Internal medicine journal
-
Internal medicine journal · Mar 2022
A prospective analysis of stroke recognition, stroke risk factors, thrombolysis rates and outcomes in Indigenous Australians from a large rural referral hospital.
Cardiovascular disease is the most common cause of death and disability in indigenous communities but limited prospective data exist about stroke. ⋯ Indigenous Australians with stroke are a decade younger and have a higher prevalence of important, modifiable stroke-risk factors. Delayed presentation to hospital is more common, due in part to stroke symptoms being underrecognised. When admitted to a specialised stroke unit, treatment rates and outcomes are comparable.
-
Internal medicine journal · Mar 2022
Introducing 1,3-Beta-D-glucan for screening and diagnosis of invasive fungal diseases in Australian high risk haematology patients: is there a clinical benefit?
Early, accurate diagnosis of invasive fungal disease (IFD) improves clinical outcomes. 1,3-beta-d-glucan (BDG) (Fungitell, Associates of Cape Cod, Inc., Falmouth, MA, USA) detection can improve IFD diagnosis but has been unavailable in Australia. ⋯ The BDG assay can add diagnostic speed and value but was hampered by low sensitivity and positive predictive value in Australian haematology patients.
-
Internal medicine journal · Mar 2022
Real-world experience with limited screening for occult malignancy in patients presenting with spontaneous venous thromboembolism: a single-centre, retrospective cohort study.
Spontaneous venous thromboembolism (VTE) may represent the first manifestation of previously undiagnosed malignancy; however, contemporary international guidelines call for a limited approach to screening for malignancy in such patients. This retrospective cohort study of 328 patients presenting to the Auckland City Hospital Thrombosis Unit identified 17 patients who were subsequently diagnosed with some form of malignancy within 12 months of their presentation. Review of their history, physical examination and limited age and gender-appropriate cancer screening investigations as described by the National Institute for Clinical Excellence and International Society of Thrombosis and Haemostasis guidelines revealed that all 17 would have been safely diagnosed by the 'limited' screening approach endorsed by these guidelines, thus presenting a 'real-world' basis for clinicians to pursue 'limited' screening for malignancy in their everyday practice in patients with spontaneous VTE.
-
Internal medicine journal · Mar 2022
Chronic inflammatory back pain commencing late in life: a neglected concept.
Chronic inflammatory back pain (CIBP) occurs in up to one-third of those with chronic back pain. Criteria for diagnosis of inflammatory back pain include an onset below 50 years. ⋯ There is little information in the literature on CIBP of late onset. Patients with late onset CIBP may be falling through the cracks.
-
Internal medicine journal · Mar 2022
Burnout in rehabilitation medicine trainees: a call for more research.
Burnout is recognised as a significant occupational hazard for medical professionals. For graduate trainees, across various medical specialties, there is growing evidence burnout results in personal harm and reduces the quality of patient care. Rehabilitation medicine, with its challenge of emotional exhaustion bought about by greater involvement in patient psychosocial well-being over a prolonged period, is significantly under-represented in research into burnout prevalence, impact and prevention strategies. We argue the lack of any evidence base in the Australian healthcare context negatively impacts the ability of training organisations to appropriately support trainees experiencing burnout.