Internal medicine journal
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The solitary pulmonary nodule represents a common diagnostic challenge for clinicians. While most are benign, a significant number represent early, potentially curable lung cancers. ⋯ This article provides an up to date review of the imaging features of both benign and malignant solitary pulmonary nodules to assist in the identification of nodules that require histological confirmation or ongoing surveillance. In addition, we summarise the newly updated Fleischner Society Guidelines that provide clinicians with a framework for the evaluation and management of solitary pulmonary nodules.
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Severe aortic stenosis (AS) is the most common form of valvular heart disease in the developed world, with a rising prevalence due to an ageing Australian population. Transcatheter aortic valve implantation (TAVI) offers a less invasive option for the treatment of severe AS, with evidence supporting TAVI compared with medical therapy in inoperable patients and superior with surgical aortic valve replacement (SAVR) in high-risk patients. Equal outcomes have been observed in all-comer intermediate-risk populations. ⋯ In 2018, TAVI is a well-established procedure in Australia that has revolutionised the management of severe AS. In the future, with an expanding elderly population, the number of patients to benefit from transcatheter therapies for severe AS is hypothesised to increase 4-10-fold. Heart Team assessment is crucial in patients with severe AS to direct appropriate management.
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Internal medicine journal · Mar 2019
Multicenter StudyOutcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke.
Endovascular thrombectomy (EVT) for management of large vessel occlusion (LVO) acute ischaemic stroke is now current best practice. ⋯ Our study supports the current practice of administering i.v. alteplase before endovascular therapy.
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Internal medicine journal · Mar 2019
Multicenter StudyBurden of skin disease in two remote primary healthcare centres in northern and central Australia.
The burden of skin infections across all age groups in remote Australian Indigenous communities is currently unknown. In a retrospective audit of 439 residents from two remote communities presenting to health clinics, skin conditions were the most common reason for presentation (1603/7392, 22%) and 330/439 (75%) residents presented at least once with a skin infection. Skin infections are an under-appreciated and dominant reason for presentation to primary healthcare centres in these indigenous communities and public health campaigns to address this should incorporate all age groups.
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Internal medicine journal · Mar 2019
Palliative care in end-stage heart failure: experience of a collaborative approach in a secondary care setting.
Heart failure remains an ultimately fatal condition that causes significant symptoms as it progresses. The involvement by palliative services in this patient group has been suboptimal despite many years of guidance from international cardiac societies who recommend a palliative focus for these patients. ⋯ Management plans and goals of care have been clearly documented, and there has been clarification of roles between the key stakeholders who manage end-stage heart failure patients. A formal integrated palliative approach has been helpful for our end-stage heart failure patients and there is potential for this concept to be beneficial for other end-stage medical conditions.