Presentations
- Acute intoxication
- Alcohol-related presentations, including but not limited to:
- cardiac
- cerebellar dysfunction
- gastritis, gastrointestinal, Mallory–Weiss tear
- haematology – macrocytic anaemia
- liver disease
- myopathy
- peripheral neuropathy
- Altered conscious state presentation
- Cognitive impairment
- Congestive cardiac failure (CCF)
- Delirium / Acute confusional state
- Drug-induced psychosis
- Drug-drug interactions:
- acamprosate
- buprenorphine
- disulfiram
- methadone
- naltrexone
- Fever
- Hypertension
- Infective complications of injecting drug use
- Rhabdomyolysis
- Seizures
Conditions
- Acute and chronic pancreatitis
- Alcohol-related brain injury
- Alcohol-related cardiovascular disease
- Alcohol-related dental conditions
- Alcohol-related hepato-steatosis and cirrhosis
- Blood borne bacterial and fungal infections
- Chronic obstructive pulmonary disease
- Cognitive impairment from substances, including alcohol and benzodiazepines (BZD)
- Hepatitis B (HBV)
- Hepatitis C (HCV)
- Human immunodeficiency virus (HIV)
- Injection-related sinuses, DVT and soft tissue infections
- Methadone and other drug-related QT prolongation
- Seizures secondary to withdrawal and intoxication
- Stimulant-related cardiomyopathy
- Thrombophlebitis
- Wernicke encephalopathy and Korsakoff syndrome
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Acute cardiac or cerebrovascular events
- Decompensated cirrhosis
- Difficult-to-engage patient with severe medical conditions
- Driving impairment due to medical complications secondary to substance use
- Sepsis needing surgical intervention
- Sexually transmitted infection (STI) in context of substance use
- Significant risk to others in a hospital setting
- Unstable diabetes mellitus
Conditions
- B12 deficiency and nitrous oxide use
- Co-occurring HBV, HCV, HIV, and STI
- Disseminated sepsis
- Epidural and related central nervous system infections
- Hypogonadism and other hormonal side effects associated with opioid use
- Infective endocarditis
- Refeeding syndrome
- Severe alcohol-related liver disease and HCV
- Stimulant-related cerebrovascular accident (CVA), ischaemic heart disease, or arrythmia
- Thiamine deficiency
- Tuberculosis treatment and significant drug interactions
- Type 3C diabetes mellitus (secondary to chronic pancreatitis)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Blood borne viruses (BBVs) and current management
- Pathophysiology of alcohol-related brain injury
- Pathophysiology of alcohol-related medical conditions
- Pathophysiology of HCV-related kidney disease and other complications
- Pathophysiology of methamphetamine-related cardiomyopathy
- Pre-exposure and post-exposure prophylaxis
- The pathophysiology of Wernicke–Korsakoff syndrome, its prevention (in the population and on an individual basis), and treatment
- Underlying evidence behind prognoses for presentations and conditions in context of high severity substance use and addictive disorders
Investigations
- Cognitive assessment tools relevant to assessing delirium and cognitive impairment
- CT scans
- Drug and alcohol testing:
- ECG
- Fibroscan – hepatic elastography and liver ultrasound
- Investigations relating to Wernicke–Korsakoff syndrome and alcohol-related brain injury
- Relevant biochemistry and haematology and BBV serology
- Advocacy for community-based supports to assist with recovery
- Advocacy for patients within the broader health system, based on evidence and health needs, countering against stigma and discrimination, to receive care in accordance with clinical need
- Assessment for liver transplant suitability, including providing neutral evidence-based advice regarding substance use prognosis
- Creative planning, balancing optimal care with respect for patient autonomy
- Fitness to drive assessment
- High risk behaviours contributing to medical problems experienced from addictive and substance use disorders
- Legal requirements, where there is risk to others
- Patient readiness for change, when developing management plans
- Promotion of preventative measures to reduce the risk of conditions
- Services and supports that are culturally safe for Aboriginal and Torres Strait Islander people and Māori
- Substance-related cognitive impairment and capacity assessments
- The role of harm reduction, including needle exchange services
- The role of HCV point-of-care testing and treatment to reach hard-to-access populations
- The role of multidisciplinary care for people with substance use and addictive disorders, and concurrent serious medical problems, including:
- notifying multidisciplinary treating teams of concerns about substance use-related medical problems currently not being addressed in hospital settings
- working within limits to scope of practice and need to seek assistance from, or handover to, more appropriate specialised services
- The role of self-help and peer support programs for patients, whānau, and their families
- The role of whānau, family, and friends in supporting change
- Therapeutic relationship and motivational interviewing to guide patients towards help-seeking, and enhancing their commitment to addressing their substance use
