Internal medicine journal
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Internal medicine journal · Feb 2023
CommentUsefulness and yield of routine electroencephalography: a retrospective study.
The electroencephalogram (EEG) is a common diagnostic tool used to investigate patients for various indications including seizure disorders. ⋯ Our findings suggest that careful selection of patients based on appropriate indications for EEG referral would likely improve the yield of an EEG. Depending on the indication, a normal EEG result can be of similar usefulness to an abnormal EEG demonstrating epileptiform abnormalities.
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Internal medicine journal · Feb 2023
Use of continuous subcutaneous insulin infusion versus multiple daily injections in emerging adults with type 1 diabetes is associated with better clinical engagement but not glycaemic control.
Limited studies have compared outcomes between emerging adults with type 1 diabetes mellitus (T1D) attending a diabetes transition support programme using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). ⋯ In our YAC cohort, glycaemic control in CSII and MDI users was similar but well below recommended international glycaemic targets (HbA1c level < 7.0%). Despite increased clinical engagement occurring in CSII users, glycaemic deterioration was observed over the 3 years.
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Globally, vaccination against COVID-19 has prevented countless infections, hospitalisations and death and represents the most successful intervention in combating the pandemic caused by SARS-CoV-2 infection. Utilisation of existing mRNA vaccine technology has allowed for rapid development of highly immunogenic and effective vaccines. ⋯ Although most cases are self-limited and respond to first-line treatment, refractory cases can occur, with a limited evidence base on which to guide management. Here, we present a brief review of COVID-19 mRNA vaccines and associated myopericarditis including risk factors, proposed mechanism, and treatment including management strategies for refractory disease.
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Internal medicine journal · Feb 2023
Idiopathic factor V inhibitor in a patient starting haemodialysis.
A 74-year-old Pacific Island man with end-stage renal failure planning to start haemodialysis presented with persistent bleeding after tunnelled dialysis catheter insertion. The laboratory findings revealed a prolonged activated partial thromboplastin time of 118 s, prothrombin ratio of 4.2, factor V activity of <2% and a factor V inhibitor of 40 Bethesda Units. No clear underlying aetiology was identified. The bleeding settled with conservative measures and the factor V inhibitor was successfully treated with oral cyclophosphamide for 6 weeks.
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Internal medicine journal · Feb 2023
When research becomes practice: the concept of the therapeutic misconception and challenges to consent in clinical trials.
Many factors influence patients' decisions to participate in clinical trials. For many, the primary motivation is the possibility that they might derive some benefit from participation. This is particularly true for patients with limited treatment options, such as patients with advanced cancer. ⋯ This is becoming increasingly problematic as clinical trial designs become more complex, as clinical trials become more embedded in routine clinical care, and as trials are increasingly used by patients and clinicians to access new diagnostic platforms and therapies. We outline some of these recent trends, focusing on the cancer clinical trials landscape as this provides a good case study of the phenomenon. We conclude by making preliminary suggestions that changes to the consent process, perhaps using 'dynamic consent' platforms, might help to mitigate the therapeutic misconception and note the need for further research to guide strategies for improving communication and decision-making.