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d'Emden M.C.,Royal Brisbane and Womens Hospital
The Medical journal of Australia | Year: 2012

For many years, the diagnosis of diabetes has been made through the laboratory-based measurement of fasting or random blood glucose levels, or using the oral glucose tolerance test. A glycated haemoglobin (HbA(1c)) level ≥ 6.5% (48 mmol/mol) is now also acceptable for diagnosing diabetes. Caution is needed in interpreting HbA(1c) test results in the presence of conditions affecting red blood cells or their survival time, such as haemoglobinopathies or anaemia.

McLeod D.S.A.,Royal Brisbane and Womens Hospital | McLeod D.S.A.,Queensland Institute of Medical Research | Sawka A.M.,University of Toronto | Cooper D.S.,Johns Hopkins University
The Lancet | Year: 2013

In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.

Iedema J.,Royal Brisbane and Womens Hospital
Australian Prescriber | Year: 2011

Codeine is a weak opioid analgesic. It has to be converted to morphine, but there is significant inter-individual variation in its pharmacokinetics which results in variable effectiveness. Codeine's efficacy in clinical trials is generally modest and while its adverse events are usually mild, serious adverse events, including death, have occurred. Tolerance and drug dependence can occur. There is a risk of toxicity especially if combination products containing codeine and other drugs are misused. Treatment with simple analgesics, or other opioids if required, provides a more predictable response.

Atherton J.J.,Royal Brisbane and Womens Hospital
JACC: Cardiovascular Imaging | Year: 2010

To address the heart failure burden, our focus needs to shift to disease prevention. Strategies to initially screen for heart failure precursors such as asymptomatic left ventricular systolic dysfunction have been evaluated, including clinical scores, the 12-lead electrocardiogram, and natriuretic peptides. However, their specificity limits their broad application as screening tools in asymptomatic populations. High-quality images are now available from hand-carried cardiac ultrasound devices, at a fraction of the capital cost of standard echocardiography with favorable diagnostic performance, especially when experienced staff perform the imaging. Questions that remain to be addressed include how we should select the target population to screen, who should perform the screening studies, how much training is required, and how often screening studies should be performed. © 2010 American College of Cardiology Foundation.

D'Emden M.C.,Royal Brisbane and Womens Hospital | D'Emden M.C.,University of Queensland
Medical Journal of Australia | Year: 2014

The International Association of Diabetes and Pregnancy Study Groups has recommended new blood glucose levels (BGLs) for the diagnosis of gestational diabetes mellitus (GDM). These BGLs supposedly identify women with at leasta 75% increased risk of developing certain adverseneonatal outcomes. The new criteria result in a significant increase in the number of women diagnosed with GDM. Most of the women diagnosed with GDM according to the new criteria have only one elevated BGL. Due to the unrecognised effect of the other BGLs being normal, up to 50% of these women are inappropriately diagnosed with GDM as they do not meet the agreed risk threshold. In absolute terms, for every 100 women diagnosed with GDM who have only one elevated BGL, nearly 50 do not meet the agreed risk threshold for diagnosis, and there are only up to seven extra cases of large-for-gestational-age infants. A more statistically valid basis for diagnosing GDM consistent with the recommended risk threshold is suggested.

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