Internal Medicine Journal最新文献

{"title":"Re-imagining general practice","authors":"Des Gorman","doi":"10.1111/imj.16459","DOIUrl":"10.1111/imj.16459","url":null,"abstract":"<p>This editorial is about general medical practitioners – GPs – also known as family physicians. It is acknowledged that some physicians, paediatricians and surgeons have general scopes of practice and also work in the community; in the USA, they are key members of the primary care health workforce. A broadening of primary care is inevitable once new values-based financial models are introduced.<span><sup>1</sup></span> In the interim, this editorial will focus on GPs <i>per se</i>.</p><p>I recommend a re-imagining of general medical practice and will describe a successful example of such a process.<span><sup>1</sup></span> It is not my intention to describe a brave new world for GPs. I have never worked in primary care. When I left medical school in November 1977, I had no intention of becoming a GP for two reasons. First, it seemed to me to be the most difficult of all medical specialities and yet ironically was pejoratively viewed from both within and without. Second, during my attachments as a medical student, the role models that I saw were unattractive.</p><p>The editorial is written from a New Zealand perspective, but similar arguments exist for any jurisdiction where the medical profession works predominantly in either hospital or community settings.</p><p>There have been many attempts at top-down reforms of primary healthcare.<span><sup>2</sup></span> Almost without exception, they have been strongly opposed by the GPs themselves and have been largely unsuccessful – the most recent attempt in 2001 in New Zealand actually had a predictably perverse outcome from a behavioural economic perspective and now (according to Ministry of Health surveys) the single biggest cause of un-met health need in New Zealand is the unavailability of the GPs that patients want to see.<span><sup>1, 2</sup></span></p><p>The most famous of these political and bureaucratic ‘reforms’ was in 1938.<span><sup>2</sup></span> New Zealand's first labour prime minister, Michael Joseph Savage, an Australian import, tried to introduce a universal healthcare system. As is often the case with such plans, he only had half of the formula – that is who was entitled (i.e. all New Zealand citizens and permanent residents). He did not have the rest of the necessary calculus, which is the nature of the entitlement. Although he was successful in regard to publicly funded hospitals, and despite all the political capital he had accrued from the Great Depression, he was successfully opposed by the New Zealand chapter of the British Medical Association (i.e. the GPs) who retained the right to charge a fee for their services. A similar outcome occurred 10 years later during the creation of the National Health Service in the United Kingdom. This is an example of a powerful political economy operating in healthcare. Murray Horn and I have described these previously and attribute significant health inequalities to the efficacy of such economies, along, of course, with the many and various ","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 9","pages":"1435-1439"},"PeriodicalIF":1.8,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16459","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874721","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":"Current surgical management of chronic thromboembolic pulmonary disease","authors":"Hayley Barnes,&nbsp;Daniel Niewodowski,&nbsp;Atsuo Doi,&nbsp;Silvana Marasco,&nbsp;Tim Joseph,&nbsp;Miranda Siemienowicz,&nbsp;Dominic Keating,&nbsp;Shaun Yo,&nbsp;David Kaye,&nbsp;Trevor Williams,&nbsp;David McGiffin,&nbsp;Helen Whitford","doi":"10.1111/imj.16470","DOIUrl":"10.1111/imj.16470","url":null,"abstract":"<p>Chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) is an important potential consequence of venous thromboembolic disease. Untreated CTEPD with pulmonary hypertension (CTEPH) is associated with high rates of morbidity and mortality. Several treatment options are now available for patients with CTEPD and CTEPH, including pulmonary endarterectomy (PEA), balloon pulmonary angioplasty, medical therapy or a combination of therapies. Choice of treatment depends on the location of the thromboembolic disease burden, presence and severity of PH and patient factors, including frailty, parenchymal lung disease and other comorbidities. PEA is a complex surgery that can result in excellent outcomes and resolution of disease, but also comes with the risk of serious perioperative complications. This manuscript examines the history of PEA and its place in Australasia, and reports on outcomes from the main Australasian CTEPH expert centre. It provides a summary of up-to-date guidance on how PEA should be utilised in the overall management of these patients and describes opportunities and challenges for the future diagnosis and management of this disease, particularly in the Australasian setting.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 10","pages":"1616-1625"},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859549","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":"A brief history of ramping","authors":"Benjamin Cook,&nbsp;James Evenden,&nbsp;Ruby Genborg,&nbsp;Brandon Stretton,&nbsp;Joshua Kovoor,&nbsp;Kieran Gibson,&nbsp;Sheryn Tan,&nbsp;Aashray Gupta,&nbsp;Weng O. Chan,&nbsp;Carol Bacchi,&nbsp;Mana Ittimani,&nbsp;Michael Cusack,&nbsp;John Maddison,&nbsp;Samuel Gluck,&nbsp;Tony Gilbert,&nbsp;Keith McNeill,&nbsp;Stephen Bacchi","doi":"10.1111/imj.16466","DOIUrl":"10.1111/imj.16466","url":null,"abstract":"<p>‘Ramping’ is a commonly used term in contemporary Australian healthcare. It is also a part of the public and political zeitgeist. However, its precise definition varies among sources. In the published literature, there are distinctions between related terms, such as ‘entry overload’ and ‘Patient Off Stretcher Time Delay’. How ramping is defined and how it came to be defined have significance for policies and procedures relating to the described phenomenon. Through examination of the history of the term, insights are obtained into the underlying issues contributing to ramping and, accordingly, associated possible solutions.