The New Zealand medical journal
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Comparative Study Observational Study
Why do patients self-present to Middlemore Hospital Emergency Department?
To determine the drivers for acute (Australasian Triage Scale Category 3-5) demand in patients who self-present to New Zealand's Middlemore Hospital Emergency Department (MMH ED), we sought to establish a demographic profile of a sample of self-presenting patients and explore their reasons for presenting to ED rather than attending a primary care centre. ⋯ Almost 25% of self-presenting patients had contacted their GP or a health professional prior to their ED presentation and were advised to attend ED. The most common reason for patients to self-present at MMH ED is the belief that a hospital emergency department is the appropriate service to treat acute sickness. Neither cost nor knowledge of the Shorter Stays in Emergency Departments Health Target featured as a reason for attendance.
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To investigate general medicine readmissions for risk factors and association with mortality. ⋯ Readmission to general medicine is strongly associated with older age, polypharmacy, and multiple comorbidities. Readmission is an independent strong risk factor for 1-year mortality, with this risk increasing after multiple readmissions. Readmissions can be a marker of deteriorating patient's condition, and a discussion in relation to prognosis, ceiling of treatment, resuscitation status documentation and advance directive may be warranted.
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To decrease hospital-wide central line associated bacteraemia (CLAB) by spreading the prevention programme beyond the intensive care unit (ICU) in a secondary care hospital in Auckland, New Zealand. ⋯ We have demonstrated that the CLAB prevention work proven effective in the ICU can be successfully adapted and expanded to the rest of the hospital. As central lines are increasingly inserted in units outside the ICU, and maintained in general wards, this work provides some useful insights into tackling this larger problem.
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Observational Study
Does seasonal level of serum 25-OH vitamin D correlate with the activity of Crohn's disease?
Vitamin D has immune modulating effects and normal to high levels might be correlated with less severe Crohn's disease (CD). We aimed to review seasonal vitamin D levels in CD patients in correlation with disease activity. ⋯ Suboptimal levels of serum 25(OH)D were found in the majority of our study participants particularly in winter and they would benefit from supplementation. Our study showed no statistically significant correlation between seasonal serum 25(OH)D levels and CD activity. Given the limitations of the study, the role of 25(OH)D as a predictor of disease activity could not be clearly concluded.
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Metronidazole can produce neurological complications although it is not a common scenario. We present a case where a patient developed features of encephalopathy following prolonged metronidazole intake. Magnetic resonance imaging (MRI) brain showed abnormal signal intensity involving both dentate nuclei of cerebellum and splenium of corpus callosum. The diagnosis of metronidazole toxicity was made by the MRI findings and supported clinically.