Internal Medicine Journal最新文献

{"title":"Wait times in diagnosis and treatment of obstructive sleep apnoea at a major tertiary centre.","authors":"Hamza Azam, Vriti Shukla, Benjamin Gerhardy","doi":"10.1111/imj.70132","DOIUrl":"https://doi.org/10.1111/imj.70132","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527813","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":"Improving the timeliness of care for regional lung cancer patients through the implementation of a web-based lung cancer referral pathway.","authors":"Zulfiquer Otty, Sarah Larkins, Rebecca Evans, Amy Brown, Sabe Sabesan","doi":"10.1111/imj.70138","DOIUrl":"https://doi.org/10.1111/imj.70138","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer remains a significant public health problem and a leading cause of cancer-related mortality worldwide. The delays in the diagnosis of lung cancer are more pronounced for rural and regional Australians compared to their urban counterparts. Implementing an online HealthPathway is one way to reduce delays in the diagnosis of lung cancer.</p><p><strong>Aim: </strong>The Townsville Lung Cancer Referral Pathway (TLCRP) was implemented to guide local general practitioners (GPs) in the referral process of people with suspected lung cancer. The aim of the study was to compare the time interval from initial GP consultation of the person with suspected lung cancer to the first specialist referral and from the first specialist referral to the initial specialist appointment, before and after implementation of TLCRP. Other lung cancer service outcomes were also compared between the pre- and post-implementation groups.</p><p><strong>Methods: </strong>A retrospective cohort study of 316 participants was conducted, and descriptive statistical analysis of the data was used to discern any difference in timelines and other clinical outcomes in the pre-pathway implementation group compared to the post-pathway implementation group.</p><p><strong>Results: </strong>The time interval from initial GP presentation to initial referral to specialist appointment was significantly reduced in the post-pathway group (15 days) compared to the pre-pathway group (8 days, P = 0.03). However, the time interval from GP referral to initial appointment with a specialist increased in the post-pathway group (15 and 20 days, P = 0.03). Many of the Cancer Australia lung cancer optimal care pathway referral guidelines were not met. Only 40% of the pre-pathway group and 34% of the post-pathway group were seen in the specialist clinic within 2 weeks of GP referral. Significant proportions of patients in both groups did not have chest x-rays ordered by the GP, and the proportion of participants who were appropriately referred to the respiratory clinic did not improve after implementation of TLCRP (76% and 72%). Nearly 30% of participants in both groups were diagnosed after emergency presentation.</p><p><strong>Conclusions: </strong>TLCRP improved the time interval from initial GP consultation to specialist referral, thus meeting its primary objective. However, better strategies are required to improve other timelines and meet Cancer Australia's lung cancer optimal care pathway guidelines.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527812","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":"Effect of adherence on asthma control: more patient knowledge, more adherence, more control.","authors":"Zeynep Celebi Sozener, Omur Aydin, Gulfem Elif Celik, Dilsad Mungan","doi":"10.1111/imj.70135","DOIUrl":"https://doi.org/10.1111/imj.70135","url":null,"abstract":"<p><strong>Background: </strong>Low adherence rates in addition to inhaler misuse is a crucial problem in asthma management.</p><p><strong>Aims: </strong>To investigate medication adherence and correct inhaler use and the relationship between adherence, asthma control and disease severity.</p><p><strong>Methods: </strong>In this cross-sectional study, demographic characteristics of patients with asthma, asthma control and severe asthma rates were recorded. Patients were categorised as non-adherent, adherent to one component (either subjectively or objectively adherent), adherent to two components or full adherent based on objective, subjective and correct inhaler device use.</p><p><strong>Results: </strong>The study included 304 patients with a mean age of 50.21 ± 12.53 years and disease duration of 12.67 ± 9.47 years. The rate of objective adherence, subjective adherence and correct inhaler use was 45.3%, 67.7% and 56.5% respectively. Overall, we found that 26% of the patients were non-adherent, 18.7% showed subjective or objective adherence, 28.8% adhered to two components, and 27% demonstrated full adherence. The risk of non-adherence was 3.1 times higher in uncontrolled patients, and regular clinician visits reduced the risk of non-adherence by 66%. Adherence was negatively associated with severe asthma rates in our cohort. The rate of correct inhaler device use was lower in patients with systemic comorbidities, while there was no difference in objective adherence, subjective adherence or full adherence.</p><p><strong>Conclusion: </strong>The results of this study revealed that correct, consistent and regular use of inhalers in accordance with clinician recommendations is important in achieving control in patients with asthma. To increase adherence in asthma, regular clinician visits and repeat training should be encouraged.