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 9","pages":"1577-1580"},"PeriodicalIF":1.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16466","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859602","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":"ANZTCT practice statement: sinusoidal obstruction syndrome/veno-occlusive disease diagnosis and management","authors":"Shaun Fleming,&nbsp;Ashleigh P. Scott,&nbsp;John Coutsouvelis,&nbsp;Chris Fraser,&nbsp;Ashish Bajel,&nbsp;Adam Nelson,&nbsp;Rachel Conyers,&nbsp;Ashley McEwan,&nbsp;David Yeung,&nbsp;Victoria Campion,&nbsp;Lochie Teague,&nbsp;Matthew McGuire,&nbsp;Edward Morris,&nbsp;Melissa Gabriel,&nbsp;Rebecca Wayte,&nbsp;Genevieve Douglas,&nbsp;Nicole Chien,&nbsp;Nada Hamad","doi":"10.1111/imj.16453","DOIUrl":"10.1111/imj.16453","url":null,"abstract":"<p>Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication which can develop after haemopoietic stem cell transplantation (HSCT) and some antibody–drug conjugates. Several SOS/VOD diagnostic and management guidelines exist, with the most recent and refined being the European Society for Blood and Marrow Transplantation adult and paediatric guidelines. Timely diagnosis and effective management (including the availability of therapeutic options) significantly contribute to improved patient outcomes. In Australia and New Zealand, there is variability in clinical practice and access to SOS/VOD therapies. This review aims to summarise the current evidence for SOS/VOD diagnosis, prevention and treatment and to provide recommendations for SOS/VOD in the context of contemporary Australasian HSCT clinical practice.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 9","pages":"1548-1556"},"PeriodicalIF":1.8,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792459","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":"Identify, screen and treat via electronic pathway: a semiautomated approach to retriaging a liver clinic waitlist","authors":"Eliza Flanagan,&nbsp;Stephen Pianko,&nbsp;Cindy Ho,&nbsp;Edward Saxby,&nbsp;Julianne Grant,&nbsp;Sally Bell,&nbsp;Rhonda Stuart,&nbsp;Suong Le","doi":"10.1111/imj.16474","DOIUrl":"10.1111/imj.16474","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Long specialist outpatient waiting lists are a source of clinical risk. Triage assignment is based on subjective assessment of referrals and fails to account for dynamic changes in disease status while patients await clinical review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To pilot an innovative triage method using a trifold approach to conduct noninvasive assessment of fibrosis and to determine the feasibility of reflex hepatitis C virus (HCV) polymerase chain reaction (PCR) testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 1006 patients awaiting an initial liver clinic appointment at a tertiary Australian hospital were sent a short message service (SMS) requesting a blood test be completed. The first 60 patients received an SMS only, and the subsequent 946 patients also received a phone call from a Liver Care Guide (LCG), a nonclinician employed to increase patient engagement. Liver fibrosis assessment through noninvasive testing was performed using an aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB4) score. Patients with an APRI ≥1, FIB4 ≥3.25 or positive HCV PCR were retriaged to Category 1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred ninety (49%) patients completed testing and 40 (4%) were triaged to Category 1. Subanalyses demonstrated increased response rates with LCG input (<i>P</i> = 0.012). Retriaged patients had been on the waitlist for a median of 216 days, exceeding initial category recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study successfully implemented a semiautomated strategy that prioritises patients with probable advanced liver disease or active HCV, demonstrating enhanced patient engagement with LCG support. It highlights the burden of patients referred for specialist care and the need for innovative strategies for monitoring and objective risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 10","pages":"1678-1685"},"PeriodicalIF":1.8,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16474","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792460","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":"Optimising the structure of outpatient clinic letters: insights from a survey of general practitioners and hospital doctors","authors":"Thisuri Jayawardena,&nbsp;Cory Lei,&nbsp;Katie McLeod,&nbsp;Aron Chakera","doi":"10.1111/imj.16460","DOIUrl":"10.1111/imj.16460","url":null,"abstract":"<p>Outpatient letters are an essential communication tool in healthcare. Yet doctors receive little training on letter writing and what details recipients consider important. We surveyed 106 hospital doctors and 63 general practitioners (GPs), identifying differences in each group's preferences; GPs preferred more structured, detailed letters. Opportunities for feedback, formal templates and advanced software systems can improve communication in outpatient clinics.