Internal medicine journal
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The mortality rate post admission to hospital after successful resuscitation from out-of-hospital cardiac arrest is high, with significant variation between regions and individual institutions. While prehospital factors such as age, bystander cardiopulmonary resuscitation and total cardiac arrest time are known to influence outcome, several aspects of post-resuscitative care including therapeutic hypothermia, coronary intervention and goal-directed therapy may also influence patient survival. ⋯ In particular, hospital factors such as hospital size and interventional cardiac care capabilities have been found to influence patient mortality. This paper reviews the evidence supporting the possible development and implementation of Australian cardiac arrest centres.
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Internal medicine journal · Nov 2012
Access to anticancer drugs: many evidence-based treatments are off-label and unfunded by the Pharmaceutical Benefits Scheme.
The off-label use of a drug refers to a use outside the terms of its approval by the Therapeutic Goods Administration (TGA). It is also possible to prescribe unlicensed drugs under the TGA's special access scheme. A high rate of off-label prescribing has previously been reported in cancer. Our study aimed to document the disparity between evidence-based clinical guidelines for anticancer therapy, product approval and funding status of these agents within an academic tertiary/quaternary cancer centre. ⋯ Over 90% of off-label protocols are supported by established treatment guidelines or published peer-reviewed research even though the medications are not approved for that particular use by the TGA. However, these off-label protocols are unfunded by the PBS; this results in a marked inequality of access to appropriate medications for cancer patients across Australia.
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Internal medicine journal · Nov 2012
Recent trends in Victorian risk-adjusted in-hospital mortality: 1999-2009.
The background of the study is a comparison of risk-adjusted mortality across hospitals from different jurisdictions is now common worldwide. ⋯ Analysis of in-hospital risk-adjusted mortality trends using the HOPE model indicates significant improvement in patient outcomes in the State of Victoria over the past decade.
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The disease burden of inpatient gout has not been reported. Using a discharge diagnosis database and individual case record review, 77 patients who developed acute gout complicating a hospital admission for another reason were identified between January 2001 and April 2010 at The Townsville Hospital. ⋯ Patients with an attack of gout were more likely to be older, male or indigenous. Early diagnosis and appropriate treatment may help to reduce the healthcare costs of this overlooked disease.