Internal medicine journal
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Pain is a common presenting symptom to consultant physicians, both in the hospital and in the clinic or rooms. Biologically, pain serves as warning of tissue damage. But this is no longer the case when pain is present for months or years, especially when it has been fully investigated. ⋯ The response to the so-called 'opioid epidemic' has led to a renewed focus on how chronic pain should be managed. The aim of this article is to update fellows and trainees on the assessment and management of chronic pain in adult medical patients. In particular, we address the role of pharmacotherapy post-opioid epidemic (primarily antidepressants and anticonvulsants in neuropathic pain), the place of interventional procedures and the nature and effectiveness of pain self-management training in people with chronic pain, many of whom have had pain for a year or more and failed other treatments.
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Internal medicine journal · Feb 2025
Antifungal stewardship in Australian hospitals: defining the scope and future targets.
Antimicrobial stewardship (AMS) guidelines now recommend antifungal stewardship (AFS) interventions to improve the management of invasive fungal diseases (IFDs). AFS programmes have not been reported in Australia. ⋯ AFS strategies utilised in Australian hospitals have focused on high-cost, intravenous agents. Although expert oversight of antifungals is evident, many sites omit potentially important targets for AFS, including fluconazole and oral posaconazole. Identifying these gaps and barriers to AFS will guide the development of an AFS model for hospitals.
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Internal medicine journal · Feb 2025
The importance of assessing and correcting hydration status prior to right heart catheterisation: a pilot study.
We evaluated whether fluid status could be accurately assessed (and corrected if necessary) prior to right heart catheterisation (RHC), to diagnose accurately post-capillary pulmonary hypertension (PHT) in patients with left heart disease risk factors. A non-invasive measure of fluid status prior to RHC identified fluid-depleted patients. Baseline RHC measurements were performed, and a novel provocation technique (passive leg raise) was compared to a 'one-dose-fits-all' fluid challenge and found to be equivalent.
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Internal medicine journal · Feb 2025
Development of a virtual multidisciplinary meeting framework for less common cancers.
Less common cancers are underserved with expertise compared to other cancers. This is accentuated in regional areas where patients may need to travel for expert opinion. Development of a virtual multidisciplinary meeting (MDM) can help overcome this disadvantage but can be a challenge to establish. We describe the development of a framework for future less common cancer MDMs.
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Internal medicine journal · Feb 2025
Teaching contributions of senior clinicians in a Basic Physician Trainee training programme.
Education of Basic Physician Trainees (BPTs) in preparation for their Royal Australasian College of Physician Divisional Examinations requires time contribution by senior medical staff towards formal teaching activities. This study, conducted at a major metropolitan teaching hospital, sought to quantify the time commitment of senior medical staff towards teaching of BPTs in one clinical year, as well as the perceptions of those staff regarding time commitments through anonymous questionnaire. Senior medical staff involved in formal teaching activities provided a mean of 10 h; questionnaire respondents indicated a mean contribution of 20 h. This study highlights the significant time contribution of senior medical staff to formal teaching activities for BPTs, as well as identifies possible unmeasured teaching contributions.