Internal medicine journal
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Internal medicine journal · Apr 2023
Immunisation used for offensive and defensive purposes during the Second World War.
The best defence against natural or intentional biological agents during armed conflict is usually immunisation, as with typhoid fever, but exceptional circumstances are informative. A large iatrogenic epidemic of hepatitis B occurred in 1942 due to contaminated lots of yellow fever (YF) vaccine used in the US military, even though there was no natural risk of infection. YF vaccine was intended to protect against Japanese Army's use of YF as a biowarfare agent, which did not eventuate. ⋯ German Army use of the Weil-Felix reaction to eliminate civilians likely to be typhus infected was subverted by Polish medical officers. They immunised civilians with locally produced Proteus antigens to create false-positive Weil-Felix reactions in order to exempt men from forced labour schemes. Immunisation against biowarfare agents has a mixed record, indicating that vaccines rarely cover well for intelligence gaps.
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Internal medicine journal · Apr 2023
Comment ReviewA scoping review of patient-led teaching of health professions students.
Patients with chronic health conditions may become experts in their own conditions. Thus, utilising patients as teachers, with autonomy over taught content, may better prepare students to deliver patient-centred care. ⋯ Patient teacher programmes range from single, short 1- to 2-h tutorials to longitudinal community-based programmes. These programmes are mutually beneficial for students, improving awareness of all patient-centred domains, and patients feel empowered by their roles in education.
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Internal medicine journal · Apr 2023
Low-dose thioguanine guided by therapeutic drug monitoring is a safe and effective alternative in inflammatory bowel disease patients intolerant to conventional thiopurines.
Thioguanine is an alternative thiopurine for inflammatory bowel disease (IBD) patients. ⋯ Thioguanine was tolerated well in 63% of patients. A clinical response was seen in 62% of patients, and maintenance of remission was high at 76%. No cases of early NRH were seen. Longer-term follow up is required to ensure safety and to assess durability of response.
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Internal medicine journal · Apr 2023
Attitudes, practices, and experiences of medical specialists towards email communication with their patients.
The medical profession has been slow in embracing email as a means of improving communication with patients. ⋯ There is a want and need for comprehensive and accessible professional guidance on email use with patients. Our results indicate opportunities to inform good clinical practice in respect of doctor-patient relationships, clinical workloads and risk management. There is also a need for formal guidelines on emailing with patients. The COVID-19 pandemic has heightened the need for such guidelines.
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Internal medicine journal · Apr 2023
Benefit and harm of anticoagulation in the prevention of thromboembolic stroke for non- valvular atrial fibrillation in haemodialysis patients - a Top End of Northern Australia study.
Warfarin for the prevention of non-valvular atrial fibrillation (AF)-related thromboembolic stroke in patients on maintenance haemodialysis is controversial. Despite the exclusion of haemodialysis patients in randomised control trials, the American Heart Association/American College of Cardiology has recommended warfarin in high-risk AF patients. ⋯ This retrospective study of prevalent haemodialysis patients with co-existing history of non-valvular AF failed to demonstrate sufficient evidence for the routine use of warfarin for prophylaxis of thromboembolic stroke.