Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Intern Med J [journal]
- Outcomes of Haematology/Oncology patients admitted to Intensive Care Unit (ICU) at The Canberra Hospital (TCH). [JOURNAL ARTICLE]
- Intern Med J 2014 Aug 5.
Outcomes for haematology/oncology patients have improved, however determining their suitability for ICU admission remains challenging and controversial.Examine outcomes of patients admitted to an Australian tertiary hospital Intensive Care Unit (ICU) and explore potential prognostic factors.A retrospective review of patients with haematological and solid tumour malignancies non-electively admitted to The Canberra Hospital (TCH) ICU, between January 2008 and December 2012. Patient demographics, cancer details, reasons for ICU admission and APACHE II scores were collected and survival rates calculated and correlated with potential prognostic factors.Of 205 patients, 113 (55%) had haematological malignancies, and 92 (45%) solid tumours; 58% male, and mean age 60.3 years (SD 13.4). 82% of solid tumour patients had metastatic disease and 55% received palliative chemotherapy. Primary reasons for ICU admission included sepsis (59%), respiratory distress (37%) and hypotension/shock (18%). Mean APACHE II score was 20.1(SD 0.55); mean length of stay in ICU, 4 days (SD 5.2); ICU survival was 76% with 62% and 41% alive at 30-days and 6 months respectively. Overall 1 year survival was 36%. High APACHE II scores and ≥2 organs failing were significant risk factors for 30-day mortality.Short-term outcomes were similar to contemporary studies from a general tertiary hospital setting and better than historical data. 62% of patients were alive 30 days post-ICU admission, with a significant minority alive at 12 months, confirming some patients achieved worthwhile outcomes. Further research is needed to ensure appropriate patient selection and to explore quality of life post ICU.
- Advances in classification, basic mechanisms and clinical science in ankylosing spondylitis and axial spondyloarthritis. [JOURNAL ARTICLE]
- Intern Med J 2014 Aug 5.
The field of spondyloarthritis has seen huge advances over the past 5 years. The classification of axial disease has been redefined by the axial spondyloarthritis criteria that incorporate disease captured before radiographic damage is evident as well as established erosive sacroiliac joint disease. Our knowledge of genetics and basic immunological pathways has progressed significantly. In addition, revolutionary progress has been achieved with the availability of tumour necrosis factor inhibitors for treating patients with moderate to severe disease. In parallel a number of novel biomarkers have been identified that show significant promise for the future. Advances in magnetic resonance imaging have helped define positive disease. We have identified that T1 and short tau inversion recovery sequences are best for the diagnosis of axial spondyloarthritis and gadolinium contrast is not additive for diagnosis. Progress has been made in identifying potential agents and strategies that reduce radiographic progression. A number of referral strategies aimed at appropriate identification of patients have been trialed and found to be effective. There is still substantial work ahead but the advances of the last 5 years have made a huge and tangible difference at the clinical coalface and we suggest this trend will continue.
- A Single-Centre Cross-Sectional Analysis of Advance Care Planning among Elderly Inpatients. [JOURNAL ARTICLE]
- Intern Med J 2014 Aug 11.
Advance Care Planning (ACP) has been shown to provide beneficial outcomes for elderly patients, however it may not be commonly implemented.To assess prevalence of Advance Care Directives (ACDs) and documented medical orders about end-of-life care for elderly inpatients; to explore the feasibility of an ACP Screening Interview.A single-centre cross-sectional analysis of 100 consecutive patients aged ≥80 admitted for ≥48 hours to a tertiary referral hospital, conducted between 16th-18th January 2013. Medical-records were reviewed for presence of 1) an ACD, 2) Resuscitation/ End-of-Life Care Intervention Orders (REOLs), and 3) documented substitute decision maker (SDM). If able, patients completed an ACP Screening Interview exploring: 1) their views on ACP, and 2) if an ACD was previously documented.In 100 medical-records there were: zero ACDs, 17 REOLs, and 8 with clear documentation of patients' preferred SDM. 33/100 patients completed the interview: 32(97%) were able to identify their preferred SDM, in 9(27%) the nominated SDM was different from their 'next of kin'. 7/33(21%) reported having an Enduring Guardian, 4/33(12%) an ACD. 23/29(79%) interviewees without an ACD were interested in discussing ACP further. 8/30(27%) interviewees without REOLs, said they would not wish to have aggressive life-prolonging measures. No patients reported discomfort with the screening interview.ACDs and correct documentation of SDM were uncommon in the medical records in this sample of elderly inpatients. The ACP Screening Interview appears feasible and acceptable, and may be a useful tool for identifying patients' preferred SDM and willingness to further discuss ACP.
