Internal medicine journal
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Internal medicine journal · Feb 2023
Diabetes and Hyperglycaemia amongst Hospitalised Patients with COVID-19 in Western Sydney: A Retrospective Cohort Study.
Diabetes has been recognised as a major risk factor for COVID-19 mortality and hospital complications in earlier studies. ⋯ There is a high prevalence of diabetes among patients hospitalised with COVID-19, with worse outcomes. In contrast to previous studies, the association of diabetes with mortality was not significant when adjusted for other variables. This is possibly related to the benefits of vaccination and current medical and ICU interventions.
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Internal medicine journal · Feb 2023
CommentImpact of travel distance on outcomes for clinical trial patients - The Kinghorn Cancer Centre (TKCC) Experience.
Geographic isolation and travel distance to specialist care is a known social determinant of health and contributes to poorer oncology survival outcomes. ⋯ All patients should be considered for clinical trial referral based on clinical parameters and preference, regardless of geographic proximity. In the meantime, improving access to clinical trials for rural and regional patients continues to be a priority.
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Internal medicine journal · Feb 2023
Observational StudyManagement of Single Subsegmental Pulmonary Embolism - a Prospective Observational Study at North Shore and Waitakere Hospitals, Auckland.
Single subsegmental pulmonary embolism is increasingly diagnosed but the benefit to anticoagulate in the absence of concurrent deep vein thrombosis is not consistently established. ⋯ Withholding anticoagulation was a feasible management option for this cohort of patients with single subsegmental pulmonary embolisms with an absence of deep vein thrombosis. The utility of a second lower limb ultrasound is questionable and would warrant further assessment in a prospective study.
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Internal medicine journal · Feb 2023
Idiopathic factor V inhibitor in a patient starting haemodialysis.
A 74-year-old Pacific Island man with end-stage renal failure planning to start haemodialysis presented with persistent bleeding after tunnelled dialysis catheter insertion. The laboratory findings revealed a prolonged activated partial thromboplastin time of 118 s, prothrombin ratio of 4.2, factor V activity of <2% and a factor V inhibitor of 40 Bethesda Units. No clear underlying aetiology was identified. The bleeding settled with conservative measures and the factor V inhibitor was successfully treated with oral cyclophosphamide for 6 weeks.
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Internal medicine journal · Feb 2023
When research becomes practice: the concept of the therapeutic misconception and challenges to consent in clinical trials.
Many factors influence patients' decisions to participate in clinical trials. For many, the primary motivation is the possibility that they might derive some benefit from participation. This is particularly true for patients with limited treatment options, such as patients with advanced cancer. ⋯ This is becoming increasingly problematic as clinical trial designs become more complex, as clinical trials become more embedded in routine clinical care, and as trials are increasingly used by patients and clinicians to access new diagnostic platforms and therapies. We outline some of these recent trends, focusing on the cancer clinical trials landscape as this provides a good case study of the phenomenon. We conclude by making preliminary suggestions that changes to the consent process, perhaps using 'dynamic consent' platforms, might help to mitigate the therapeutic misconception and note the need for further research to guide strategies for improving communication and decision-making.