Internal medicine journal
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Internal medicine journal · Jul 2021
Accessible and affordable healthcare? Views of Australians with and without chronic conditions.
With 50% of Australians having chronic disease, health consumer views are an important barometer of the 'health' of the healthcare system for system improvement and sustainability. ⋯ Health consumers, especially those with chronic conditions, identified significant cost barriers to access of healthcare. Equitable access to healthcare must be at the centre of health reform.
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Internal medicine journal · Jul 2021
Supporting cancer care clinicians to 'hold' their patients during and beyond the COVID-19 pandemic: a role for reflective ethics discussions.
The COVID-19 pandemic has placed an overwhelming burden on healthcare delivery globally. This paper examines how COVID-19 has affected cancer care clinicians' capacity to deliver cancer care in the Australian context. We use the lens of 'holding patients' (drawing from attachment theory, psychology and from Australian Indigenous knowledge) to conceptualise cancer clinicians' processes of care and therapeutic relationships with patients. ⋯ They enrich ethical language beyond duties to benefit, avoid harm, respect patients' autonomy and provide just treatment. We consider the disruptive effects of COVID-19 on care delivery and on clinicians themselves. We then show how models of clinical ethics and other similar reflective discussion approaches are a relevant support mechanism to assist clinicians to process and make sense of COVID-19's disruptions to their professional ethical role of holding patients during and beyond the pandemic.
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Internal medicine journal · Jul 2021
Risk factors of SARS-CoV-2 seroprevalence among hospital employees in Italy - a single center study.
The SARS-CoV-2 outbreak early in 2020 overwhelmed the Italian national health system, and hospitals were considered places at high risk of spreading the infection. We explored specific antibody seroprevalence of all employees at a single hospital in the epicentre of the outbreak, to identify areas of risk in nosocomial setting and to evaluate the usefulness of antibody testing. ⋯ Seroprevalence for SARS-CoV-2 in this population of hospital workers was overall about 10%, with an excess prevalence in roles and departments associated with contacts with COVID-19 patients.
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Dysphagia is a common problem affecting all ages. It is increasing in frequency particularly among the younger population due to the rising incidence of eosinophilic oesophagitis, a condition which often leads to acute presentation to hospital for the first time with food bolus obstruction requiring endoscopic removal. ⋯ The three main investigations for dysphagia remain endoscopy, barium study and manometry, with endoscopy also offering therapeutic potential. Management is largely determined by the eventual diagnosis, often in a multi-disciplinary setting.
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Internal medicine journal · Jul 2021
Endurance cycle ergometry tests performed at a sub-maximal work rate elicit peak physiological and symptom responses in adults with cystic fibrosis.
Time to symptom limitation (Tlim ) achieved during constant work rate tests is considerably more responsive to change than measures commonly recorded during ramp-based tests, such as peak rate of oxygen uptake and maximal work rate (Wmax ). There is limited literature on the use of, and physiological and symptom responses to, constant work rate cycle ergometry tests in people with cystic fibrosis (CF). The results of this study provide evidence that the constant work rate cycle ergometry test, when conducted at 80% of the Wmax , elicits peak physiological and symptom responses and appears to be safe in adults with CF. For clinicians prescribing exercise at an intensity approaching or equivalent to 80% of the Wmax in a non-laboratory-based setting, consideration needs to be given to the level of supervision and patient monitoring required.