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
ReviewMachine Learning in the Prediction of Medical Inpatient Length of Stay.
Length of stay (LOS) estimates are important for patients, doctors and hospital administrators. However, making accurate estimates of LOS can be difficult for medical patients. This review was conducted with the aim of identifying and assessing previous studies on the application of machine learning to the prediction of total hospital inpatient LOS for medical patients. ⋯ The variable performance reported by the studies identified in this review supports the need for further research of the utility of machine learning in the prediction of total inpatient LOS in medical patients. Future studies should follow and report a more standardised methodology to better assess performance and to allow replication and validation. In particular, prospective validation studies and studies assessing the clinical impact of such machine learning models would be beneficial.
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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
Prospective Study of Policies and Use of Therapies for COVID-19 Amongst Australian Health Services during 2020.
The COVID-19 pandemic has generated significant debate about how emerging infections can be treated in the absence of evidence-based therapies to combat disease. In particular, the use of off-label therapies outside of a clinical trial setting has been controversial. ⋯ Our results reflect the reactive nature of prescribing of therapies for COVID-19 and highlight the importance of evidence-based guidelines to assist prescribers.
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Internal medicine journal · Feb 2022
Evidence-practice gaps in P2Y12 inhibitor use after hospitalisation for acute myocardial infarction: findings from a new population-level data linkage in Australia.
P2Y12 inhibitor therapy is recommended for 12 months in patients hospitalised for acute myocardial infarction (AMI) unless the bleeding risk is high. ⋯ Post-hospitalisation use of P2Y12 inhibitor therapy in AMI patients is low and varies substantially by hospital of discharge. Our findings suggest strategies addressing both health system (hospital and physician) and patient factors are needed to close this evidence-practice gap.