Internal Medicine Journal最新文献

{"title":"Predicting the prevalence and outcomes of frailty through ICD-10 in older adults: experiences from a regional hospital in Taiwan","authors":"Chiu-Ying Chen,&nbsp;Yi-Ching Yang,&nbsp;Wan-Chen Hsu,&nbsp;Shu-Fen Su,&nbsp;Susan C. Hu","doi":"10.1111/imj.70069","DOIUrl":"10.1111/imj.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In acute care hospitals, nearly 50% of hospitalised patients aged 65 and over suffer from frailty, which significantly affects their health outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Using a regional hospital as an example, we utilised the Hospital Frailty Risk Score (HFRS) to investigate the risk of frailty in Taiwanese older patients and to predict its impact on medical costs, hospital stays and mortality rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from hospital medical records were extracted, and 16 775 patients aged ≥65 years hospitalised between January 2019 and December 2021 were included. International Classification of Diseases, Tenth Revision (ICD-10) data for each inpatient were collected and weighted. The risk of frailty was defined according to the HFRS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of moderate to high frailty risk was 54.1%, of which 43.6% were moderate risk and 10.5% were high risk. Those identified as having a moderate or high risk of frailty were males, of advanced age, with pneumonia and sepsis. Internal medicine patients had a higher rate of moderate to high risk of frailty than surgical patients. Patients with moderate or high frailty risk usually experienced more intensive care unit stays and had higher re-admission rates and medical costs. Moreover, high-risk patients had a greater chance of mortality at 30-day/90-day and 1-year intervals than low-risk patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>More than half of older patients admitted to hospitals have a moderate to high risk of frailty. Utilising ICD-10 weights to assess frailty risk is a feasible strategy to reduce the workload of medical personnel and identify patients at risk of frailty at an earlier stage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1120-1126"},"PeriodicalIF":1.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994616","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":"Glomerular disease registry and biobank: design and baseline results.","authors":"Andrew Jeyaruban, Bhadran Bose, Vincent W Lee, Meg Jardine, Amali Mallawaarachchi, Angus Ritchie, Muh-Geot Wong, Angela Makris, Sunil Badve, Amanda Siriwardana, Kenneth Yong, Vlado Perkovic, Sradha Kotwal","doi":"10.1111/imj.70056","DOIUrl":"https://doi.org/10.1111/imj.70056","url":null,"abstract":"<p><p>9 May 2025: This article has been published on Early View in error. The corrected version of the article is under production and will be republished shortly.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963524","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":"Association between serum uric acid levels and galectin-3 in patients with uncomplicated type 2 diabetes","authors":"Funda Yildirim Borazan,&nbsp;Ihsan Ergun,&nbsp;Tuba Candar,&nbsp;Ali Kemal Oguz","doi":"10.1111/imj.70070","DOIUrl":"10.1111/imj.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Serum uric acid (SUA) has been associated with an increased risk of cardiovascular disease (CVD) in both the general population and individuals with type 2 diabetes (T2DM). Identification of high-risk individuals is crucial for the primary prevention of CVD. A growing array of newly discovered biomarkers has been identified for predicting CVD. Galectin-3 (Gal-3) is linked to inflammatory and fibrotic processes and has been suggested as a biomarker in patients with heart failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Our aim is to investigate whether Gal-3 is a marker that may predict the risk of CVD caused by asymptomatic hyperuricemia in patients with uncomplicated T2DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty patients (male/female: 10/10) with T2DM with high SUA levels and 20 controls (male/female: 10/10) matched for age and gender with T2DM with normal SUA levels were involved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SUA and Gal-3 levels exhibited a statistically significant correlation (<i>r</i>_s = 0.33, <i>P</i> = 0.03). Although the high SUA group had higher Gal-3 levels than the normal SUA group, the observed difference did not achieve statistical significance (mean: 18 (95% confidence interval (CI): 10.7–29)) vs 14.4 (95% CI: 10.4–30), <i>P</i> = 0.33)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The present study is the first to show a correlation between the level of SUA and Gal-3 in patients with uncomplicated T2DM. This result suggests that Gal-3 could potentially serve as a marker to predict the risk of CVD in patients with uncomplicated T2DM with high SUA levels.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1169-1173"},"PeriodicalIF":1.