Internal medicine journal
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Internal medicine journal · Dec 2013
Impact of opening a new emergency department on healthcare service and patient outcomes: analyses based on linking ambulance, emergency and hospital databases.
Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload. ⋯ An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a 'whole of health service area' approach to solve crowding issues.
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Internal medicine journal · Dec 2013
Total length of stay, costs and outcomes at final discharge for admitted patients with hip fracture: linked episode data for Australian veterans and war widows.
To identify the total duration of hospital stay, total hospital costs and outcomes at final discharge for a series of Australian patients with hip fracture. ⋯ For complex conditions such as hip fracture, a process of patient-specific episode linkage is required to identify accurately hospital LOS, costs and patient outcomes.
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Internal medicine journal · Nov 2013
Meta AnalysisPopulation attributable risks for modifiable lifestyle factors and breast cancer in New Zealand women.
Breast cancer is the most commonly diagnosed invasive cancer in New Zealand women and modifiable lifestyle risk factors may contribute to this. ⋯ The most important primary preventive strategies to reduce the risk of breast cancer in New Zealand are lifestyle changes to reduce obesity, promoting regular physical activity (which may in turn reduce the prevalence of obesity), reducing HRT use and avoiding high alcohol intake. Strategies that encourage regular physical activity and reduce obesity could also have other benefits, such as reduced risks of cardiovascular disease and diabetes.
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Thrombotic microangiopathy (TMA) is a microvascular occlusive disorder characterised by platelet aggregation, thrombocytopenia and end-organ damage. It is commonly idiopathic, although several drug classes, including cytotoxic chemotherapy, have been implicated. Several of cases of gemcitabine-induced TMA have been documented with incidence likely to increase with the escalating use of gemcitabine. We report the cases of two patients who developed TMA while on gemcitabine chemotherapy.
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Internal medicine journal · Nov 2013
Multicenter StudyAdministration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy.
Appropriately timed cessation of chemotherapy is an important aspect of good quality palliative care. There is wide variation in the reported rates of chemotherapy administration within the last 30 days of life. ⋯ Patients who received chemotherapy in the last 30 days of life were more likely to be male and have a shorter duration of palliative care team involvement. In this study, the observed rate of death within 30 days of chemotherapy is within the range of published data. It is recommended that a standard definition be used to benchmark medical oncology centres and individual oncologists, and to allow comparison over time.