Internal medicine journal
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Internal medicine journal · Aug 2024
Clinical outcomes of hepatocellular carcinoma surveillance in Melbourne, Australia.
Ultrasound surveillance for hepatocellular carcinoma (HCC) may improve early tumour detection but may additionally result in surveillance-related harm through increased evaluation of non-HCC lesions. The incidence of these outcomes has not been reported outside North America. ⋯ In our study, HCC surveillance was associated with early tumour detection, although many patients experienced mild surveillance-related harm. Novel surveillance strategies and pathways are required to improve detection in high-risk patients and minimise harm in low-risk patients.
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The current fallback position for the elderly frail nearing the end of life (less than 12 months to live) is hospitalisation. There is a reluctance to use the term 'terminally ill' for this population, resulting in overtreatment, overdiagnosis and management that is not consistent with the wishes of people. This is the major contributor to the so-called hospital crisis, including decreased capacity of hospitals, reduced ability to conduct elective surgery, increased attendances at emergency departments and ambulance ramping. ⋯ The authors discuss the reasons why this may have occurred, such as the current avoidance of discussing death and dying by society and the concentration of healthcare workers on actively managing the acute presenting problem and ignoring the underlying prognosis in the elderly frail. The authors discuss ways of improving the management of the elderly nearing the end of life, such as more detailed goals of care discussions using the concept of shared decision-making rather than simply completing Advanced Care Decision documents. Empowering people in this way could become the most important driver of people's health care.
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Internal medicine journal · Aug 2024
An audit for the inpatient management of patients with severe hypertension without acute end-organ damage at the Northern Sydney Local Health District.
Severe hypertension without acute end-organ damage is commonly encountered in inpatients. Despite this, there is a lack of international guidelines to manage this disorder. We conducted an audit to investigate the local practices within our health district. Current practices favour the use of rapidly acting antihypertensive drugs, which have been associated with iatrogenic injury.
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Internal medicine journal · Aug 2024
The burden of non-alcoholic fatty liver disease in Australia: an analysis of Global Burden of Disease study from 1990 to 2019.
Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease. Global Burden of Disease (GBD) data from 1990 to 2019 reported a rise in prevalence (9-13%) in Australia, which also ranked third highest for NAFLD prevalence compared to 14 similar countries. As a result of underdiagnosis, NAFLD burden is underestimated by GBD.