Internal Medicine Journal最新文献

{"title":"A retrospective cohort study on the association between antipsychotics prior to and in the emergency department and their longer-term impacts in older adults with acute agitation.","authors":"Harshithaa Thavarajah, Alexandra Radke, Srinivas Kondalsamy-Chennakesavan, Faryal Qureshi, Deepak Darshan","doi":"10.1111/imj.70443","DOIUrl":"https://doi.org/10.1111/imj.70443","url":null,"abstract":"<p><strong>Background: </strong>Increasing prevalences of dementia are resulting in more presentations of older patients with agitation to the emergency department (ED). Antipsychotics are used for symptom management but increase the risk of sedation, falls and cognitive impairment.</p><p><strong>Objective: </strong>This study aims to determine whether antipsychotics in older adults with acute agitation in emergency settings is associated with adverse hospital-related outcomes and longer-term mortality.</p><p><strong>Method: </strong>We conducted a single-centre, retrospective cohort study of patients aged >65 years presenting to the ED with acute agitation over a 6-month period. Exposure to antipsychotics in and prior to ED, hospital length of stay (LOS) and hospital-acquired complications (HACs) were assessed.</p><p><strong>Results: </strong>Of 138 presentations, 63 received antipsychotics. The average age of participants was 81 years, with 52% being male. Median ED LOS was longer in participants who received antipsychotics 8.31 h vs 5.45 h in those who did not (P = 0.001). Similarly, median in-hospital LOS in participants who received antipsychotics was longer at 5.00 days vs 0.56 days (P = 0.005). The incidence of HACs (49.2% vs 14.7%, P < 0.001) and in-hospital mortality (15.9% vs 4.0%, P = 0.013) was higher in participants who received antipsychotics. Patients given antipsychotics were more likely to be discharged with new or higher doses of antipsychotics 23.8% vs 4.0% (P = 0.001). Mortality at 6 and 12 months was not different between the two groups (P = 0.512 and 0.204 respectively).</p><p><strong>Conclusion: </strong>Emergent antipsychotic use is associated with increased LOS, HACs and hospital mortality. These patients are also more likely to be discharged with new antipsychotics.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837535","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":"Intestinal transplantation in Australia: Progress, challenges and future directions.","authors":"Brooke Chapman, Darren Wong, Graham Starkey, Marcos Perini, Jason Yap, Adam Testro","doi":"10.1111/imj.70466","DOIUrl":"https://doi.org/10.1111/imj.70466","url":null,"abstract":"<p><strong>Background: </strong>Intestinal transplant is a rare procedure reserved for patients with intestinal failure who cannot be sustained on total parenteral nutrition due to severe, life-threatening complications. This study aims to describe the activity and outcomes of intestinal transplantation undertaken in Australia.</p><p><strong>Methods: </strong>Observational retrospective cohort study of all adult and paediatric patients who have received an intestinal transplant in Australia. The primary outcomes were patient and graft survival, with secondary outcomes including incidence of post-transplant enteral autonomy and post-transplant complications.</p><p><strong>Results: </strong>Nineteen patients (14 adults, five children) received a total of 20 intestinal transplants in Australia between 2010 and 2026. One-year conditional graft and patient survival was 87% and 93% respectively, with 5-year conditional graft and patient survival rates of 67% and 75% respectively. The median time to cease total parenteral nutrition and achieve enteral autonomy after transplant was 21 days (interquartile range: 17-30 days). Median body mass index was within ideal range for adult patients by 12 months post-transplant and growth centiles improved for paediatric patients. Eight patients (40%) experienced a total of 14 episodes of rejection at a median onset of 7.5 months after transplant, of which five were graded severe. Rates of post-transplant lymphoproliferative disorder and graft-versus-host disease were low (5% each).</p><p><strong>Conclusions: </strong>The Australian Intestinal Transplant Service demonstrates excellent patient outcomes, with short- to medium-term graft and patient survival similar to that of leading international centres and enteral autonomy achieved in all patients. Intestinal transplant is now an acceptable, life-saving procedure in appropriately selected patients in our region.