Internal medicine journal
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Internal medicine journal · May 2023
Poor engagement and adherence predict neoplasia in inflammatory bowel disease: a case-control study.
Colorectal adenocarcinoma is an important and preventable complication of inflammatory bowel disease (IBD). A previous case series suggested mental health issues and poor engagement in care as novel risk factors. ⋯ This study confirms poor adherence or engagement with care as a new risk factor for colorectal adenocarcinoma in patients with IBD; identifying a vulnerable group whom clinicians should endeavour to engage in order to avoid this catastrophic complication.
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Internal medicine journal · May 2023
Prothrombin complex concentrates for the urgent reversal of apixaban and rivaroxaban - an Australian retrospective cohort study.
Direct acting oral anticoagulants (DOAC) are now commonly prescribed medications. Urgent reversal of their anticoagulant effect is sometimes required in emergency situations. In Australia, a specific reversal agent for factor Xa (FXa)-inhibitor DOAC is not available. Instead, two non-specific haemostatic agents, activated prothrombin complex concentrate (aPCC) and 3 factor-prothrombin complex concentrate (3F-PCC), are used off-label despite a paucity of evidence for their effectiveness or safety. ⋯ Both aPCC and 3F-PCC are useful adjuncts for the management of patients who require urgent reversal of the anticoagulant effect of FXa-inhibitor DOAC. However, the risk of thromboembolism in this patient group requires careful consideration. Prospective, comparator studies are needed along with the development of guidelines that reflect the availability of haemostatic agents in Australia.
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Internal medicine journal · May 2023
Impact of a pharmacist led thiopurine monitoring service in outpatients with inflammatory bowel disease.
Thiopurines are effective therapies for inflammatory bowel disease (IBD); however, treatment comes with safety concerns and adverse effects. Knowledge of the impact of pharmacists performing thiopurine monitoring is limited. ⋯ Pharmacist monitoring of thiopurine therapy initiation in IBD outpatients improves adverse effect monitoring and increases medication persistence.
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Internal medicine journal · May 2023
A Centre-Based Comparison of Double vs Single Prevention Strategy on Transfusion Transmitted-Cytomegalovirus in At-Risk Haemopoietic stem cell transplant Patients and a State Survey on CMV-Seronegative Ordering Practices.
Universal leucocyte depletion reduces the risk of transfusion-transmitted cytomegalovirus; however, many clinicians still prescribe cytomegalovirus seronegative units. ⋯ The analysis suggests a double prevention strategy does not provide additional protection against transfusion-transmitted cytomegalovirus. There is ongoing variability in the acceptance of leucocyte depletion alone despite the low risk of cytomegalovirus infection.
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Internal medicine journal · May 2023
Improving Care For People With Bronchiectasis: Opportunities And Challenges Highlighted From Service Evaluation.
Bronchiectasis is a serious, debilitating condition warranting specialist care. ⋯ Our cohort had a high proportion of patients with severe disease and significant mortality; some, but not all, aspects of recommended care were delivered.