Internal medicine journal
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Internal medicine journal · Nov 2023
Aspirin deprescribing in primary prevention of cardiovascular disease: a prospective risk-benefit approach.
Current evidence and practice guidelines do not recommend aspirin for primary prevention of cardiovascular disease (CVD). Insufficient all-cause mortality benefits juxtaposed to increased gastrointestinal bleeding rates are well established. Pharmacists are well placed to assess the clinical appropriateness of aspirin in CVD and initiate deprescribing as required with medical colleagues. ⋯ This study described an impactful pharmacist-led initiative utilising a validated aspirin-specific tool to conduct risk-benefit analysis to reduce potential major bleeding associated with inappropriate aspirin use.
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Internal medicine journal · Nov 2023
Tunnelled central venous catheters for incident haemodialysis patients - a Victorian survey exploring reasons for use.
Tunnelled central venous catheters (T-CVCs) are used globally as vascular access for patients on haemodialysis (HD) but are associated with increased sepsis, mortality, cost and length of hospitalisation compared with more permanent HD vascular access. The reasons for using T-CVC are varied and poorly understood. A significant and increasing proportion of incident HD patients in Victoria, Australia, have required T-CVC over the last decade. ⋯ These survey results provide an opportunity for quality improvement initiatives with respect to dialysis access planning and care.
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Internal medicine journal · Nov 2023
Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians.
The majority of Indigenous Australians reside in non-urban locations, with reduced access to chest radiology such as computed tomography (CT). Spirometry and chest X-ray (CXR) may be used in the absence of CT; however, the correlation of spirometry indices to CT-defined chronic airway diseases (i.e. chronic obstructive pulmonary disease (COPD) and bronchiectasis) compared with CXR among Indigenous people is sparsely reported. ⋯ Indigenous Australians tend to demonstrate restrictive impairment in the absence of radiological evidence of airway disease. However, in the presence of airway disease, combinations of mixed and obstructive impairments were common. Obstructive impairment shows greater sensitivity for identifying COPD than that shown by CXR; however, CXR shows greater specificity. Hence, spirometry in conjunction with chest radiology should be utilised to aid in the assessment of airway diseases in this population.
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Internal medicine journal · Nov 2023
Artificial intelligence-enabled penicillin allergy delabelling: an implementation study.
Inaccurate penicillin allergy labels may be delabelled following evaluation. The intervention in this study was an email-based notification system regarding the appropriateness for penicillin allergy evaluation, with a view to delabelling, as identified by a deep learning artificial intelligence algorithm. Of the intervention group (n = 59), three (5.1%) individuals had their penicillin allergies delabelled, which was significantly more than the control group (0%, P = 0.002). Further research to optimise such approaches is required.