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837450","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":"Fatigue and mood disorders are highly prevalent in patients with inflammatory bowel disease: A single-centre, cross-sectional study using patient-reported outcomes.","authors":"Andrew Chen, Darren Wong","doi":"10.1111/imj.70456","DOIUrl":"https://doi.org/10.1111/imj.70456","url":null,"abstract":"<p><strong>Background: </strong>Fatigue is a common and debilitating symptom in inflammatory bowel disease (IBD), yet it remains under-recognised in clinical practice. This study aimed to quantify fatigue among Australian patients with IBD and examine associations with disease control, psychological distress and quality of life (QoL).</p><p><strong>Methods: </strong>We conducted a cross-sectional study of adult patients with IBD at a tertiary centre. Participants completed four validated questionnaires: Functional Assessment of Chronic Illness Therapy-Fatigue, IBD-Control 8, Short Inflammatory Bowel Disease Questionnaire and Hospital Anxiety and Depression Scale. Associations between fatigue and other patient-reported outcomes were analysed, and multivariate regression identified independent predictors of fatigue.</p><p><strong>Results: </strong>Of 1179 patients invited, 327 (28%) participated; 166 (51%) had Crohn disease, 152 (46%) ulcerative colitis and nine (3%) IBD-unclassified. Severe fatigue was reported in 46% of participants. Depression and anxiety were present in 29% and 41% of patients respectively. Fatigue was significantly associated with poorer disease control and QoL (P < 0.0001). On multivariate analysis, independent predictors of fatigue included depressive symptoms (β = -1.03, P < 0.0001), anxiety (β = -0.41, P = 0.003), reduced disease control (β = 0.70, P < 0.0001) and lower QoL (β = 0.23, P = 0.0006). Notably, in a subgroup of 55 patients (17%) with well-controlled disease, fatigue remained strongly linked with psychological distress and impaired QoL.</p><p><strong>Conclusion: </strong>Fatigue is highly prevalent in IBD and persists even among patients with good disease control. Psychological distress, poor disease control and reduced QoL are independently associated with fatigue, underscoring the need for routine screening and multidisciplinary management.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837467","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":"The trend of obesity and inflammatory bowel disease in Australia and New Zealand: a bi-nation cohort study.","authors":"Patricia Kaazan, Warren Seow, Bill Wilson, Susan J Connor, Jane M Andrews","doi":"10.1111/imj.70454","DOIUrl":"https://doi.org/10.1111/imj.70454","url":null,"abstract":"<p><p>The paradigm of inflammatory bowel disease is shifting from a malabsorptive, undernourished state to one where obesity is a prevalent comorbidity, yet large-scale Australasian data are lacking. We conducted a retrospective, multicentre cohort study from the binational Crohns Colitis Care registry, highlighting a high prevalence of obesity and overweight in our cohort where increasing body mass index was associated with older age and cardiometabolic comorbidities including diabetes and metabolic dysfunction associated steatotic liver disease.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837518","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":"Estimating the healthcare costs of overweight and obesity amongst Australian children.","authors":"Winnie Chen, Anagha Killedar, Mohammad Nure Alam, Kirsten Howard, Louise A Baur, Alison Hayes","doi":"10.1111/imj.70432","DOIUrl":"https://doi.org/10.1111/imj.70432","url":null,"abstract":"<p><p>This study aimed to describe healthcare utilisation and costs associated with excess weight amongst Australian children (mean age 11 years). We analysed self-reported data from the Child Health CheckPoint study. From a healthcare provider perspective, children with overweight and obesity incurred annual excess costs of AUD +$140 and +$379 (+$117 and $328 adjusted) respectively compared to those in the healthy weight category. These findings suggest obesity is a significant driver of healthcare costs in children and support the economic argument for reducing childhood obesity.