Internal Medicine Journal最新文献

{"title":"First-line treatment of osteoporosis with osteoanabolic therapy: a new opportunity.","authors":"Jasna Aleksova, Peter Ebeling","doi":"10.1111/imj.70061","DOIUrl":"https://doi.org/10.1111/imj.70061","url":null,"abstract":"<p><p>Osteoporosis is a national health priority, and over six million Australians over the age of 50 years have poor bone health. Fragility fractures due to osteoporosis are associated with an increased morbidity and mortality risk and a high economic cost to the community. It is a chronic condition requiring long-term management. Despite notable advances in pharmacotherapy, large treatment gaps remain. Antiresorptive drugs have been the foundation of treatment; however, their efficacy wanes and rare adverse effects accumulate with prolonged use. Osteoanabolic drugs form new bone and can also restore deteriorated bone microarchitecture, in addition to increasing bone mineral density. Currently, antiresorptive drugs are used as first-line drugs for osteoporosis. However, recent studies have highlighted the superiority of anabolic drugs for fracture reduction over antiresorptives. Furthermore, for patients at very high risk or imminent risk of fracture, the use of sequential therapy with an osteoanabolic medication followed by an antiresorptive is superior to achieving optimal long-term bone health outcomes. This article will discuss the evidence supporting the anti-fracture benefits of osteoanabolic drugs, emphasising their benefits as first-line agents for osteoporosis. Challenges surrounding transitions between osteoanabolic and antiresorptive medications are also discussed, highlighting considerations for the optimal treatment sequence with a focus on recent updates to Australian prescribing recommendations and PBS requirements.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for diabetic ketoacidosis at first presentation of type 1 diabetes: an 8-year (2015-2022) audit at an Australian regional hospital.","authors":"David D Je, Amogh Bhardwaj, Zhi Yi Lim, Venkat N Vangaveti, Usman H Malabu, Yong Mong Tan","doi":"10.1111/imj.70058","DOIUrl":"https://doi.org/10.1111/imj.70058","url":null,"abstract":"<p><strong>Background: </strong>Risk factors for diabetic ketoacidosis (DKA) at first presentation of type 1 diabetes (T1DM) have been investigated in a small number of studies, but further studies are required to better define them. In particular, a family history of T1DM was shown to be protective, while the effect of pancreatic autoimmunity is uncertain.</p><p><strong>Aims: </strong>This retrospective study, performed at Townsville University Hospital, aimed to study whether the incidence of DKA at first presentation of T1DM was associated with (i) a family history of T1DM and (ii) the number and titre of pancreatic autoantibodies. This study was the first of its kind covering both adult and paediatric cohorts in regional Queensland, Australia.</p><p><strong>Methods: </strong>Patients diagnosed with T1DM between January 2015 and December 2022 were included. Medical and patient data were retrospectively collected and analysed using spss.</p><p><strong>Results: </strong>A total of 146 patients met the inclusion criteria. Seventy-eight (53.4%) patients presented with DKA, whereas 68 (46.6%) did not. Among patients with at least one relative with T1DM, 19 (36.5%) patients had DKA and 33 (63.5%) did not (odds ratio (OR): 0.35, confidence interval (CI): 0.17-0.72, P = 0.004). Among those with a first-degree relative with T1DM, four (18.2%) patients had DKA and 18 (81.8%) did not (OR: 0.16, CI: 0.05-0.49, P < 0.001). There was no significant difference in DKA incidence at diagnosis with status or titre of antibodies.</p><p><strong>Conclusions: </strong>Family history was protective against DKA at first presentation of T1DM, whereas there was no relationship with the presence or titre of pancreatic autoantibodies.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sulfonamide allergy label on clinical outcomes of acute cystitis: a retrospective matched cohort study.","authors":"Ray Moussa, Tyler Miluski, Gisoo Ghaffari, Taha Al-Shaikhly","doi":"10.1111/imj.70057","DOIUrl":"https://doi.org/10.1111/imj.70057","url":null,"abstract":"<p><strong>Background: </strong>Cystitis is a common infection in an otherwise healthy individual. Sulfonamide antibiotics are first-line treatment options. Sulfonamide allergy label (SAL) is the second most common antibiotic allergy label in electronic health records, yet its impact on clinical outcomes in patients with cystitis is not well-characterised.</p><p><strong>Aims: </strong>The aim of this study is to characterise the impact of SAL on clinical outcomes of acute cystitis.</p><p><strong>Methods: </strong>In this retrospective matched cohort study utilising the TriNetX US Collaborative Network (Cambridge, MA, USA), adult patients with cystitis were categorised based on their SAL status. The 28-day risks of acute pyelonephritis and Clostridium difficile infection and the risk of recurrent or relapsed cystitis (defined as cystitis 15-28 days post-indexed cystitis) were contrasted. Antibiotic prescription practices within 14 days of the index cystitis were also compared.</p><p><strong>Results: </strong>When comparing 19 767 patients with cystitis and SAL to an equal number of matched controls, more patients with SAL had acute pyelonephritis (RR 1.27; 95% CI 1.08-1.48; P = 0.003; corrected P = 0.027) within 28 days of index. More patients with SAL developed recurrent/relapsed cystitis 15-28 days post-indexed cystitis (RR 1.19; 95% CI 1.08-1.31; P = 0.001; corrected P = 0.009) as compared to controls. SAL altered antibiotic prescription practices with under-utilisation of trimethoprim and sulfamethoxazole and increased utilisation of alternative antibiotics, including fluoroquinolones and nitrofurantoin, which was associated with an increased risk of Clostridium difficile infection.