Internal medicine journal
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Internal medicine journal · Sep 2018
Multicenter StudySuboptimal behaviour and knowledge regarding overnight glycaemia in adults with type 1 diabetes is common.
In people with type 1 diabetes (T1D), nocturnal hypoglycaemia (NH) can be slept through and can cause seizures, arrhythmias and death. Hypoglycaemia avoidance can induce hyperglycaemia and ketosis. Patient behaviour impacts clinical outcomes and may be changed by education. ⋯ Many adults with T1D have suboptimal knowledge and behaviour regarding overnight BG self-management. A survey, piloted herein, may facilitate the identification of patients who could benefit from further education.
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Internal medicine journal · Sep 2018
End-stage renal disease patients using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may reduce the risk of mortality: a Taiwanese Nationwide cohort study.
The association between the use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) and mortality in end-stage renal disease (ESRD) patients lacks sufficient evidence. ⋯ In this large-scale, population-based cohort study, ESRD patients using ACEI/ARB had a lower risk of CV death and all-cause mortality than non-users did.
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Internal medicine journal · Sep 2018
Long-term renal outcomes in multi-ethnic Southeast Asians with lupus nephritis: a retrospective cohort study.
Renal involvement is common among Asians with systemic lupus erythematosus and long-term renal outcomes have been described in homogeneous Caucasian and East Asian populations with lupus nephritis, but data are scarce for other ethnicities. ⋯ Multi-ethnic Southeast Asians with biopsy-proven lupus nephritis had high remission rates and low incidence of progressive CKD. Progressive CKD was associated with poorer baseline renal function, higher histological chronicity index, failure to achieve remission and occurrence of relapse.
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Internal medicine journal · Sep 2018
Multidisciplinary team meetings appear to be effective in inflammatory bowel disease management: an audit of process and outcomes.
Multidisciplinary team meetings (MDTM) have proven efficacy in cancer management. Whilst widely implemented in inflammatory bowel disease (IBD) care, their value is yet to be investigated. We reviewed the performance of MDTM for IBD patients. ⋯ The majority of MDTM encounters were successful from both a process and clinical outcome perspective. System opportunities to improve the process include ensuring that 100% of reports are available and addressing implementation delays. Patient factors that require addressing include improved engagement and understanding reasons for declining recommendations.
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Internal medicine journal · Sep 2018
Multicenter StudyAge-adjusted cut-off using the IL D-dimer HS assay to exclude pulmonary embolism in patients presenting to emergency.
The ADJUST-PE study showed that an age-adjusted D-dimer (AADD) (age years × 10 ng/mL if >50 years) combined with an unlikely pre-test probability (PTP) can increase the proportion of older patients in whom pulmonary embolism (PE) can be safely excluded, but the IL D-dimer HS assay was not assessed. To assess the ability of the IL D-dimer HS assay to exclude PE using the AADD. ⋯ The absolute increase in efficiency of an AADD compared to conventional cut-off using the IL D-dimer HS assay is modest (~10%) and requires prospective validation. Modifying our cut-off to 230 ng/mL and systematic implementation of a clinical algorithm, including D-dimer testing and PTP, is likely a more important first step.