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Antony George Attokaran FRACP FCICM Mahesh Ramanan MMed FCICM Lisa Hunt MBBS Kavita Chandra MBBS Rajbir Sandha FACEM Stacey Watts RN BN GC Balasubramanian Venkatesh MD FCICM FAHMS 《Emergency medicine Australasia : EMA》2023,35(4):657-663
Objective
To test the hypothesis that fluid resuscitation in the ED with plasmalyte-148 (PL) compared with 0.9% sodium chloride (SC) would result in a lower proportion of patients with diabetic ketoacidosis (DKA) requiring intensive care unit (ICU) admission.Methods
We performed a prespecified nested cohort study at two hospitals within a cluster, crossover, open label, randomised, controlled trial comparing the effects of PL versus SC as fluid therapy for patients who presented to the ED with DKA. All patients presenting within a fixed recruitment period were included. The primary outcome was the proportion of patients admitted to ICU.Results
Eighty-four patients were enrolled (SC n = 38, PL n = 46). The SC group had a lower median pH on admission (SC: 7.09 [interquartile range (IQR) 7.01–7.21], PL: 7.17 [IQR 6.99–7.26]). The median volume of intravenous fluids administered in ED was 2150 mL (IQR 2000–3200 mL; SC) and 2200 mL (IQR 2000–3450; PL); respectively. A higher proportion of patients in the SC group, 19 (50%), was admitted to ICU compared with PL group, 18 (39.1%); however, after adjustment for pH at presentation and diabetes type in a multivariable logistic regression model, the PL group did not have a significantly different rate of ICU admission compared with the SC group (odds ratio for ICU admission 0.73, 95% confidence interval 0.13–3.97, P = 0.71).Conclusion
Patients with DKA treated with PL compared with SC in the EDs had similar rates of requiring ICU admission. 相似文献2.
Jinhan Xie MPharm PhD Amit Kumar PhD M. Emmy M. Dolman PhD Chelsea Mayoh BSc Dong-Anh Khuong-Quang MD PhD Roxanne Cadiz BSc Marie Wong-Erasmus PhD Emily V. A. Mould PhD Dylan Grebert-Wade BSc Paulette Barahona PhD Alvin Kamili BMedSc PhD Maria Tsoli PhD Timothy W. Failes PhD Shu-Oi Chow BSc Greg M. Arndt BSc PhD Kanika Bhatia MD Glenn M. Marshall AM MB BS MD FRACP David S. Ziegler MBBS BSc FRACP MD Michelle Haber AM PhD Hon DSc FAHMS Richard B. Lock BSc PhD Vanessa Tyrrell BAppSc MHGSA FHGSA MBA CSA ARCPA Loretta Lau MBBS MMed PhD FRACP Penny Athanasatos BAppSc CT CF Andrew J. Gifford BSc Hons PhD MBBS FRCPA 《Cancer cytopathology》2021,129(10):805-818
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Shantelle Smith BSc MPH MCncrSc Daniel Sapkaroski BBiomed MMedRad PhD Margaret Brand MPH Anh Tran MDataSci John Zalcberg MB BS PhD FRACP FRACMA FAHMS FAICD Robert G. Stirling BSc MB BCh MRCPI FRACP RCPI MPH 《Nursing & health sciences》2023,25(3):411-423
The lung cancer Optimal Care Pathway recommends supportive care and palliative care integration throughout its various steps, with early referral to appropriate services improving the quality of life in advanced stage non-small cell lung cancer patients. Using Victorian Lung Cancer Registry data and linked administrative datasets, this retrospective cohort study mapped clinical care pathways of 525 Stage III–IV non-small cell lung cancer patients in Victoria to 11 recommendations in the Optimal Care Pathway, identifying unwarranted variations in clinical care. Supportive care and palliative care delivery were further examined to understand the involvement and timing of specialist care teams. Our findings showed that palliative care utilization is highest at the time of treatment, despite recommendations that it should be provided early after diagnosis to improve patient outcomes and satisfaction. Early supportive care screening was observed in half the cohort and almost three-quarters of the patients had been presented at a multidisciplinary meeting. Multidisciplinary meeting presentations and supportive care provide an opportunity to improve communication about palliative care needs and integration into routine clinical practice, such as at the time of treatment planning. 相似文献
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Matthew C. Kiernan PhD DSc FRACP FAHMS Ulf Ziemann MD Andrew Eisen MD FRCPC 《Muscle & nerve》2019,60(3):232-235