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 9","pages":"1557-1560"},"PeriodicalIF":1.8,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787939","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":"Frequency and potential causes of non-beneficial Code Blue activations at a metropolitan teaching hospital","authors":"David Crosbie,&nbsp;Josta Barton,&nbsp;Angaj Ghosh,&nbsp;Barbara Hayes,&nbsp;Daryl Jones","doi":"10.1111/imj.16487","DOIUrl":"10.1111/imj.16487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Code Blue activations in patients who are not for resuscitation (NFR) may be regarded as non-beneficial and may cause harm to patients, relatives and hospital staff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To estimate the prevalence of non-beneficial Code Blue calls in a metropolitan teaching hospital and identify modifiable factors that could be utilised to reduce these events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study consisted of two parts: (i) a retrospective analysis of all Code Blue activations over a 12-month period using prospectively collected data. Non-beneficial activations were defined as calls made in patients with a NFR order in either the current or any previous hospital admissions and (ii) an anonymous voluntary survey of staff who were present at a Code Blue activation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 186 Code Blue activations over the study period, with 48 (25.8%) defined as non-beneficial. Such patients had more comorbidities, previous hospitalisations and greater levels of frailty. Most non-beneficial calls occurred on general wards and more than three-quarters of patients had been reviewed by a consultant prior to the call. The survey determined that despite ward staff having a considerable degree of resuscitation experience, there were deficiencies in understanding of Code Blue criteria, the resuscitation status of patients under their care and the interpretation of goals of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Over a quarter of Code Blue calls were deemed non-beneficial. Improving the visibility of NFR status and staff understanding of patient goals of care are needed, along with timely, proactive documentation of NFR status by experienced clinicians.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 10","pages":"1713-1718"},"PeriodicalIF":1.8,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758525","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":"Gender-affirming hormone therapy for transgender and gender-diverse adults in Australia","authors":"Brendan J. Nolan,&nbsp;Ada S. Cheung","doi":"10.1111/imj.16413","DOIUrl":"10.1111/imj.16413","url":null,"abstract":"<p>Gender-affirming hormone therapy (GAHT) is used by many transgender and gender-diverse adults to align physical characteristics with their gender identity, reduce gender incongruence and improve psychological functioning. This narrative review provides an overview of the initiation and monitoring of GAHT in an Australian context. Trans individuals treated with testosterone typically receive standard testosterone doses and formulations recommended for cisgender men, whereas those receiving estradiol GAHT are typically treated with estradiol in combination with an anti-androgen in those without orchidectomy. Proactive monitoring and mitigation of cardiovascular risk factors is pertinent in all transgender and gender-diverse adults and bone health is an important consideration in those using estradiol GAHT.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 9","pages":"1450-1457"},"PeriodicalIF":1.8,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758526","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":"Omalizumab for management of hypersensitivity reactions to anticancer drugs","authors":"Piyush Grover,&nbsp;Matthew Krummenacher,&nbsp;Timothy Loy,&nbsp;Anna K. Nowak,&nbsp;Michaela Lucas","doi":"10.1111/imj.16464","DOIUrl":"10.1111/imj.16464","url":null,"abstract":"<p>Hypersensitivity reactions to anticancer drugs include treatment-limiting toxicity. Standard drug desensitisation offers temporary tolerance and hence requires repetition. We used omalizumab, an anti-immunoglobulin E antibody, to overcome immediate and delayed hypersensitivity reactions to various anticancer drugs. Seven of the eight patients in the current study successfully resumed the desired anticancer drug regimen without standard desensitisation. No safety issues from omalizumab were observed.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 8","pages":"1396-1400"},"PeriodicalIF":1.8,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16464","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731130","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":"Preventing diabetes complications","authors":"Sophie Templer,&nbsp;Sarah Abdo,&nbsp;Tang Wong","doi":"10.1111/imj.16455","DOIUrl":"10.1111/imj.16455","url":null,"abstract":"<p>The key aim of diabetes management is to prevent complications, which are a major cause of morbidity and mortality. At an individual level, people with diabetes are less likely than they were several decades ago to experience classical macrovascular and microvascular complications as a result of improvements in modifiable cardiovascular risk factors and preventive healthcare. However, a significant burden of diabetes complications persists at a population level because of the increasing incidence of diabetes, as well as longer lifetime exposure to diabetes because of younger diagnosis and increased life expectancy. Trials have shown that the most effective strategy for preventing complications of diabetes is a multifactorial approach focussing simultaneously on the management of diet, exercise, glucose levels, blood pressure and lipids. In addition to the cornerstone strategies of addressing diet, exercise and lifestyle measures, the introduction of newer glucose-lowering agents, including sodium-glucose transport protein 2 inhibitors and glucagon-like peptide-1 agonists, have brought about a paradigm shift in preventing the onset and progression of complications of type 2 diabetes, particularly cardiovascular and renal disease. The improvement in rates of classical complications of diabetes over time has been accompanied by a growing awareness of non-traditional complications, including non-alcoholic fatty liver disease. These emerging complications may not respond to a glycaemic-centred approach alone and highlight the importance of foundational strategies centred on lifestyle measures and supported by pharmaceutical therapy to achieve weight loss and reduce metabolic risk in patients living with diabetes.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 8","pages":"1264-1274"},"PeriodicalIF":1.8,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633430","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}