Internal medicine journal
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Internal medicine journal · Sep 2009
Historical ArticleMedicinal use of leeches in the texts of ancient Greek, Roman and early Byzantine writers.
Blood-letting was a common therapeutic method in antiquity; many means were used to draw blood, including the application of leeches. In this paper, ancient Greek, Roman and Byzantine authors up to the 7th century AD were studied, a research that provided us with references that may be divided into two groups: those related to the medicinal use of leeches, and those related to cases in which leeches were swallowed and had to be removed. ⋯ In the second group, brief reference is made to the problems caused by swallowing leeches, and to the methods used to expel them from the human organism. The earliest references to the medicinal use of leeches may be found in the writings of Theocritus (3rd century BC), Nicander (2nd century BC) and Horace (1st century BC, while the phenomenon of swallowing a leech is first mentioned in one of the Epidaurian 'iamata' dating to the 4th century BC.
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Internal medicine journal · Aug 2009
ReviewThe six-minute walk test: a useful metric for the cardiopulmonary patient.
Measurement of exercise capacity is an integral element in assessment of patients with cardiopulmonary disease. The 6-min walk test (6MWT) provides information regarding functional capacity, response to therapy and prognosis across a range of chronic cardiopulmonary conditions. A distance less than 350 m is associated with increased mortality in chronic obstructive pulmonary disease, chronic heart failure and pulmonary arterial hypertension. ⋯ However, it appears less reliable to detect changes in clinical status associated with medical therapies for heart failure. A change in walking distance of more than 50 m is clinically significant in most disease states. When interpreting the results of a 6MWT, consideration should be given to choice of predictive values and the methods by which the test was carried out.
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Internal medicine journal · Aug 2009
Randomized Controlled Trial Comparative StudyPatterns of glycaemic control in Australian primary care (NEFRON 8).
Intensive glycaemic control delays the onset and progression of diabetes-related complications, especially microvascular complications. However, only limited information is available regarding glucose-lowering treatment practices in Australian primary care. The aim of the study was to describe patterns of glycaemic control in subjects participating in the National Evaluation of the Frequency of Renal Impairment co-existing with Non-Insulin Dependent Diabetes Mellitus study. ⋯ Current targets for glycaemic control in type 2 diabetes have generally been followed in Australian general practice, but there is still a significant gap in the achievement of recommended glycaemic goals. A quarter of the patients clearly have poor glycaemic control. The immediate steps that can be taken to improve glycaemic control include the early use of combination oral glucose-lowering therapies and the increased use of insulin.
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Internal medicine journal · Aug 2009
Multicenter StudyIntravenous aminoglycoside usage and monitoring of patients with cystic fibrosis in Australia. What's new?
The aim of this study was to determine the current situation regarding aminoglycoside use and monitoring in patients with cystic fibrosis (CF) throughout Australia. ⋯ Aminoglycoside dosing regimens have changed since the last survey was carried out in 1999. There has been an increase in the use of once-daily dosing from 54 to 88% of units. The reporting of both ototoxicity and renal toxicity has also increased (from 27 to 75% and from 19 to 65%, respectively). Standardization of management protocols for antibiotic use and patient monitoring may help reduce the risk of cumulative toxicity to aminoglycosides in CF patients.
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Internal medicine journal · Jul 2009
Comparative StudyDo medical courses adequately prepare interns for safe and effective prescribing in New South Wales public hospitals?
To assess ability of interns immediately before starting clinical practice in New South Wales (NSW) teaching hospitals to prescribe medications safely and appropriately and to describe their impressions of the adequacy of their clinical pharmacology training in medical school. ⋯ Interns about to commence clinical practice in NSW teaching hospitals demonstrated significant deficits in prescribing of regular medications, initiation of new therapies, prescribing of discharge medications, and particularly prescribing of Schedule 8 medications. Most interns recognized these deficits and would have liked more clinical pharmacology training at medical school.