Internal medicine journal
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Myelodysplastic syndrome (MDS), a haematological disorder of the elderly, has been formally classified as a neoplastic disease for 10 years. ⋯ In New Zealand and Australia, MDS is a common haematological neoplasm. The marked difference between male and female incidence rates, especially with advancing age, may provide insights into the causes of this disease.
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Internal medicine journal · Nov 2012
Access to anticancer drugs: many evidence-based treatments are off-label and unfunded by the Pharmaceutical Benefits Scheme.
The off-label use of a drug refers to a use outside the terms of its approval by the Therapeutic Goods Administration (TGA). It is also possible to prescribe unlicensed drugs under the TGA's special access scheme. A high rate of off-label prescribing has previously been reported in cancer. Our study aimed to document the disparity between evidence-based clinical guidelines for anticancer therapy, product approval and funding status of these agents within an academic tertiary/quaternary cancer centre. ⋯ Over 90% of off-label protocols are supported by established treatment guidelines or published peer-reviewed research even though the medications are not approved for that particular use by the TGA. However, these off-label protocols are unfunded by the PBS; this results in a marked inequality of access to appropriate medications for cancer patients across Australia.
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Internal medicine journal · Nov 2012
SPECT ventilation perfusion scanning with the addition of low-dose CT for the investigation of suspected pulmonary embolism.
Single-photon emission computed tomography (SPECT) ventilation perfusion (V/Q) scanning with low-dose computed tomography (LDCT) is an emerging imaging technique for investigation of suspected pulmonary embolism (PE). We aimed to estimate diagnostic utility of the combined technique using results from all patients referred in 2009 compared with final diagnosis and 6-month follow-up status. ⋯ LDCT was abnormal in 43 (41%) patients, including 41 patients who had negative SPECT V/Q. In 29 (27%) patients, LDCT provided information on alternative pathologies that accounted for presenting symptoms, and the combined technique had a diagnostic yield of 52%.
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Internal medicine journal · Nov 2012
Blastocystis subtypes in symptomatic and asymptomatic family members and pets and response to therapy.
Blastocystis is a common, enteric parasite. The pathogenicity of the organism is uncertain, but subtypes (ST) 1 and 3 have been reported more likely to cause irritable bowel-like symptoms. ⋯ Conventional therapy is ineffective for symptomatic Blastocystis infection. The high prevalence of Blastocystis infection within households suggested transmission between humans and their pets. Subtyping analysis of SSU rDNA alone in Blastocystis does not appear to predict pathogenicity.
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The disease burden of inpatient gout has not been reported. Using a discharge diagnosis database and individual case record review, 77 patients who developed acute gout complicating a hospital admission for another reason were identified between January 2001 and April 2010 at The Townsville Hospital. ⋯ Patients with an attack of gout were more likely to be older, male or indigenous. Early diagnosis and appropriate treatment may help to reduce the healthcare costs of this overlooked disease.