Internal medicine journal
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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
Observational StudyManagement of Single Subsegmental Pulmonary Embolism - a Prospective Observational Study at North Shore and Waitakere Hospitals, Auckland.
Single subsegmental pulmonary embolism is increasingly diagnosed but the benefit to anticoagulate in the absence of concurrent deep vein thrombosis is not consistently established. ⋯ Withholding anticoagulation was a feasible management option for this cohort of patients with single subsegmental pulmonary embolisms with an absence of deep vein thrombosis. The utility of a second lower limb ultrasound is questionable and would warrant further assessment in a prospective study.
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Internal medicine journal · Feb 2023
Potentially Preventable Hospitalisations in rural Community-Dwelling Patients.
Potentially preventable hospitalisations (PPH) are a common occurrence. Knowing the factors associated with PPH may allow high-risk patients to be identified and healthcare resources to be better allocated, and these factors may differ between urban and rural locations. ⋯ This study found that being single and having a higher comorbidity burden were the strongest independent risk factors for PPH in a rural population. Demographic and socioeconomic factors appeared to be as, if not more, important than medical factors and warrant attention when considering the design of programmes to reduce PPH risk in rural communities.
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Internal medicine journal · Feb 2023
Diagnostic reasoning is associated with lower physician satisfaction with patient communication.
Prior research suggests that the quality of communication between doctors and patients influences the quality of medical care and adherence to treatment regimens, but little is known about factors that contribute to successful interactions between doctors and patients. ⋯ We propose two possible accounts for this finding regarding diagnostics: (i) the cognitive demands of diagnosis disrupt communication; and/or (ii) diagnoses are interpreted by patients as opinions with which they are sometimes motivated to disagree. Further research is needed to replicate these findings and establish the underlying mechanism.
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Internal medicine journal · Feb 2023
A novel allocation strategy for the difficult-to-allocate donor: audit of deceased donor kidneys utilised for preemptive recipients within Western Australia.
Kidney donor allocation can occasionally be difficult in Australia given a small population spread over vast distances. Therefore, between 2017 and 2019 our service allowed transplantation from deceased donors into local (same-state) preemptive recipients, only if no well-matched dialysis-dependent transplant waitlist recipient was available. Transplantation using this novel allocation pathway was associated with good clinical and immunological outcomes.