Internal medicine journal
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Internal medicine journal · Nov 2023
Improving the Accuracy of Discharge Medication Documentation in People with Kidney Disease through Pharmacist-led Partnered Prescribing.
Inaccurate medication documentation in prescriptions and discharge summaries produce poorer patient outcomes, are costly to healthcare systems and result in more readmissions to hospital. Errors in medication documentation are common in Australian hospitals. ⋯ PPP improves the accuracy of the documentation of medications in both the discharge prescription and the discharge summary of patients with kidney disease.
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Internal medicine journal · Nov 2023
Meta AnalysisDiagnostic test accuracy of D-dimer with or without a clinical decision rule in peripartum patients with suspected venous thromboembolism: A systematic review and meta-analysis.
Pregnancy and the peripartum period is a hypercoagulable state increasing the risk of venous thromboembolism (VTE). There may be a role in utilising D-dimer in the peripartum setting. ⋯ This review highlighted that D-dimer use in the peripartum period for detection of VTE had a high sensitivity and high DOR but a poor area under ROC, which may limit its use in clinical practice.
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Internal medicine journal · Nov 2023
ReviewFour-year review of New Zealand laboratory infliximab and adalimumab concentration results indicating potential for improved dosing.
A review of laboratory results across New Zealand for therapeutic drug monitoring (TDM) of infliximab and adalimumab concentrations and antidrug antibodies (ADAs) over 4 years was completed. Of 6591 results, the median serum concentration for infliximab was 5.7 mg/L and for adalimumab was 5.5 mg/L. ⋯ The high number of samples with subtherapeutic drug concentrations and common ADA detection is consistent with failing therapy but could also suggest that standard dosing is frequently too low for patients. These results reinforce the value of antitumour necrosis factor drug TDM in making decisions to adjust dosing or switch agents in patients taking infliximab and adalimumab.
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Internal medicine journal · Nov 2023
Initial outcomes of a dedicated multi-disciplinary non-alcoholic fatty liver disease clinic: a retrospective cohort study.
Non-alcoholic fatty liver disease (NAFLD) is a major healthcare burden. Real-world outcomes in dedicated tertiary care settings in Australia remain unknown. ⋯ This study highlights a new model of care for patients with NAFLD and demonstrates promising initial outcomes in relation to significant reductions in markers of liver disease severity. Although most patients achieved weight control, further refinements are needed to achieve significant weight reduction including more frequent and structured dietetic and/or pharmacotherapeutic interventions.
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Internal medicine journal · Nov 2023
Aspirin deprescribing in primary prevention of cardiovascular disease: a prospective risk-benefit approach.
Current evidence and practice guidelines do not recommend aspirin for primary prevention of cardiovascular disease (CVD). Insufficient all-cause mortality benefits juxtaposed to increased gastrointestinal bleeding rates are well established. Pharmacists are well placed to assess the clinical appropriateness of aspirin in CVD and initiate deprescribing as required with medical colleagues. ⋯ This study described an impactful pharmacist-led initiative utilising a validated aspirin-specific tool to conduct risk-benefit analysis to reduce potential major bleeding associated with inappropriate aspirin use.