Internal medicine journal
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Internal medicine journal · Nov 2023
Long term outcomes of corticosteroid graft versus host disease prophylaxis in peripheral blood allogeneic hematopoietic stem cell transplant: A comparative cohort analysis.
Corticosteroids (CSs) have previously been incorporated into graft versus host disease (GVHD) prophylaxis regimens for bone marrow (BM) and haemopoietic stem cell transplant (HSCT). ⋯ There does not appear to be a role for adding CS to standard GVHD prophylaxis regimens in PB-HSCT.
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Internal medicine journal · Nov 2023
Serum ammonia does not guide management and is over utilised in patients with cirrhosis in hospital settings.
Hepatic encephalopathy is a confusional state associated with cirrhosis. Serum ammonia levels are neither sensitive nor specific for the diagnosis. ⋯ We affirm the poor utility of serum ammonia levels for guiding management of hepatic encephalopathy within the Australian context. ED and general medical units account for the majority of test ordering within the hospital. Understanding where ordering occurs provides a target for targeted education.
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Internal medicine journal · Nov 2023
Improving palliative and supportive care in advanced cirrhosis: the HepatoCare model of integrated collaborative care.
Patients with advanced cirrhosis experience an unpredictable disease trajectory but are infrequently referred to palliative care (PC) services and rarely undertake advance care planning (ACP). ⋯ HepatoCare is a novel multidisciplinary model of care that integrates effective PC and specialist hepatology management to improve outcomes in advanced cirrhosis.
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Internal medicine journal · Nov 2023
Pneumococcal Bacteraemia in Adults over a 10-year period (2011 - 2020): A Clinical and Serotype Analysis.
Streptococcus pneumoniae (pneumococcus) is a human nasopharyngeal tract coloniser responsible for invasive pneumococcal disease, which is largely vaccine preventable. Vaccination is recommended from birth for all, and through adulthood for those with risk conditions. ⋯ Most patients with pneumococcal bacteraemia had age- or comorbidity-related risk factors but were not vaccinated. Two-thirds of cases occurred in people aged <70 years. 13vPCV and 23vPPV covered 41.7% and 69.0% of bacteraemic isolates.
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Internal medicine journal · Nov 2023
A Survey of Hospital Practitioners: Common Understanding of CPR Definition and Outcomes.
Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out-of-hospital cardiac arrest, CPR is now frequently used for in-hospital cardiac arrest (IHCA) with different causes and outcomes. ⋯ The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision-making around patient deterioration. This may involve reframing current in-hospital algorithms and uncoupling CPR from wider resuscitative measures.