Internal medicine journal
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Internal medicine journal · Dec 2021
Utilization of telehealth for outpatient diabetes management during COVID-19 pandemic: how did the patients fare?
During the Coronavirus disease 2019 (COVID-19) pandemic, many outpatient services at public hospitals, including diabetes services, had adopted telehealth appointments for their clinic patients. There was concern that patients' glycaemic control may worsen during the pandemic. ⋯ The present study showed that for patients with diabetes who received care via telehealth consultations during the COVID-19 lockdown, their glycaemic control was slightly better, and unplanned admission rates were not higher compared with those in the pre-COVID-19 period. Telehealth consultation offers an important care delivery option in the management of patients with diabetes under these circumstances.
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Internal medicine journal · Dec 2021
Developments in systemic therapies for the management of lung cancer.
Lung cancer accounts for approximately 1 in 10 new cancer diagnoses annually and is responsible for the most cancer-associated deaths in Australia. Despite such figures, there is reason for optimism with many practice-changing developments to report for the management of patients with thoracic malignancies over the last few years. We outline such changes, including the emerging role of immunotherapy in the neoadjuvant and adjuvant setting for patients with localised non-small-cell lung cancer, as well as the established standard of consolidation immunotherapy following definitive chemoradiotherapy for those with locally advanced disease. ⋯ Even among patients with small-cell lung cancer, who account for the worst prognoses and until recently have received a chemotherapy regimen that has remained unchanged in over 20 years, there is a new standard-of-care in combination chemotherapy-immunotherapy. Furthermore, immunotherapy and potentially anti-vascular endothelial growth factor agents now also play a role in mesothelioma treatment. Last, given recent developments in immunotherapy, targeted therapy and combination approaches in the non-small-cell lung cancer space, there is an increasing recognition of the diversity of lived experience for such patients and need for survivorship programmes to acknowledge such nuances.
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Internal medicine journal · Dec 2021
Prevalence, Types and Recognition of Cognitive Impairment in Dialysis Patients in South Eastern Sydney.
In international studies, cognitive impairment is a common but underdetected issue in dialysis patients. Chronic kidney disease (CKD) shares risk factors with and is an independent risk factor for cognitive impairment. There is a lack of Australian data on cognitive impairment in this at-risk population. This has implications on service planning because cognitive impairment in CKD is associated with higher mortality, morbidity and healthcare costs. ⋯ Although cognitive impairment is common in dialysis patients, there are low levels of detection by clinical teams. Cognitive screening of dialysis patients should be incorporated as part of wider assessment and determination of management goals such as individuals' capacity to self-care and provide informed consent to treatments.
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We examined the pattern of adrenaline administration in patients presenting with anaphylaxis. Forty-four percent required repeated adrenaline administration, among whom there had been greater cardiorespiratory compromise. Repeated administration was more frequent in males and older patients, and those triggered by insect sting or unknown cause; no other patient factors were identified. This study supports the provision of two adrenaline auto-injectors to all anaphylaxis patients.