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527811","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":"Clinical outcomes of patients seen by psychiatrists in a multidisciplinary clinic for disorders of gut-brain interaction.","authors":"Evangelia Dendrinos, Hannah Kim, Daniel Hubik, Jessica Green, Linda Yang, Annalise Stanley, Michael Salzberg, Michael A Kamm, Chamara Basnayake","doi":"10.1111/imj.70134","DOIUrl":"https://doi.org/10.1111/imj.70134","url":null,"abstract":"<p><strong>Background: </strong>Patients with disorders of gut-brain interaction (DGBIs) presenting to specialist care have a high prevalence of psychiatric morbidity. Psychiatrists can provide effective treatments for these disorders; however, care is rarely delivered in an integrated manner.</p><p><strong>Aims: </strong>This study aimed to characterise patients seen by psychiatrists in a multidisciplinary gastrointestinal (GI) clinic, describe the treatment provided and examine clinical outcomes.</p><p><strong>Methods: </strong>In a single-centre multidisciplinary gastroenterology clinic, clinical records were retrospectively evaluated for patients with DGBIs seen by a psychiatrist. Patient demographics, medical and psychiatric history, records of adverse childhood experiences (ACEs) and adult trauma were collected. GI and mental health symptom outcomes were assessed using a five-point scale.</p><p><strong>Results: </strong>Ninety-seven patients (median age, 35 years; 77% female) were seen by the psychiatrist (median treatment duration 2.5 months) between January 2017 and November 2021. Fifty-six per cent had irritable bowel syndrome and 18% had functional dyspepsia. Common psychiatric comorbidities were anxiety (51%) and depression (43%). Seventy-seven per cent had a history of ACEs and 26% had a history of sexual trauma. Seventy-five per cent had previously seen a psychiatrist or psychologist. DGBI-Clinic psychiatrists provided a range of treatments including psychoeducation (64%), insight-oriented psychotherapy (39%), medication changes (27%) and cognitive behavioural therapy (19%). A majority of patients had improvement (46%) or resolution (11%) in GI symptoms. Forty per cent experienced improvement in mental health symptoms. Improvement in GI and mental health symptoms were correlated (P = 0.002).</p><p><strong>Conclusions: </strong>A majority of patients with DGBI who were seen by psychiatrists within a multidisciplinary clinic demonstrated improvement in GI and mental health symptoms.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505601","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":"Proposing core competencies for physicians in using artificial intelligence tools in clinical practice.","authors":"Ian A Scott, Tim Shaw, Christine Slade, Tai Tak Wan, Rahul Barmanray, Craig Coorey, Sandra Lj Johnson, Lana Bell, Michael Herd, Clair M Sullivan","doi":"10.1111/imj.70112","DOIUrl":"https://doi.org/10.1111/imj.70112","url":null,"abstract":"<p><p>Artificial intelligence (AI) will likely transform many aspects of healthcare, and physicians will need to adapt and lead. The expanding range of AI tools calls for physicians to become competent in their proper use if we are to achieve better patient experience, population health and health equity, and with greater efficiency, while enhancing physician satisfaction. This viewpoint proposes a practical and manageable set of core competencies for physicians in using AI tools effectively and ethically and suggests methods for acquiring these competencies.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505602","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":"Turning the tide on bronchiectasis in adult Aboriginal Australians: from neglect to action.","authors":"Subash S Heraganahally, Timothy Howarth, Sanjana Heraganahally, Dayna Duncan, Winnie Chen, Payi L Ford, Lisa Sorger, Simone Barry, Lucy Burr","doi":"10.1111/imj.70116","DOIUrl":"https://doi.org/10.1111/imj.70116","url":null,"abstract":"<p><p>Chronic respiratory disorders are highly prevalent among adult Aboriginal and Torres Strait Islander peoples, with emerging evidence suggesting that there is a significant burden of bronchiectasis contributing to overall higher morbidity and mortality. Despite this, bronchiectasis in adult Aboriginal Australians has attracted little attention in the past few decades, and only recently is published evidence on this topic beginning to emerge. This paper highlights recent insights into the disease profiles of bronchiectasis among adult Aboriginal populations, revealing a particularly high prevalence among rural and remote residing Aboriginal people that is disproportionately higher in comparison to global diverse ethnic cohorts. Studies reveal differences in disease characteristics as well as prevalence, with higher presence of multi-morbidity, impaired lung function (spirometry), multi-lobar involvement on chest radiology and higher bacterial load measured in sputum. In addition, hospital admission rates and all-cause mortality are high, significantly influencing the economic impact. These findings highlight the need for further research into the unique characteristics of bronchiectasis in adult Aboriginal Australian patients and highlight the need for targeted action.