Internal medicine journal
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Internal medicine journal · May 2020
Troponin measurements, myocardial infarction diagnoses and outcomes. An analysis of linked data from New South Wales, Australia.
Cardiac troponin assays are very widely requested tests, particularly in emergency departments. Thus, many seriously ill patients who may not have heart disease as their primary discharge diagnosis have undergone troponin testing during hospitalisation. ⋯ In a very large state-wide hospitalised patient cohort, among patients with elevated troponin levels and non-cardiac diagnoses, mortality was higher than in those with cardiovascular diagnoses, including MI.
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Internal medicine journal · May 2020
Population-based analysis of radiotherapy and chemotherapy treatment in the last month of life within regional Australia.
Cancer treatment near end of life is not likely to add meaningful benefit and minimising intervention rates has been promoted as an indicator of quality of care. Population-based analysis of treatment allows comparative analysis of treatment rates and provides insight into patterns of care. ⋯ This population-based analysis of AST and radiotherapy treatment within the last 30 days of life within a region of Australia has shown overall treatment rates below 10%. Treatment rates appear influenced by both patient and tumour characteristics. Future focus on subgroups with high rates of late intervention may help minimise treatment unlikely to add benefit.
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Much of the debate over the use of transvaginal mesh for incontinence and prolapse has been conducted on social media, in the tabloid press and through a very public Senate inquiry. It has been a very emotionally charged debate with surgeons variously accused of scandalous behavior, financial impropriety, surgical experimentation and misogyny. What really happened, how did we get here and what can we learn from these complex events?
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Internal medicine journal · May 2020
Olmesartan-associated duodenal villous atrophy, an emerging clinical issue.
Duodenal villous atrophy with olmesartan was described in 2012, 10 years following registration of olmesartan. Clinical features are severe watery diarrhoea, usually occurring in association with weight loss. Onset is delayed, with a mean duration of prior exposure to olmesartan of 3 years. ⋯ Symptoms resolve over weeks following cessation of olmesartan. Epidemiological studies suggest increased risk with olmesartan, rather than a class effect of all angiotensin receptor blockers. Post-marketing surveillance for drug safety remains important.