Internal medicine journal
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Internal medicine journal · Jul 2009
Comparative StudyEndoscopic evaluation of significant gastrointestinal lesions in patients with iron deficiency with and without anaemia: a Korean Association for the Study of Intestinal Disease study.
Although endoscopy is recommended for patients with iron deficiency anaemia, there is, currently, no consensus on the role of endoscopy for iron-deficient patients without anaemia. The goal of this study was to determine the prevalence of serious gastrointestinal (GI) lesions, identified by endoscopy in patients with iron deficiency and anaemia compared with patients with iron deficiency without anaemia. ⋯ The results of this study suggest that patients with iron deficiency should undergo endoscopic evaluation of the GI tract, irrespective of whether they have anaemia. The endoscopic evaluation of the GI tract in patients with iron deficiency without anaemia could provide an opportunity for the detection of early-stage neoplasia at a curable stage.
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Internal medicine journal · Jul 2009
Comparative StudyEndobronchial ultrasound convex-probe transbronchial needle aspiration as the first diagnostic test in patients with pulmonary masses and associated hilar or mediastinal nodes.
In the diagnosis of patients with a lung mass and hilar or mediastinal lymph nodes (N1or N2) it may be that patients are unnecessarily having biopsies of the primary lung cancer when sampling of the nodes would give both a tissue diagnosis and staging. By comparing node station and size in patients having just one procedure (endobronchial ultrasound transbronchial needle aspiration [EBUS TBNA]) with those having extra procedures on the primary mass before EBUS TBNA, similarity of nodes in the two groups might suggest that the extra procedures were unnecessary. ⋯ There was no difference between the two groups in node size or location. Diagnostic yield overall was high. With expanding use of EBUS TBNA, a new guideline for its initial application in such patients could reduce the overall number of procedures.
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Internal medicine journal · Jul 2009
Comparative StudyDo medical courses adequately prepare interns for safe and effective prescribing in New South Wales public hospitals?
To assess ability of interns immediately before starting clinical practice in New South Wales (NSW) teaching hospitals to prescribe medications safely and appropriately and to describe their impressions of the adequacy of their clinical pharmacology training in medical school. ⋯ Interns about to commence clinical practice in NSW teaching hospitals demonstrated significant deficits in prescribing of regular medications, initiation of new therapies, prescribing of discharge medications, and particularly prescribing of Schedule 8 medications. Most interns recognized these deficits and would have liked more clinical pharmacology training at medical school.
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Internal medicine journal · Jun 2009
MODELING COST-EFFECTIVENESS OF HIGH DOSE CHEMOTHERAPY AS TREATMENT FOR RELAPSED AGGRESSIVE NON-HODGKIN'S LYMPHOMA IN AN AUSTRALIAN SETTING.
Background: Since 1995 patients with relapsed aggressive non Hodgkin's lymphoma (NHL) have been treated with high dose chemotherapy (HDC) instead of standard dose chemotherapy (SC) because of superior survival demonstrated in the "Parma study". As HDC involves hospital admission and intensive supportive care, the cost of HDC would be predicted to be higher than for SC. The aim of this study was to calculate the Incremental Cost-Effectiveness Ratio (ICER) for HDC compared to SC using Australian costs. ⋯ The ICER was calculated according to formula: Incremental Cost / Incremental Benefit = (Costs(HDC)-Costs(SDC)) / (AUC(HDC)-AUC(SDC)). Results: Cost for HDC and SC were $AU37,490 and $AU33,360 respectively, and the AUC(0-infinity) were 4.09 and 3.5 patient life years respectively giving an ICER of $AU7,070 per discounted life year gained. Conclusion Compared to published studies in multiple myeloma and solid organ transplant these results support HDC as a cost-effective treatment in relapsed aggressive NHL.