Internal medicine journal
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Internal medicine journal · Sep 2016
Endovascular thrombectomy for acute ischaemic stroke: a real-world experience.
Endovascular thrombectomy for acute ischaemic stroke due to proximal vessel occlusions in the anterior cerebral circulation within 6 h of stroke onset is now recognised as highly beneficial. Five randomised controlled trials in 2015 showed significant improvement in functional outcome at 90 days compared with intravenous thrombolysis alone. Liverpool Hospital is a tertiary referral centre with an acute stroke service, including 24/7 intravenous thrombolysis and endovascular thrombectomy. ⋯ This cohort of patients with anterior cerebral circulation occlusions was treated outside the well-resourced situation of clinical trials and good functional outcomes are similar. The study translates endovascular thrombectomy to a 'real-world' situation.
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Internal medicine journal · Sep 2016
Multicenter Study Observational StudyEffectiveness and response predictors of omalizumab in a severe allergic asthma population with a high prevalence of comorbidities: the Australian Xolair Registry.
Severe asthma is a high impact disease. Omalizumab targets the allergic inflammatory pathway; however, effectiveness data in a population with significant comorbidities are limited. ⋯ Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. Symptomatic response to omalizumab was high despite significant comorbid disease. Omalizumab is an effective targeted therapy for severe allergic asthma with comorbidity in a real-life setting.
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Internal medicine journal · Sep 2016
Multicenter StudyInconsistencies and time delays in site-specific research approvals hinder collaborative clinical research in Australia.
The aim of this study was to describe the time and documentation needed to gain ethics and governance approvals in Australian states with and without a centralised ethical review system. ⋯ The benefits of centralised ethics review systems have not been realised due to duplicative, inflexible governance processes. A system that allowed the recognition of prior ethical approval and low-risk applications was more efficient than a central ethics and site-specific governance process.
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Internal medicine journal · Sep 2016
Comparative StudyApixaban versus enoxaparin in the prevention of venous thromboembolism following total knee arthroplasty: a single-centre, single-surgeon, retrospective analysis.
There is a high risk of developing venous thromboembolism (VTE) following total knee arthroplasty (TKA). Conventional thromboprophylactic agents have limitations, such as route of administration, the need for monitoring, narrow therapeutic windows and interactions. Apixaban is a new oral anticoagulant with the potential to overcome these limitations. ⋯ Compared with enoxaparin, thromboprophylaxis with apixaban resulted in a lower VTE incidence and fewer haemorrhagic complications.
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Internal medicine journal · Aug 2016
Prescription opioid analgesics for pain management in Australia: 20 years of dispensing.
Opioid prescribing/dispensing data can inform policy surrounding regulation by informing trends and types of opioid prescribed and geographic variations. In Australia so far only partial data on dispensing have been published, and data for states/territories remain unknown. ⋯ Prescription opioid dispensing increased substantially over the study period. With an ageing population, this trend is likely to continue in future. A growing concern about harms associated with opioid use warrants balanced control measures so that harms could be minimised without reducing effective pain treatment. Research examining utilisation in small geographic areas may help design spatially tailored interventions. A real-time drug-monitoring programme may reduce undue prescribing and dispensing.