Internal medicine journal
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Internal medicine journal · Apr 2023
Attitudes, practices, and experiences of medical specialists towards email communication with their patients.
The medical profession has been slow in embracing email as a means of improving communication with patients. ⋯ There is a want and need for comprehensive and accessible professional guidance on email use with patients. Our results indicate opportunities to inform good clinical practice in respect of doctor-patient relationships, clinical workloads and risk management. There is also a need for formal guidelines on emailing with patients. The COVID-19 pandemic has heightened the need for such guidelines.
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Internal medicine journal · Apr 2023
Benefit and harm of anticoagulation in the prevention of thromboembolic stroke for non- valvular atrial fibrillation in haemodialysis patients - a Top End of Northern Australia study.
Warfarin for the prevention of non-valvular atrial fibrillation (AF)-related thromboembolic stroke in patients on maintenance haemodialysis is controversial. Despite the exclusion of haemodialysis patients in randomised control trials, the American Heart Association/American College of Cardiology has recommended warfarin in high-risk AF patients. ⋯ This retrospective study of prevalent haemodialysis patients with co-existing history of non-valvular AF failed to demonstrate sufficient evidence for the routine use of warfarin for prophylaxis of thromboembolic stroke.
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Internal medicine journal · Apr 2023
Analysing Monday discharges to identify lost opportunities for weekend discharge.
Lower rates of hospital discharge occur on weekends compared with weekdays. The authors performed a retrospective chart review of Monday discharges from the Hospital Medicine service at an academic hospital over a 3-month period to identify reasons for delayed discharge despite medical stability. Of 202 eligible patients, 81 (40%) had documentation indicating stability for earlier discharge. Common causes included bed availability or insurance authorisation at a skilled nursing facility, home care services and patient/family disagreement with discharge.
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Internal medicine journal · Apr 2023
Pancreatitis and Post-Pancreatitis Diabetes in Central Australia.
Pancreatitis and diabetes are common among Aboriginal people of Central Australia. The contribution of pancreatitis to the development of post-pancreatitis diabetes mellitus (PPDM) is not known. ⋯ Prevalence of AP and CP in Central Australia was higher in Aboriginal than non-Aboriginal people. Few patients with diabetes recorded after pancreatitis had appropriate PPDM diagnostic testing. Interdisciplinary education on the diagnosis of PPDM is required.
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Internal medicine journal · Apr 2023
Immunisation used for offensive and defensive purposes during the Second World War.
The best defence against natural or intentional biological agents during armed conflict is usually immunisation, as with typhoid fever, but exceptional circumstances are informative. A large iatrogenic epidemic of hepatitis B occurred in 1942 due to contaminated lots of yellow fever (YF) vaccine used in the US military, even though there was no natural risk of infection. YF vaccine was intended to protect against Japanese Army's use of YF as a biowarfare agent, which did not eventuate. ⋯ German Army use of the Weil-Felix reaction to eliminate civilians likely to be typhus infected was subverted by Polish medical officers. They immunised civilians with locally produced Proteus antigens to create false-positive Weil-Felix reactions in order to exempt men from forced labour schemes. Immunisation against biowarfare agents has a mixed record, indicating that vaccines rarely cover well for intelligence gaps.