Internal medicine journal
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Internal medicine journal · Mar 2024
Advanced-scope pharmacist roles in medical outpatient clinics: a cost-consequence analysis.
There is a growing body of evidence that supports the clinical effectiveness of pharmacist roles in outpatient settings. However, limited studies have investigated the economic efficiency of advanced-scope outpatient pharmacist roles, particularly in the Australian setting. Assessing the overall costs and benefits of these outpatient pharmacist roles is needed to ensure service sustainability. ⋯ The addition of pharmacist roles to outpatient clinics can increase the cost of services; however, they also can increase medication optimisation activities. Future research should examine a societal perspective that includes broader cost and effectiveness outcomes. This study could justify the implementation of advanced-scope outpatient pharmacist roles in other Australian hospitals.
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Internal medicine journal · Mar 2024
Case ReportsCushing syndrome and tertiary adrenal insufficiency from prolonged concomitant use of budesonide and posaconazole.
Budesonide is a 'non-absorbable' corticosteroid often used for gut graft versus host disease. Systemic exposure is usually minimal because of metabolism by cytochrome (CYP) 3A4 in enterocytes and the liver. However, concomitant use of posaconazole and voriconazole, inhibitors of CYP3A4 commonly used as antifungal prophylaxis in allograft patients receiving immunosuppression, can lead to substantial systemic steroid exposure. This paper describes a case of severe iatrogenic Cushing syndrome and tertiary adrenal insufficiency because of this interaction, highlighting the necessity for improved awareness of this phenomenon.
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Internal medicine journal · Mar 2024
Serum lipase in acute pancreatitis associated with hypertriglyceridaemia.
The incidence of hypertriglyceridaemic pancreatitis is increasing. Hypertriglyceridaemia may be associated with false lowering of serum amylase and lipase in vitro. ⋯ Serum lipase levels were in the normal range in two patients (7.7%) and less than three times the upper end of the reference interval in 11 individuals (42%). Awareness of the potential for normal and nonsignificantly elevated serum lipase levels in the setting of hypertriglyceridaemic pancreatitis is important to avoid a missed diagnosis, to enable appropriate short- and long-term management and to prevent recurrent episodes.
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Internal medicine journal · Mar 2024
Chronic hepatitis B care in regional Australia: implications for clinical practice and public health policy.
Australia is struggling to meet its National Hepatitis B Strategy care targets, particularly in nonmetropolitan settings. It is vital to engage priority populations and improve their access to recommended care to reach these targets. ⋯ Current approaches are failing to deliver optimal CHB care to Indigenous Australians in regional North Queensland. Targeted strategies to ensure that Indigenous Australians in the region receive equitable care are urgently needed.
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Internal medicine journal · Mar 2024
COVID-19 vaccination: are more jabs needed or are we now immune?
As the COVID-19 pandemic has progressed, it has become apparent that COVID-19 vaccination has limited impact on SAR-CoV-2 transmission and provides only short-term protection against acquiring infection, but more robust protection against severe disease and death. As a result, vaccinated people remain susceptible to SARS-CoV-2 infection but are less likely to experience severe outcomes. Studies show that immunity derived from the combination of vaccination and natural infection, so-called hybrid immunity, is superior to that provided by vaccination or natural infection alone. ⋯ The predominance of the Omicron strain initially led to the development of bivalent vaccines containing both the Wuhan strain and Omicron variants. Currently, vaccines containing the original Wuhan strain of spike protein are being phased out, and new COVID-19 vaccines based exclusively on the Omicron strain XBB have become available in Australia. This article explores the question of whether further doses will be required from 2024 onwards and, if so, who should receive them?