Internal medicine journal
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Māori have known health disparities that may be addressed through increasing the cultural competency of New Zealand's medical workforce. There is a paucity of Māori health professionals choosing paediatrics or adult medicine as a career and the factors influencing their career decision are yet to be explored. ⋯ Mentoring provides an opportunity to attract Māori into paediatric and adult physician training. The use of existing mentoring programmes could facilitate in expanding Māori RACP workforce development. This extended Māori workforce would have benefits for the health of New Zealand as a whole.
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Internal medicine journal · Jun 2014
Comparative StudyOutcomes of an Australian testing programme for epidermal growth factor receptor mutations in non-small cell lung cancer.
Molecular characterisation of non-squamous non-small-cell lung cancer (NSCLC) is required to direct optimal treatment. Treatment of NSCLC with inhibitors of epidermal growth factor receptor (EGFR) tyrosine kinase (EGFR-TKI) should be guided by the presence of activating mutations of the EGFR gene. ⋯ EGFR gene mutation testing is feasible on local and interstate lung cancer samples. The rate of valid test outcomes is high, but FNA samples are associated with more frequent test failure.
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Internal medicine journal · Jun 2014
Disabling disease codes predict worse outcomes for acute medical admissions.
Concurrent with an extension in longevity, a prodrome of ill-health ('disability' identifiable by certain International Classification of Disease (ICD) 9/ICD10 codes) predates the acute emergency presentation. To date, no study has assessed the effect of such 'disability' on outcomes of emergency medical admissions. ⋯ Disability burden, irrespective of organ system at emergency medical admission, independently predicts worse outcomes and a longer in-hospital stay.
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Internal medicine journal · Jun 2014
Gastrointestinal amyloidosis in Australian indigenous patients.
This study documents the symptoms, racial distribution, pathological findings and outcomes of patients diagnosed with gastrointestinal amyloidosis in Alice Springs Hospital. In a 4 year retrospective survey. 9 patients, all indigenous, 7F/2M, had biopsy proven gastrointestinal amyloidosis. Four out of four patients tested were found to have AA amyloidosis. ⋯ Five of the patients died, and the gastrointestinal symptoms of the remaining 4 remitted. Gastrointestinal amyloidosis should be included in the differential diagnosis of indigenous patients presenting with chronic diarrhoea, vomiting or abdominal pain. It carries a grave prognosis, is probably secondary to chronic infections but is potentially reversible.
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Internal medicine journal · Jun 2014
Implementing practice change in chronic cancer pain management: clinician response to a phase III study of ketamine.
An adequately powered, double-blind, multisite, randomised controlled trial has shown no net clinical benefit for subcutaneous ketamine over placebo in the management of cancer pain refractory to combination opioid and co-analgesic therapy. The results of the trial were disseminated widely both nationally and internationally. ⋯ Although two-thirds of respondents reported practice change as a result of the randomised controlled trial, a minority remained convinced of the benefit of the drug from their own observations and would require additional evidence.