Internal medicine journal
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Internal medicine journal · Feb 2016
Subspecialisation in cardiology care and outcome: should clinical services be redesigned, again?
Inpatient management of cardiac patients by cardiologists results in reduced mortality and hospitalisation. With increasing subspecialisation of the field because of growing management complexity and use of technological innovations, the impact of sub-specialisation on patient outcomes is unclear. ⋯ The benefits of subspecialty care seem attributable to the appropriate selection of patients who would benefit from technological innovations in care. These results suggest that the development of healthcare systems which align cardiovascular disease with the subspecialist may be more effective.
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Internal medicine journal · Jan 2016
Anaemia in elective orthopaedic surgery - Royal Adelaide Hospital, Australia.
An anaemia clinic was established to improve the preoperative management of elective orthopaedic patients scheduled for arthroplasty. This paper is a report on the first 100 patients assessed. ⋯ Half of the anaemic patients in a joint replacement screening clinic were iron deficient, and treatment was effective in improving the pre-operative haemoglobin and reducing perioperative transfusion rates. This screening process should improve patient outcome. Another important finding in this group of patients is that ferritin levels cannot be reliably used as the sole indicator in the diagnosis of iron deficiency anaemia in this group of patients undergoing elective arthroplasty.
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Compared with other health professionals and the general population, doctors and medical students reported higher rates of psychological distress, burnout, diagnosed mental illness, suicidal ideation and attempted suicide. Where possible, the problematic and unnecessarily stressful aspects of working as a doctor must be improved. Collectively, we must change the often toxic culture of medicine into a culture that promotes a nurturing and supportive approach to teaching and supervision. The goal should be to develop medical practices that facilitate well-being and quality of life, where sustainable medical careers can develop and better serve the community.
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Internal medicine journal · Jan 2016
Observational StudyAtrial fibrillation in older inpatients: are there any differences in clinical characteristics and pharmacological treatment between the frail and the non-frail?
Frailty is common in patients with atrial fibrillation and may impact on antithrombotic and anti-arrhythmic treatment. ⋯ Frailty status had little impact on antithrombotic prescription and no impact on anti-arrhythmic prescription.
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Internal medicine journal · Dec 2015
Polycystic ovary syndrome and metabolic syndrome in Indigenous Australian women.
Polycystic ovary syndrome (PCOS) affects around 15% of Indigenous women who are also a group at high risk of cardiometabolic disease. ⋯ While MetS was more common in Indigenous women with PCOS, PCOS was not an independent predictor of MetS. This may be because obesity and insulin resistance are integral parts of PCOS and are the mechanisms through which PCOS exerts metabolic effects.