Internal Medicine Journal最新文献

{"title":"Experience of Australian rheumatologists managing polymyalgia rheumatica: results from a national survey","authors":"Jessica L. Leung,&nbsp;Victor Yang,&nbsp;Jem V. Ninan,&nbsp;Carlee Ruediger,&nbsp;David F. L. Liew,&nbsp;Russell R. C. Buchanan,&nbsp;Helen I. Keen,&nbsp;Catherine L. Hill,&nbsp;Claire E. Owen","doi":"10.1111/imj.70457","DOIUrl":"10.1111/imj.70457","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Polymyalgia rheumatica is the commonest inflammatory condition affecting adults over 50 years of age, however it has been under-researched and management varies in everyday clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This national survey of rheumatologists and trainees managing polymyalgia rheumatica (PMR) in Australia sought to determine current diagnostic and management approaches and establish a baseline for future development of a disease-specific clinical care standard.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following ethics approval, an online survey was circulated to the membership of the Australian Rheumatology Association. Relevant demographic information about respondents was collected, along with answers to multiple-choice questions on the clinical presentation, diagnosis, management and prognosis of PMR. Free-text responses were also permitted at the end of each section. The survey remained open between 25 March 2022 and 11 November 2022. Data analysis involved descriptive statistics for multiple-choice questions and thematic analysis for free-text responses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-nine clinicians completed the survey, of whom the majority were qualified rheumatologists who regularly managed patients with PMR. Most respondents relied upon clinical diagnosis, but some did not recognise peripheral joint involvement or normal inflammatory markers as possible features of PMR. Access to imaging investigations like ¹⁸F-fluorodeoxyglucose positron emission tomography combined with computed tomography was limited but desirable in circumstances of diagnostic uncertainty. Management predominantly involved glucocorticoid monotherapy; however, long-term outcomes were diverse and almost every clinician had prescribed a conventional synthetic DMARD for steroid-sparing purposes. The use of adjunctive physical therapy was inconsistent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Variability remains in the diagnosis and management of PMR among Australian clinicians, with gaps in recognition of atypical presentations, imaging access and incorporation of physical therapy, ultimately supporting the need for standardised, evidence-based clinical care guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1341-1348"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70457","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163130","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":"Are respiratory physicians adherent to guidelines when evaluating pulmonary nodules?","authors":"Laura Tu,&nbsp;Raymond Wong,&nbsp;Amy Baker,&nbsp;Fergal O’Donoghue,&nbsp;Christine F McDonald,&nbsp;Tracy L. Leong","doi":"10.1111/imj.70491","DOIUrl":"10.1111/imj.70491","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although fewer than 1% of pulmonary nodules are malignant, appropriate evaluation is essential in optimising patient outcomes. The 2017 Fleischner Society Guidelines provide recommendations on management of incidentally detected nodules; however, studies to date have shown variable guideline adherence. Adherence to guidelines in Australian nodule clinics has not been reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of medical records was conducted for new patients evaluated in a pulmonary nodule clinic between 1 July 2017 and 1 July 2020. Patient demographics, past medical history, family history of malignancy, smoking history, baseline lung function tests, reasons for referral and lung nodule characteristics were analysed. Follow-up recommendations were evaluated to determine Guideline adherence. Final diagnoses, where available, were extracted from multidisciplinary meeting (MDM) data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three hundred sixty-one patients were included (mean age 68.2 years, female 44.3%). One hundred ten patients (30.5%) were never smokers, 106 (29.3%) current smokers, and 140 (38.8%) former smokers. Most lung nodules were identified incidentally (77.0%) with mean diameter (±SD) 12.1 ± 6.4 mm averaged from the long and short axes. Adherence to guidelines was 97.2%. Ninety-seven patients (26.9%) were diagnosed with malignancy. Among patients diagnosed with lung cancer, former smokers had a higher risk (48.1%, relative risk (RR) 1.8; 95% confidence interval (CI) 1.08–3.1; <i>P</i> = 0.02) of lung cancer than never smokers (20.3%), with current smokers being intermediate in risk (31.6%, RR 1.6; 95% CI 0.96–2.84; <i>P</i> = 0.07).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings from this first-in-Australia study demonstrate appropriate lung nodule follow-up in accordance with Fleischner Society Guidelines in a dedicated respiratory physician-led nodule clinic.