Internal medicine journal
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Internal medicine journal · Jun 2024
Fabry-specific treatment in Australia: time to align eligibility criteria with international best practices.
Disease-specific therapy aims to improve symptoms, stabilise current disease and delay progression in patients with Fabry disease. In Australia, treatment access is subject to eligibility criteria initially established in 2004. Patients and their clinicians question why these criteria have remained unchanged despite significant progress in disease understanding. ⋯ Australian access criteria are misaligned with current clinical evidence. The clinical statements and proposed classification and initiation criteria should prompt discussions to support more equitable access to treatment and better align Australian practice with contemporary evidence and international guidelines.
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Internal medicine journal · Jun 2024
Multicenter StudyPrior hospital attendances in deceased Australian patients with alcohol-related liver disease: a multicentre project.
To establish the hospital visit history of patients who die with alcohol-related liver disease (ArLD). To determine if patients with ArLD present to hospital early or in the terminal phase of their disease. ⋯ Most patients with ArLD have multiple early attendances, which present an opportunity for early interventions. There are missed opportunities for Aboriginal and Torres Strait Islander patients for outpatient hospital engagement.
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Internal medicine journal · Jun 2024
Substance use during hospitalisation requiring an urgent clinical response: an opportunity for intervention.
There are few reports on drug use in patients while hospitalised and none regarding management or clinical outcomes. ⋯ Inpatient drug use requiring an urgent clinical response was infrequently recognised but presents a risk of harm to patients and staff and increases service utilisation and costs. Both harm reduction and systematic approaches guided by institutional policy are recommended. Using these events as reachable moments to address driving factors may modify patients' risk from future events.
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Internal medicine journal · Jun 2024
Australian clinicians' perceptions of patients with very high risk of fracture.
International osteoporosis guidelines have recommended treatment approaches based on fracture risk stratification, in particular, anabolic therapy for patients with very high risk (VHR) of fragility fracture. ⋯ Australian clinicians' perceptions of patients with a VHR of fracture and the use of anabolic agents appear to be heavily influenced by local reimbursement criteria. The mismatch between patients deemed eligible for reimbursed anabolic therapy and those prescribed an anabolic agent suggests treatment inertia.
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Internal medicine journal · Jun 2024
Marginal zone lymphomas: a consensus practice statement from the Australasian Lymphoma Alliance.
Marginal zone lymphomas (MZLs) are a rare, indolent group of non-Hodgkin lymphomas with different diagnostic, genetic and clinical features and therapeutic implications. The most common is extranodal MZL of mucosa-associated lymphoid tissue, followed by splenic MZL and nodal MZL. ⋯ The heterogeneous presentation and relapsing course present the clinician with several diagnostic and therapeutic challenges. This position statement presents evidence-based recommendations in the setting of Australia and New Zealand.