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
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
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
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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Internal medicine journal · May 2020
Predictors of a long length of stay in the emergency department for older people.
Dedicated geriatric models of care are becoming more prevalent due to the complexity of, and increase in, acute healthcare presentations for older patients. For older people, a long stay in the emergency department (ED) may reflect the complexity of their presentation, or deficiencies in systems that manage these complexities. ⋯ This study assists clinicians and decision-makers to identify reasons why older persons have a LLoS, whether admitted or discharged. Interventions to streamline care for older patients arriving after-hours and who require imaging and pathology are required. LoS targets should consider age distribution. The use of ED LoS as a quality of care indicator should be assessed for admissions and discharges, separately.