</p><p><strong>Conclusions: </strong>SAL alters antibiotic prescription practices and is associated with a slightly increased risk of poor outcomes in adult patients with cystitis.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vulnerability of a New Zealand hospital computerised provider order entry system to prescribing error: a comparative study with other systems.","authors":"Milan Sundermann, Lorna Pairman, Olivia Clendon, Dali Fan, Matthew Doogue, Paul K L Chin","doi":"10.1111/imj.70053","DOIUrl":"https://doi.org/10.1111/imj.70053","url":null,"abstract":"<p><strong>Background: </strong>The computerised provider order entry (CPOE) system MedChart is going to be the national CPOE system in New Zealand's public hospitals.</p><p><strong>Aims: </strong>We tested the vulnerability of our health region configuration of MedChart and its clinical decision support (CDS) to prescription ordering errors and compared it to other CPOE systems. We also tested whether ordering workflow influenced system vulnerability.</p><p><strong>Methods: </strong>Ten testers completed 16 published scenarios simulating ordering errors in a training environment of MedChart. The difficulty of completing each scenario was recorded using a five-point Likert scale (1 = easily, 5 = impossible). Difficulty scores were summarised for each scenario. Sub-group analysis was conducted based on whether testers ordered sequentially or concurrently for scenarios involving two prescriptions.</p><p><strong>Results: </strong>MedChart best protected (difficulty score 5) against omission and mixed frequency errors. Worst protections (difficulty score 1) were against drug-drug interaction, duplicate ordering error, wrong frequency for medicine form error, and under dosing error scenarios. Compared to other CPOE systems, MedChart provided better protection against more than half of the scenarios, but similar vulnerabilities were identified. Sequential versus concurrent ordering workflows significantly altered system protections for only one test scenario involving duplicate enoxaparin orders (median 3.0 vs 1.0, P = 0.004).</p><p><strong>Conclusions: </strong>These findings highlight areas for improvement in MedChart system configuration. Different ordering workflows require consideration when implementing CDS. Publication of CPOE testing using standardised tools could facilitate comparison of safety performance between institutions.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing a rural and remote apheresis service in Western New South Wales: the Orange Hospital experience","authors":"Jun Y. Ng,&nbsp;Savisha Fernando,&nbsp;Lisa Phipps,&nbsp;Charmaine Wong,&nbsp;Karen Fogo,&nbsp;Donna Crameri,&nbsp;Douglas Lenton","doi":"10.1111/imj.70039","DOIUrl":"10.1111/imj.70039","url":null,"abstract":"<p>Traditionally, patients requiring therapeutic apheresis from rural and remote areas have been compelled to seek treatment at metropolitan hospitals, at great social and economic cost to the patient and the health service, or to receive in-patient apheresis in local intensive care units using renal replacement therapy machines. We outline our experience establishing an apheresis service in Western New South Wales. Our experience demonstrates that a clinically and economically viable apheresis service in the rural setting can be established.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"669-672"},"PeriodicalIF":1.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practise as you preach: climate stewardship in healthcare integrating top-down and bottom-up approaches with clinician as positive role models for the community","authors":"Joseph Ting,&nbsp;Daniel Schweitzer,&nbsp;Nina Lansbury","doi":"10.1111/imj.70047","DOIUrl":"10.1111/imj.70047","url":null,"abstract":"&lt;p&gt;The conference of the parties under the auspices of the United Nations framework convention on climate change has declared global warming and climate emergencies as a threat to planetary health and life since its inaugural meeting in 1995,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; with each meeting having to deal with worsening threats of global climate change.&lt;/p&gt;&lt;p&gt;Climate change is in crisis mode, imposing significant existential risk for healthcare systems as well as the long-term environmental sustainability of healthcare systems.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Healthcare systems, including hospitals, have a significant impact on the ecology of the planet. Hospitals and laboratories are responsible for between 4.4% and 4.6% of total worldwide carbon emission.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Healthcare professionals should be involved at all levels of the response to climate change to help deliver evidence-based responses to climate change health challenges across community and hospital-based settings. Urgent actions and proactive attitudes taken in the healthcare setting act as important drivers of innovation leading to more resilient healthcare systems.&lt;/p&gt;&lt;p&gt;As significant contributors to greenhouse gas emissions and resource consumption, healthcare practitioners are well positioned to try to reduce the adverse impact of a carbon-intensive healthcare practice on climate change.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Climate change is escalating demand for health care in community practice, emergency departments, outpatient clinics, hospitals and disaster response units. Rising global average temperatures and increased intensity of extreme weather events worsen symptoms across mental health, heat stress, respiratory, cardiovascular and neurological disorders including asthma, coronary artery disease, chronic neurological disease, reproductive and climate change anxiety.