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1412-1420"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149765","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 hyperacute intracerebral haemorrhage management: factors influencing timely intervention","authors":"Edmund Proper,&nbsp;Thanh Phan,&nbsp;Henry Ma,&nbsp;Michael Valente","doi":"10.1111/imj.70486","DOIUrl":"10.1111/imj.70486","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bundled-care protocols, which include rapid lowering of blood pressure, have improved functional outcomes in patients with intracranial haemorrhage (ICH). Specifically, the intensive blood pressure reduction in acute cerebral hemmorhage trail (INTERACT) 3 trial aimed to achieve rapid lowering of systolic blood pressure (SBP) to 140 mmHg within an hour of arrival. We analyse factors that influenced the timely delivery of hyperacute ICH management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We aimed to identify the factors that delay the timely delivery of antihypertensive therapies for hyperacute ICH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of acute ICH patients admitted to Monash Health (January–December 2023) was performed to evaluate time to achieve SBP &lt;140 mmHg. A Gamma regression model was used to assess the relationship of predictors, which included patient factors (age, GCS, admission SBP), process factors (times to antihypertensive medication, emergency department (ED) bed, computed tomography (CT) scan), and system factors (Code Stroke status, ED resuscitation bed assignment, care goals). Median times for antihypertensive medication delivery, neurosurgical review, neurosurgical intervention and anticoagulation reversal were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 209 patients (median age 74 (IQR 63–84), GCS 14 (IQR 6–15), National Institute of Health Stroke Severity 13 (interquartile range (IQR) 4–27), admission SBP 160 mmHg (IQR 137.5–187)), 52% were treated as a Code Stroke. Median time to CT was 33 min (IQR 23–47.5) with Code Stroke versus 121 min (IQR 36–254) without. Patients who received non-palliative therapies (74%) achieved SBP &lt; 140 in 193 min (IQR 91–552) and 25% achieved this in 60 min. Higher admission SBP, longer times to ED bed and absence of Code Stroke were associated with increased time to reach 140 mmHg SBP (<i>P</i> &lt; 0.01). Other dependent variables did not reach significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SBP on arrival, delayed access to ED beds and Code Stroke activation were key factors associated with achieving early BP lowering. These findings underscore the need for protocolised, rapid-response systems to optimise ICH management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1394-1401"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217639","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":"Triple combination cystic fibrosis transmembrane receptor modulator effects on glycaemia and insulin kinetics in cystic fibrosis with and without diabetes","authors":"Yi W. Chen,&nbsp;Rachel Prasad,&nbsp;Peter G. Middleton,&nbsp;D. Jane Holmes-Walker","doi":"10.1111/imj.70471","DOIUrl":"10.1111/imj.70471","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Greater insight into the effects of cystic fibrosis (CF) transmembrane modulators such as elexacaftor-tezacaftor-ivacaftor (ETI) on glucose metabolism can support a more dynamic and individualised approach to CF-related dysglycaemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess changes in glycemia, body weight and pulmonary function in adults with CF with and without cystic fibrosis related diabetes (CFRD) following ETI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-centre retrospective cohort study included adults with at least one F508del mutation (23 with CFRD, 38 without CFRD). Exploratory outcomes were HbA1c and total daily insulin doses in the CFRD group and glucose and insulin profiles (0–120 min oral glucose tolerance test [OGTT]), HOMA2-derived indices of insulin resistance (IR), secretion (%S), and β-cell function (%B) in the non-CFRD group. Pulmonary function and weight were assessed in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean age was 33.8 ± 10.0 years (CFRD) and 32.8 ± 8.8 years (non-CFRD), with median ETI exposure of 12.3 and 13.4 months, respectively. In the CFRD cohort, HbA1c decreased non-significantly (6.6% to 6.1%, <i>p</i> = 0.2) with no significant change in insulin dose (0.28 to 0.20 IU/kg/day, <i>p</i> = 0.1). In non-CFRD participants, ETI significantly reduced 1- and 2-hour OGTT glucose levels (9.6 vs. 9.2 mmol/L at 1 h, <i>p</i> &lt; 0.01; 6.1 vs. 4.8 mmol/L at 2 hours, <i>p</i> = 0.01), with 13/38 participants improving OGTT classification; no progression to CFRD occurred. Lung function improved in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adults with at least one F508del mutation, ETI was associated with a clinically relevant reduction in HbA1c in those with CFRD and improved glucose tolerance in those without, supporting favourable metabolic effects beyond established respiratory benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1356-1360"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308010","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":"Australasian