Internal medicine journal
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Internal medicine journal · Jan 2023
Tinzaparin for venous thromboembolism in patients with renal impairment - a single-centre, prospective pilot study.
Low molecular weight heparins (LMWH) are used extensively for prophylaxis and treatment of venous thromboembolism (VTE), bridging therapy for warfarin and standard of care in cancer-associated VTE (CA-VTE). Tinzaparin has the highest molecular weight of all LMWH and relies least on renal clearance to Cockcroft-Gault creatinine clearance (CrCl) of 20 mL/min. Previous pharmacological studies have demonstrated safety and effectiveness in elderly patients. Prospective clinical trials have confirmed these findings to CrCl 20 mL/min and in CA-VTE. We describe the pilot program developed at Concord Repatriation General Hospital for tinzaparin. ⋯ For patients with renal insufficiency, tinzaparin represents an attractive alternative anticoagulant with once-daily administration in a range of potential indications.
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Internal medicine journal · Jan 2023
A clinical scoring approach for detection of histiocytic necrotizing lymphadenitis in adults.
Histiocytic necrotising lymphadenitis (HNL) is rare and can be easily ignored. ⋯ The present study suggests that the novel scoring approach we put forward might be useful to detect HNL in adult patients though further studies are needed.
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Internal medicine journal · Jan 2023
ANZTCT Position Statement: COVID-19 Management in Haematopoietic Stem Cell Transplant and Chimeric Antigen Receptor T cell Patients.
Patients with post-haemopoietic stem cell transplant or chimeric antigen receptor T -cell (CAR-T) therapy face a significant risk of morbidity and mortality from coronavirus disease 2019 because of their immunosuppressed state. As case numbers in Australia and New Zealand continue to rise, guidance on management in this high-risk population is needed. Whilst we have learned much from international colleagues who faced high infection rates early in the pandemic, guidance relevant to local health system structures, medication availability and emerging therapies is essential to equip physicians to manage our patients optimally.
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Internal medicine journal · Jan 2023
Penicillin Allergy Delabeling Program: an exploratory economic evaluation in the Australian context.
Internationally, clinical and economic advantages of low-risk penicillin delabelling have been explored, supporting changes to healthcare delivery systems where penicillin delabelling is embedded into inpatient usual care. ⋯ Consistent with international literature, delabelling low-risk penicillin allergies in the inpatient setting had economic advantages in the Australian context. Fully powered economic evaluations are urgently required to consolidate these findings.
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Internal medicine journal · Jan 2023
Patterns and rates of confirmed transfer of care of patients with Juvenile Idiopathic Arthritis at a tertiary paediatric rheumatology centre.
Disease activity in juvenile idiopathic arthritis (JIA) commonly persists into adulthood. Transfer of JIA patients to adult healthcare services can be challenging, with prior studies showing poor rates of success. ⋯ Lack of confirmed transfer of care for JIA patients is common and carries a risk of suboptimal outcomes. Strategies to improve communication with adult services, the routine use of 'backstop' appointments and vigilance regarding potential loss to follow up at the time of transfer would minimise this risk.