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837462","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":"Outcomes and opportunities: evaluating an unselected cohort of patients with adrenal incidentaloma at a tertiary hospital in New Zealand.","authors":"Anthony Benfell, Liam Quinlan, Kunj Joshi, Tej Joshi, Shekhar Sehgal","doi":"10.1111/imj.70451","DOIUrl":"https://doi.org/10.1111/imj.70451","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of adrenal incidentalomas is increasing, along with the incidence of functional or malignant lesions. This study assessed how imaging of adrenal incidentalomas at a tertiary hospital in Auckland, New Zealand, without a dedicated adrenal incidentaloma service, conformed to the American College of Radiology (ACR) recommendations for radiological screening, as well as how using a non-washout imaging approach affected clinical and service outcomes. Secondary outcomes included determining how biochemical screening conformed to the European Society of Endocrinology (ESE) guidelines and patient-related factors influencing completion of ACR screening.</p><p><strong>Methods: </strong>A retrospective audit of adrenal incidentalomas was performed using a local healthcare database RESULTS: Data from 10 278 consecutive patients with computed tomography scans were evaluated. The overall prevalence of incidentalomas was 1.4%, and 143 lesions were detected. Of these, 65/143 (45.5%) followed the ACR imaging guidelines, and 21/143 (14.7%) followed the ESE guidelines. Older adults were 2.9 times less likely to complete ACR and ESE follow-up compared to younger adults, while people with lesions >4 cm versus ≤4 cm were more likely to complete ACR follow-up. Only 11 patients were referred to endocrinology, and this subgroup had a significantly higher rate of ACR adherent evaluation (81.8% vs 12.1%, P = 0.0002). Using a non-washout method of radiological follow-up resulted in 80 fewer scans.</p><p><strong>Conclusion: </strong>Most patients with adrenal incidentalomas did not receive guideline-recommended imaging or biochemical follow-up. The establishment of integrated adrenal incidentaloma clinics and the use of non-washout follow-up scans may improve both clinical outcomes and patient experience.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837515","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":"Exploring virtual reality for stress and anxiety management in intensive care settings: perspectives from intensive care professionals.","authors":"Tjasa Savoric, Nik Savoric, Kaja Antlej, Sylvester Arnab, Sushma Ashwin, Brittany Cann, Jonathan Devine, Amanda Hirst, Kerrianne Huynh, Karena Watson, Ashwin Subramaniam","doi":"10.1111/imj.70453","DOIUrl":"https://doi.org/10.1111/imj.70453","url":null,"abstract":"<p><strong>Background: </strong>Psychological distress is highly prevalent among patients in intensive care units (ICUs), yet current management remains predominantly pharmacological and often insufficient to address emotional and cognitive wellbeing. Virtual reality (VR) is emerging as a potential non-pharmacological adjunct for stress and anxiety reduction in critical care.</p><p><strong>Aims: </strong>To explore ICU professionals' perspectives on the design, feasibility and clinical integration of a gamified, art-based VR prototype intended to support psychological wellbeing and reduce stress and anxiety in ICU patients.</p><p><strong>Methods: </strong>Qualitative study using a semi-structured focus group and thematic analysis.</p><p><strong>Interventions: </strong>Seven ICU participants (three doctors, three nurses, one allied health clinician) trialled an early-stage VR prototype designed for ICU patients that included narrative-driven content, artistic environments and planned accessibility features such as eye-tracking and multiple modes of engagement.</p><p><strong>Outcome measures: </strong>ICU professionals' perspectives on VR's therapeutic potential, recommended content features, perceived facilitators and barriers to implementation and strategies for clinical integration.</p><p><strong>Results: </strong>Seven themes emerged. Participants viewed VR as a calming, purposeful form of diversional therapy offering emotional escape, cognitive engagement and restoration of patient agency. Flexible content modes and opportunities for personalisation were valued, as were accessibility features such as eye-tracking. For implementation, participants emphasised clear infection-control workflows, reliable device-management processes and basic staff training. A phased introduction, beginning with carefully selected patient groups, was recommended before broader clinical adoption.