Internal medicine journal
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Internal medicine journal · Feb 2025
Antifungal stewardship in Australian hospitals: defining the scope and future targets.
Antimicrobial stewardship (AMS) guidelines now recommend antifungal stewardship (AFS) interventions to improve the management of invasive fungal diseases (IFDs). AFS programmes have not been reported in Australia. ⋯ AFS strategies utilised in Australian hospitals have focused on high-cost, intravenous agents. Although expert oversight of antifungals is evident, many sites omit potentially important targets for AFS, including fluconazole and oral posaconazole. Identifying these gaps and barriers to AFS will guide the development of an AFS model for hospitals.
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Internal medicine journal · Feb 2025
Clinical outcomes of patients with non-tuberculous mycobacterial pulmonary disease in Auckland, New Zealand.
This review of non-tuberculous mycobacterial pulmonary disease over an 11-year period identified 87 patients (74% women, mean age 66 years). Mycobacterium avium complex was isolated in 86% of patients. Antibiotics were commenced in 52% of patients; however, treatment was poorly tolerated with 36% terminating prematurely. Mortality was significant; death occurred in 31% of patients, with no relationship between death and treatment.
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Internal medicine journal · Feb 2025
Statewide neurology inpatient whole body and brain 18F-fluorodeoxyglucose positron emission tomography utilisation patterns demonstrate avenues for optimisation.
18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) can provide unique insights; however, access may be difficult. In this 2-year statewide study of all neurology inpatient admissions, 27.9% (41/147) of PET (any field of view) demonstrated significant abnormalities. At sites without on-site PET access, the proportion of patients receiving PET was lower (P < 0.01), and the time from admission to receiving PET was longer (P = 0.018), as compared to those with on-site access. Investigation of strategies to improve access is warranted.
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Internal medicine journal · Feb 2025
Neoadjuvant chemotherapy in breast cancer: a retrospective pathway assessment in a regional cancer centre.
The optimal care pathway (OCP) for people with breast cancer provides a framework for investigation and management of patients with breast cancer, with delays previously identified regionally. ⋯ Adherence to OCP timeframes for patients undergoing neoadjuvant therapy in a regional centre was feasible and strategies are needed to bridge gaps identified for rural patients.
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Internal medicine journal · Feb 2025
Multicenter StudyPrevalence of heart failure pharmacotherapy utilisation, frailty and adverse drug events among hospitalised adults older than 75 years: a multicentre cross-sectional study.
Optimal heart failure (HF) pharmacotherapy (guideline-directed medical therapy and diuretics) in older people with frailty is uncertain due to limited evidence. ⋯ Frailty, HF-pharmacotherapy changes in hospital and ADEs were common among older inpatients with HF. The association of adverse outcomes according to frailty needs further investigation. Poor documentation of HF phenotype may be a barrier to medication optimisation in older inpatients.