Internal medicine journal
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Despite diversity initiatives, inequities persist in medicine with negative implications for the workforce and patients. Little is known about workplace inequity in nephrology. ⋯ Inequity, particularly driven by gender and race, is common for nephrology health professionals in Australia and New Zealand and impacts career progression.
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Internal medicine journal · Nov 2022
Real World Opioid Prescription To Patients With Serious, Non-Malignant, Respiratory Illnesses And Chronic Breathlessness.
Chronic breathlessness is a disabling symptom that is often under-recognised and challenging to treat despite optimal disease-directed therapy. Low-dose, oral opioids are recommended to relieve breathlessness, but little is known regarding long-term opioid prescription in this setting. ⋯ Within this integrated respiratory and palliative care service, patients with severe, non-malignant respiratory diseases safely used long-term, low-dose opioids for breathlessness with subjective benefits reported and no serious adverse events.
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Internal medicine journal · Nov 2022
ReviewTakotsubo Syndrome in New Zealand: Current Knowledge and Future Challenges.
Takotsubo syndrome (TS), also known as apical ballooning syndrome, is a transient stress-related cardiomyopathy characterised by acute but reversible left ventricular dysfunction. The condition tends to occur in postmenopausal women after a stressful event. At presentation, TS typically mimics acute myocardial infarction (MI) and the incidence of TS has been increasing worldwide. ⋯ Similar to other countries, TS is being increasingly recognised in New Zealand. In this review, we discuss the demographics, clinical features and outcomes of patients with TS in New Zealand. Doing so informs us not only of the pattern of disease in New Zealand but it also provides insights into the condition itself.
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Older patients with hypertension are at a higher risk of cardiovascular events compared to younger adults but are also more vulnerable to the adverse effects of blood pressure (BP) lowering. Frailty is an important predictor of vulnerability to such adverse events, and age alone may not best reflect underlying risk. Therefore, an individualised approach to management of hypertension in the older person is required. ⋯ Management needs to be holistic and take account of the older person's care needs, wishes and priorities. This review describes physiological considerations and current guidelines and best practices regarding BP lowering in older people and highlights areas with paucity of evidence. A proposed and testable approach to managing hypertension in the older person (≥70 years) is discussed.
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Internal medicine journal · Nov 2022
Clinical evaluation of the national hospital acquired complication program.
The national hospital-acquired complication programme captures complications arising from patient-related and hospital-related factors, but the proportion of the two is unclear. ⋯ Prevalence of HAC events was higher than expected, but PPV for healthcare errors was low, suggesting provision of care is a less common cause of HAC events than patient factors. HAC may be an indicator of hospital admission complexity rather than HAC.