Internal medicine journal
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Internal medicine journal · Apr 2022
Prior oral proton-pump inhibitor use is associated with reduced severity of aspirin-related upper gastrointestinal bleeding in older people.
Low-dose aspirin is commonly used for primary or secondary prophylaxis against cardiovascular disease in older people. However, the potential risk of upper gastrointestinal (UGI) ulceration and bleeding associated with low-dose aspirin use is often not appreciated by prescribers and older consumers. Among 133 serial patients with UGI bleeding, aspirin-users aged ≥70 years had a ninefold increased likelihood of overt UGI bleeding compared with non-users, reducing by 90% in regular proton-pump inhibitor users (adjusted odds ratio 0.10). We recommend risk-versus-benefit discussions when recommending aspirin to older people.
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Internal medicine journal · Apr 2022
Factors associated with the development of acute general surgical pathology in medical in-patients.
Medical inpatients can develop acute general surgical conditions. However, this is rare. The presence of multiple acute pathologies delays diagnosis and these patients have poorer prognoses. ⋯ The development of acute surgical pathology in medical inpatients is rare but associated with longer inpatient stays and higher mortality. We have identified risk-factors associated with the development of surgical pathology, which can be used to identify patients at risk of surgical pathology.
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Blackwater fever is a haemolytic syndrome associated with malaria that coincided with the use of quinine chemoprophylaxis. Once quinine was no longer chronically used to prevent malaria, blackwater fever largely disappeared and its aetiology remains poorly understood. Blackwater fever is representative of classical tropical medicine and its history was reflected in Australia's colonial development of Papua New Guinea particularly as reported in the Australian medical literature.
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Internal medicine journal · Apr 2022
Clinical relevance of Shear Wave Elastography compared with Transient Elastography and other markers of liver fibrosis - a cross-sectional study.
Early and accurate non-invasive diagnosis of liver fibrosis is important for reducing the burden of cirrhosis and related complications. ⋯ Across various liver diseases, SWE is at least comparable with TE and other non-invasive tests of liver fibrosis. SWE is accurate for predicting liver-related portal hypertension.
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Internal medicine journal · Apr 2022
Patient-initiated follow up as a means of reducing pressures in secondary care.
Outpatient services, largely dedicated to routine follow up, have been under increasing pressure in recent years. The growing and ageing UK population has been a large driver of this pressure, requiring a significant increase in annual outpatient appointments. ⋯ One such model, patient-initiated follow up (PIFU) has shown significant promise, empowering patients while simultaneously reducing appointment numbers and increasing attendance rates. However, for PIFU to be implemented nationwide several key considerations must be made to ensure patients are appropriately engaged, and supported, in directing their own care.