine specific GI disorders that contributed to this caseload, and in particular inform whether the establishment of a GI specialist service is justified.
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Internal medicine journal · May 2020
Comparison of expenditure between an inpatient palliative care unit and tertiary adult medical and surgical wards for patients at end of life: a retrospective chart analysis.
The highest healthcare expenditures occur towards the end of life. Costs relate to hospital admissions and investigations to diagnose, prognosticate and direct treatment. ⋯ Inpatient PCU are less likely to order investigations and are more cost-effective. A prospective study comparing an inpatient PCU and patients at a tertiary centre, with and without consult liaison palliative care input, would be worthwhile to see if outcomes remain the same and if consult liaison palliative care affects the investigative burden.
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Internal medicine journal · May 2020
Transvaginal mesh, gender and the ethics of clinical innovation.
On 10 October 2018, Australian Health Minister Greg Hunt issued a national apology to the Australian women who experienced 'horrific outcomes' following surgery using transvaginal mesh-acknowledging the 'historic agony and pain that has come from mesh implantation'. This apology followed many decades of 'innovative' use of transvaginal mesh for the treatment of pelvic organ prolapse. We use the case of transvaginal mesh to explore how clinical innovation may not only harm patients, but also entrench vulnerability and exacerbate existing inequities-in this case, those relating to gender.
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Internal medicine journal · May 2020
Troponin measurements, myocardial infarction diagnoses and outcomes. An analysis of linked data from New South Wales, Australia.
Cardiac troponin assays are very widely requested tests, particularly in emergency departments. Thus, many seriously ill patients who may not have heart disease as their primary discharge diagnosis have undergone troponin testing during hospitalisation. ⋯ In a very large state-wide hospitalised patient cohort, among patients with elevated troponin levels and non-cardiac diagnoses, mortality was higher than in those with cardiovascular diagnoses, including MI.