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
Multicenter StudyPrevalence of heart failure pharmacotherapy utilisation, frailty and adverse drug events among hospitalised adults older than 75 years: a multicentre cross-sectional study.
Optimal heart failure (HF) pharmacotherapy (guideline-directed medical therapy and diuretics) in older people with frailty is uncertain due to limited evidence. ⋯ Frailty, HF-pharmacotherapy changes in hospital and ADEs were common among older inpatients with HF. The association of adverse outcomes according to frailty needs further investigation. Poor documentation of HF phenotype may be a barrier to medication optimisation in older inpatients.
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Internal medicine journal · Feb 2025
Multicenter StudyCharacteristics and management of eosinophilic esophagitis in Australasian children: a decade of experience.
The frequency of EoE has been increasing in Northern Hemisphere cohorts, yet there is a scarcity of data in our region. Regional climatic factors, and lifestyle habits may influence the presentation of EoE, and appropriate management is crucial to prevent complications. WIth this is mind we undertook the first comprehensive multisite study of EoE in Australasian children. ⋯ The prevalence of EoE in Australasian children is comparable to that observed elsewhere, and the incidence is increasing significantly. Regional differences in disease frequency, management practices and access to endoscopy warrant further study.
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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
Clinical outcomes of patients with non-tuberculous mycobacterial pulmonary disease in Auckland, New Zealand.
This review of non-tuberculous mycobacterial pulmonary disease over an 11-year period identified 87 patients (74% women, mean age 66 years). Mycobacterium avium complex was isolated in 86% of patients. Antibiotics were commenced in 52% of patients; however, treatment was poorly tolerated with 36% terminating prematurely. Mortality was significant; death occurred in 31% of patients, with no relationship between death and treatment.