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Ecushla C Linedale, Jane M Andrews
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 309-315; https://doi.org/10.5694/mja17.00457

Abstract:
Irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGIDs) are so prevalent they cannot reasonably have their diagnoses and management based within specialty care. However, delayed diagnosis, lengthy wait times for specialist review, overinvestigation and lack of clear diagnostic communication are common. The intrusive symptoms of IBS and other FGIDs impair patient functioning and reduce quality of life, and come with significant costs to individual patients and the health care system, which could be reduced with timely diagnosis and effective management. IBS, in particular, is no longer a diagnosis of exclusion, and there are now effective dietary and psychological therapies that may be accessed without specialist referral. The faecal calprotectin test is widely available, yet not on the Medical Benefits Schedule, and a normal test result reliably discriminates between people with IBS and patients who warrant specialist referral.
Helen Francombe, Heather A Buchan, Anne Duggan
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 277-278; https://doi.org/10.5694/mja17.00676

, , John Hodges
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 303-308; https://doi.org/10.5694/mja16.01458

Abstract:
Behavioural variant frontotemporal dementia is characterised by insidious changes in personality and interpersonal conduct that reflect progressive disintegration of the neural circuits involved in social cognition, emotion regulation, motivation and decision making. The underlying pathology is heterogeneous and classified according to the presence of intraneuronal inclusions of tau, TDP-43 or, occasionally, fused in sarcoma proteins. Biomarkers to detect these histopathological changes in life are increasingly important with the development of disease-modifying drugs. A number of gene abnormalities have been identified, the most common being an expansion in the C9orf72 gene, which together account for most familial cases. The 2011 international consensus criteria propose three levels of diagnostic certainty: possible, probable and definite. Detailed history taking from family members to elicit behavioural features underpins the diagnostic process, with support from neuropsychological testing designed to detect impairment in decision making, emotion processing and social cognition. Brain imaging is important for increasing the level of diagnosis certainty over time. Carer education and support remain of paramount importance.
Susan J Wareham
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 284-284; https://doi.org/10.5694/mja17.00470

Comment
, Amy Pai, Stephanie H Young
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 316-316; https://doi.org/10.5694/mja17.00452

Cate Swannell
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 276-276; https://doi.org/10.5694/mja17.n0210

, R C Andrew Symons
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 316-316; https://doi.org/10.5694/mja17.00384

, Helen I Opdam, Laura Gladkis, Byron Arcia, Michael A Fink, John Kanellis, Peter S Macdonald, Gregory I Snell,
Published: 25 September 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 294-301; https://doi.org/10.5694/mja16.01405

Abstract:
To determine the potential for organ donation after circulatory death (DCD) in Australia by applying ideal and expanded organ suitability criteria, and to compare this potential with actual DCD rates. Retrospective cohort study. Setting, methods: We analysed DonateLife audit data for patients aged 28 days to 80 years who died between July 2012 and December 2014 in an intensive care unit or emergency department, or who died within 24 hours of discharge from either, in the 75 Australian hospitals contributing data to DonateLife. Ideal and expanded organ donation criteria were derived from international and national guidelines, and from expert opinion. Potential DCD organ donors were identified by applying these criteria to patients who had been intubated and were neither confirmed as being brain-dead nor likely to have met brain death criteria at the official time of death. 8780 eligible patients were identified, of whom 202 were actual DCD donors. For 193 potential ideal (61%) and 313 potential expanded criteria DCD donors (72%), organ donation had not been discussed with their families; most were potential donors of kidneys (416 potential donors) or lungs (117 potential donors). Potential donors were typically older, dying of non-neurological causes, and more frequently had chronic organ disease than actual donors. Identifying all these potential donors, assuming a consent rate of 60%, would have increased Australia's donation rate from 16.1 to 21.3 per million population in 2014. The untapped potential for DCD in Australia, particularly of kidneys and lungs, is significant. Systematic review of all patients undergoing end-of-life care in critical care environments for donor suitability could result in significant increases in organ donation rates.
Paul Bird, Terrence Diamond, William A Clark
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 279-281; https://doi.org/10.5694/mja16.01423

Melissa H Lee, Genevieve L Calder, Richard J MacIsaac, Nirupa Sachithanandan
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 282-283; https://doi.org/10.5694/mja16.00921

Christine M Shearman
Published: 2 October 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 284-284; https://doi.org/10.5694/mja17.00275

Published: 10 December 2012
by AMPCo
Medical Journal of Australia, Volume 197, pp 605-605; https://doi.org/10.5694/mja12.n1119

Steven J Lindstrom, , Michael F Sutherland, Andrew Ba Treloar, Ed Newbigin, Christine F McDonald, Jo A Douglass
Published: 18 September 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 235-237; https://doi.org/10.5694/mja17.00285

