Internal medicine journal
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Internal medicine journal · May 2022
Impact of electronic medical records and COVID-19 on adult Goals-of-Care document completion and revision in hospitalised general medicine patients.
Conversion from paper-based to electronic medical records (EMR) may affect the quality and timeliness of the completion of Goals-of-Care (GOC) documents during hospital admissions and this may have been further impacted by the COVID-19 pandemic. ⋯ EMR improved the timeliness and overall completion rates of GOC at the cost of a lower quality of documented discussion. COVID-19 reversed the negative trend in proper GOC completion but increased the number of early revisions.
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Internal medicine journal · May 2022
Chest pain and palpitations in postmenopausal women with mitral valve prolapse, is there a gastroesophageal origin?
Mitral valve prolapse (MVP) is a common disease in women, causing chest pain and palpitation due to structural and functional valve abnormality, and is sometimes associated with gastro-oesophageal reflux disease (GERD). This is a challenging clinical problem in clinical practice and requires targeted diagnostic assessment to identify the underlying causes of the symptoms, because treatment needs to be tailored, according to the causes themselves, to resolve the symptoms. ⋯ GERD is relatively common in women with MVP. Moreover, women with MVP are approximately three times more likely to be affected by GERD; the two conditions are correlated in a statistically high significant way. GERD assessment needs to be included into routine follow-up strategies in women with MVP to optimise medical therapy, improvinge symptom relief for better quality of life.
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Internal medicine journal · May 2022
The Diagnostic Value of clinical examination for identifying patients with large and small fibre neuropathy.
The diagnosis of polyneuropathy usually requires neurophysiological investigation, necessitating specialised testing and interpretation thereby increasing the time to final diagnosis. ⋯ The absence of ankle jerks performed moderately well in identifying patients likely to have large-fibre neuropathy and could potentially be used to help decide who should be sent for NCS. Gradient temperature testing was much more subjective and did not change the likelihood of abnormal TTT.
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Internal medicine journal · May 2022
Telling the difference and the telling differences between hospital in the home and outpatient parenteral antibiotic therapy.
Doctors, authors, funders and hospital managers should take care to distinguish the important differences between hospital in the home (HIH) and outpatient parenteral antimicrobial therapy (OPAT) services. HIH is an inpatient service delivered at home usually by (or on behalf of) hospitals, which aims to substitute for a traditional inpatient stay. It does so by delivering a wide range of hospital treatments to patients at home, or residential aged care, using hospital medical and nursing staff, delivery technologies and venous access, pharmacy, radiology and pathology, and a structured system of on call and governance. ⋯ OPAT places a greater onus of care, supervision and travel needs on the patient and family. Where HIH is not available, OPAT may remain an alternative for some patients. However, HIH seeks to redefine the delivery of inpatient care away from the location of care.