Internal medicine journal
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Internal medicine journal · Jul 2013
Review Case ReportsPractical aspects of telehealth: financial considerations.
The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The practical aspects of telehealth article series considers the contextual, clinical, technical and ethical components of online video consultations.
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Internal medicine journal · Jul 2013
Multicenter StudyDescription of the Western Sydney and Nepean Blue Mountains local health districts' influenza prevention programme.
Influenza is a major cause of morbidity and mortality. In 2011, influenza vaccination was provided free for people at greatest risk of severe disease: people aged 65 years and over, Aboriginal Australians 15 years and older, pregnant women, and individuals aged 6 months and over who suffered chronic medical conditions. ⋯ A hospital-based influenza vaccination programme can be an effective way to improve influenza vaccination rates among specific population groups at high risk of severe disease with influenza, particularly pregnant women and those younger than 65 years with a chronic medical condition.
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Internal medicine journal · Jul 2013
ReviewManaging the generalised tonic-clonic seizure and preventing progress to status epilepticus: a stepwise approach.
Seizures are a commonly encountered medical problem. Seizure protocols have been shown to be effective by avoiding inappropriate over- and undertreatment, but are not presently utilised in many centres in Australia. We outline a stepwise approach to effective seizure management based on timely investigation and escalating treatment with an appropriate choice of medications. ⋯ Novel approaches and agents, including ketamine, topiramate, lacosamide, pregabalin and intravenous immunoglobulins, are discussed. We provide our own recently developed hospital protocol as a guide. This protocol relies on a time-based four-step escalating approach to seizure management, ranging from supportive management of the initial simple seizure to the use of multiple agents for established status epilepticus.
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Internal medicine journal · Jul 2013
Characteristics and outcomes of discharges against medical advice among hospitalised patients.
Discharge against medical advice (DAMA) occurs when an in-patient chooses to leave the hospital before discharge is recommended by the treating clinicians. The long-term outcomes of patients who DAMA are not well documented. ⋯ Patients who self-discharged against medical advice carry a significant risk of readmission and mortality. Patients with characteristics of 'at risk of DAMA' should have greater attention paid to their care before and especially after any premature discharge.
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Internal medicine journal · Jul 2013
Early prosthetic hip joint infection treated with debridement, prosthesis retention and biofilm-active antibiotics: functional outcomes, quality of life and complications.
Patients treated for early prosthetic joint infection (PJI) with surgical debridement, prosthesis retention and biofilm-active antibiotics, such as rifampicin or fluoroquinolones have a rate of successful infection eradication that is similar to patients treated with the traditional approach of prosthesis exchange. It is therefore important to consider other outcomes after PJI treatment that may influence management decisions, such as function, quality of life (QOL) and treatment-associated complications. ⋯ Treatment of PJI with debridement, prosthesis retention and biofilm-active antibiotics is successful, well tolerated and results in significant improvements in function and QOL, which are similar to patients without PJI.