Internal medicine journal
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Internal medicine journal · Dec 2019
Differential clinical characteristics, management and outcome of delirium among ward compared with intensive care unit patients.
Delirium is common in hospitalised patients but its epidemiology remains poorly characterised. ⋯ Delirium in ward patients is profoundly different from delirium in ICU patients. It has a dominant hypoactive clinical phenotype, is preceded by dementia and is less likely to recover at hospital discharge. Therefore, delirium prevention, detection and goals of care should be adapted to the environment in which it occurs.
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Internal medicine journal · Dec 2019
Predictors and histopathological characteristics of non-diabetic renal disorders in diabetes: a look from the tubulointerstitial point of view.
Prevalence and characteristics of non-diabetic renal diseases (NDRD) in patients with type 2 diabetes mellitus is different between populations, and seems to be largely dependent on biopsy policies. ⋯ Renal biopsy is essential in certain clinical conditions as diagnosis of NDRD is vital for favourable renal survival. DN may facilitate superimposed tubular injury in the presence of toxic insults.
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Internal medicine journal · Dec 2019
Case ReportsRET-rearranged non-small-cell lung cancer and therapeutic implications.
First-line tyrosine kinase inhibitors are standard of care for non-small-cell lung cancers (NSCLC) harbouring an epidermal growth factor receptor mutation, anaplastic lymphoma kinase fusion or c-ros oncogene 1 rearrangement. Other targetable oncogenic drivers have been identified but testing for these is neither funded nor commonly performed in Australia. Using a case example, we discuss the importance of considering several other genomic aberrations in our population, such as rearrangements in the RET proto-oncogene, which occur in 1-2% of lung adenocarcinoma. New oncogenic drivers and corresponding targeted agents are constantly being discovered; these will continue to refine the treatment of non-small-cell lung cancer in the era of precision medicine.
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The current Australian Medical Association doctors in training enterprise agreement dictates that hours beyond 38 or 43 ordinary hours per week incur overtime. Costly overtime has led to strict adherence to ordinary hours with dramatically reduced rostered and unrostered overtime. ⋯ Reduced shift duration adds to the number of clinical handovers, while reduced exposure to patients and training opportunities may prolong training time. Now is the time for renegotiation of working hours, which are most favourable for doctor training and well-being.
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Internal medicine journal · Dec 2019
Epidemiology, symptomatology and treatment of patients with myasthenia gravis in an Australian hospital.
Myasthenia gravis (MG) is a disorder affecting neuromuscular transmission with heterogeneous manifestations and treatments. This study describes clinical features and management of MG patients at a metropolitan hospital in Australia. ⋯ However, frequency of intravenous immuno-globulin use was higher, reasons for which are explored. Management is best conducted through specialist clinics with necessary expertise and standardised treatment protocols.