&lt;span&gt;&lt;sup&gt;5-8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Rather than a one-size-fits-all approach, there is a need for climate stewardship that is able to accommodate a wide range of interests and advocacy, incorporating the involvement of a broad range of healthcare professionals across a diversity of healthcare settings.&lt;/p&gt;&lt;p&gt;How healthcare practitioners deal with the impact of climate change within current healthcare frameworks impacts the health of future generations and health system adaptability and resilience. As high levels of respect and trust are bestowed on healthcare practitioners by Australian and UK society,&lt;span&gt;&lt;sup&gt;9, 10&lt;/sup&gt;&lt;/span&gt; medical practitioners are well-positioned to advocate for, and influence, changes in climate change policy across healthcare settings. The attitudes and actions of healthcare professionals and modelling these to patients who still respect doctors and nurses could benefit from pro-active climate change stewardship. There is an urgent need to go beyond environmental stewardship&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; to our proposed new interdisciplinary framework around climate stewardship.&lt;/p&gt;&lt;p&gt;Given the","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"547-549"},"PeriodicalIF":1.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different historical approaches to leprosy in the Asia-Pacific","authors":"G. Dennis Shanks","doi":"10.1111/imj.70045","DOIUrl":"10.1111/imj.70045","url":null,"abstract":"<p>Leprosy, or Hansen disease, is a greatly feared infection of <i>Mycobacterium leprae</i> whose neuropathy induces disfiguring injuries subject to great social stigma. Historically, Australia largely confined its few leprosy patients to remote leper colonies (leprosaria) or in quarantine hospitals. The Philippines and the Dutch East Indies (now Indonesia) had much larger infected populations in the early 20th century and required alternative approaches. The US military government of the Philippines chose actively to identify and confine all leprosy patients to segregated colonies on remote islands. Although intended to eliminate transmission by quarantine, the lack of effective chemotherapy to render patients non-infectious meant that the census of patients (≈5000) at the primary facility on Palawan climbed to the point that the colony could not be funded from the Health Department's budget. The Dutch government in the East Indies knew large leper colonies were unaffordable, so focussed segregation only in the capital Batavia and on plantations in Sumatra with the objective of minimising infection in the expatriate population. Neither approach was satisfactory largely due to resource constraints. Improved chemotherapy remains the best hope for the eventual elimination of leprosy.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"677-681"},"PeriodicalIF":1.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in multiple sclerosis.","authors":"Turlough Montague, James Drummond, Karl Ng, John Parratt","doi":"10.1111/imj.70023","DOIUrl":"https://doi.org/10.1111/imj.70023","url":null,"abstract":"<p><p>The global prevalence of multiple sclerosis (MS) is increasing, and early diagnosis and treatment is essential in mitigating disability. While recent therapeutic advancements have significantly reduced relapse rates, the progressive and degenerative aspects of MS continue to pose major challenges. This year updates to the McDonald diagnostic criteria aim to enhance sensitivity and facilitate earlier use of disease-modifying therapies in asymptomatic patients. Additionally, novel biomarkers will gain ground in clinical practice and offer new approaches to optimising care. Following the widespread use of cell depleting immunosuppressive agents, innovative therapeutic directions such as chimeric antigen receptor T-cell therapy and Epstein-Barr virus (EBV) vaccination represent promising new directions in the management of MS. This clinical perspective provides a comprehensive overview of the disease while highlighting important advancements shaping the future of the field.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing best practice in the Australian haematology setting for the use of chimeric antigen receptor T-cell therapy for relapsed and refractory lymphoma","authors":"Michael Dickinson,&nbsp;Nicole O'Leary,&nbsp;Nada Hamad,&nbsp;Tara Cochrane,&nbsp;P. Joy Ho,&nbsp;Chan Y. Cheah,&nbsp;David Bishop,&nbsp;Gareth P. Gregory,&nbsp;Jason Butler,&nbsp;Allison Barraclough","doi":"10.1111/imj.16544","DOIUrl":"https://doi.org/10.1111/imj.16544","url":null,"abstract":"<p>Autologous CD19 chimeric antigen receptor T (CAR T)-cell therapies have significantly improved clinical outcomes for many patients with relapsed and refractory (R/R) lymphoma. However, the process of delivering CAR T-cell therapy is specialised and complex, in part due to specific post-infusion toxicities. Several CAR T-cell products are now available in Australia, although not all states have treatment centres. In this review, we aim to define best practice for the referral and treatment of patients with R/R B-cell lymphoma with CAR T-cell therapy in Australia. We outline the processes for referral, optimal patient selection and best practice in the management of patients receiving CAR T cells.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 S2","pages":"4-27"},"PeriodicalIF":1.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid desensitisation therapy in a patient with furosemide-induced anaphylactic shock: a case report and short-term follow-up","authors":"Chuanwei Zhao,&nbsp;Yane Yang,&nbsp;Shizhen Gao","doi":"10.1111/imj.70041","DOIUrl":"10.1111/imj.70041","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"688-689"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}