chronic lymphocytic leukaemia consensus statement: 2026 update","authors":"Sean McKeague,&nbsp;Joanna Katarzyna Czerwinski,&nbsp;Xavier Badoux,&nbsp;Rory Bennett,&nbsp;Giles Best,&nbsp;Nicole Chia,&nbsp;Tara Cochrane,&nbsp;Kyle Crassini,&nbsp;Gavin Cull,&nbsp;Pietro Di Ciaccio,&nbsp;Pasquale Fedele,&nbsp;Rosemary Harrup,&nbsp;Sharon Jackson,&nbsp;Bryone Kuss,&nbsp;Masa Lasica,&nbsp;Denise Lee,&nbsp;Thomas Lew,&nbsp;Paula Marlton,&nbsp;Monique Menzies Wojtowicz,&nbsp;Stephen Opat,&nbsp;Sumita Ratnasingam,&nbsp;John Francis Seymour,&nbsp;Dipti Talaulikar,&nbsp;Constantine Si Lun Tam,&nbsp;Robert Weinkove,&nbsp;Joel Wight,&nbsp;Stephen Mulligan,&nbsp;Mary Ann Anderson","doi":"10.1111/imj.70503","DOIUrl":"10.1111/imj.70503","url":null,"abstract":"<p>In 2023, a consensus statement on the diagnosis and management of chronic lymphocytic leukaemia (CLL) in Australasia was published. Since then, advances in clinical evidence and increased availability of molecular diagnostics and targeted therapies have further influenced contemporary CLL management. This paper provides an expert consensus update to the 2023 statement, offering current, regionally relevant guidance on the diagnosis, risk stratification and management of CLL, including treatment selection, sequencing of therapy, management of complications and supportive care. Recommendations were developed through a structured consensus process involving Australian and New Zealand clinicians with expertise in CLL and are endorsed by the Australasian Lymphoma Alliance, the Australasian Leukaemia and Lymphoma Group CLL Working Party and the Haematology Society of Australia and New Zealand. Levels of evidence and grades of recommendation were assigned using the Grading of Recommendations Assessment, Development and Evaluation framework.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1421-1428"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70503","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396642","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":"The trend of obesity and inflammatory bowel disease in Australia and New Zealand: a bi-nation cohort study","authors":"Patricia Kaazan,&nbsp;Warren Seow,&nbsp;Bill Wilson,&nbsp;Susan J Connor,&nbsp;Jane M Andrews","doi":"10.1111/imj.70454","DOIUrl":"10.1111/imj.70454","url":null,"abstract":"<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":"56 8","pages":"1429-1432"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70454","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous positive airway pressure usage before and after issue of an urgent product defect correction notice following a global Philips recall","authors":"Kirra Liu,&nbsp;Christopher Worsnop,&nbsp;Julie Tolson,&nbsp;Thomas Churchward","doi":"10.1111/imj.70437","DOIUrl":"10.1111/imj.70437","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Following the global recall of three to four million Philips continuous positive airway pressure (CPAP) devices in 2021 due to emissions of harmful products, the Therapeutic Goods Administration (TGA) issued guidance recommending continuing usage, stating discontinuing treatment could be immediately harmful. At the time of the recall, Philips devices were exclusively utilised in the subsidised CPAP programme at Austin Health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aims to evaluate the mean nightly usage of affected Philips CPAP devices before and after the TGA notice. (<i>Hypothesis</i>: Our hypothesis is that mean nightly usage of affected Philips CPAP devices decreased after the TGA notice.)</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Automatically uploaded nightly CPAP usage data from a single centre 6 months prior to the TGA notice was compared with the data 6 months after using a paired <i>t</i>-test analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 629 Philips pumps issued in the period before the TGA notice. Usage data were available from 368 devices. Of these, 30 devices had no usage data after the notice. The average Apnoea-Hypopnea Index was 47.7 (±25.7). Mean usage over the 6 months prior to the notice decreased by 1.33 h (±2.14) from 5.56 (±2.45) h/night to 4.23 (±3.08) with a 95% confidence interval (CI) (1.11, 1.55), <i>P</i> &lt; 0.001. There was a large effect size (Cohen's <i>d</i> = 2.14).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The TGA notice was associated with decreased mean nightly CPAP usage. Possibly due to concerns regarding inhalation of toxic compounds or coincidental reasons. Decreased use has implications for participant health, with function normalisation predicted with increased duration of use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1332-1340"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143297","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":"Geographical variability in dabigatran dosing within New Zealand","authors":"Liam T. Berryman,&nbsp;Paul K. L. Chin,&nbsp;Lorna J. Pairman,&nbsp;Milan Sundermann,&nbsp;Matthew Doogue","doi":"10.1111/imj.70477","DOIUrl":"10.1111/imj.70477","url":null,"abstract":"<p>Dabigatran etexilate is an oral anticoagulant with increased risk of bleeding at high drug exposure. It is available in three capsule strengths (75, 110 and 150 mg). We analysed New Zealand dispensing data from 2019 to 2023 to compare use between health districts. Overall use was similar across districts. Canterbury had the highest 75 mg use (22.2 vs 1.6–7.6 people per 10 000 in the other districts). This relates to differences in local guidelines, therapeutic drug monitoring and availability of clinical pharmacology services. It is unknown if there are differences in patient outcomes.