Internal medicine journal
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Internal medicine journal · Aug 2021
Clinical, psychological and demographic factors in a contemporary adult cohort with diabetic ketoacidosis and type 1 diabetes.
Diabetic ketoacidosis (DKA) is a potentially life-threatening but often preventable acute complication of type 1 diabetes (T1D). Understanding clinical and psychosocial characteristics of people with DKA, particularly those with multiple presentations, may aid the development of prevention strategies. ⋯ There is a high prevalence of psychiatric illness, illicit substance use and social disadvantage among people admitted with DKA, particularly those with recurrent presentations. Insulin omission, often due to inappropriate sick day management, was the most common reason for DKA occurrence. Innovative multidisciplinary models of care are required to address these challenges.
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Internal medicine journal · Aug 2021
ReviewE-Health and remote management of patients with inflammatory bowel disease: lessons from Denmark in a time of need.
In Denmark, remote monitoring and management of inflammatory bowel disease (IBD) started two decades ago with the web application Constant Care. The disease monitoring in Constant Care consists of simple disease activity questionnaires and home measurement of faecal calprotectin, a stool biomarker for inflammation. It has now been implemented in clinical practice at North Zealand University Hospital in Denmark. ⋯ The significant portion of IBD patients managed in private practice in Australia, and the infrastructure within private practice that is well suited to implementation of E-Health makes Australia a viable setting for an E-Health IBD management model like Denmark's Constant Care model. One pilot study is currently underway investigating the feasibility of rapid and remote IBD monitoring and E-Health in an Australian IBD population. The current COVID-19 pandemic has further illustrated the importance of telehealth as a means of maintaining health services to patients in geographic, or social, isolation.
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Internal medicine journal · Aug 2021
Increases in early discharge following acute coronary syndrome hospitalisations and associated clinical outcomes in New Zealand between 2006 and 2015: ANZACS-QI 43 study.
International guidelines recommend early discharge for uncomplicated acute coronary syndrome (ACS) patients within 3 days; however, there is a paucity of contemporary literature regarding the safety of this strategy. ⋯ There was a substantial increase in early discharge post-ACS over 10 years. These patients were associated with reduction in adverse clinical events up to 1 year and no increase in all-cause mortality. These findings from a comprehensive national register suggest that guideline recommendations on early discharge after uncomplicated ACS are safe and appropriate.
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Internal medicine journal · Aug 2021
Acute pulmonary embolism in patients presenting pulmonary deterioration after hospitalization for non-critical COVID-19.
Emerging evidence suggests an association between COVID-19 and acute pulmonary embolism (APE). ⋯ Among patients presenting pulmonary deterioration after hospitalisation for non-critical COVID-19, the prevalence of APE is high. Traditional diagnostic tools to identify high APE pre-test probability patients do not seem to be clinically useful. These results support the use of a high index of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.
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Internal medicine journal · Aug 2021
Australia and New Zealand Transplant and Cellular Therapies COVID-19 vaccination consensus position statement.
Australia and New Zealand have achieved excellent community control of COVID-19 infection. In light of the imminent COVID-19 vaccination roll out in both countries, representatives of all adult and paediatric allogeneic bone marrow transplant and cellular therapy (TCT) centres as well as representatives from autologous transplant only centres in Australia and New Zealand collaborated with infectious diseases specialists with expertise in TCT on this consensus position statement regarding COVID-19 vaccination in TCT patients in Australia and New Zealand. ⋯ Vaccination should not replace other public health measures in TCT patients given the effectiveness of COVID-19 vaccination in TCT patients is unknown. Furthermore, given the limited available data, prospective collection of safety and efficacy data of COVID-19 vaccination in this patient group is a priority.