Internal medicine journal
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Internal medicine journal · Oct 2021
How do hospitals help patients prepare for and participate in outpatient clinics?
Patients attending general medicine outpatient clinics (GM OPC) at hospital face multiple healthcare demands in an environment that has evolved with the clinician at its centre. The ideas, knowledge and understanding that patients bring to their clinic appointments are not well studied in the New Zealand setting. ⋯ Limited information and support is provided to patients attending follow-up GM OPC and is not tailored to individuals' health literacy. This practice assumes patients have comparable health literacy to clinicians, which may have downstream impacts on the usefulness of the clinic experience. The information that health users bring to clinic may be improved by increasing pre-clinic user engagement and deploying patient-centred tools within the healthcare environment.
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Internal medicine journal · Oct 2021
Prediction of cardiovascular events in patients with chronic myeloid leukaemia using baseline risk factors and coronary artery calcium scoring.
A standardised method for cardiovascular risk stratification in chronic myeloid leukaemia patients treated with tyrosine kinase inhibitors is lacking. We report an algorithm for risk stratification applicable to all patients commencing tyrosine kinase inhibitor therapy based on age, prior cardiovascular disease and Framingham Risk Score, incorporating coronary artery calcium scoring in patients at intermediate Framingham Risk Score risk. Of 88 patients retrospectively studied, major adverse cardiovascular event rates in our study-defined low-, intermediate- and high-risk categories were 0%, 10% and 19% respectively. Of nine patients down-classified from intermediate to low risk on the basis of coronary artery calcium scoring, none went on to experience a major adverse cardiovascular event.
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Internal medicine journal · Oct 2021
Anticoagulation prescribing practice following ischaemic strokes in the setting of non-valvular atrial fibrillation.
It is well established that anticoagulation following an ischaemic stroke in the setting of non-valvular atrial fibrillation is an effective means of secondary prevention. However, there is a lack of a solid evidence base to guide both the agent choice and the optimal timing in which to initiate anticoagulation therapy. ⋯ We found apixaban was by far the anticoagulation of choice for non-valvular atrial fibrillation. The median time to anticoagulation initiation was Day 1 post transient ischaemic attack, Day 2 post small infarcts, Day 4 post moderate infarcts and Day 5 post large infarcts.
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Internal medicine journal · Oct 2021
Subcutaneous ertapenem delivered by an Australian outpatient parenteral antimicrobial therapy service: a retrospective comparative efficacy study.
Subcutaneous (SC) administration of ertapenem in outpatient parenteral antimicrobial therapy (OPAT) services may be a practical alternative to intravenous delivery for complicated infections. The clinical features and outcomes according to route of administration were compared from a large Australian OPAT service. Chronic renal impairment was more common in the SC group, reflecting an opportunity for route of administration as a vein preservation strategy. Adverse events were uncommon and successful outcomes were not different between the groups.
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Internal medicine journal · Oct 2021
Ten-year trends in prescribing of antiarrhythmic drugs in Australian primary care patients with atrial fibrillation.
Despite changes in antiarrhythmic drug (AAD) choice in patients with atrial fibrillation (AF), trends in AAD prescribing remain not investigated. We aimed to examine these changes using a nationwide Australian general practice data from 2009 to 2018. Over the 10 years, AAD prescribing in patients with AF decreased, which was mainly due to a reduction in the use of amiodarone, sotalol and digoxin. In contrast, the use of beta-blockers and flecainide increased.