Internal medicine journal
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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
ReviewPulmonary arterial hypertension: updates and perspective with newer therapies.
Pulmonary arterial hypertension (PAH) is a rare condition for which a remarkable change has been witnessed in the epidemiology, assessment and treatment landscape over the last three decades. Well-established registries from the Western world have not only highlighted the shift in the epidemiology to an older, more comorbid cohort but have also identified markers of prognosis that have been validated as part of risk stratification scores in multiple cohorts. The emphasis on early identification through a systematic assessment pathway and the option of upfront combination therapy with serial risk stratification assessment has laid the foundation for the standard of care and improved prognosis. This review provides an update on the assessment and newer therapies for PAH.
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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.
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Internal medicine journal · Dec 2024
Historical ArticleBlack-and-white pepper: unravelling Cruella De Vil's medical diagnoses.
Cruella De Vil, the iconic character from Dodie Smith's novel The Hundred and One Dalmatians, was traditionally viewed through a psychodynamic lens as a figure embodying narcissistic personality disorder, psychosis and mania. In this article, we propose an alternative hypothesis that her erratic behaviour and distinctive physical appearance may be attributed to a chronic systemic condition.
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Internal medicine journal · Dec 2024
ReviewThe heart of the matter: a re-iteration of the role of the social determinants of health in addressing health inequity in Central Australia.
The persisting life-expectancy 'gap' between First Nations and non-First Nations Australians is fundamentally driven by the social determinants of health. These include income and social protection, access to adequate housing and food security, among others. These factors are particularly prominent in Central Australia. ⋯ Food insecurity and inadequate social protection manifesting as energy insecurity result in inadequate nutrition and have resulted in a huge burden of diabetes in Central Australia. These factors, combined with social exclusion, racism and the pervasive effect of colonisation, also drive a high rate of alcohol misuse. Only by prioritising equity in these 'social determinants' and emphasising the importance of First Nations leadership in formulating and implementing solutions will health inequity be addressed.