Internal medicine journal
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Internal medicine journal · Nov 2019
Dysregulation of calcium metabolism in type 1 myotonic dystrophy.
Patients with type 1 myotonic dystrophy (DM1) have a higher incidence of hypercalcaemia compared with the general population. The nature and effects of dysregulated calcium metabolism underpinning this phenomenon have not been fully characterised. ⋯ One in three patients with DM1 was hypercalcaemic with unsuppressed PTH. Their clinical features and biochemical pictures resemble those of familial hypocalciuric hypercalcaemia (FHH) and raises the possibility that impaired activity of calcium-sensing receptors, due to abnormal splicing of the calcium-sensing receptor messenger RNA in DM1, causes a FHH-like syndrome ('pseudo-FHH of DM1').
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Internal medicine journal · Nov 2019
Time to acute stroke treatment in-hours was more than halved after the introduction of the Helsinki Model at Westmead Hospital.
Management of acute ischaemic stroke is time critical. Reducing time to treatment with thrombolysis is strongly associated with improved outcomes in properly selected patients. However, there are barriers to ensuring timely treatment in the hospital setting. ⋯ Time to treatment in acute stroke was dramatically improved with a simple intervention. This was achieved without a large stroke team or additional funding, making it highly accessible to other health services also seeking to improve their stroke service.
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Internal medicine journal · Nov 2019
Observational StudyEnd-of-life care in an Australian acute hospital: a retrospective observational study.
There is a gap in knowledge about the kind and quality of care experienced by hospital patients at the end of their lives. ⋯ There were differences in managing the dying process between all disciplines. A possible solution to these discrepancies would be to create an integrated palliative care approach across the hospital. Improving and reducing interdisciplinary practice variations will allow more patients to have a high-quality and safe death in acute hospitals.
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Internal medicine journal · Nov 2019
Why we should stop performing vertebroplasties for osteoporotic spinal fractures.
While vertebroplasty enjoys continued use in some settings, there is now high-moderate quality evidence based on systematic review that includes five placebo-controlled trials that it provides no benefits over placebo and these results do not differ according to pain duration (≤6 vs >6 weeks). A clinically important increased risk of incident symptomatic vertebral fractures or other serious adverse events cannot be excluded due to small event numbers. ⋯ At the very least, clinicians should fully inform their patients about the evidence including the likelihood of improving without vertebroplasty and the potential harms, so that patients can make evidence-informed decisions about their treatment. They should also warn patients about the pitfalls of relying on information sourced from the internet or from 'awareness raising' campaigns.
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Internal medicine journal · Nov 2019
Long-term oxygen therapy-related adverse outcomes resulting in hospitalisation: 3-year experience of an Australian metropolitan health service.
The aim of this study was to evaluate the incidence of long-term oxygen therapy (LTOT)-related adverse outcomes in our health service. LTOT patients retrospectively recruited had their medical records reviewed for the period of 1 January 2014 to 30 June 2018. Burns, physical injuries, any falls attributable to LTOT requiring admission were the outcomes measured. Of 291 patients, four patients required admission due to LTOT-related adverse events where three admissions were related to falls secondary to tripping over oxygen tubing.