Internal medicine journal
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Internal medicine journal · Jul 2024
Heart failure and the cost of dying: must the ferryman always be paid?
Provision of palliative care in chronic heart failure (CHF) can support complex decision-making, significantly improve quality of life and may lower healthcare costs. ⋯ A palliative approach in terminal CHF admission may improve quality at the end of life and decrease costs associated with care.
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Internal medicine journal · Jul 2024
Challenges for trainee physician-scientists during their PhD candidature: a cross-sectional study.
Physician-scientists are important drivers of research, in both knowledge acquisition and research translation. In Australia, many newly qualified physicians and advanced physician trainees enrol in PhD studies, with a view to training as physician-scientists. However, data on perceived challenges and ways to support them are limited. ⋯ Trainee physician-scientists report multiple challenges during their PhD candidature and envisage significant challenges in establishing their research independence after PhD completion. They valued several potential support mechanisms, particularly a mentoring program. Australian universities and their associated academic health services should consider establishing programs to support trainee physician-scientists.
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Internal medicine journal · Jul 2024
Clinical outcomes of chronic myeloid leukaemia patients taking asciminib through a Managed Access Programme (MAP) in Australia.
Asciminib is a novel allosteric STAMP (specifically targets the ABL myristoyl pocket) inhibitor of the BCR::ABL1 oncogene. Real-world clinical outcomes of patients with tyrosine kinase inhibitor (TKI)-resistant/intolerant chronic myeloid leukaemia (CML) in Australia on the Managed Access Programme for asciminib showed higher molecular responses for those with intolerance versus resistance ± intolerance to their last TKI. There remains a clinical need to improve outcomes in patients with CML who have resistance to multiple TKIs, especially in the ponatinib-pretreated cohort.
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Internal medicine journal · Jul 2024
Clinical practice guidelines: Their utility, dissemination and monitoring at Colonial War Memorial Hospital: A mixed methods study from Fiji.
Clinical practice guidelines (CPGs) improve patient care by standardising medical practice. However, little is known about their applicability in low-resource settings. Since 2010, Fiji has introduced guidelines to increase the application of evidence-based practice. ⋯ Most physicians found CPGs to be valuable for improving the consistency of care. In low-resource settings, dissemination of guidelines should be paired with CME to improve their uptake. Increased monitoring of guideline use appears necessary.
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Internal medicine journal · Jul 2024
Australians with chronic lymphocytic leukaemia continue to have high rates of second primary malignancies in the modern era.
Population-based studies have demonstrated a high risk of second cancers, especially of the skin, among patients with chronic lymphocytic leukaemia (CLL). We describe age-standardised incidence ratios (SIRs) of second primary malignancies (SPM) in Australian patients with relapsed/refractory CLL treated with at least two lines of therapy, including ibrutinib. ⋯ SIR for melanoma and all cancers (excluding nonmelanomatous skin cancers) were 15.8 (95% confidence interval (CI): 7.0-35.3) and 4.6 (95% CI: 3.1-6.9) respectively. These data highlight the importance of primary preventive interventions and surveillance, particularly as survival from CLL continues to improve.