Internal medicine journal
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Internal medicine journal · Mar 2010
Comparative StudyPilot study of high-sensitivity troponin T testing to facilitate safe early disposition decisions in patients presenting to the emergency department with chest pain.
Many patients present to emergency departments with chest pain, but little is known about this population and the safest, most efficient testing strategies. We assessed clinical risk stratification of all patients with chest pain and, on a subset, utility of high-sensitivity troponin at 4 and 6 h after pain onset in aiding disposition decisions. ⋯ These preliminary data suggest that high-sensitivity troponin 6 h after chest pain onset may be diagnostically useful. Marked differences in outpatient testing attendance suggest bookings should be made before discharge.
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Internal medicine journal · Mar 2010
ReviewUn-promoted issues in inflammatory bowel disease: opportunities to optimize care.
Inflammatory bowel diseases (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gut, which lead to significant morbidity and impaired quality of life (QoL) in sufferers, without generally affecting mortality. Despite CD and UC being chronic, life-long illnesses, most medical management is directed at acute flares of disease. ⋯ This leads to less attention on relatively 'low-technology' issues including: (i) the psychosocial burden of chronic disease, QoL and specific psychological comorbidities; (ii) comorbidity with functional gastrointestinal disorders (FGIDs); (iii) maintenance therapy, monitoring and compliance; (iv) smoking (with regard to CD); (v) sexuality, fertility, family planning and pregnancy; and (vi) iron deficiency and anaemia. We propose these to be the 'Un-promoted Issues' in IBD and review the importance and treatment of each of these in the current management of IBD.
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Obstructive sleep apnoea (OSA) is a common disorder characterized by the repetitive complete or partial collapse of the upper airway during sleep. It results in intermittent hypoxaemia and hypercapnia, cortical arousals and surges of sympathetic activity. The occurrence of OSA has also been linked to serious long-term adverse health consequences; such as hypertension, metabolic dysfunction, cardiovascular disease, neurocognitive deficits and motor vehicle accidents. There have been several advances in the field of particular clinical importance: (i) the development of portable monitoring as part of a simplified clinical algorithm for the diagnosis of OSA in selected patients; (ii) growing awareness of the cardio-metabolic health consequences of OSA and (iii) emerging evidence to support a range of non-continuous positive airway pressure (CPAP) treatment modalities, such as oral appliances.
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Internal medicine journal · Feb 2010
Multicenter Study Comparative StudyPatients with acute myocardial infarction using ambulance or private transport to reach definitive care: which mode is quicker?
One of the main reasons cited by patients with acute myocardial infarction (AMI) for not using an ambulance was quickness of private transport. ⋯ Although private transportation results in a faster trip to the hospital, quicker definitive care is obtained with the use of ambulance.