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965664","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":"Implementing DPYD genotyping to predict chemotherapy toxicity in Australia: a feasibility study","authors":"Cassandra White,&nbsp;Christine Paul,&nbsp;Esther Liet,&nbsp;Dilshan Kalpage,&nbsp;David Mossman,&nbsp;Andrew Ziolkowski,&nbsp;Stephen Ackland,&nbsp;Rodney J. Scott","doi":"10.1111/imj.16576","DOIUrl":"https://doi.org/10.1111/imj.16576","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Implementing pharmacogenomic-guided management in cancer patients equitably and effectively in a large population presents challenges. <i>DPYD</i> genotyping determines clinically significant variants of patients at increased risk of developing grade3–5 fluoropyrimidine (FP) toxicity. FP chemotherapies are prescribed for ~16,000 Australians with a 10%–40% grade3–4 toxicity incidence and 1% mortality. Variant carriers can have FP dosing adjusted to improve treatment tolerance without compromising anticancer effect. This strategy has not been formally adopted within Australia, despite widespread international standardisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This pilot study determined genotyping turnaround-times (TAT) for 4 <i>DPYD</i> variants (c.1905+1G&gt;A, c.1679T&gt;G, c.2846A&gt;T and c.1236G&gt;A/Haplotype B3) in Australian patients. Secondary objectives were identification of FP toxicities of <i>DPYD</i> variant carriers, and analysis of healthcare stakeholder perspectives, including enablers/barriers to implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Genotyping was determined by Real-Time Polymerase Chain Reaction. Qualitative data were determined through semi-structured questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>104 patients recruited over 24 months had a mean TAT of 7.2 days, 5.2 business days (range 1–30). Grade3–4 toxicity occurred in 9/16 <i>DPYD</i> variant carriers, including 2 ICU admissions and 1 death. Themes from 30 questionnaire respondents suggest that clinical environment and resources were fundamental barriers, and motivation to improve patient care was the predominant enabler of change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p><i>DPYD</i> genotyping is feasible for improving precision-oncology for patients requiring FP chemotherapies. A TAT of 7 days is acceptable by both stakeholder respondents and national oncology clinician groups. This pilot study, although small, informs a large national project evaluating prospective <i>DPYD</i> genotyping and its impact on FP tolerability, patient safety and cost-effectiveness in Australia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"741-748"},"PeriodicalIF":1.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949890","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":"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,&nbsp;Amogh Bhardwaj,&nbsp;Zhi Yi Lim,&nbsp;Venkat N. Vangaveti,&nbsp;Usman H. Malabu,&nbsp;Yong Mong Tan","doi":"10.1111/imj.70058","DOIUrl":"10.1111/imj.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients diagnosed with T1DM between January 2015 and December 2022 were included. Medical and patient data were retrospectively collected and analysed using <span>spss</span>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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, <i>P</i> = 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, <i>P</i> &lt; 0.001). There was no significant difference in DKA incidence at diagnosis with status or titre of antibodies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1136-1145"},"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,&nbsp;Tyler Miluski,&nbsp;Gisoo Ghaffari,&nbsp;Taha Al-Shaikhly","doi":"10.1111/imj.70057","DOIUrl":"10.1111/imj.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study is to characterise the impact of SAL on clinical outcomes of acute cystitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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 <i>Clostridium difficile</i> 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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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; <i>P</i> = 0.003; corrected <i>P</i> = 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; <i>P</i> = 0.001; corrected <i>P</i> = 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 <i>Clostridium difficile</i> infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SAL alters antibiotic prescription practices and is associated with a slightly increased risk of poor outcomes in adult patients with cystitis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"993-1000"},"PeriodicalIF":1.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70057","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":"OA","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,&nbsp;Lorna Pairman,&nbsp;Olivia Clendon,&nbsp;Dali Fan,&nbsp;Matthew Doogue,&nbsp;Paul K. L. Chin","doi":"10.1111/imj.70053","DOIUrl":"10.1111/imj.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The computerised provider order entry (CPOE) system MedChart is going to be the national CPOE system in New Zealand's public hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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, <i>P</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"975-984"},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70053","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":"OA","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}