The Medical journal of Australia
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New guidelines and a multidisciplinary approach have the potential to help patients in need while minimising inappropriate use of opioids.
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A 49-year-old man presented with verapamil toxicity complicated by hypotension and a junctional rhythm, in the context of deliberate self-poisoning with multiple drugs. The patient's hypotension normalised following the early use of high-dose insulin euglycaemic therapy (HIET), without the need for additional vasopressors; it recurred when HIET was prematurely stopped, and again stabilised when HIET was recommenced. Consideration should be given to the early use of HIET in treating severe calcium channel blocker toxicity, rather than as a last resort after other therapies have failed.
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Practice Guideline
Acute coronary syndromes: consensus recommendations for translating knowledge into action.
A systematic, integrated national approach is needed to implement 2006 Australian guidelines for management of acute coronary syndromes (ACS). Clinical outcomes can be improved by closing the current gaps between evidence and practice. In 2007, the National Heart Foundation of Australia, the Cardiac Society of Australia and New Zealand, and the Australasian College for Emergency Medicine held a national forum to identify current gaps in ACS management and priority strategies to improve outcomes. ⋯ All patients with an ACS should be referred to rehabilitation and secondary prevention programs, including alternative models of care where appropriate. Equal access to recommended care for all Australians with an ACS - including those in rural, remote and Aboriginal and Torres Strait Islander communities - should be achieved by improving workforce capacity in under-resourced regions and ensuring access to third-generation fibrinolytic agents, defibrillation, timely essential pathology tests and invasive revascularisation facilities. National standards for data collection and clinical outcomes should be established, and performance should be monitored.
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To examine the effect of the level of patient copayment on the rate of purchase of inhaled corticosteroids (ICS) by patients with obstructive lung disease. ⋯ As the patient copayment for general beneficiaries is over six times higher than for concession card holders, our findings imply that cost is a barrier to the purchase of ICS prescriptions for obstructive lung disease, independent of socioeconomic status.
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Although glycated haemoglobin (HbA(1c)) has become the key biochemical marker of long-term glycaemic control, analytical method-dependent differences in results can occur when haemoglobin variants are present or HbA(1c) is reduced by decreased red cell survival. When the measured HbA(1c) level is discordant with the patient's blood glucose measurements and clinical status, fructosamine is an alternative biochemical marker that can provide a more accurate estimate of the glycaemic control and enable clinicians to appropriately manage patients.