Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Intern Med J [journal]
- Health Status, Late Effects and Long Term Survivorship of Allogeneic Bone Marrow Transplantation: A Retrospective Study. [JOURNAL ARTICLE]
- Intern Med J 2013 Dec 10.
Survival after allogeneic haematopoietic stem cell transplantation (allo-HSCT) has improved due to advancements in allo-HSCT. Allo-HSCT has been performed in Australia since late 1970s. However, there is little published data about health problems of allo-HSCT survivors in Australia.Identify health issues in long term survivors of allo-HSCT in an Australian centre to better manage and prevent long term complications.The health records of all recipients of allo-HSCT in a single centre from January 2000 to December 2007 and survived beyond two years were assessed.99 of the 200 allo-HSCT patients survived beyond two years and the median time from allo-HSCT was 74 months. Twenty-eight percent died at a median of 37 months after allo-HSCT due to relapsed malignancy (12%), stroke (1%), infection (3%), cGVHD (9%), secondary malignancy (2%) and unknown cause (1%). Ninety-one percent reported one or more chronic health conditions. Health issues were chronic graft versus host disease (70%), respiratory (66%), ophthalmic (40%), bone (33%), and renal (26%) problems, and malignancies (14% skin, 3% solid organ). Seventy-nine percent resumed vocation at full or reduced capacity two years after allo-HSCT. Clinicians identified forty percent with quality of life (QOL) issues, but survivors' self-reported QOL was comparable to the general Australian population.This study shows that allo-HSCT recipients are living with high burdens of chronic diseases that warrant lifelong surveillance and engagement with healthcare. Structured, multi-disciplinary care as recommended by published guidelines for allo-HSCT survivors may reduce long term effects and improve their outcomes.
- Utilization of beds on the general medical unit by "non acute medical" patients: A retrospective study of incidence and cost in two Tasmanian regional medical hospital units. [JOURNAL ARTICLE]
- Intern Med J 2013 Dec 10.
Demand for health care services threatens to overwhelm the Australian health care system. Public hospitals have the largest component of expenditure growth and as such represent the largest opportunity for efficiency gains. Utilization of in-patient hospital beds, and in particular those on general medical units has not been studied in Australia.To undertake a retrospective patient medical record review of 200 sequential admissions to the medical wards in two regional Tasmanian hospitals to determine, the incidence of non acute medical patient admission to the medical unit, and the subsequent days in hospital that were not required for medical reasons. The cost of these days was estimated.Sixteen patient admissions (8%) could not be justified on medical grounds. Forty eight (24%) patient admissions had at least one day hospital day that could not be justified on medical grounds. Of the 1438 total bed days, 475 (33%) were for non medical reasons. The estimated cost of those non medical bed days for this cohort was $764,800.The incidence of non acute medical admissions and non acute medical bed days to the medical unit and associated cost was significant. Further research is needed to design alternative care provision for such patients particularly in regional Australia. The potential savings to the Australian health care system could be significant.
- Quality of care factors associated with unplanned readmissions of older medical patients - a case-control study. [JOURNAL ARTICLE]
- Intern Med J 2013 Dec 10.
