Internal medicine journal
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Internal medicine journal · May 2023
Improving Care For People With Bronchiectasis: Opportunities And Challenges Highlighted From Service Evaluation.
Bronchiectasis is a serious, debilitating condition warranting specialist care. ⋯ Our cohort had a high proportion of patients with severe disease and significant mortality; some, but not all, aspects of recommended care were delivered.
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Internal medicine journal · May 2023
Prothrombin complex concentrates for the urgent reversal of apixaban and rivaroxaban - an Australian retrospective cohort study.
Direct acting oral anticoagulants (DOAC) are now commonly prescribed medications. Urgent reversal of their anticoagulant effect is sometimes required in emergency situations. In Australia, a specific reversal agent for factor Xa (FXa)-inhibitor DOAC is not available. Instead, two non-specific haemostatic agents, activated prothrombin complex concentrate (aPCC) and 3 factor-prothrombin complex concentrate (3F-PCC), are used off-label despite a paucity of evidence for their effectiveness or safety. ⋯ Both aPCC and 3F-PCC are useful adjuncts for the management of patients who require urgent reversal of the anticoagulant effect of FXa-inhibitor DOAC. However, the risk of thromboembolism in this patient group requires careful consideration. Prospective, comparator studies are needed along with the development of guidelines that reflect the availability of haemostatic agents in Australia.
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Internal medicine journal · May 2023
Dose-Adjusted-EPOCH-R is a safe and well tolerated outpatient treatment regimen in double-hit lymphoma.
Double-hit lymphoma (DHL) is an aggressive subtype of high-grade B-cell lymphoma with inferior prognosis using standard dose chemotherapy. Controversy remains whether more intensive chemotherapy regimens such as dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin and rituximab (DA-EPOCH-R) provide better outcomes in this cohort. ⋯ This study suggests that DA-EPOCH-R is a well tolerated outpatient regimen for DHL and should be considered for initial treatment in medically fit patients. Further prospective studies are warranted to confirm these findings.
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Internal medicine journal · May 2023
A Centre-Based Comparison of Double vs Single Prevention Strategy on Transfusion Transmitted-Cytomegalovirus in At-Risk Haemopoietic stem cell transplant Patients and a State Survey on CMV-Seronegative Ordering Practices.
Universal leucocyte depletion reduces the risk of transfusion-transmitted cytomegalovirus; however, many clinicians still prescribe cytomegalovirus seronegative units. ⋯ The analysis suggests a double prevention strategy does not provide additional protection against transfusion-transmitted cytomegalovirus. There is ongoing variability in the acceptance of leucocyte depletion alone despite the low risk of cytomegalovirus infection.
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Internal medicine journal · May 2023
Observational StudySite of care and factors associated with mortality in unvaccinated Australian aged care residents during COVID-19 outbreaks.
Residential InReach presents an alternative to hospital admission for aged care residents swabbed for coronavirus disease 2019 (COVID-19), although relative outcomes remain unknown. ⋯ Unvaccinated aged care residents meeting COVID-19 testing criteria seen by InReach during a pandemic experience high mortality rates, including with negative swab result. Residents remaining within-facility (with InReach) experienced similar adjusted mortality odds to residents transferred to hospital for public health/facility-based reasons, and lower than those transferred for clinical acuity.