Internal medicine journal
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Internal medicine journal · Aug 2023
Scedosporium species and Lomentospora prolificans fungaemia is uniformly fatal in patients with haematological malignancy.
Scedosporium and Lomentospora species are environmental moulds that are virulent in immunocompromised hosts and rarely cause bloodstream infection (BSI). Patients with Scedosporium and Lomentospora species BSI were identified by the state public laboratory service in Queensland, Australia, over a 20-year period. ⋯ Seventeen (81%) patients died during their index admission, and all-cause mortality at 30, 90 and 365 days was 73%, 82% and 91% respectively. All 20 patients with haematological malignancy died within 365 days of follow-up with a median time to death of 9 days (interquartile range, 6-20 days) following diagnoses of BSI.
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Internal medicine journal · Aug 2023
Post-Traumatic stress disorder is associated with a higher rate of polypectomy independent of an increased frequency of colonoscopy in Australian Veterans - a retrospective review.
Post-traumatic stress disorder (PTSD) is associated with extensive physical comorbidities, including lower gastrointestinal symptoms. Diagnostic uncertainty and poor therapeutic responses may result in more frequent colonoscopies than clinically necessary. Polypectomy is standard practice when polyps are identified, and if PTSD is a risk factor for polyp formation, one would expect a higher rate of polyp detection and removal in veterans with PTSD than those without PTSD. ⋯ The presence of PTSD has a marked impact on colonoscopy rates in Australian veterans. The increased polypectomy rate independent of increased colonoscopy rate suggests that PTSD is a risk factor for colonic polyp formation.
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Internal medicine journal · Aug 2023
Discordant imaging-adrenal vein sampling in almost half of patients with primary aldosteronism and a unilateral adrenal adenoma.
Primary hyperaldosteronism (PHA) is an underdiagnosed cause of secondary hypertension, with an increased risk of cardiovascular and renal complications compared with those with essential hypertension alone. Distinguishing between unilateral and bilateral aldosterone secretion is important as management differs. Adrenal vein sampling (AVS) is the gold standard for determining lateralisation. Current international guidelines suggest AVS may be omitted in those aged <35 years with PHA and a unilateral adrenal adenoma on imaging. ⋯ AVS at WDHB is successful on first attempt in most patients. AVS is essential in the management of PHA for those deemed to be surgical candidates, regardless of age.
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The incidence of venous thromboembolism (VTE) for non-hospitalised patients with coronavirus disease-2019 infection has not been very widely studied. 13 019 persons with a positive SARS-CoV-2 nucleic acid amplification test were identified. In total, 447 (0.2%) VTEs were identified in the study population, 293 (66%) of these were pulmonary embolisms. A positive SARS-CoV-2 test did not increase the risk for VTE in the univariate analysis (odds ratio (OR): 1.0, 95% confidence interval (CI): 0.69-1.4) or multivariable analysis (OR: 1.36, 95% CI: 0.93-1.97).
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Internal medicine journal · Aug 2023
Key aspects of teaching that affect perceived preparedness of medical students for transition to work: insights from the COVID-19 pandemic.
The self-perceived preparedness of medical students to transition into practising junior doctors has implications for patient safety, graduate well-being and development of professional identity. ⋯ The current study highlights key aspects of clinical placements and formal teaching programs that contribute to perceptions of preparedness for transition to clinical practice. Relevant experiential learning in the clinical setting, opportunities for deliberate practice of necessary skills (in simulation and the clinical setting) and reflective opportunities from formal teaching programs contribute to perceived preparedness and are important elements to be included in the final phase of any medical program.