Internal medicine journal
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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
Effectiveness and safety of cyclophosphamide or tacrolimus therapy for idiopathic membranous nephropathy.
Guidelines recommend classical combined therapy of steroid and cyclophosphamide (CYC) for patients with idiopathic membranous nephropathy (IMN), while it is associated with severe adverse effects. ⋯ Because of its short-term effectiveness and long-term safety profile, steroid plus TAC might be a better option for IMN.
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Much of the debate over the use of transvaginal mesh for incontinence and prolapse has been conducted on social media, in the tabloid press and through a very public Senate inquiry. It has been a very emotionally charged debate with surgeons variously accused of scandalous behavior, financial impropriety, surgical experimentation and misogyny. What really happened, how did we get here and what can we learn from these complex events?
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Internal medicine journal · May 2020
ReviewTransfusion strategies in upper gastrointestinal bleeding management: a review of South Australian hospital practice.
Upper gastrointestinal bleeding (UGIB) is a common cause of hospital admission and red cell transfusion is frequently required. A large single-centre randomised study from 2013 showed that a restrictive transfusion strategy in UGIB management was associated with better outcomes compared to a liberal strategy. Subsequently multiple international guidelines favour a restrictive transfusion strategy. However, given the multiple exclusion criteria in the study, generalisation to everyday practice was unclear. ⋯ A restrictive transfusion strategy may be suitable for many patients presenting with UGIB; however, important exclusions were not uncommon. Opportunities for increased uptake of restrictive thresholds were identified. Ongoing improvement initiatives should address the risks of both over and under-transfusion.