Internal medicine journal
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Internal medicine journal · May 2022
Observational StudyA mixed-method analysis of screening for Strongyloides stercoralis prior to immunosuppression: A problem of limited bandwidth?
Guidelines recommend screening for strongyloidiasis prior to immunosuppression in those at epidemiological risk, as hyperinfection following immunosuppression is often fatal. The uptake of this recommendation is unknown and we aimed to explore this in our setting. ⋯ We identified many missed opportunities to screen patients at risk of hyperinfection, particularly those most vulnerable. To improve screening, this study highlights the importance of reducing cognitive load by using decision-support tools, which may facilitate screening in vulnerable patients and in time-constrained settings.
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Internal medicine journal · May 2022
ReviewRheumatoid arthritis is a preventable disease: 11 ways to reduce your patients' risk.
New evidence shows that up to 40% of rheumatoid arthritis (RA) cases are attributable to exposure to potentially modifiable factors. We can now identify people at higher risk of RA (pre-RA) through their family history, risk factors, autoantibodies and symptoms. ⋯ This consumer-focussed narrative review is targeted at primary care providers and physicians to describe 11 changes that can be made, based on current evidence linking potentially modifiable factors to RA risk. These evidence-based recommendations are: (i) cease smoking; (ii) reduce exposure to inhaled silica, dusts and occupational risks; (iii) maintain a healthy weight; (iv) increase leisure time physical activity; (v) maintain good dental hygiene; (vi) maximise breastfeeding if able; (vii) maximise dietary quality and avoid high-salt diets; (viii) consume high levels of omega-3 fatty acids and fish; (ix) reduce consumption of sugar-sweetened soft drinks; (x) consume moderate levels of alcohol; and (xi) remain vitamin D replete.
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Internal medicine journal · May 2022
Group B Streptococcal bacteraemia - Changing trends in a tropical region of Australia.
Group B streptococcus (GBS) is a recognised perinatal and neonatal pathogen. There are reports of increasing GBS sepsis globally outside this demographic. North Queensland is part of tropical Australia, with a relatively high proportion of Indigenous Australians. ⋯ GBS bacteraemia is deviating from being primarily a neonatal disease. While the indigenous population of North Queensland are disproportionately affected, the demographics affected differ. GBS appears to target the older non-indigenous patients with greater comorbidities. In the non-indigenous population, invasive GBS disease is an emerging issue. Three-month mortality appears to be increased in males and the immunosuppressed.
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Internal medicine journal · May 2022
Patient preferences using telehealth during COVID-19 pandemic in four Victorian tertiary hospital services.
The Coronavirus disease 2019 (COVID-19) pandemic has had a major impact on healthcare services with many changes to telehealth care delivery. More information is needed about the patient perspective of telehealth in hospital services and the potential costs and benefits for patients. ⋯ Telehealth video consultations were largely evaluated positively with most patients considering the service to be as good as in-person. Understanding patient preference is critical to consider when implementing telehealth as mainstream across hospital health services.
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Internal medicine journal · May 2022
Corticosteroid exposure prior to admission and predicting need for rescue therapy in acute severe ulcerative colitis.
Steroid exposure has been associated with poorer outcomes following colectomy in acute severe ulcerative colitis (ASUC). ⋯ Prolonged steroid use prior to ASUC admission is a significant predictor of need for rescue therapy. A generalised linear model incorporating steroid prior to admission, endoscopic Mayo score and albumin was highly accurate at predicting failure of corticosteroid. Consideration should be given for commencement of rescue therapy prior to Day 3, especially in those with prolonged steroid prior to admission.