Internal medicine journal
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Internal medicine journal · Oct 2023
Germline mutations predispose New Zealand Māori to phaeochromocytoma/paraganglioma.
Phaeochromocytomas (PCC) and paragangliomas (PGL; together PPGL) are rare tumours of the adrenal medulla or extra-adrenal paraganglia. They may secrete catecholamines with significant cardiovascular effects. Management of PPGL is predominantly surgical, despite the anaesthetic risks related to potential haemodynamic instability. Meticulous pre-treatment and intra-operative management are required to improve cardiovascular outcomes. ⋯ Māori were over-represented due to high rates of germline SDHB R46Q mutations. There were few post-operative adverse outcomes in this contemporary cohort.
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Internal medicine journal · Oct 2023
Observational StudyContribution of general medicine to perioperative and consultative care: an Australian metropolitan teaching hospital experience.
Little is known about the contribution of general medicine to perioperative and consultative care in Australia. A descriptive observational study was undertaken at a quaternary institution to evaluate the characteristics of perioperative and nonoperative consultations undertaken by general medicine. Results demonstrated patterns of engagement within a 'traditional' model of perioperative care and highlighted several opportunities for a redesign to a more proactive and collaborative cross-disciplinary model.
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Internal medicine journal · Oct 2023
Comment ReviewNarrative review of inpatient nutritional management of anorexia nervosa with management recommendations for Australian tertiary health services.
Patients with anorexia nervosa (AN) may experience life-threatening malnutrition-related complications requiring inpatient medical stabilisation. Several management guidelines have been developed but discrepancies exist because of limited high-level evidence. ⋯ The evidence supports high-calorie refeeding of 2000 kcal/day in AN inpatient medical management and zinc supplementation in improving the rate of weight restoration. This is inconsistently reflected in different Victorian health services guidelines. Updated national consensus guidelines could assist in improving consistency of evidence-based health care.
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Internal medicine journal · Oct 2023
CommentPrevalence and predictors of inappropriate dosing of direct oral anticoagulants.
Information on inappropriate dosing of direct oral anticoagulants (DOACs) is scarce in the Australian context. ⋯ Inappropriate dosing of DOACs, especially underdosing, is common in clinical practice. Clinicians should exercise due diligence when prescribing DOACs to patients with renal impairment and in outpatient settings.
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Internal medicine journal · Oct 2023
Observational StudyCharacterising Patients and Clinician Experiences in Comprehensive Conservative Care for Kidney Failure in Northern Queensland.
Comprehensive conservative care (CCC) is an emerging treatment option in kidney failure (KF), but its implementation has been restricted by a limited understanding of KF populations, outcomes and clinician experiences. ⋯ Patients who are highly co-morbid and frail and have functional impairment are suitable candidates for CCC. More focus needs to be placed on objective prognostication of patients and the upskilling of clinicians to advocate for, and deliver, CCC.