Internal medicine journal
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Internal medicine journal · Aug 2022
ReviewApproved gene therapies in Australia: coming to a store near you.
Gene therapy has been promising paradigm-shifting advances in medical science for over two decades. Broadly, it is defined as a human therapy in which an existing defective gene function is added to, replaced, edited or disrupted to achieve a clinical benefit, up to and including a potential lifelong cure. ⋯ In this review, six approved gene and cell therapies available in Australia are described. Their efficacy, adverse effects, limitations and eligibility are discussed, as well as an overview of cost and future directions.
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Internal medicine journal · Aug 2022
Survey of barriers to adherence to international inflammatory bowel disease guidelines: Does gastroenterologists' confidence translate to high adherence?
Despite the availability of evidence-based inflammatory bowel disease (IBD) guidelines, suboptimal care persists. There is little published research assessing barriers to IBD guideline adherence. ⋯ Although gastroenterologists have high confidence in guidelines, they use them infrequently, primarily due to specifics being difficult to remember and lack of time. Self-reported confidence in an area of IBD management does not always reflect knowledge. An intervention targeting these barriers, for example, computer-based clinical decision support tools, might improve adherence and standardise care.
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Internal medicine journal · Aug 2022
A real-world estimate of the value of one metabolic equivalent in a population of patients planning major surgery.
One metabolic equivalent (MET) is equal to resting oxygen consumption. The average value for one MET in humans is widely quoted as 3.5 mL/kg/min. However, this value was derived from a single male participant at the end of the 19th century and has become canonical. Several small studies have identified varied estimates of one MET from widely varying populations. The ability of a patient to complete 4 MET (or 14 mL/kg/min) is considered an indicator of their fitness to proceed to surgery. ⋯ The estimate of 3.6 mL/kg/min for resting VO2 presented here is consistent with the previous literature, despite this being the first large study of its kind. This estimate can be safely used for pre-operative risk stratification.
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Internal medicine journal · Aug 2022
Case ReportsSuccessful cerebral intravascular thrombectomy stops the heart stopping.
A 65-year-old man presented with an acute ischaemic stroke due to right posterior cerebral artery occlusion, complicated by episodes of sinus arrest in the absence of intrinsic cardiac disease. His neurological deficits and sinus node dysfunction resolved following mechanical thrombectomy. We believe this to be a novel case where thrombectomy resulted in successful treatment of cerebral ischaemia mediated cardiac autonomic dysfunction.