, , , Rodney T Judson, , Ronan A Lyons, Belinda J Gabbe
Published: 11 September 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 244-249; https://doi.org/10.5694/mja17.00015

Abstract:
To investigate temporal trends in the incidence, mortality, disability-adjusted life-years (DALYs), and costs of health loss caused by serious road traffic injury. A retrospective review of data from the population-based Victorian State Trauma Registry and the National Coronial Information System on road traffic-related deaths (pre- and in-hospital) and major trauma (Injury Severity Score > 12) during 2007-2015.Main outcomes and measures: Temporal trends in the incidence of road traffic-related major trauma, mortality, DALYs, and costs of health loss, by road user type. There were 8066 hospitalised road traffic major trauma cases and 2588 road traffic fatalities in Victoria over the 9-year study period. There was no change in the incidence of hospitalised major trauma for motor vehicle occupants (incidence rate ratio [IRR] per year, 1.00; 95% CI, 0.99-1.01; P = 0.70), motorcyclists (IRR, 0.99; 95% CI, 0.97-1.01; P = 0.45) or pedestrians (IRR, 1.00; 95% CI, 0.97-1.02; P = 0.73), but the incidence for pedal cyclists increased 8% per year (IRR, 1.08; 95% CI; 1.05-1.10; P < 0.001). While DALYs declined for motor vehicle occupants (by 13% between 2007 and 2015), motorcyclists (32%), and pedestrians (5%), there was a 56% increase in DALYs for pedal cyclists. The estimated costs of health loss associated with road traffic injuries exceeded $14 billion during 2007-2015, although the cost per patient declined for all road user groups. As serious injury rates have not declined, current road safety targets will be difficult to meet. Greater attention to preventing serious injury is needed, as is further investment in road safety, particularly for pedal cyclists.
David Molloy
Published: 18 September 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 240-240; https://doi.org/10.5694/mja16.01360

Cate Swannell
Published: 18 September 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 228-228; https://doi.org/10.5694/mja17.n1809

Marion G Carey, Mark P Monaghan,
Published: 18 September 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 232-234; https://doi.org/10.5694/mja17.00511

Michael R Cox
Published: 18 September 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 240-240; https://doi.org/10.5694/mja17.00120

Rebekah M Ahmed, Imelda P Hannigan, , Raymond C Chan,
Published: 4 June 2012
by AMPCo
Medical Journal of Australia, Volume 196, pp 701-704; https://doi.org/10.5694/mja11.10850

Abstract:
To review patients with severe bilateral vestibular loss associated with gentamicin treatment in hospital. A retrospective case series of presentations to a balance disorders clinic between 1988 and 2010. Relationship between vestibulotoxicity and gentamicin dose or dosing profile; indications for prescribing gentamicin. 103 patients (age, 18-84 years; mean, 64 years) presented with imbalance, oscillopsia or both, but none had vertigo. Only three noted some hearing impairment after having gentamicin, but audiometric thresholds for all patients were consistent with their age. In all patients, the following tests gave positive results: a bilateral clinical head-impulse test, a vertical head-shaking test for vertical oscillopsia, and a foam Romberg test. In 21 patients, imbalance occurred during gentamicin treatment (ignored or dismissed by prescribers in 20) and in 66 after treatment; the remaining 16 could not recall when symptoms were first noticed, except that it was after gentamicin treatment in hospital. Total gentamicin dose range was 2-318 mg/kg (mean, 52 mg/kg), daily dose range was 1.5-5.6 mg/kg (mean, 3.5mg/kg), and duration was 1-80 days (mean, 17 days). Six patients had only a single dose; 26 had five or fewer doses. Serum gentamicin levels, measured in 82 patients, were in the recommended range in 59. Time to diagnosis ranged from 4 days to 15 years. Nephrotoxicity developed in 43 patients. Gentamicin dosage complied with contemporary or current Australian antibiotic guidelines in under half the patients. Gentamicin ototoxicity is vestibular, not cochlear, producing permanent loss of balance, but not of hearing. Gentamicin can be vestibulotoxic in any dose, in any regimen, at any serum level.
Christine L Paul, Paul Ishiguchi, Catherine A D'este, Jonathan E Shaw, , Kristy Forshaw, , Jennifer Robinson, Claudia Koller,
Published: 4 September 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 206-210; https://doi.org/10.5694/mja16.00769

, Tanya Milburn, Sarah Ashover, Wade Skoien, Jaimi H Greenslade, Louise McCormack,
Published: 4 September 2017
by AMPCo
Medical Journal of Australia, Volume 207, pp 201-205; https://doi.org/10.5694/mja16.01479

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