Internal medicine journal
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Internal medicine journal · Dec 2003
Impact of an integrated approach to diabetes care at the Rumbalara Aboriginal Health Service.
To describe the effectiveness of an integrated primary-secondary care diabetes clinic on metabolic control among indigenous patients in a rural community. ⋯ The introduction of an integrated diabetes care service in an Aboriginal health service can overcome many of the pre-existing barriers to achieving metabolic targets. Poor metabolic control in Aboriginal patients is often due to lack of resources and inappropriateness of approach, rather than "compliance".
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Internal medicine journal · Nov 2003
Randomized Controlled Trial Clinical TrialRandomized, placebo-controlled trial of intramuscular vitamin B12 for the treatment of hyperhomocysteinaemia in dialysis patients.
Plasma homocysteine is elevated in patients with end-stage renal disease (ESRD) and is a risk factor for cardiovascular disease. Folic acid has been shown to partially reduce homocysteine levels in dialysis patients. It is not known whether vitamin B12 reduces homocysteine independent of folic acid in patients who are not vitamin B12 deficient. ⋯ The administration of intramuscular vitamin B12 over a 3-month period does not result in any reduction of plasma homocysteine levels in haemo-dialysis patients independent of folate status, however reductions of <30% cannot be excluded by the present study. High-dose folic acid remains the treatment of choice in reducing homocysteine, but whether this results in a reduction in cardiovascular events remains to be determined.
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Internal medicine journal · Aug 2003
Health effects of kava use in an eastern Arnhem Land Aboriginal community.
Heavy kava use in Aboriginal communities has been linked to various health effects, including anecdotes of sudden cardiac deaths. ⋯ Kava use was associated with dermopathy, liver function abnormalities and decreased lymphocytes. If kava continues to be used by Aboriginal populations, monitoring should focus on the health consequences of these findings, including a possible increase in serious infections. The interaction between kava, alcohol and other substances requires further study. Although markers of cardiovascular risk are increased across the population, these were not higher in kava users, and this increase may be linked to the large infectious pathogen burden reflective of the socioeconomic disadvantage seen in many remote Aboriginal communities.
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Internal medicine journal · Aug 2003
Complication rates of colonoscopy in an Australian teaching hospital environment.
Quality assurance is an important part of health-care delivery. With the high level of awareness relating to adverse events from medical care, demonstration of a high standard of practice in gastroenterology is desirable. ⋯ The incidence of bleeding and perforation is similar to other reported series and reflects procedures performed by personnel with a wide range of endoscopic experience. The incidence of complications was not greater for trainees compared with consultant endoscopists. All bleeding episodes and the majority of perforations were associated with a therapeutic intervention. Diagnostic colonoscopy in particular is a very safe procedure.