Internal medicine journal
-
Internal medicine journal · Apr 2012
The association between time to disposition plan in the emergency department and in-hospital mortality of general medical patients.
A perceived risk of time-limited emergency department (ED) assessment of patients is inadequate workup leading to inappropriate disposition. The aim of this study was to examine the association of time to disposition plan (TDP) on ED length of stay (LOS) and correlate this to mortality. ⋯ In the setting of prolonged ED LOS, completing ED assessment and management within 4 h of presentation was associated with significantly higher mortality. Further prospective studies are required to understand the relationship between rapid decision making in the ED and patient safety.
-
Internal medicine journal · Apr 2012
Immunophenotypic analysis of erythroid dysplasia and its diagnostic application in myelodysplastic syndromes.
Abnormal immunophenotypes of haematopoietic cells in myelodysplastic syndromes (MDS) have been identified by flow cytometry (FCM) as a typical characteristic of myeloid dysplasia. Considering that most MDS patients show varying degrees of erythroid dysplasia, we analysed the immunophenotypic feature of erythroblasts to evaluate its diagnostic application in MDS. ⋯ Developmental defects and immune-associated factors may contribute to the erythroid dysplasia. The DI derived from ratios of CD71 and CD105 expression is a useful marker to characterise dyserythropioiesis associated with MDS and can be helpful in distinguishing it from dyerythropoiesis associated with non-clonal disorders.
-
Internal medicine journal · Apr 2012
Psychology of earthquake-induced stress cardiomyopathy, myocardial infarction and non-cardiac chest pain.
To compare psychological factors in patients presenting to hospital with earthquake-induced stress cardiomyopathy, myocardial infarction (MI) and non-cardiac chest pain. We hypothesised that patients with stress cardiomyopathy and non-cardiac chest pain would be more psychologically vulnerable than those with MI. ⋯ Our hypothesis was incorrect. Women with non-cardiac chest pain following an earthquake have higher anxiety and neuroticism scores than women with either MI or stress cardiomyopathy. Stress cardiomyopathy following an earthquake is not specific to psychologically vulnerable women. The psychology of natural disaster-induced stress cardiomyopathy may differ from that of sporadic cases.
-
Internal medicine journal · Apr 2012
Initiating allopurinol therapy: do we need to know the patient's human leucocyte antigen status?
Allopurinol hypersensitivity (AH) can rarely be manifest as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) that have high mortality rates. Less serious, but still significant, skin and systemic hypersensitivity reactions form part of the AH spectrum. One hundred per cent of Han Chinese with SJS/TEN due to allopurinol have been found to be at least heterozygous for HLA-B*5801, the carriage rate for this allele in the Han Chinese population being about 15%. The association has been found to be weaker in Caucasians whose HLA-B*5801 carriage rate is less than 6%. We examined the relationship between the different skin hypersensitivity reactions to allopurinol and the HLA-B locus in Australian patients. ⋯ Cases of AH manifesting as SJS/TENS in Australians are more likely to be in those of Asian heritage. The place of routine testing for HLA-B*5801 prior to commencing allopurinol therapy requires further investigation. However, Han Chinese origin patients commencing allopurinol might be informed of the test and may elect to have it performed as there are alternative hypouricaemic medicines, such as probenecid thereby reducing the risk of a catastrophic reaction to allopurinol.
-
This study aimed to assess the degree of patient compliance with medications prescribed at hospital discharge following ischaemic stroke, and concordance between self-reported medication use and general practitioner (GP) records. ⋯ Adherence to secondary stroke prevention medication was between 87% and 100% at 6 weeks with similar findings at 6 months after discharge. We speculate that these high compliance rates may be due to one-on-one stroke nurse counselling and the use of stroke information packs, which include information about the importance of adherence to secondary prevention medication.