Internal medicine journal
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Gaucher disease (GD) manifests heterogeneously and other conditions are often misdiagnosed in its place, leading to diagnostic delays. The Gaucher Earlier Diagnosis Consensus (GED-C) initiative proposed a point-scoring system (PSS) based on the signs and covariables that are most indicative of GD to help clinicians identify which individuals to test for GD. ⋯ Preliminary validation of the GED-C PSS discriminated effectively between patients with GD and those with overlapping signs.
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Internal medicine journal · Dec 2020
Observational StudyGuillain-Barré syndrome: clinical features, treatment choices and outcomes in an Australian cohort.
Guillain-Barré syndrome (GBS) causes acute neuromuscular weakness. Severe cases are life-threatening and many are left disabled. Intravenous immunoglobulin (IVIg) and plasma exchange (PE), along with supportive care, are the mainstays of treatment. Treatment choice is influenced by multiple factors. The clinico-epidemiological features of GBS in Australia have not been reviewed in 30 years and few studies have assessed contemporary treatment choices. ⋯ The clinico-epidemiological features are consistent with previous cohorts. Our experience in a large Australian tertiary centre demonstrates a clear preference for IVIg over PE.
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Internal medicine journal · Dec 2020
A 1 g dose of intravenous iron is sufficient to treat iron deficiency anaemia.
One hundred and ninety-four patient episodes were audited for response to a standardised 1 g intravenous iron infusion for medical outpatients with iron deficiency anaemia. Patients received either ferric carboxymaltose or iron polymaltose. At 5-7 weeks after infusion, mean increase in Hb was 26.7 g/L and ferritin was 161 mcg/L, and only one patient had Hb <100 g/L. This reassures that 1 g dose of intravenous iron is sufficient for most patients, with benefits for treatment costs and patient convenience.
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Internal medicine journal · Dec 2020
ReviewClinical leadership development in Australian healthcare: a systematic review.
Despite clear priority and high costs of leadership capability programmes in healthcare, and significant investments into improving clinical leadership, there remains a prominent gap around evidence of effectiveness or impact on patient outcomes in Australia. We aimed to conduct a systematic review on postgraduate clinical leadership programmes to gather learnings on the processes, theoretical underpinnings, and impact of such programmes for medical and other health professionals. ⋯ Four studies met criteria. Findings revealed that currently, little value is placed on formal evaluations and peer-reviewed publication including assessment of individual, organisational or system level impacts of clinical leadership development programmes, with limited evidence available on effective approaches to clinical leadership development in the Australian healthcare system.
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Internal medicine journal · Dec 2020
Point-of-care testing of HbA1c, renal function and lipids in remote or disadvantaged regions.
For optimal diabetes management HbA1c, lipid and renal function measurements are key. Suitable point-of-care systems can provide such data in remote areas, diabetes camps, disaster relief, small community hospitals and in community screening days in disadvantaged regions. Some systems are currently used in Australian rural, remote and indigenous health services.