Internal medicine journal
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Internal medicine journal · Mar 2021
Mental health illness in chronic respiratory disease is associated with worse respiratory health and low engagement with non-pharmacological psychological interventions.
Patients with chronic respiratory disease commonly experience comorbid mental illness. This study aimed to explore associations between mental illness and respiratory health, as well as determine access to and uptake of mental health treatment. ⋯ Active treatment with psychotropic drugs was common; however, acceptance of non-pharmacological interventions was poor. Further research is required to understand co-existing mental illness management in chronic respiratory disease.
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Internal medicine journal · Mar 2021
ReviewFrailty in patients with aortic stenosis awaiting intervention.
Aortic stenosis (AS) is a common valvular disease in older age. Definitive interventions include surgical aortic valve replacement or transcatheter aortic valve implantation (TAVI). In high-risk patients, frailty is observed in up to 50% awaiting TAVI. ⋯ Identifying patients who are frail at baseline provides an opportunity to modify dynamic aspects of frailty prior to, and after definitive intervention for AS. A multidisciplinary approach including comprehensive geriatric pre-operative assessment will likely become standard of care to identify and optimise frail patients awaiting TAVI. In this review, we discuss the definition and measurement of frailty in patients with AS, evaluate recent data on risk prediction associated with frailty, and outline approaches to optimisation of dynamic components of frailty to improve outcomes after AS intervention.
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Internal medicine journal · Mar 2021
Managing inpatient hyperglycaemia and initiating sodium-glucose cotransporter 2 inhibitor therapy in the setting of diabetes and acute coronary syndrome.
We previously showed that implementing algorithms for managing diabetes in acute coronary syndrome was associated with improved inpatient glycaemic control and increased sodium-glucose cotransporter 2 (SGLT2) inhibitor prescriptions. The present study performed 1 year later found that inpatient hyperglycaemia had relapsed to pre-intervention rates, although SGLT2 inhibitor prescriptions remained increased. We discuss the challenges of improving inpatient glycaemic control.