Internal medicine journal
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Internal medicine journal · Jul 2003
ReviewProgress towards achieving new vaccine and vaccination goals.
Abstract Viral and bacterial vaccines, especially for childhood use, are one of the most successful public health measures of the last two centuries and have a good safety record. However, there are still many diseases that are caused by infectious agents for which vaccines are not available. ⋯ A surprising recent development is the use of vaccine technology to test whether a range of other generally non-communicable diseases can be prevented (or at least controlled) in this way. Investigation of these diseases is still mainly at the experimental level, however the list includes different types of cancers, allergies, drug addiction and neurodegenerative diseases.
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Transfusion-related acute lung injury (TRALI) can be a life-threatening transfusion complication and should be considered whenever respiratory distress occurs during a transfusion. Management of donors implicated in TRALI is a n important haemovigilance responsibility for blood services. To enable this, it is imperative to develop an effective strategy for investigating TRALI. The present paper describes an effective approach. ⋯ TRALI is a serious non-infectious hazard of transfusion that must be reported and investigated promptly. Prompt investigations allow appropriate management of implicated donations and donors so as to minimize the incidence of TRALI. Therefore, the role of clinicians in reporting such cases and the hospital blood banks in collecting appropriate samples is critical. We suggest that hospital blood banks retain transfused donation units for at least 24 h after transfusion to expedite TRALI investigations. Due to the specialized nature of investigation, it is necessary to direct such investigations to specialist reference neutrophil testing services. In cases where the recipient has the leucocyte antibody, the use of white cell filters in future transfusions should be beneficial, because there is little evidence to substantiate the use of phenotyped blood products.
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Internal medicine journal · Jul 2003
Comparative StudyPrevalence and predictors of renal artery stenosis in Chinese patients with coronary artery disease.
Ischaemic nephropathy is currently a major public health issue in atherosclerotic populations. Although atherosclerotic cardiovascular disease in Asia has reached epidemic proportions over the last two decades, there is little published data on the prevalence of atherosclerotic renal artery stenosis (ARAS) in Oriental subjects. Because ARAS may be clinically silent until end-stage renal failure sets in, it is important to identify patients with significant but clinically unsuspected ARAS. ARAS and coronary artery disease (CAD) often coexist. ⋯ Clinically silent yet angiographically significant ARAS is common among CAD patients. The prevalence and predictors of ARAS among Chinese patients with CAD are similar to those reported for Caucasian subjects. Underlying ARAS should be suspected in CAD patients with such comorbidities as hypertension, renal insufficiency, extracranial cerebrovascular disease, and more so in the elderly and those with multivessel disease.
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Internal medicine journal · May 2003
Case ReportsQuestioning the decision-making capacity of surrogates.
When patients are unable to make medical decisions for themselves due to cognitive impairment, surrogate decision makers are often called on to guide the medical team. Important to any decision made on behalf of the patient is that the decision reflects the values and preferences of the patient in light of the patient's clinical status and prognosis. ⋯ Even if an alternative surrogate is available, there is no consensus on when and how to switch from the primary surrogate to the alternative surrogate. This paper uses a clinical case to explore the notion of surrogate decision-making capacity, offering guidance for determining when it is appropriate to defer to an alternative surrogate, as well as guidance for managing the process of appointing the alternative as the new primary decision maker.
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Internal medicine journal · Apr 2003
Full publication of trials initially reported as abstracts in the Australian and New Zealand Journal of Medicine 1980-2000.
Abstract Failure to identify all relevant reports of controlled trials is a potential source of bias in systematic reviews of health-care interventions. The present study aims to identify how many reports of trials -initially published as conference abstracts in the Australian and New Zealand Journal of Medicine were subsequently published in full. We identified trial reports by handsearching conference abstracts published in the Journal from 1980 to 2000. ⋯ A total of 962 reports of controlled trials was identified from the conference proceedings of 17 medical societies. Of these, 589 (61%) reports of trials were subsequently published in full, and on average within 1-2 years. Handsearching conference abstracts identified a large number of reports of controlled trials, over one-third of which were unpublished and therefore not easily accessible.