</p><p><strong>Conclusions: </strong>ICU professionals consider VR a promising adjunct to support emotional wellbeing in ICU, provided it is purpose-built, flexible, personalised and integrated smoothly into clinical routines. Their insights offer actionable guidance for refining and piloting this VR intervention within ICU settings.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814040","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":"Two decades of biologic and JAK inhibitor prescription patterns in the western region of Melbourne.","authors":"Alexander Kwan, Elvina Ingrid, Sara Vogrin, Ken Luong, Fei Jin, Emma Brown, Dongzhe Li, Matthew Jiang, Keith K T Lim","doi":"10.1111/imj.70455","DOIUrl":"https://doi.org/10.1111/imj.70455","url":null,"abstract":"<p><strong>Background and aim: </strong>Safety concerns and medication shortages may influence prescribing practices in rheumatology. This study aimed to explore the impact of Janus kinase inhibitor (JAKi) safety warnings and the COVID-19 pandemic on biologic and targeted-synthetic disease-modifying antirheumatic drug (b/tsDMARD) prescription patterns from 2002 to 2024 in the western region of Melbourne.</p><p><strong>Methods: </strong>A retrospective audit was conducted on data from rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients who attended Western Health and Western Rheumatology clinics between 2002 and January 2024 inclusive. b/tsDMARD switching was analysed based on the first date of b/tsDMARD prescription using interrupted time series analysis, with ethics approval granted by the Western Health Office for Research (HREC/23/WH/101783).</p><p><strong>Results: </strong>There were 3124 new b/tsDMARD prescriptions. Following the 2021 United States JAKi boxed warning, the JAKi prescription rate decreased to -0.04/month (-0.20, 0.11) from 0.30/month (0.18, 0.42), P = 0.002. Supply shortages during the COVID-19 pandemic led to 44 b/tsDMARD switches. The most common cause of switching was inefficacy (32.6% of new prescriptions for AS, 42.6% for RA and 46.1% for PsA (P < 0.001)). Less than 5.4% of new prescriptions were from adverse events, underscoring b/tsDMARD safety.</p><p><strong>Conclusions: </strong>b/tsDMARD switches were primarily driven by inefficacy. Black box warning issuance led to decreased JAKi prescriptions. The COVID-19 pandemic led to minimal b/tsDMARD switches. Switching due to adverse events was infrequent, highlighting the overall safety of b/tsDMARDs in clinical practice.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814387","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":"Haemochromatosis - a modern clinician's guide.","authors":"James G Fiori, John K Olynyk","doi":"10.1111/imj.70427","DOIUrl":"https://doi.org/10.1111/imj.70427","url":null,"abstract":"<p><p>Haemochromatosis is an inherited disorder of iron metabolism affecting approximately 100 000 Australians. Iron overload may result in end organ dysfunction, most commonly manifesting as chronic liver disease, arthropathy and endocrinopathies. End organ complications can be prevented, minimised or reversed, with early diagnosis and initiation of treatment in the form of venesection. Our understanding of the pathogenesis and epidemiological characteristics of the disorder has evolved in recent decades, including identification of HFE gene variants and sex-specific differences in phenotypic expression of the disorder. This clinical perspective article summarises the up-to-date evidence regarding the pathophysiology, clinical manifestations and treatment recommendations for haemochromatosis.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814301","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":"Unaccredited medical training in Australia: From hidden problems to practical workforce solutions.","authors":"Jerome Martin Laurence","doi":"10.1111/imj.70421","DOIUrl":"https://doi.org/10.1111/imj.70421","url":null,"abstract":"<p><p>Unaccredited medical training in Australia represents a substantial yet poorly described component of the clinical workforce. This essay examines the scale, drivers and consequences of unaccredited roles for doctors, patients and health services. The essay concludes with pragmatic system-level reforms to track and move away from unaccredited training to a more efficient alternative.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770414","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}