Internal medicine journal
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Internal medicine journal · Jul 2023
Direct percutaneous endoscopic gastrostomy for nutritional support in patients with aerodigestive tract cancers.
Conventional pull-through percutaneous endoscopic gastrostomy (PEG) risks infection and tumour implantation in head and neck cancers. Endoscopically inserted direct gastrostomy has lower rates of complications but is underutilised. ⋯ Direct PEG is safe and effective and should be considered for patients with aerodigestive tract cancer in need of nutritional support.
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Internal medicine journal · Jul 2023
Clinical Predictors of Pulmonary Embolism for Inpatients: Are Computed Tomography Pulmonary Angiograms being requested appropriately?
The heterogeneity of inpatient pulmonary embolism (PE) presentations may lead to computed tomography pulmonary angiograms (CTPA) being over-requested. Current clinical predictors for PE, including Wells criteria and Pulmonary Embolism Rule-out Criteria (PERC), have predominantly focussed on outpatient and emergency department populations. ⋯ Inpatient CTPA appear to be over-requested and can potentially be rationalised based on a combination of clinical predictors and Wells criteria and/or PERC rule. Further prospective studies are needed to develop accurate clinical decision tools targeted towards inpatients.
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Internal medicine journal · Jul 2023
Is there a 'weekend effect' on mortality among hospitalized patients in an internal medicine ward? a retrospective study.
Previous studies demonstrated a 'weekend effect' and a 'night effect' of increased mortality among patients admitted during weekends or night shifts, presumably due to understaffing. ⋯ Our study did not find a pattern of 'weekend effect' or 'night effect' on all-cause mortality among hospitalised patients in internal medicine wards. Our findings suggest that perhaps specifically death from sepsis, and not all-cause mortality, can be used as a surrogate for the measurement of understaffing or quality of care in the internal ward.
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Internal medicine journal · Jul 2023
Case ReportsEpiploic appendagitis: a commonly undiagnosed non-surgical acute abdominal emergency.
Epiploic appendagitis is a rare cause of acute abdomen and is diagnostically challenging as it mimics common causes of acute abdomen. However, advancements in computerised tomography/Ultrasound imaging have improved the frequency and confidence of diagnosing epiploic appendagitis, preventing unnecessary surgeries. We present a case of an acute abdomen who had to undergo laparoscopy before being diagnosed with epiploic appendagitis, underscoring the difficulty in diagnosis.