Internal medicine journal
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Internal medicine journal · Mar 2011
Multicenter Study Comparative StudyThe Bosentan Patient Registry: long-term survival in pulmonary arterial hypertension.
The Bosentan Patient Registry (BPR) was a prospective, multicentre, Australian registry funded by Actelion Pharmaceuticals. The primary aim of the registry was to collect survival data in patients with pulmonary arterial hypertension (PAH) treated with bosentan. ⋯ This large Australian registry provides 'real life' information on the characteristics and management of PAH in clinical practice. Treatment with bosentan improved survival outcomes in both iPAH and SSc-PAH compared with historical controls. Age, disease severity and aetiology were critical factors in determining clinical outcomes.
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Internal medicine journal · Mar 2011
Comparative StudyComparison of the Wells and Revised Geneva Scores for the diagnosis of pulmonary embolism: an Australian experience.
Clinical prediction rules form an integral component of guidelines on the diagnostic approach to pulmonary embolism (PE). The Wells Score is commonly used but is subjective, while the newer Revised Geneva Score is based entirely on objective variables. The aim of this study was to compare the diagnostic accuracy of the Wells and Revised Geneva Scores for the diagnosis of PE. ⋯ Using the accepted guidelines in which a high pretest probability leads to further imaging and a low probability leads to a D-dimer blood test, use of the more specific Wells Score could safely reduce the number of unnecessary scans. This would need to be confirmed with larger, prospective trials.
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Internal medicine journal · Mar 2011
Comparative StudyManagement of chronic obstructive pulmonary disease in Australia after the publication of national guidelines.
Information on the management of chronic obstructive pulmonary disease (COPD) in Australia, especially the extent of adherence to the COPD-X Plan, is sparse. ⋯ Management of COPD in Australia by both patients and providers remains suboptimal despite the publication and wide dissemination of the COPD-X Plan, suggesting the need to intensify both patient and provider education in COPD management.
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Internal medicine journal · Mar 2011
Comparative StudyStudy of compliance with a clinical pathway for suspected pulmonary embolism.
Clinical pathways to guide the investigation of suspected pulmonary embolism have been increasingly adopted by emergency departments worldwide. This study evaluated the compliance with a clinical pathway that combines risk assessment (Wells score) with d-dimer, ventilation-perfusion scanning or computed tomographic pulmonary angiography (CTPA). The aims of this study were to identify factors that contribute to compliance and to assess patient outcomes and resource utilization. ⋯ Compliance with this clinical pathway allowed emergency department doctors in an Australian university teaching hospital to complete diagnostic testing for suspected pulmonary embolism appropriately unless non-emergency department doctors became involved. Compliance with this pathway altered the distribution of diagnostic tests performed with less reliance on CTPA, but was not associated with better patient outcomes.
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Internal medicine journal · Mar 2011
Comparative StudyEthnicity and lupus nephritis: an Australian single centre study.
The clinical impression of Australian physicians is that systemic lupus erythematosus (SLE) is more prevalent and more severe in Asian patients than in their Caucasian counterparts. The presence and severity of lupus nephritis is a major determinant of prognosis in SLE, and largely determines disease impact. ⋯ This study supports the common clinical impression that SLE is more common and more severe in the Asian-Australian population. Asian patients with SLE were more commonly diagnosed with LN. However, the spectrum of histological severity of LN was similar in Asian and Caucasian patients.