Internal medicine journal
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Internal medicine journal · Nov 2019
Multicenter StudyAssociation between ribociclib and changes in creatinine in patients with hormone receptor positive metastatic breast cancer.
Combination ribociclib and aromatase inhibitors are currently the preferred treatment in Australia for newly diagnosed hormone receptor positive metastatic breast cancer in the absence of visceral crisis. In our case series of 32 patients, 28% experienced grade 1 elevations in creatinine, a toxicity that was under-recognised in large phase III studies. Creatinine rise appears to be due to a reversible inhibition of renal efflux transporters rather than an acute kidney injury in the majority of cases.
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Internal medicine journal · Nov 2019
Use of a three-tiered clinical decision rule to quantify unnecessary radiological investigation of suspected pulmonary embolism.
Clinical decision rules for suspected pulmonary embolism are proposed to identify patients suitable for discharge without radiological investigation. Their use varies between institutions. ⋯ Retrospective application of the proposed clinical decision rule to the studied cohort indicates at least 9% of radiological investigations were unnecessary. A prospective study is needed to assess the safety and cost-effectiveness of applying such a pathway to all patients presenting to ED with suspected PE.
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Lung cancer screening can reduce lung cancer mortality. Australian cost estimates are important to inform policy but remain uncertain. ⋯ Advanced cancer cost more to treat and had worse survival than early cancer. Screening costs are similar to international studies and suggest that lung cancer early detection could limit treatment costs and improve outcomes.
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Internal medicine journal · Nov 2019
Ethical considerations relating to healthcare resource allocation decisions.
Public policy decisions about patients' access to limited healthcare resources must be defensible and responsive to the interests of those affected. Decision-makers should articulate their reasoning and recommendations so that citizens can judge them. While the context of policy decisions will differ, their legitimacy depends upon the transparency of the reasoning, the accountability of the decision-makers, the testability of the evidence used to inform the decision-making and the inclusive recognition of those the decision affects. An example of applying this framework to resource allocation is that of approving effective high-cost anticancer drugs in a timely fashion.