Internal medicine journal
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Internal medicine journal · Sep 2023
Correct dosing of Prothrombinex-VF in normalising elevated international normalised ratio in critically ill patients: a prospective cohort pilot study.
Prothrombinex-VF is being increasingly used as an off-label therapy to correct non-warfarin-related elevations in international normalised ratio (INR) in the critically ill. Currently there are no dosing guidelines for such use. ⋯ The app appeared to be reasonably accurate at predicting normalisation of elevated INRs after administration of Prothrombinex-VF, especially among patients without liver disease. Its dosing recommendations were similar to or possibly better than preexisting warfarin reversal guidelines in over 85% of the situations analysed, if we assume a higher dose of Prothrombinex-VF would achieve a greater reduction in INR than a lower dose.
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Internal medicine journal · Sep 2023
Chronic lymphocytic leukaemia Australasian consensus practice statement.
Chronic lymphocytic leukaemia (CLL) is the most common haematological malignancy in Australia and New Zealand (ANZ). Considerable changes to diagnostic and management algorithms have occurred within the last decade. The availability of next-generation sequencing and measurable residual disease assessment by flow cytometry allow for advanced prognostication and response assessments. ⋯ Recommendations regarding appropriate supportive management continue to evolve, and special considerations are required for patients with CLL with respect to the global SARS-CoV-2 pandemic. The unique funding and treatment environments in Australasia highlight the need for specific local guidance with respect to the investigation and management of CLL. This consensus practice statement was developed by a broadly representative group of ANZ experts in CLL with endorsement by peak haematology bodies, with a view to providing this standardised guidance.
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Internal medicine journal · Sep 2023
The unique COVID-19 experience in Western Australia: lessons learnt.
Western Australia (WA) was in a unique position to experience coronavirus disease 2019 (COVID-19) in a highly vaccinated and geographically isolated population. ⋯ COVID-19 case numbers following WA state border opening were of lower care acuity and disease severity than predicted. Two-thirds of admissions were for other primary diagnoses, with incidental COVID detection. Hospital admissions were overrepresented by partially or unvaccinated patients and by ATSI Australians. An increase in social support along with general and geriatric medicine speciality input were required to treat hospitalised COVID-19 cases in the WA Omicron wave.
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Internal medicine journal · Sep 2023
Artificial intelligence in medicine: has the time come to hang up the stethoscope?
The question of whether the time has come to hang up the stethoscope is bound up in the promises of artificial intelligence (AI), promises that have so far proven difficult to deliver, perhaps because of the mismatch between the technical capability of AI and its use in real-world clinical settings. This perspective argues that it is time to move away from discussing the generalised promise of disembodied AI and focus on specifics. ⋯ Ultimately, ML is just a fancy method of automation. We show that it is useful in automating specific and narrowly defined clinical tasks but likely incapable of automating the full gamut of decisions and tasks performed by clinicians.
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Internal medicine journal · Sep 2023
Role of communication in successful outpatient attendance in a New Zealand hospital: a qualitative study.
There are significant implications for both patients and providers when patients do not attend outpatient specialist appointments. Nonattendance has an impact on the efficiency of health care, provider resources and patient health outcomes. ⋯ We recommend that a patient-oriented approach to communication should be implemented, and alternative methods of communication should be explored.