Amyotrophic lateral sclerosis (ALS) is an adult onset disease but with an increasingly recognized preclinical prodrome. A wide spectrum of investigative approaches has identified loss of inhibitory function at the heart of ALS. In developing an explanation for the onset of ALS, it remains a consideration that ALS has its origins in neonatal derangement of the γ-aminobutyric acid (GABA)-ergic system, with delayed conversion from excitatory to mature inhibitory GABA and impaired excitation/inhibition balance. If this is so, the resulting chronic excitotoxicity could marginalize cortical network functioning very early in life, laying the path for neurodegeneration. The possibility that adult-onset neurodegenerative conditions might have their roots in early developmental derangements is worthy of consideration, particularly in relation to current models of disease pathogenesis. Unraveling the very early molecular events will be crucial in developing a better understanding of ALS and other adult neurodegenerative disorders. Muscle Nerve, 2019 相似文献
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Jessica M. Gereis BSc Kate Hetherington BSc MPsych PhD Eden G. Robertson BPsych GC-ADOLHW PhD Rebecca Daly BSc MSc Mark W. Donoghoe BSc PhD David S. Ziegler MBBS BSc MD/PhD FRACP Glenn M. Marshall MBBS MD FRACP FAHMS Loretta M. S. Lau MBBS MMed PhD FRACP Jonathan M. Marron MD MPH Claire E. Wakefield BPsych MPH PhD 《Cancer》2023,129(22):3645-3655
Background
Precision medicine is projected to become integral to childhood cancer care. As such, it is essential to support families to understand what precision medicine entails.Methods
A total of 182 parents and 23 adolescent patients participating in Precision Medicine for Children with Cancer (PRISM), an Australian precision medicine clinical trial for high-risk childhood cancer, completed questionnaires after study enrollment (time 0 [T0]). Of the parents, 108 completed a questionnaire and 45 completed an interview following return of precision medicine results (time 1 [T1]). We analyzed the mixed-methods data comprising measures exploring families’ perceptions and understanding of PRISM’s participant information sheet and consent form (PISCF), and factors associated with understanding.Results
Most parents were satisfied with the PISCF, rating it as at least “somewhat” clearly presented (n = 160/175; 91%) and informative (n = 158/175; 90%). Many suggested improvements including the use of clearer language and a more visually engaging format. Parents’ actual understanding of precision medicine was low on average, but scores improved between T0 and T1 (55.8/100-60.0/100; p = .012). Parents from culturally and/or linguistically diverse backgrounds (n = 42/177; 25%) had lower actual understanding scores than those from a Western/European background whose first language was English (p = .010). There was little correlation between parents’ perceived and actual understanding scores (p = .794; Pearson correlation –0.020; 95% CI, –0.169 to 0.116). Most adolescent patients read the PISCF either “briefly” or “not at all” (70%) and had a perceived understanding score of 63.6/100 on average.Conclusions
Our study revealed gaps in families’ understanding of childhood cancer precision medicine. We highlighted areas for potential intervention such as through targeted information resources.Plain Language Summary
- Precision medicine is projected to become part of the standard of care for children with cancer. Precision medicine aims to give the right treatment to the right patient and involves several complex techniques, many of which may be challenging to understand.
- Our study analyzed questionnaire and interview data from parents and adolescent patients enrolled in an Australian precision medicine trial.
- Findings revealed gaps in families’ understanding of childhood cancer precision medicine. Drawing on parents’ suggestions and the literature, we make brief recommendations about improving information provision to families, such as through targeted information resources.
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Samantha Spanos BPsych PhD Nehal Singh BPsych Bela I. Laginha BA/BSc MMSc Gaston Arnolda BSc MPH PhD David Wilkinson MBChB PhD FRACGP Andrea L. Smith BSc MPH PhD Anne E. Cust BA BSc MPH PhD Jeffrey Braithwaite BA DipLR MIR MBA PhD FIML FACHSM FAHMS FFPHRCP FAcSS Hon FRACMA Frances Rapport PhD MPhil BA Cert Ed FRSA 《The Australasian journal of dermatology》2023,64(2):177-193
Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited. 相似文献