Internal medicine journal
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Internal medicine journal · Dec 2024
ReviewPlatelet factor 4 immune disease: medical emergencies that look like heparin-induced thrombocytopenia.
Heparin-induced thrombocytopenia (HIT) is a serious adverse reaction to heparin. Other HIT-like syndromes are increasingly recognised, mediated by antibodies binding to platelet factor 4, with or without identifiable polyanions. The history of heparin exposure is atypical for classical HIT and standard HIT laboratory tests may be negative. This manuscript describes subtypes of HIT-like syndromes and highlights practical tips for diagnosis and therapy.
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Internal medicine journal · Dec 2024
Observational StudyEpidemiology and outcome of medical emergency team calls within 48 hours of intensive care unit discharge.
Some patients experience early (within 48 h) clinical deterioration and medical emergency team (MET) review following intensive care unit (ICU) discharge. Few studies have explored early MET review, despite it being a recognised quality and safety indicator. ⋯ One in 12 patients received post-ICU early MET review. This was more likely in patients who were invasively ventilated, had higher illness severity and had certain admission diagnoses. Such patients were at risk for worse outcomes. There is a need to identify reversible factors contributing to such increased risk.
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Internal medicine journal · Dec 2024
Putting skin in the game: a descriptive study of lower extremity ulcers in general medical inpatients.
Lower extremity ulcers contribute a significant burden to patient care. Targeted investigation and management are pertinent to improving patient outcomes. ⋯ There was evidence of under-ordering of appropriate investigations, and over-treatment for infection. We proposed a quality improvement initiative to optimise lower extremity ulcer care.
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Internal medicine journal · Dec 2024
Development and validation of a predictive scoring system for hypoglycaemic agents for optimal control of blood glucose during glucocorticoid therapy.
Glucocorticoid (GC) treatments are often used. There is limited information on the prediction of hyperglycaemia after GC administration. ⋯ This scoring system is a novel, valid and reliable tool for predicting GC-induced hyperglycaemia and the need for hypoglycaemic agents to correct it.
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Internal medicine journal · Dec 2024
Infective endocarditis outcomes at a tertiary hospital in Western Australia: a retrospective cohort study from 2016 to 2021.
Infective endocarditis (IE) is a severe infection with considerable mortality. It is associated with geographical variation, complicating diagnosis and treatment of patients in a standardised manner. ⋯ IE mortality rates remain high, particularly in patients who do not undergo surgical management. Streamlined MDT assessment and referral for surgical management where appropriate is necessary to improve outcomes.