Internal medicine journal
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Internal medicine journal · Mar 2019
Palliative care in end-stage heart failure: experience of a collaborative approach in a secondary care setting.
Heart failure remains an ultimately fatal condition that causes significant symptoms as it progresses. The involvement by palliative services in this patient group has been suboptimal despite many years of guidance from international cardiac societies who recommend a palliative focus for these patients. ⋯ Management plans and goals of care have been clearly documented, and there has been clarification of roles between the key stakeholders who manage end-stage heart failure patients. A formal integrated palliative approach has been helpful for our end-stage heart failure patients and there is potential for this concept to be beneficial for other end-stage medical conditions.
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Internal medicine journal · Feb 2019
Prevalence and nature of lung function abnormalities among Indigenous Australians referred to specialist respiratory outreach clinics in the Northern Territory.
Poor lung function is a predictor of future all-cause mortality. In Australia, respiratory diseases are particularly prevalent among the indigenous population, especially in remote communities. However, there are little published pulmonary function tests' (PFT) data of remote-based adult indigenous patients. ⋯ In this first study of PFT findings of indigenous adults from a remote-based clinical service, we found a high rate of at least moderate airflow limitation and low FVC along with preserved FEV1/FVC ratio. Increased awareness and screening for reduced lung function needs to be considered in this population.
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Internal medicine journal · Feb 2019
Cross-sex hormone therapy in Australia: the prescription patterns of clinicians experienced in adult transgender healthcare.
Despite increasing demand for transgender healthcare, guidelines for cross-sex hormone therapy are based on low-level evidence only. As most data are based on international expert opinions, interpretations and practices vary significantly. ⋯ Experienced hormone prescribers in Australia largely use medication regimens and monitor sex steroid levels and potential adverse effects of sex hormone therapy in accordance with broad, subjective recommendations listed in international guidelines. Additional practitioner training is necessary, and local Australian-based guidelines would offer specific, relevant guidance to clinicians in the initiation and monitoring of cross-sex hormone therapy for adult transgender individuals.
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Internal medicine journal · Feb 2019
Comparative StudyGreater insulin response to acute fructose ingestion among Māori and Pacific people compared to European people living in Aotearoa New Zealand.
Fructose consumption has been linked with insulin resistance, obesity and diabetes, which are more prevalent in those of Māori or Pacific ethnicity compared to New Zealand European. ⋯ Even after adjustment for BMI, those of Māori and Pacific ethnicity have a significantly higher insulin response to fructose than New Zealand Europeans. Higher habitual SSB intake may be a contributing factor.
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Internal medicine journal · Jan 2019
Multicenter StudySubstantial variation exists in spirometry interpretation practices for airflow obstruction in accredited lung function laboratories across Australia and New Zealand.
Spirometry forms the foundation investigation for the diagnosis and monitoring of common pulmonary conditions. However, potential variation in spirometry interpretation for airflow obstruction may impact subsequent clinical management. ⋯ Significant heterogeneity in spirometry interpretation for airflow obstruction exists across Australian and New Zealand accredited lung function laboratories. Lack of standardisation may translate into clinically appreciable differences for the diagnosis and management of common respiratory conditions. Ongoing discussion regarding formal standardisation is required.