Internal medicine journal
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Internal medicine journal · Mar 2022
Outcomes and anticoagulation use for elderly patients that present with an Acute Hip Fracture: multi-centre, retrospective analysis.
Hip fractures are a common problem and corrective surgery is recommended within 24 h. However, most peri-operative direct oral anticoagulant (DOAC) guidelines suggest a washout period of 48 h before major surgery. There are limited data on utility of drug levels. ⋯ People on DOAC treatment had a significant delay before corrective surgery compared with those on warfarin. The frequent finding of early DOAC levels <50 ng/mL suggests this delay may be unnecessary in a significant proportion of patients.
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Internal medicine journal · Mar 2022
Does distance to hospital affect emergency department presentations and hospital length of stay among COPD patients?
The primary goal of chronic obstructive pulmonary disease (COPD) management is to optimise a patient's functional status and quality of life. By encouraging effective patient self-management within primary healthcare, unplanned and potentially avoidable COPD admissions to the emergency department (ED) can be avoided. ⋯ Several distance-specific studies have concluded that lower utilisation of hospital care is associated with distance to hospital.
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Internal medicine journal · Mar 2022
Specialist haematology consultation services in regional Western Australia: Evaluating a model combining telehealth and onsite clinics.
Models of care that increase specialist medical services to regional or remote patients are being explored worldwide. Many of the models include telehealth (also called telemedicine or video-conferencing consultations) alone or in combination with traditional face-to-face clinic visits. ⋯ The present study demonstrated that the model was effective in providing outpatient services and cost effective to the health service, while being experienced as a satisfactory model by patients.
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Internal medicine journal · Mar 2022
ReviewA Practical Approach to Vertigo: A Synthesis of the Emerging Evidence.
Vestibular presentations are common in both the acute and recurrent setting, burdening emergency departments and community clinics alike. Commonly, an unease among the emergency or general physician is felt, and historically focus has been on gaining knowledge of each potential disease rather than honing the diagnostic process. ⋯ Its simplicity is aimed to minimise uncertainty and highlight clear scenarios when to refer. Together with descriptions of the clinically relevant pathophysiology, the reader should approach the vertiginous patient with a new clarity.
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Internal medicine journal · Mar 2022
ReviewCytomegalovirus in inflammatory bowel disease: a clinical approach.
Cytomegalovirus (CMV) infection can be a challenging clinical problem in patients with inflammatory bowel disease (IBD), particularly ulcerative colitis. Clinical presentation is difficult to distinguish from an underlying disease flare. Several diagnostic modalities are now available and when combined can aid clinicians in the identification of patients who are most likely to benefit from antiviral therapy. The aim of this article is to review the available literature and outline a practical approach to the diagnosis and management of CMV in patients with IBD.