Internal medicine journal
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Internal medicine journal · Jan 2020
Case ReportsWilson disease: copper deficiency and iatrogenic neurological complications with zinc therapy.
A 17-year-old female was diagnosed with Wilson disease and commenced on oral zinc therapy. She re-presented 6 months later with a fall and had classical signs of subacute combined degeneration of the spinal cord confirmed on nerve conduction studies, as a result of zinc-induced copper deficiency. ⋯ Early detection of zinc-induced copper deficiency and stringent follow-up mechanisms are crucial. Early initiation of copper replacement may both limit and completely reverse neurological deficits.
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This article presents current diagnostic conceptualisations of eating disorders, including new disorders such as binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). This is followed by contemporary findings in the epidemiology of eating disorders, their broad sociodemographic distribution and the increases in community prevalence. Advances and the current status of evidence-based treatment and outcomes for the main eating disorders, anorexia nervosa, bulimia nervosa and BED are discussed with focus on first-line psychological therapies. Deficits in knowledge and directions for further research are highlighted, particularly with regard to treatments for BED and ARFID, how to improve treatment engagement and the management of osteopenia.
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Internal medicine journal · Jan 2020
Diabetes care: addressing psychosocial well-being in young adults with a newly developed assessment tool.
Psychosocial assessment should be part of clinic visits for people with diabetes mellitus (DM). ⋯ DPAT revealed a high prevalence of psychosocial stress among young adults with DM. The tool was easy to use and accepted by patients and may aid streamlining referrals to relevant members of a multidisciplinary team.
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Internal medicine journal · Jan 2020
Evidence-poor medicine: just how evidence-based are Australian clinical practice guidelines?
Clinical practice guidelines aim to assist medical practitioners in making efficient evidence-based decisions in daily practice. However, international studies have shown that the majority of recommendations in American and European guidelines are not based on strong evidence. ⋯ Despite the enthusiasm of the evidence-based medicine movement and its documented successes, contemporary medicine appears to remain largely evidence-poor, not evidence-based. Future research should aim to provide reliable descriptions of what constitutes valid clinical reasoning in evidence-poor situations.
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Internal medicine journal · Jan 2020
Providing palliative care closer to home: a retrospective analysis from a remote Australian hospital.
Rural and remote patients have reduced access to palliative care, often resulting in inter-hospital transfers and death a long way from home and family. Katherine Hospital (KH), a 50-bed hospital services a population with high Aboriginality who experience this issue. ⋯ Increasing the capacity of a remote hospital to provide palliative care allowed more patients to die closer to home and decreased inappropriate aeromedical retrievals. An increased in-hospital mortality rate should not be misinterpreted as reflecting suboptimal care if palliative intent, patients' wishes and non-clinical risk factors have not been ascertained.