Internal medicine journal
-
Internal medicine journal · Jan 2019
Lessons learnt from local real-life experience with idarucizumab for the reversal of dabigatran.
Idarucizumab is a specific antidote for the direct thrombin inhibitor oral anticoagulant dabigatran etexilate. It has been used with increasing frequency in Australia since it was granted Therapeutic Goods Administration approval in October 2016. ⋯ Idarucizumab helped achieve haemostasis in 15 bleeding patients and allowed 6 patients to undergo urgent surgery. Half the patients had prolonged TT/APTT at 24 h post-idarucizumab, which was more likely to occur in patients with impaired renal function.
-
Internal medicine journal · Dec 2018
Staggering shifts to rebalance night medical registrar workload.
Lone night medical registrars, particularly those working at busy urban hospitals have high workloads and low job satisfaction. Handover of pending referrals from day staff can contribute to further delays in providing care with increased risks for patient safety. ⋯ Rearranging medical registrar shifts can result in significant reduction in night medical registrar workload. It may also have other potential benefits in terms of increased capacity for ward reviews and reduced MET calls/codes.
-
Internal medicine journal · Dec 2018
Radial-probe endobronchial ultrasound outcomes in the investigation of peripheral pulmonary lesions: a New Zealand perspective.
Radial-probe endobronchial ultrasound (radial-EBUS) is becoming an important investigation for peripheral pulmonary lesions (PPL). A key advantage of radial-EBUS is the favourable risk profile compared with current gold-standard computerised tomography-guided biopsy. ⋯ Radial-EBUS was shown to be safe with diagnostic yield similar to international reports. Important predictors of success include distance from hilum, probe position and forceps as first instrument. We also demonstrated that molecular analysis is possible in radial-EBUS obtained samples.
-
Internal medicine journal · Nov 2018
Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience.
Timely diagnosis of malignant pleural effusions is critical to guide prognosis and management decisions. Cytological analysis of pleural fluid has been the first-line diagnostic test for many decades, with highly variable reported sensitivities of 40-90%. Its diagnostic accuracy in modern practice in Australia needs to be understood. ⋯ Tumour type is an important determinant of pleural fluid cytology diagnostic yield. Cytology has good sensitivity and specificity for the diagnosis of adenocarcinoma, but if another tumour type is suspected, particularly mesothelioma, clinicians should be aware of the limitations.