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505604","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":"Comment on Medicine Access Programmes: what do patients think - a patient-reported outcome study on ribociclib in metastatic breast cancer in Australia.","authors":"Anita Shutt, Lisa Pulver, Julie Briggs","doi":"10.1111/imj.70133","DOIUrl":"https://doi.org/10.1111/imj.70133","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496139","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":"Transoesophageal endoscopic ultrasound with bronchoscope: insights from an Australian Local Health District ahead of lung cancer screening.","authors":"Matthew Lindfield, Angus Lloyd, Vineeth George, Christopher Grainge, Scott Twaddell, David Arnold","doi":"10.1111/imj.70113","DOIUrl":"https://doi.org/10.1111/imj.70113","url":null,"abstract":"<p><strong>Background: </strong>The combined use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transoesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is preferred in the diagnosis and staging of non-small cell lung cancer (NSCLC); however, there is limited utilisation of EUS-B-FNA in Australia. With a National Lung Cancer Screening program (NLCSP) commencing in 2025, additional diagnostics may be required by bronchoscopists.</p><p><strong>Aims: </strong>We describe the endoscopic model of care offered and outcomes achieved by Respiratory Physicians experienced in EUS-B-FNA practicing in a regional Australian tertiary referral hospital.</p><p><strong>Methods: </strong>Adult patients within the Hunter New England Local Health District (HNELDH) who underwent a diagnostic/staging EBUS-TBNA or EUS-B-FNA procedures, as recorded in a prospectively collected procedural database from 2016 to 2022, were included.</p><p><strong>Results: </strong>1564 patients (688 female), median age 68 years had a diagnostic or staging EBUS-TBNA and/or EUS-B-FNA (1268 EBUS-TBNA, 262 EUS-B-FNA and 34 combined). The diagnostic yield for procedures performed with an indication of suspected lung malignancy was as follows: EBUS-TBNA: 75.5%, EUS-B-FNA: 85.7%, and combined procedure: 61.1%. Three major infectious complications were observed in EUS-B-FNA (1.15%) and two in EBUS-TBNA (0.16%). These complications precede the institution's policy of pre-procedural antibiotic prophylaxis started in 2021.</p><p><strong>Conclusion: </strong>EUS-B-FNA can be performed safely by competent EBUS-TBNA respiratory physicians provided that prospective data and complication monitoring are in place.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505603","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":"Defining the scope of point-of-care ultrasound in internal medicine: a consensus statement by the point-of-care special interest group of the Internal Medicine Society of Australia and New Zealand.","authors":"Ximena Cid-Serra, Harry Gibbs, Nicolas Szecket, Drew Comeau, Patrick Elliott, Victor Duong, Padeepa Perera, Peter Thorson, Ronan O'Donovan, Graeme Maguire, Rattanak Visal Hean, Elizabeth Potter","doi":"10.1111/imj.70127","DOIUrl":"https://doi.org/10.1111/imj.70127","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) complements physical examination to advance diagnosis and treatment in a range of clinical scenarios. However, the scope for adult internal medicine physicians is not defined in Australia and New Zealand.</p><p><strong>Aim: </strong>To outline the clinical scope and core competencies of POCUS for internal medicine physicians in Australia and New Zealand using a consensus process.</p><p><strong>Methods: </strong>A steering committee and expert panel utilised the Delphi method, comprising rounds of questionnaires and anonymous feedback, to define scope by determining (i) clinical scenarios in which POCUS provides benefit and (ii) core competencies in scanning. An 80% agreement cut-off was used in each round for both inclusion and exclusion of items, and items could be added depending on feedback. Synthesis of qualitative feedback was included.</p><p><strong>Results: </strong>The expert panel endorsed the use of POCUS in eight clinical scenarios: assessment of fluid status, undifferentiated shock or hypotension, dyspnoea/respiratory failure, acute kidney injury, suspected venous thromboembolism, synovitis/joint effusion and for guiding invasive procedures and diuretic therapy in heart failure. Core competencies based on identification of organ system pathology were endorsed, incorporating abnormalities of the heart, lung, inferior vena cava, abdomen, peripheral veins, soft tissue collection and joint effusion. The consensus intended not to mandate POCUS use nor limit the scope for physicians with advanced training, but offer a structured schema.</p><p><strong>Conclusion: </strong>We successfully established a consensus on the POCUS scope for internal medicine in our region. This provides a foundation to develop formal training and credentialing.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496140","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":"Additional obstacles to overcome for the advancement of generative artificial intelligence (GenAI) in clinical medicine.","authors":"Ryan W E Ho, Isaac K S Ng, Samuel Z Q Cheong, Li Feng Tan","doi":"10.1111/imj.70131","DOIUrl":"https://doi.org/10.1111/imj.70131","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484185","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}