Internal medicine journal
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Internal medicine journal · Jul 2022
Pharmacogenomic testing: perception of clinical utility, enablers and barriers to adoption in Australian hospitals.
Despite healthcare professionals (HCP) endorsing the clinical utility of pharmacogenomics testing, use in clinical practice is limited. ⋯ Pharmacogenomic testing was considered important to guide drug selection and dosing decisions. However, limited knowledge, low confidence and an absence of guidelines impede the use of pharmacogenomic testing. Establishment of local resources including multidisciplinary models-of-care was suggested to facilitate implementation of pharmacogenomics.
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Internal medicine journal · Jul 2022
Evaluation of pleural fluid cytology for the diagnosis of malignant pleural effusion: a retrospective cohort study.
Cytological examination of pleural fluid has good specificity, but imperfect sensitivity for the diagnosis of malignant pleural effusion (MPE). Published estimates of sensitivity vary and predictors of false negative cytology are not well established. ⋯ Sensitivity of pleural fluid cytology was greatest in primary lung and breast cancer, and lowest in mesothelioma. Clinicians should be alert to false negative results when suspecting mesothelioma or if pleural thickening is present.
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Internal medicine journal · Jul 2022
Upfront tandem autologous non-myeloablative allogeneic stem cell transplant in high-risk multiple myeloma: a long-term single-centre experience.
The role of upfront non-myeloablative allogeneic stem cell transplantation (NMA alloSCT) in high-risk multiple myeloma (HR-MM) is unclear. We evaluated outcomes of NMA alloSCT following autologous stem cell transplant (ASCT) compared with ASCT alone for newly diagnosed HR-MM. Two-year progression-free survival was improved in the ASCT-NMA alloSCT group (44% vs 16%; P = 0.035), with a trend for improved overall survival (P = 0.118). These results suggest that ASCT-NMA alloSCT can be considered as upfront therapy in HR-MM.
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Internal medicine journal · Jul 2022
Aggregation of autoimmunity in extended families of people with autoimmune Addison's disease.
Autoimmunity accounts for 90% of cases of primary adrenal insufficiency (Addison disease (AD)). Affected people present a significant co-occurrence of autoimmune conditions; hence, clustering of autoimmunity is also predicted among their relatives. ⋯ Considerable prevalence of autoimmune conditions in relatives of people with AD confirms substantial risk of autoimmunity, especially in females and relatives of patients affected by multiplex autoimmunity. Our data corroborate the recommendation of active screening for autoimmune disorders, particularly thyroid disease, among AD family members.
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Internal medicine journal · Jul 2022
Myocardial perfusion imaging failed to improve patient risk classification compared to the revised cardiac risk index for early cardiac complications after major non-cardiac surgery.
Myocardial perfusion imaging (MPI) is frequently used for cardiac risk assessment before major non-cardiac surgery, but its ability to improve patient risk classification beyond simple clinical assessment is unknown. ⋯ MPI risk factors are weak predictors for early cardiac complications after major non-cardiac surgery and failed to improve patient risk classification beyond essential assessment using age, RCRI and surgical priority. Clinicians should consider alternative risk assessment strategies because of MPI's poor prognostic utility and its associated time and financial costs.