Internal medicine journal
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Internal medicine journal · Sep 2024
Examining capillary ketone testing in hospitalised patients: indications and outcomes.
Elevated blood ketone levels (ketosis) in inpatients with diabetes can herald diabetic ketoacidosis (DKA). However, ketosis can also occur in individuals without diabetes in certain settings. It is unclear what proportion of inpatients with ketosis are in DKA and which patients are at the highest risk of DKA. This study determined that many ketone tests are performed in individuals at low risk of DKA, and a β-hydroxybutyrate <1.0 mmol/L had a low incidence of DKA and less need for escalation in their management.
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Internal medicine journal · Sep 2024
A retrospective review of the short Synacthen test in Queensland hospitals.
The short Synacthen test (SST) is widely used to investigate adrenal insufficiency, but it can be time-consuming, costly and labour-intensive to perform and is not without risk of adverse events. ⋯ There was wide variability in requesting patterns and practices for SSTs across Queensland. More than one in six SSTs could have been avoided if a static morning cortisol had been performed prior. Clinician education and the adoption of a structured referral form may improve testing practices.
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Internal medicine journal · Sep 2024
Colorectal polyps in young adults: a retrospective review of colonoscopy data from Toowoomba and the Darling Downs.
Polyps are the predominant precursors of colorectal cancer. In the past three decades, the incidence and mortality rates of colorectal cancer have been increasing in adults younger than 50 years. ⋯ Data from this audit supported the temporal trend of increasing prevalence of polyps in adults younger than 50 years. Patient cohorts aged 30-39 and 40-49 years may benefit from earlier first colonoscopies. Findings could be the impetus for future research in young adults presenting for colonoscopy.
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Internal medicine journal · Sep 2024
Utility of mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index in clinical pH-impedance reflux study.
Analysis of mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPWi) have been proposed to increase the diagnostic yield of pH-impedance studies in reflux disease. However, routine use of these indices in clinical studies is yet to be established, particularly with PSPWi, which requires laborious manual analysis. Our study aimed to assess the utility of MNBI and PSPWi and their potential for future incorporation into clinical practice. ⋯ MNBI and PSPWi are both useful adjuncts in the diagnosis of reflux disease, although in our cohort MNBI showed stronger correlation with AET with less time to analyse. The role of these indices remains to be further explored, particularly in patients with inconclusive AET and in those with positive compared to negative symptom association.