Internal medicine journal
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Internal medicine journal · Jun 2015
Proton pump inhibitors utilisation in older people in New Zealand from 2005 to 2013.
The prescriptions for proton pump inhibitors (PPI) to treat acid-related disorders continue to rise internationally and in New Zealand. Concerns have been raised regarding its widespread use, costs and potential adverse effects in older people. ⋯ Utilisation of PPI among older people in New Zealand increased by a fifth from 2005 to 2013. Given the concerns surrounding the long-term PPI use in older people, the appropriateness of the increased utilisation needs to be continuously re-evaluated by prescribers and health policy makers.
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Internal medicine journal · Jun 2015
Multicenter Study Observational StudyCompassionate access anti-tumour necrosis factor-α therapy for ulcerative colitis in Australia: the benefits to patients.
The efficacy of infliximab has been demonstrated in patients with both acute severe and moderate-severe ulcerative colitis (UC). However, there is a need for 'real-life data' to ensure that conclusions from trial settings are applicable in usual care. We therefore examined the national experience of anti-tumour necrosis factor-α (TNF-α) therapy in UC. ⋯ These data show an excellent overall benefit for anti-TNF-α therapy in both ASUC and MRUC. In particular, only short-duration anti-TNF-α was required in ASUC. These real-life data thus support the clinical trial data and should lead to broader use of this therapy in UC.
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Internal medicine journal · Jun 2015
Comparative StudyPredictive value of serum markers for the development of interstitial lung disease in patients with polymyositis and dermatomyositis: a comparative and prospective study.
Interstitial lung disease (ILD) is one of the most common and devastated complication of polymyositis/dermatomyositis (PM/DM). Several studies have focused on serum biomarkers for ILD in PM/DM patients; however, there have been no prospective studies. ⋯ Considering the ability of KL-6 for predicting the onset of ILD and monitoring the treatment response of ILD in PM/DM patients, it may be of great significance for clinical practice, and the prognosis of patients may be substantially improved if serum KL-6 was regularly monitored.
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Internal medicine journal · May 2015
ReviewConsensus guidelines for the investigation and management of encephalitis in adults and children in Australia and New Zealand.
Encephalitis is a complex neurological syndrome caused by inflammation of the brain parenchyma. The management of encephalitis is challenging because: the differential diagnosis of encephalopathy is broad; there is often rapid disease progression; it often requires intensive supportive management; and there are many aetiologic agents for which there is no definitive treatment. ⋯ For patients who require admission to hospital and in whom encephalitis is likely, a staged approach to investigation and management is preferred with the potential involvement of multiple medical specialties. Key considerations in the investigation and management of patients with encephalitis addressed in this guideline include: Which first-line investigations should be performed?; Which aetiologies should be considered possible based on clinical features, risk factors and radiological features?; What tests should be arranged in order to diagnose the common causes of encephalitis?; When to consider empiric antimicrobials and immune modulatory therapies?; and What is the role of brain biopsy?
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Internal medicine journal · May 2015
Obvious emphysema on computed tomography during an acute exacerbation of chronic obstructive pulmonary disease predicts a poor prognosis.
Emphysematous change on computed tomography (CT) during the stable phase of chronic obstructive pulmonary disease (COPD) is reported to correlate with COPD prognosis. Acute exacerbation of COPD (AECOPD) is associated with a high risk of mortality and a poor prognosis. ⋯ Obvious emphysematous changes on CT (LAA% > 7.5%) during an AECOPD predicts a poor prognosis independent of other known indicators.