Internal medicine journal
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Internal medicine journal · Sep 2014
Case ReportsSevere cardiomyopathy revealing antineutrophil cytoplasmic antibodies-negative eosinophilic granulomatosis with polyangiitis.
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of systemic vasculitis in which cardiac involvement is frequent and severe, and accounts for half of EGPA-related deaths. ANCA-positive EGPA differs from ANCA-negative EGPA in that the former is significantly associated with renal involvement, peripheral neuropathy and biopsy proven vasculitis, whereas the latter is associated with cardiac involvement. Herein, we report a case of EGPA with myocarditis in a woman, who was successfully treated with steroids and cyclophosphamide. This report highlights the importance of diagnosing cardiac involvement in EGPA early, especially in ANCA-negative patients.
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Internal medicine journal · Sep 2014
Introduction of an interdisciplinary heart team-based transcatheter aortic valve implantation programme: short and mid-term outcomes.
Transcatheter aortic valve implantation (TAVI) has been developed to treat symptomatic aortic stenosis in patients deemed too high risk for open-heart surgery. To address this complex population, an interdisciplinary heart team approach was proposed. ⋯ Excellent results can be achieved with TAVI in very high-risk patients at an Australian institution. A comprehensive evaluation based on a heart team can overcome most of the difficulties imposed by this challenging population.
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Internal medicine journal · Sep 2014
ReviewThiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders.
Wernicke encephalopathy is an acute, reversible neuropsychiatric emergency due to thiamine deficiency. Urgent and adequate thiamine replacement is necessary to avoid death or progression to Korsakoff syndrome with largely irreversible brain damage. ⋯ Currently, different dose recommendations are being made. We present recommendations for the assessment and treatment of Wernicke encephalopathy based on literature review and our clinical experience.
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Internal medicine journal · Sep 2014
Randomized Controlled TrialEffect of hospital-based telephone coaching on glycaemic control and adherence to management guidelines in type 2 diabetes, a randomised controlled trial.
Failure to achieve treatment targets is common among people with type 2 diabetes. Cost-effective treatments are required to delay the onset and slow the progression of diabetes-related complications. ⋯ Telephone coaching improved glycaemic control and adherence to complication screening in people with type 2 diabetes, for the duration of its delivery, but these effects were not maintained on withdrawal of the intervention. Strategies that assist patients to sustain these benefits are required.
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Internal medicine journal · Sep 2014
Randomized Controlled TrialEffect of a patient-directed discharge letter on patient understanding of their hospitalisation.
Poor patient understanding of their diagnosis and treatment plan can adversely impact clinical outcome following hospital discharge. Discharge summaries are primarily written for the doctor rather than the patient. We determined patient understanding of the reasons for hospitalisation, in-hospital tests, treatments and post-discharge recommendations, and whether a brief patient-directed discharge letter (PADDLE) delivered during a brief discussion prior to discharge would improve understanding. ⋯ A simple patient-directed letter delivered during a brief discussion improves patient understanding of their hospitalisation and post-discharge recommendations, which is otherwise limited. Further evaluation of this brief and well-received intervention is indicated, with the goal of improving patient understanding, satisfaction and clinical outcomes.