Internal medicine journal
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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 StudyComparing Surgeon and Nephrologist-Inserted Tenckhoff Catheters: Experience from a Metropolitan Centre in Sydney.
Peritoneal dialysis (PD) is an effective home-based form of dialysis. Although several factors limit its use, the timely and successful insertion of a PD catheter is essential for increased uptake. ⋯ The current study highlights that with careful patient selection, trained nephrologists in metropolitan areas can successfully insert PD catheters. Our experience noted fewer delays to catheter insertion, with similar total complication rates.
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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.
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Internal medicine journal · Oct 2023
ReviewMultidisciplinary team discussion: the emerging gold standard for management of cardiopulmonary complications of connective tissue disease.
Cardiopulmonary complications of connective tissue diseases (CTDs), particularly pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), are major determinants of morbidity and mortality. Multidisciplinary meetings may improve diagnostic accuracy and optimise treatment. We review the literature regarding multidisciplinary meetings in CTD-ILD and PAH and describe our tertiary centre experience of the role of the multidisciplinary meeting in managing CTD-PAH.
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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.