Internal medicine journal
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Internal medicine journal · Nov 2013
Recurrent hospitalisation with pneumonia is associated with higher 1-year mortality in frail older people.
Previous studies persistently showed that functional dependence was associated with higher long-term (≥1 year) mortality of older patients hospitalised with community-acquired pneumonia (CAP). The importance of other factors was, however, not well reported. ⋯ Recurrent pneumonia may be a terminal life event of frail older people so that advance care planning should be considered in those with recurrent admission for pneumonia.
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Internal medicine journal · Nov 2013
Meta AnalysisPopulation attributable risks for modifiable lifestyle factors and breast cancer in New Zealand women.
Breast cancer is the most commonly diagnosed invasive cancer in New Zealand women and modifiable lifestyle risk factors may contribute to this. ⋯ The most important primary preventive strategies to reduce the risk of breast cancer in New Zealand are lifestyle changes to reduce obesity, promoting regular physical activity (which may in turn reduce the prevalence of obesity), reducing HRT use and avoiding high alcohol intake. Strategies that encourage regular physical activity and reduce obesity could also have other benefits, such as reduced risks of cardiovascular disease and diabetes.
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Internal medicine journal · Nov 2013
Multicenter StudyAdministration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy.
Appropriately timed cessation of chemotherapy is an important aspect of good quality palliative care. There is wide variation in the reported rates of chemotherapy administration within the last 30 days of life. ⋯ Patients who received chemotherapy in the last 30 days of life were more likely to be male and have a shorter duration of palliative care team involvement. In this study, the observed rate of death within 30 days of chemotherapy is within the range of published data. It is recommended that a standard definition be used to benchmark medical oncology centres and individual oncologists, and to allow comparison over time.
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Internal medicine journal · Nov 2013
ReviewDemonstrable professionalism: linking patient-centred care and revalidation.
The move by the Medical Board of Australia to commence a conversation with the medical profession about revalidation reflects that patient-centred care is at the heart of good medical practice. Patients judge their doctors' commitment to them based on whether their individual interactions with doctors meet their needs. We argue that ensuring that doctors are continuing to perform at a level that the community regards as acceptable is a demonstration of an individual doctor's professionalism and thus their commitment to patient-centred care. ⋯ This needs to be supported by organisations in which doctors work, reflecting the importance of organisational context to clinical practice. Revalidation processes thus need both to reflect the work of doctors and be meaningful to the community. The move to consider revalidation of doctors by regulatory authorities should not be seen by the profession as a threat, but more as an opportunity to demonstrate the profession's commitment to patient-centred care.
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Internal medicine journal · Nov 2013
Heightened clinical suspicion of pulmonary embolism and disregard of the D-dimer assay: a contemporary trend in an era of increased access to computed tomography pulmonary angiogram?
Prospective studies have shown that utilising qualitative D-dimers in those with a low Wells pre-test probability (PTP) of pulmonary embolism (PE) have significantly reduced the number of computed tomography pulmonary angiograms (CTPA) being performed. These studies have been based on a PE prevalence of approximately 6% in the low PTP group. ⋯ The overall prevalence of PE in subjects undergoing CTPA was significantly lower compared with data in the literature. The authors recommend warranted clinical suspicion of PE should be confirmed by a senior physician prior to placing a patient in the PE work-up pathway. In such patients, the qualitative D-dimer assay should be utilised if PTP is low, and the exclusionary efficiency of the D-dimer will be improved in the setting of higher PE prevalence in this subgroup. Hospitals should audit local PE prevalence, as cost-benefit analyses raises questions about the effectiveness of D-dimers when PE prevalence is very low in the low PTP subgroup.