Internal medicine journal
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Internal medicine journal · Sep 2021
Observational StudyImpacts of multidisciplinary meeting case discussion on palliative care referral and end-of-life care in lung cancer: A retrospective observational study.
Multidisciplinary meeting (MDM) discussion and early palliative care are recommended in lung cancer management. The literature is unclear whether MDM discussion leads to early palliative care and improved end-of-life care. ⋯ Discussion at lung MDM did not increase palliative care referral, but did reduce ICU admission among metastatic patients at the end of life. Longer palliative care referral-to-death interval was associated with reduced aggressive end-of-life care. Further research is needed in these areas.
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Internal medicine journal · Sep 2021
ReviewDemystifying machine learning - a primer for physicians.
Machine learning is a tool for analysing digitised data sets and formulating predictions that can optimise clinical decision-making. It aims to identify complex patterns in large data sets and encode them into models that can then classify new unseen cases or make predictions on new data. Machine learning methods take several forms and individual models can be of many different types. ⋯ The reliability and robustness of any model depends on multiple factors, including the quality and quantity of the data used to develop the models, and the selection of features in the data considered most important to maximising accuracy. In ensuring models are safe, effective and reproducible in routine care, physicians need to have some understanding of how these models are developed and evaluated, and to collaborate with data and computer scientists in their design and validation. This narrative review introduces principles, methods and examples of machine learning in a way that does not require mastery of highly complex statistical and computational concepts.
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Internal medicine journal · Sep 2021
ReviewImpact of subclinical hypothyroidism on health-related quality of life: a narrative review.
A biochemical diagnosis of subclinical hypothyroidism (SCH) is defined by an elevated serum thyroid-stimulating hormone (TSH) with a normal serum free thyroxine (FT4). This paper discusses SCH in the Australian population, the impact of SCH on health-related quality of life (HRQoL), and the evidence for thyroid hormone therapy as well as exercise therapy to improve HRQoL in SCH. The prevalence of SCH in Australia is approximately 4-5% and is higher in females and the elderly. ⋯ Because the majority of research to date has been done in elderly, largely asymptomatic individuals, this may not be representative of the entire SCH population. In addition, alternative treatments, such as exercise therapy, have not been well explored in the literature, despite exercise therapy's effects on HRQoL in other populations. Further research is required to define clearly which individuals with SCH are likely to experience an impaired HRQoL, as well as explore the effects of thyroid hormone therapy and exercise therapy in these individuals.
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Internal medicine journal · Sep 2021
Alcohol Misuse and Critical Care Admissions in the Northern Territory.
The Northern Territory (NT) has a long history of heavy alcohol consumption with a correspondingly high attributable morbidity and mortality. ⋯ Alcohol misuse is associated with a substantial number of critical care admissions and consumes considerable acute care resources. Further policy directed at harm minimisation and epidemiological work at jurisdictional and national level is necessary.
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Internal medicine journal · Sep 2021
Communicating deprescribing decisions made in hospital with general practitioners in the community: a qualitative study.
Deprescribing, the supervised withdrawal of inappropriate medications, intends to manage polypharmacy, which is prevalent in older patients. ⋯ GP welcome increased communication with hospital clinicians regarding deprescribing decisions made while patients are in hospital. Communication needs to be timely, transparent, succinct and accessible. Lack of time and difficulties contacting hospital clinicians challenge this process.