Internal medicine journal
-
Internal medicine journal · Apr 2020
Hospitalised exacerbations of chronic obstructive pulmonary disease: adherence to guideline recommendations in an Australian teaching hospital.
Optimal management of exacerbations of chronic obstructive pulmonary disease (COPD) reduces patient morbidity and healthcare system burden. COPD guidelines, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the COPD-X Plan, provide evidence-based recommendations, but adherence in hospital practice is variable. ⋯ Level of adherence to guideline recommendations in the management of COPD exacerbations is inadequate and further strategies are required to elevate standards of practice.
-
Lithium-induced neurotoxicity typically occurs with chronic accumulation rather than following acute overdose. There is little emphasis in the literature on the protracted nature of lithium neurotoxicity long after the lithium concentration returns to the therapeutic range. ⋯ Lithium neurotoxicity has a prolonged course. Its severity correlates poorly with lithium concentrations, which normalise quickly. Most poisonings occur in elderly patients with acute kidney injury. Prolonged delirium often prompts multiple unnecessary investigations. Rationalisation of lithium therapy is important in elderly patients.
-
Internal medicine journal · Apr 2020
Gender equity within medical specialties of Australia and New Zealand: cardiology's outlier status.
Gender disparity remains a prominent medical workforce issue, extending beyond surgical specialties with low proportions of female doctors. ⋯ Cardiology is the only physician specialty with <20% female consultants, and this disparity is reflected throughout every stage of the cardiology training programme. Increased awareness and proactive strategies are needed to improve gender disparity within this underrepresented medical specialty.
-
Internal medicine journal · Apr 2020
Pleurisy and pulmonary embolism: physician sees through patient eyes.
As a respiratory physician personally affected by pulmonary thromboembolism, I bring a unique perspective to managing this condition. It has made me realise that sometimes we do not see in detail the ways our colleagues practise, even working alongside them, although general management principles are the same. While banned from work, but permitted 'as much paperwork as I like' (the sole compromise that would ensure this patient's adherence), I sought to learn from my time as patient, hoping that other clinicians might gain from my experience in both roles. When it came to deciding which insights would be most useful to impart for the benefit of our patients, the leading concepts were not novel but important to emphasise in our current medical world, which prioritises both efficiency and quality of patient care.