Internal medicine journal
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Internal medicine journal · Jul 2020
Resurrecting New Zealand's public healthcare system or a charity hospital in every town?
Radical market-oriented health reforms in New Zealand in the early 1990s failed to deliver key financial targets, resulted in unnecessary patient deaths, adversely affected public healthcare services, induced serious tensions between clinicians and managers and encouraged a predisposition to private healthcare. A more co-operative health system was implemented in the late 1990s but remaining problems of inadequate patient access led to establishment of a charity hospital in Christchurch which, by November 2018, had registered over 18 000 patient visits. This is one indication of the need to resurrect our public healthcare system. In this paper, we discuss briefly the health reforms of the 1990s then, for discussion and debate, provide seven suggestions for how this resurrection might be achieved thereby avoiding the need for charity hospitals throughout the country.
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Internal medicine journal · Jul 2020
Taking the pulse of Timor-Leste's cardiac needs: a 10-year descriptive time-trend analysis.
Timor-Leste is one of the poorest countries in the world. The East Timor Hearts Fund is a charitable organisation involving Australian cardiologists providing outreach screening and access to cardiac interventions. ⋯ Demand for cardiac services in Timor-Leste is rising exponentially, with inequitable geographic coverage. Rheumatic and congenital cardiac diseases remain priorities for assessment, and paediatric case volume is increasing. Patients undergoing intervention experience good medical outcomes.
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Internal medicine journal · Jul 2020
Improving regional lung cancer optimal care pathway compliance through a rapid-access respiratory clinic.
Lung cancer is the leading cause of cancer-related morbidity and mortality in Australia and delays in diagnosis and management increase the potential for disease progression. Incidence and mortality from lung cancer in our region, Gippsland, are higher than the national average, yet there is no known standard referral pathway for diagnosis in the region. ⋯ Our project highlights the disjointed and delayed lung cancer care in our region and the improvements a dedicated rapid access clinic can have on diagnosis and treatment commencement timeframes.
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Internal medicine journal · Jul 2020
Diabetes insipidus complicating apoplexy during pregnancy: the potential use of copeptin.
Pituitary apoplexy during pregnancy is rare but important to recognise, particularly in the hyperoestrogenaemic state when known lactotroph hyperplasia occurs. Untreated, the complication rates from pituitary adenomas depend upon the size of the adenoma before pregnancy. A history of thirst plus polydipsia during pregnancy raises suspicion for diabetes insipidus and a 24-h urine collection quantifying polyuria with an inappropriately low urine osmolality confirms the diagnosis. Further evaluation for assessing diabetes insipidus in pregnancy may be facilitated by the use of a copeptin.