Internal medicine journal
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Internal medicine journal · Apr 2011
Guidelines for patient selection and performance of carotid artery stenting.
The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) is controversial. The inter-collegiate Carotid Stenting Guidelines Committee (CSGC) recommends that CAS should not be performed in the majority of patients requiring carotid revascularization. CAS may be considered for specific high risk patients with symptomatic severe carotid stenosis who have contraindications for carotid endarterectomy, or in those under 70years of age where carotid re-vascularization is considered appropriate. Advances in endovascular technologies and the long-term results of randomized controlled trials will guide future revisions of these guidelines.
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Internal medicine journal · Apr 2011
Comparative StudyProthrombin complex concentrates used alone in urgent reversal of warfarin anticoagulation.
Prothrombinex-VF (a three-factor prothrombin complex concentrate) contains little factor VII. Therefore, the Warfarin Reversal Consensus Guidelines from 2004 published by The Australasian Society of Haemostasis and Thrombosis recommend that it be administered with fresh frozen plasma to reverse warfarin anticoagulation. ⋯ Prothrombinex-VF is very effective and safe when used alone to reverse warfarin anticoagulation. The supplementary use of fresh frozen plasma in these patients is not required. A review of the current Warfarin Reversal Consensus Guidelines is needed.
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Internal medicine journal · Apr 2011
Comparative StudyEliciting views of Australian pharmaceutical industry employees on collaboration and the concept of Quality Use of Medicines.
Pharmaceutical industry involvement in biomedicine has produced major benefits but has also caused concern. At present, there is no consensus as to how medical and government organizations should relate to the pharmaceutical industry and this is partly due to the absence of systematic study of the various alternatives. In Australia industry cooperation has been elicited through the 'Quality Use of Medicines' (QUM) framework within the 'National Medicines Policy'. Little is known about the way employees of pharmaceutical companies respond to the QUM policy and strategies. ⋯ Employees within the pharmaceutical industry claim a commitment to collaboration and QUM. While these claims cannot be taken entirely at face value, there is potential for meaningful collaboration with industry.
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Internal medicine journal · Apr 2011
Comparative StudyMetropolitan-rural divide for stroke outcomes: do stroke units make a difference?
Stroke care across Australian hospitals is variable. The impact on health outcomes, in particular levels of disability for patients in rural areas, is unclear. The aim of this study was to determine whether geographic location and access to stroke units are associated with differences in health outcomes in patients with acute stroke. ⋯ Patients with stroke treated in rural hospitals have poorer health outcomes, especially if not managed in stroke units.
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Internal medicine journal · Apr 2011
Review Case ReportsMultiple myeloma presenting with a fever of unknown origin and development of thrombotic thrombocytopenic purpura post-bortezomib.
Multiple myeloma rarely presents with a fever of unknown origin and diagnosis may be delayed. We describe a case of myeloma presenting in this way with raised serum-free light chains and TP53 deletion on cytogenetics. ⋯ We believe this is only the second case to describe this phenomenon post-bortezomib and the first to rechallenge the patient successfully without further recurrence of TTP. Possible mechanisms for this successful rechallenge are discussed.