Internal medicine journal
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Internal medicine journal · Apr 2024
Challenges for trainee physician-scientists during their PhD candidature: a cross-sectional study.
Physician-scientists are important drivers of research, in both knowledge acquisition and research translation. In Australia, many newly qualified physicians and advanced physician trainees enrol in PhD studies, with a view to training as physician-scientists. However, data on perceived challenges and ways to support them are limited. ⋯ Trainee physician-scientists report multiple challenges during their PhD candidature and envisage significant challenges in establishing their research independence after PhD completion. They valued several potential support mechanisms, particularly a mentoring program. Australian universities and their associated academic health services should consider establishing programs to support trainee physician-scientists.
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Internal medicine journal · Apr 2024
Clinical outcomes of hepatocellular carcinoma surveillance in Melbourne, Australia.
Ultrasound surveillance for hepatocellular carcinoma (HCC) may improve early tumour detection but may additionally result in surveillance-related harm through increased evaluation of non-HCC lesions. The incidence of these outcomes has not been reported outside North America. ⋯ In our study, HCC surveillance was associated with early tumour detection, although many patients experienced mild surveillance-related harm. Novel surveillance strategies and pathways are required to improve detection in high-risk patients and minimise harm in low-risk patients.
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Internal medicine journal · Apr 2024
ReviewAutosomal dominant hypercalciuric hypocalcaemia: the calcium-sensing receptor in renal calcium homeostasis and the impact of renal transplantation.
Calcium-sensing receptors (CaSRs) are G protein-coupled receptors that help maintain Ca2+ concentrations, modulating calciotropic hormone release (parathyroid hormone (PTH), calcitonin and 1,25-dihydroxyvitamin D) by direct actions in the kidneys, gastrointestinal tract and bone. Variability in population calcium levels has been attributed to single nucleotide polymorphisms in CaSR genes, and several conditions affecting calcium and phosphate homeostasis have been attributed to gain- or loss-of-function mutations. ⋯ After kidney transplantation, she remains asymptomatic, with decreased vitamin D and elemental calcium requirements, stable fluid and electrolyte homeostasis during intercurrent illnesses and has normalised urinary calcium and phosphate excretion, reducing the likelihood of hypercalciuria-induced graft impairment. We review the actions of the CaSR, its role in regulating renal Ca2+ homeostasis along with the impact of a proven gain-of-function mutation in the CaSR gene resulting in autosomal dominant hypercalciuric hypocalcaemia before and after kidney transplantation.
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Internal medicine journal · Apr 2024
A retrospective review of the short Synacthen test in Queensland hospitals.
The short Synacthen test (SST) is widely used to investigate adrenal insufficiency, but it can be time-consuming, costly and labour-intensive to perform and is not without risk of adverse events. ⋯ There was wide variability in requesting patterns and practices for SSTs across Queensland. More than one in six SSTs could have been avoided if a static morning cortisol had been performed prior. Clinician education and the adoption of a structured referral form may improve testing practices.