Internal medicine journal
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Internal medicine journal · Dec 2020
Rapid response team trigger modifications: are we using them safely?
Rapid response teams (RRT) were first proposed as a means of reducing inpatient morbidity and mortality. Modifying RRT activation triggers poses a potential risk for delayed recognition of a deteriorating patient. Trigger modifications have not been validated for safety. ⋯ Trigger modifications are associated with increased hospital LOS and increased rate of in-hospital death and do not reduce the number of recurrent events. For patients in whom escalation of care is not appropriate, the presence of multiple trigger modifications at the time of an RRT activation may be a useful trigger for conversations around goals of care.
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Internal medicine journal · Dec 2020
Fragmented QRS as a predictor of subclinical cardiovascular disease in patients with chronic kidney disease.
Fragmented QRS (fQRS) on surface electrocardiogram is correlated with increased cardiovascular risk and mortality in normal population. ⋯ This is the first study in the literature showing the relation of fQRS with CIMT and CACS in patients with CKD without known cardiovascular disease.
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Internal medicine journal · Dec 2020
Observational StudyCatheter-related thrombosis incidence and risk factors in adult cancer patients with central venous access devices.
Central venous access devices (CVAD) are commonly employed in the management of cancer patients. While having several benefits they are associated with significant risks. ⋯ Age <50 years, PICC lines and prior CRT were associated with highest CRT rate. Cancer subtype and insertion side were not predictive of thrombosis.
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Internal medicine journal · Dec 2020
Observational StudyClinical profile, anatomical features and long-term outcome of acute coronary syndromes in human immunodeficiency virus-infected patients.
Long-term prognosis of acute coronary syndromes (ACS) in human immunodeficiency virus (HIV)-infected patients is unknown. ⋯ HIV patients with ACS had more frequent multivessel disease and heart failure than matched controls. However, in-hospital and long-term mortality was similar in both groups. Non-cardiovascular re-hospitalisations were more common in HIV patients.
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Internal medicine journal · Dec 2020
Trends in practice: attitudes and challenges in the diagnosis, treatment and management of HIV infection in Australia.
As life expectancy for people living with human immunodeficiency virus (HIV) (PLWHIV) increases, management models for HIV infection are changing. To understand approaches to practice within this shifting climate and across different medical settings, in 2017 we conducted a baseline survey among the main medical practitioner groups responsible for HIV-infection care in Australia: hospital-based physicians (HBP), sexual health physicians (SHP) and 'accredited general practitioners' (referred to in 2017 study as 's100 GPs'), who are GPs authorised to prescribe HIV therapies after completing accredited national training. The follow-up survey presented here explores any changes in approaches, attitudes and challenges associated with HIV-infection management among the same practitioner groups: 17 HBP, 15 SHP and 69 accredited GP (referred to throughout as GP; includes those with sexual health diploma). ⋯ Addressing mental health issues for PLWHIV was again highlighted as a major priority, with practitioners overwhelmingly reporting mental health management as among their most difficult clinical challenges. Reduction in stigma/discrimination and better access to substance dependency programmes were also identified as unmet needs for this patient cohort. Consistent with our baseline survey, it appears targeted interventions and supports appropriate to this population are still required to improve overall wellbeing for PLWHIV.