Unplanned readmissions befall up to 25% of acutely hospitalised older patients and many may be potentially preventable.To assess the type and prevalence of quality of care factors associated with potentially preventable readmissions to a tertiary hospital general medicine service.A retrospective case-control study was undertaken of hospital records of patients 65 years or older admitted acutely between January 1, 2005 and December 31, 2010. Readmissions up to 30 days post-discharge (cases) were purposively sampled according to frequencies of primary discharge diagnoses coded during the study period. Non-readmitted patients (controls), matched according to age, sex and primary discharge diagnosis on index admission, were selected in a 1.7:1 ratio.113 cases and 198 controls were analysed, the former demonstrating a significantly higher co-morbidity burden (mean [+/- SD] co-morbidity score 6.6 [+/-2.2] versus 5.6 [+/-2.4], p=0.003) and a higher proportion of individuals with one or more hospitalisations over the preceding 6 months (54.8% vs 8.0%, p<0.001). Among readmitted patients, 50 (44.3%) were associated with one or more quality factors versus 23 (11.6%) controls (p<0.001). The most common were: failure to develop/activate an advance care plan (18, 15.9% vs 2, 1.0%; p<0.001); suboptimal management of presenting illness (13, 11.4% vs 0, 0%; p<0.001); inadequate assessment of functional limitations (11, 9.7% vs 0, 0%; p<0.001); and potentially preventable complication of therapy (8, 7.1% vs 1, 0.5%, p=0.002).Quality of care factors are more common among readmitted than among non-readmitted older patients suggesting potential for remedial strategies. Such strategies may still have limited effects as older, frail patients with advanced diseases and multi-morbidity will likely retain a high propensity for readmission despite optimal care.
- Improving the logic and rigour of delirium trials. [Letter]
- Intern Med J 2013 Nov; 43(11):1260.
- Management dilemmas in a case of angioedema with normal C1 inhibitor function during pregnancy. [Letter]
- Intern Med J 2013 Nov; 43(11):1259.
- Cost of misdiagnosing difficult asthma. [Letter]
- Intern Med J 2013 Nov; 43(11):1258.
- Antibodies to Australian bat lyssavirus in an asymptomatic bat carer. [Letter]
- Intern Med J 2013 Nov; 43(11):1256-7.
- Demonstrable professionalism: linking patient-centred care and revalidation. [Journal Article]
- Intern Med J 2013 Nov; 43(11):1254-6.
The move by the Medical Board of Australia to commence a conversation with the medical profession about revalidation reflects that patient-centred care is at the heart of good medical practice. Patients judge their doctors' commitment to them based on whether their individual interactions with doctors meet their needs. We argue that ensuring that doctors are continuing to perform at a level that the community regards as acceptable is a demonstration of an individual doctor's professionalism and thus their commitment to patient-centred care. This impacts on the profession as a whole, which needs to commit to what we call 'demonstrable professionalism' - the ongoing and active demonstration of performance that the community regards as acceptable. This needs to be supported by organisations in which doctors work, reflecting the importance of organisational context to clinical practice. Revalidation processes thus need both to reflect the work of doctors and be meaningful to the community. The move to consider revalidation of doctors by regulatory authorities should not be seen by the profession as a threat, but more as an opportunity to demonstrate the profession's commitment to patient-centred care.
- Teaching Junior Medical Officers safe and effective prescribing. [Journal Article]
- Intern Med J 2013 Nov; 43(11):1250-3.
Medication errors are an iatrogenic threat to patient safety, and recently graduated Junior Medical Officers (JMOs) are a common source of these errors. A ward-based, physician-led, small-group interactive teaching session was developed to improve JMOs competence in prescribing. The ability of JMOs to detect problems in mock medication charts before and after the teaching session was assessed, with the majority improving after the intervention, a result sustained on re-testing later in the year. The teaching sessions were well received by JMOs.
- Impact of the 2009 Melbourne heatwave on a major public hospital. [Journal Article]
- Intern Med J 2013 Nov; 43(11):1246-50.
In the week following the onset of the 2009 heatwave in Melbourne, Australia, The Alfred Hospital observed a significant increase in total hospital admissions (adjusted incidence rate ratio (IRR) 1.11, P = 0.046), emergency department presentations (IRR 1.15, P < 0.01) and general medical admissions (IRR 1.81, P < 0.01). Under the general medical unit there was a rise in the number of deaths (IRR 3.9, P < 0.01), and patients with a broad range of disorders, particularly of the endocrine/metabolic (IRR 2.2, P < 0.01), circulatory (IRR 1.9, P < 0.01) and genitourinary (IRR 2.6, P < 0.01) systems.