Internal medicine journal
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Internal medicine journal · Jun 2020
Pre-hospital thrombolysis for ST-segment elevation myocardial infarction in regional Australia: long-term follow up.
Delivering reperfusion therapy to patients with ST-segment elevation myocardial infarction (STEMI) in regional areas without access to tertiary cardiology care remains challenging. The systems of care in Hunter New England Health, New South Wales, Australia (area covered = 130 000 km2 ) to provide reperfusion to patients with STEMI involve a 12-lead electrocardiogram in the ambulance, discussion between cardiologist and paramedic, followed by pre-hospital thrombolysis (PHT) delivered in ambulance to appropriate patients >60 min from the cardiac catheterisation laboratories. Patients who can access the cardiac catheterisation laboratories within 60 min are treated with primary percutaneous coronary intervention (PCI). ⋯ Our real-world experience shows that PHT followed by early transfer to a primary PCI-capable centre is an effective reperfusion strategy, with comparable results to primary PCI, and mortality benefits are sustained to more than 6 years.
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Internal medicine journal · Jun 2020
Charlson comorbidity index scores and in-hospital prognosis of patients with severe acute respiratory infections.
Respiratory infections are one of the leading causes of mortality, and comorbid conditions play a significant role in the severity and fatality of these infections. ⋯ The comorbidity scores used to assess mortality risk in hospitalised patients with SARI displayed poor results, but HIV infection was considered a marker of severity. However, other factors should be considered in order to compose a score system that allows us to specifically assess the risk of mortality in patients with SARI.
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Internal medicine journal · Jun 2020
Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward.
Older vascular surgical patients are at high risk of hospital-associated complications and prolonged stays. ⋯ Physician-led co-management plus a multidisciplinary improvement programme may reduce LOS and improve functional outcomes in older vascular surgical patients.
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Internal medicine journal · Jun 2020
Complicated skin and soft tissue infections in remote indigenous communities.
The burden and consequences of skin infections for remote living indigenous people are high. While skin infections are recognised as an antecedent to conditions such as acute rheumatic fever in children, data are limited concerning skin infection complications such as cellulitis, abscesses and osteomyelitis in older children and adults. In a 1-year retrospective audit of 439 patients presenting to two remote health clinics, 330/439 (75%) patients presented with a skin infection and 18 (4%) developed a complication.
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Internal medicine journal · Jun 2020
Investigation burden for patients with fibrotic interstitial lung disease at the end of life.
Fibrotic interstitial lung disease (f-ILD) has a guarded prognosis, and the goal of therapy in advanced-stage disease should be symptom-based. Despite this, patients may still undergo burdensome investigation at the end of life. ⋯ Eighteen per cent of patients underwent ongoing investigations after the institution of comfort care. These findings highlight the unmet end-of-life care needs of people with f-ILD.