Internal medicine journal
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Internal medicine journal · Feb 2021
Meta AnalysisImmunosuppression as a risk factor for COVID-19: a meta-analysis.
While immunosuppression poses a theoretical increase in the risk of COVID-19, the nature of this relationship is yet to be ascertained. ⋯ Compared to the general population, immunosuppressed patients were not at significantly increased risk of COVID-19 infection. This finding provides support for current expert consensus statements, which have recommended the continuation of immunosuppressant therapy in the absence of COVID-19.
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Internal medicine journal · Feb 2021
ReviewSevere asthma assessment, management and the organisation of care in Australia and New Zealand: expert forum roundtable meetings.
Severe asthma imposes a significant burden on individuals, families and the healthcare system. Treatment is complex, due to disease heterogeneity, comorbidities and complexity in care pathways. New approaches and treatments improve health outcomes for people with severe asthma. ⋯ We recommend development of education and training activities, clinical resources and standards of care documents, increased stakeholder engagement and public awareness campaigns and improved access to infrastructure and funding. Further, we propose specific future research to inform clinical decision-making and develop novel therapies. A concerted effort is required from all stakeholders (including patients, healthcare professionals and organisations and government) to integrate new evidence-based practices into clinical care and to advance research to resolve questions relevant to improving outcomes for people with severe asthma.
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Internal medicine journal · Feb 2021
Transparency in clinical practice guidelines: the problem of consensus-based recommendations and practice points.
Clinical practice guidelines often provide 'consensus-based recommendations' for issues where there is a lack of evidence to support an evidence-based recommendation, and 'practice points' to assist clinicians in various aspects of everyday clinical care. However, Australian clinical practice guidelines often fail to define these terms clearly, and there is significant inconsistency in how they are used. This lack of clarity presents an impediment to the effective practice of evidence-based medicine and an opportunity for reform in Australian clinical guideline development.
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Internal medicine journal · Feb 2021
Current issues in the prevalence, diagnosis and management of hepatocellular carcinoma in Australia.
Hepatocellular carcinoma (HCC) is the commonest primary liver cancer encountered in the community and a leading cause of cancer morbidity and mortality. In Australia, there are several current important issues that need to be addressed in HCC management. There is a dramatically rising incidence of HCC in Australia with comparatively poorer outcomes in remote regions and in socioeconomic disadvantaged groups. ⋯ Managing HCC is complex involving many disciplines with the multidisciplinary team approach being the current accepted standard of care for patients. New immunotherapy combinations promise to offer patients with advanced HCC promising novel management options. However, the Australian inequities in prevalence, diagnosis and service provision, especially in Aboriginal people, need to be redressed concurrently with the adoption of new HCC management options.
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Internal medicine journal · Feb 2021
New normal: caring for hospitalised patients in the Bronx, New York, during COVID-19.
The Bronx, New York, is the poorest congressional district in the United States and has the highest COVID-19 infection rate in New York City. COVID-19 has led to major changes in our healthcare system, including heightened infection-control practices, novel staffing patterns and widespread social distancing. In this article, we describe how our experience with inpatient care has changed in the wake of COVID-19.