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1433-1437"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70477","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015168","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":"Demographic, perioperative, biochemical and illness-severity predictors of thirst in critically ill patients: a systematic review and meta-analysis","authors":"Xiaokun Shen,&nbsp;Xiaohong Lei,&nbsp;Yu Chen,&nbsp;Lihua Liu","doi":"10.1111/imj.70440","DOIUrl":"10.1111/imj.70440","url":null,"abstract":"<p>Thirst is a prevalent and distressing symptom among critically ill and surgical patients, yet its predictors remain poorly characterised. We aimed to quantify the associations between patient demographics, treatment modalities, biochemical markers and illness severity with self-reported thirst in critical settings. We conducted a systematic review and meta-analysis of studies published through April 2025 in PubMed, Embase, Web of Science, Cochrane Library and Ovid MEDLINE. Eligible observational studies in adult intensive care or perioperative cohorts reported associations between thirst and at least one of six factors: sex, anaesthetic technique, mechanical ventilation, blood urea nitrogen (BUN), serum osmolality or Acute Physiology and Chronic Health Evaluation (APACHE-II) score. Data were pooled using DerSimonian–Laird random-effects models to estimate odds ratios (ORs) for dichotomous predictors and weighted or standardised mean differences (WMDs/SMDs) for continuous variables. Heterogeneity was assessed by <i>I</i>². Fifteen studies (<i>n</i> = 11 657) met inclusion criteria. Sex (OR = 1.04 (95% confidence interval (CI): 0.95–1.14) <i>I</i>² = 0%) and mechanical ventilation (OR = 1.36 (95% CI: 0.91–2.05) <i>I</i>² = 63%) were not significantly associated with thirst. Anaesthetic technique (OR = 1.43 (95% CI: 0.97–1.89); <i>P</i> &lt; 0.001; <i>I</i>² = 57%). APACHE-II score (WMD = 0.24 points (95% CI: −0.55 to 1.04); <i>I</i>² = 26%) and BUN (SMD = 0.27 (95% CI: −0.11 to 0.65); <i>I</i>² = 84%) showed no significant effects. Serum osmolality exhibited the strongest relationship, with a mean elevation of 3.04 mOsm/kg in thirsty patients (95% CI: 0.15–5.93 (<i>P</i> = 0.039); <i>I</i>² = 85%). Among the factors examined, elevated serum osmolality most reliably predicts patient-reported thirst. Incorporating osmolality-guided monitoring and tailored oral-care protocols into critical-care pathways may help pre-empt and alleviate thirst, enhancing patient comfort in high-acuity environments.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1301-1313"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70440","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163109","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":"Clinical approach to neurological paraneoplastic syndromes","authors":"Neil E. Anderson","doi":"10.1111/imj.70500","DOIUrl":"10.1111/imj.70500","url":null,"abstract":"<p>Neurological paraneoplastic syndromes are immune-mediated disorders. The diagnosis of paraneoplastic syndromes is often difficult because they are rare and the onset of symptoms usually precedes detection of the underlying malignancy. Accurate diagnosis depends on recognition of the clinical phenotypes likely to be associated with a paraneoplastic aetiology and detection of an anti-neuronal antibody. Clinical phenotypes associated with a high risk of a paraneoplastic cause are limbic encephalitis, encephalomyelitis, rapidly progressive cerebellar syndrome, opsoclonus-myoclonus syndrome, subacute sensory neuronopathy, enteric neuropathy and Lambert Eaton myasthenic syndrome. Clinical phenotypes with an intermediate risk of a paraneoplastic aetiology are brainstem encephalitis, myelopathy, stiff person syndrome, Morvan syndrome and retinopathy. Anti-neuronal antibodies are extremely useful in the diagnosis of paraneoplastic neurological syndromes, but false-negative results can occur when only serum or cerebrospinal fluid (CSF) is tested. Commercial antibody panels do not include all antibodies associated with paraneoplastic syndromes, and if this diagnosis is strongly suspected, serum and CSF should be sent to a research laboratory. The risk of a false-positive result is increased if antibody tests are requested when there is a low pre-test probability of a paraneoplastic syndrome or if an antibody is detected in low titre.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1314-1322"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70500","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470251","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}