- Prevalence and predictors of advance directives in Australia. [JOURNAL ARTICLE]
- Intern Med J 2014 Aug 11.
Advance care planning is regarded as integral to better patient outcomes yet little is known about the prevalence of advance directives in Australia.To determine the prevalence of advance directives (ADs) in the Australian population.A national telephone survey about estate and advance planning. Sample was stratified by age (18-45 and >45 years) and quota sampling occurred based on population size in each State and Territory.Fourteen percent of the Australian population has an AD. There is State variation with people from South Australia and Queensland more likely to have an AD than people from other states. Will making and particularly completion of a financial enduring power of attorney are associated with higher rates of AD completion. Standard demographic variables were of limited use in predicting whether a person would have an AD.Despite efforts to improve uptake of advance care planning (including ADs), barriers remain. One likely trigger for completing an AD and advance care planning is undertaking a wider future planning process (e.g. making a will or financial enduring power of attorney). This presents opportunities to increase advance care planning but steps are needed to ensure that planning which occurs outside the health system is sufficiently informed and supported by health information so that it is useful in the clinical setting. Variations by State could also suggest that redesign of regulatory frameworks (such as a user-friendly and well publicised form backed by statute) may help improve uptake of ADs.
- Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. [Journal Article, Research Support, Non-U.S. Gov't]
- Intern Med J 2014 Jun; 44(6):568-74.
Antimicrobial stewardship programmes aim to optimise use of antibiotics and are now mandatory in all Australian hospitals.We aimed to identify barriers to and enablers of appropriate antimicrobial prescribing among hospital doctors.Two paper-based and one web-based surveys were administered at three Australian university teaching hospitals from March 2010 to May 2011. The 18-item questionnaire recorded doctors’ level of experience, their knowledge regarding the use of common antimicrobials and their attitudes regarding antimicrobial prescribing. Local survey modifications allowed inclusion of specific questions on: infections in intensive care unit patients, clinical microbiology and use of local guidelines.The respondents (n = 272) were comprised of 96 (35%) registrars, 67 (25%)residents, 57 (21%) interns and 47 (17%) consultant hospital doctors. Forty-one per cent were working in a medical specialty. Identified barriers included: gaps in antimicrobial prescribing knowledge (especially among interns), a lack of awareness about which antimicrobials were restricted and a reliance on senior colleagues to make antimicrobial prescribing decisions. Enablers of optimal prescribing included: an acknowledgement of the need for assistance in prescribing and reported readiness to consult national prescribing guidelines. These results were used to help guide and prioritise interventions to improve prescribing practices.A transferable knowledge and attitudes survey tool can be used to highlight barriers and facilitators to optimal hospital antimicrobial prescribing in order to inform tailored antimicrobial stewardship interventions.
- Familial haemophagocytic lymphohistiocytosis: Australian experience and perspectives. [Letter]
- Intern Med J 2014 Aug; 44(8):826-7.
- Author reply. [Letter]
- Intern Med J 2014 Aug; 44(8):825.
- 7 + 3 idarubicin is still an effective induction therapy in acute myeloid leukaemia. [Letter]
- Intern Med J 2014 Aug; 44(8):823-4.
- Returning to medical practice following illness or injury. [Letter]
- Intern Med J 2014 Aug; 44(8):822.
- Stakes are high when caring for the dying. [Letter]
- Intern Med J 2014 Aug; 44(8):822-3.