Internal medicine journal
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Internal medicine journal · Sep 2020
Does the evidence justify routine transfer of residents of aged care facilities for CT scan after minor head trauma?
In 2014, the South Australian coroner recommended that residents of residential aged care facilities (RACF) who had sustained a head injury should be transported to emergency departments (ED) for assessment and a head CT scan, with the view to preventing mortality. The evidence base for the recommendation is unclear. ⋯ The rate of emergent intervention for ICH in patients from RACF who sustained a minor head trauma but had their normal cognitive function was <1%. None underwent neurosurgical intervention. The low rate of intervention seriously challenges the appropriateness of routine transfer and CT for this patient group.
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The corrected QT (QTc) interval is a strong predictor of ischaemic heart disease and cardiovascular mortality. It may trigger lethal arrhythmias and sudden death. Risk factors include electrolyte disorders, medications, prior cardiovascular disease and genetic predisposition. We previously demonstrated that QTc intervals are prolonged in patients hospitalised with pneumonia, regardless which antibiotics were given. It is unclear whether QTc prolongation is associated with pneumonia itself or whether it occurs with other infections. ⋯ We found no association between hospitalisation due to infection and prolongation of the QTc interval.
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Internal medicine journal · Sep 2020
Exercise testing and exercise training within cystic fibrosis centres across Australia and New Zealand: what is considered important and what is current practice?
Within Australian and New Zealand cystic fibrosis (CF) centres, exercise testing and exercise training are common components of clinical care, but current practices regarding these components have not been reported. ⋯ This survey captures the current practices of exercise testing and training in CF centres across Australia and New Zealand.
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Internal medicine journal · Sep 2020
Case ReportsSwitching from long-acting beta-agonist and inhaled corticosteroid to long-acting beta-agonist and long-acting muscarinic antagonist for chronic obstructive pulmonary disease: a case report of inhaled corticosteroid withdrawal.
Chronic obstructive pulmonary disease (COPD) is a medical condition characterised by persistent respiratory symptoms and airflow limitation. For the long-term management of COPD, inhaled therapies are the main approach to maintenance treatment. In order to improve treatment efficacy and tolerability for patients with COPD, recent clinical trials have focused on the withdrawal of inhaled corticosteroids (ICSs), the use of which has been associated with adverse outcomes, including pneumonia. ⋯ He was subsequently maintained in a stable condition, and was able to live and travel independently. This case report of successful ICS withdrawal suggests that, for moderate-to-severe COPD, if it is assessed individually, dual therapy of LABA and long-acting muscarinic antagonist can be highly effective and well-tolerated. Treatment compliance and lifestyle modifications have been shown to be critical in optimising treatment outcomes.
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Internal medicine journal · Sep 2020
Ambiguous medical abbreviation study: challenges and opportunities.
Healthcare workers often abbreviate for convenience, but ambiguous abbreviations may cause miscommunication, which jeopardises patient care. Robust large-scale research to quantify abbreviation frequency and ambiguity in medical documents is lacking. ⋯ Close to one-third of abbreviations used in general medical discharge summaries were ambiguous. Electronic auto-expansion of ambiguous abbreviations is likely to reduce miscommunication and improve patient safety.