Internal medicine journal
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Internal medicine journal · Sep 2011
Comparative StudyMeasurement properties of the 6-min walk test in individuals with exercise-induced pulmonary arterial hypertension.
Exercise-induced pulmonary arterial hypertension (EIPAH) is associated with reduced peak exercise cardiac output (CO) and aerobic capacity (peak ). We investigated the validity of the encouraged 6-min walk test (6MWT) to identify exercise limitation and estimate aerobic capacity in subjects with EIPAH. ⋯ The encouraged 6MWT identifies reduced exercise capacity and provides a valid estimate of aerobic capacity in EIPAH.
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Internal medicine journal · Sep 2011
ReviewPractical guidelines for the acute emergency sedation of the severely agitated older patient.
The vulnerability of older people to serious underlying medical illness and adverse effects of psychotropics means that the safe and effective treatment of severe agitation can be lifesaving, the primary management goals being to create a safe environment for the patient and others, and to facilitate assessment and treatment. We review the literature on acute sedation and provide practical guidelines for the management of this problem addressing a range of issues, including aetiology, assessment, pharmacological and non-pharmacological strategies, restraint and consent. The assessment of the agitated older patient must include concurrent assessment of the likely aetiology of, the risks posed by, and the risks/benefits of management options for, the agitation. ⋯ It is advised to start low and go slow, using small increments of dose increase. Medical staff are frequently called to sedate agitated older patients in hospital settings, often after hours, with limited access to relevant medical information and history. Safe and effective management necessitates adequate assessment of the aetiology of the agitation, exhausting all non-pharmacological strategies, and resorting to pharmacological and/or physical restraint only when necessary, judiciously and for a short-term period, with frequent review and the obtaining of consent as soon as possible.
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Internal medicine journal · Aug 2011
Comparative StudyPre-hospital oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease.
High concentration oxygen is commonly administered during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The aim of this study was to determine the association between oxygen, severity markers and poor outcomes in AECOPD. ⋯ In AECOPD high flow oxygen in the ambulance is associated with poor clinical outcomes. A number of easily identified markers of chronic disease severity indicate an increased risk of a poor clinical outcome.
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Internal medicine journal · Aug 2011
Case ReportsUse and disclosure of genetic information without consent: a decision-making tool for health practitioners--who, when, why and how?
As a result of legislative changes to the Privacy Act 1988 (Cth), Australian health practitioners in the private sector are now permitted to use or disclose patients' genetic information, without their consent, in circumstances where the health practitioner reasonably believes that doing so is necessary to lessen or prevent a serious threat to the life, health or safety of a genetic relative. ⋯ The Guidelines establish when, by whom and in what manner, use or disclosure of genetic information may take place. The Guidelines outline the factors that health practitioners should consider when determining whether use or disclosure is necessary to lessen or prevent a serious threat to an individual's life, health or safety.