Internal medicine journal
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Internal medicine journal · Feb 2022
Oral amoxicillin challenge for low risk penicillin allergic patients.
Penicillin allergy is the most reported adverse drug reaction (ADR). Being labelled with 'penicillin allergy' is associated with suboptimal antibiotic therapy and poor patient outcomes. Most labelled with 'penicillin allergy' are at low risk of harm from penicillins and guidelines recommend testing for accurate diagnosis. Although skin testing is recommended to exclude immunoglobulin E (IgE)-mediated reactions, there is limited access in most settings. ⋯ A careful ADR history enables de-labelling of many patients. An oral amoxicillin challenge without prior skin testing is safe and feasible for low-risk penicillin allergic patients while in hospital.
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Internal medicine journal · Feb 2022
ReviewThe association between socioeconomic status and joint replacement of the hip and knee: A population-based cohort study of older adults in Tasmania.
A socioeconomic gradient exists in the utilisation of total hip replacements (THR) and total knee replacements (TKR) for osteoarthritis. However, the relations between socioeconomic status (SES) and time to THR or TKR is unknown. ⋯ The present study suggests that time to joint replacement was determined according to the symptoms/need of the participants rather than their SES.
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Internal medicine journal · Feb 2022
Optimal management of blood glucose, blood pressure and atrial fibrillation to reduce the risk of heart failure with preserved ejection fraction.
Type 2 diabetes mellitus (T2DM), hypertension and atrial fibrillation (AF) are risk factors for heart failure with preserved ejection fraction (HFpEF). ⋯ This study demonstrated that, besides intensive BP control, conservative BG control and rhythm control of AF were crucial factors to delay the progression of HFpEF among patients with T2DM, hypertension and AF.
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Social distancing was the predominant strategy used to mitigate the spread of Coronavirus disease 2019 (COVID-19) at the start of the COVID-19 pandemic. ⋯ The incidences of streptococcal bacteraemia and bacteraemia of organisms transmitted through respiratory secretions were lower when there were social distancing restrictions. Adopting measures of social distancing may decrease the morbidity from bacteraemia caused by oropharynx and respiratory bacteria.
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Internal medicine journal · Feb 2022
Death determination, organ donation and the importance of the Dead Donor Rule following withdrawal of life-sustaining treatment: A survey of community opinions.
Background: Organ donation (OD) following circulatory determination of death (DCDD) is an increasing source of transplant organs but little is known about community opinions on treatment withdrawal, determination of death and acceptance of OD in DCDD. ⋯ We found high levels of support for treatment withdrawal in severe brain injury and when requested by a quadriplegic patient. While there was variable agreement with the timing of death determination and with OD under anaesthesia, support for OD was high in both scenarios. For many people death determination prior to OD may not be of paramount importance.