Internal Medicine Journal最新文献_第2页

Shorter-term and longer-term mortality prediction in the Australian Diabetes, Obesity and Lifestyle (AusDiab) study.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-25 DOI: 10.1111/imj.70015

Dunya Tomic, Agus Salim, Elizabeth L M Barr, Paul Z Zimmet, Dianna J Magliano, Jonathan E Shaw

{"title":"Shorter-term and longer-term mortality prediction in the Australian Diabetes, Obesity and Lifestyle (AusDiab) study.","authors":"Dunya Tomic, Agus Salim, Elizabeth L M Barr, Paul Z Zimmet, Dianna J Magliano, Jonathan E Shaw","doi":"10.1111/imj.70015","DOIUrl":"https://doi.org/10.1111/imj.70015","url":null,"abstract":"Background: While identification of key risk factors for mortality has contributed to advances in healthcare, the effect of these risk factors in predicting mortality over different time horizons remains unclear.Aims: We sought to determine how risk factors predicted shorter-term and longer-term mortality across the age spectrum in adults.Methods: We used data from 11 247 adults of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Cox multivariable regression models were used to estimate hazard ratios (HRs) of shorter-term (0-10 years) and longer-term (10-20 years) all-cause and cardiovascular disease (CVD)-related mortality associated with risk factors. Models with interaction between baseline age and each risk factor were also fitted.Results: During a 20-year follow-up, 2185 deaths occurred. Smoking, diabetes, male sex and albuminuria all independently predicted shorter- and longer-term all-cause and CVD mortality. Most associations were stronger in the shorter term compared to the longer term. A notable exception was the association between smoking and CVD mortality, which was stronger in the longer term (HR 3.55, 95% confidence interval (CI) 2.57-4.90) compared to the shorter term (HR 2.06, 95% CI 1.33-3.20). The magnitude of association between most risk factors and mortality attenuated with age.Conclusions: Classical risk factors for total and CVD mortality remain important up to 20 years after their measurement. In unselected adult cohorts, longer-term follow-up (e.g. beyond 10 years) may not provide additional information on associations of risk factors with mortality beyond that obtained in shorter-term follow-up.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700385","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}

引用次数: 0

Echocardiography in diagnosing ovarian carcinoid: linking tricuspid valve dysfunction, elevated gastrin and Gallium-68 DOTATATE positron emission tomography.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-25 DOI: 10.1111/imj.70046

Mehmet R Sonsöz, Duygu Inan, Gulden Güven, Alev Kılıçgedik

引用次数: 0

Secondary prevention of coronary heart disease in Aboriginal and Torres Strait Islander people in primary care.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-24 DOI: 10.1111/imj.70025

Edwina Wing-Lun, Simone Marschner, Desi Quintans, Sean Taylor, Jakelin Troy, Clara Chow, Sarah Zaman

{"title":"Secondary prevention of coronary heart disease in Aboriginal and Torres Strait Islander people in primary care.","authors":"Edwina Wing-Lun, Simone Marschner, Desi Quintans, Sean Taylor, Jakelin Troy, Clara Chow, Sarah Zaman","doi":"10.1111/imj.70025","DOIUrl":"https://doi.org/10.1111/imj.70025","url":null,"abstract":"Background: Coronary heart disease (CHD) is the primary cause of mortality in Australia and the largest contributor to the 'gap' in cardiovascular disease deaths between Aboriginal and Torres Strait Islander (First Nations) people and non-indigenous Australians.Aim: To assess secondary prevention of CHD in First Nations people in primary care in Australia.Methods: Retrospective cohort study of patients with CHD under active primary care management using electronic medical records from 406 general practices across Australia. Ultimately, 50 088 people with CHD were included in the study, and 3.5% of those were First Nations people. After 5.9 years (standard deviation 5.0) in primary care adjusting for gender, age, remoteness, comorbidities, smoking status and continuity of care, First Nations peoples received equal statin (adjusted odds ratio (aOR): 0.9; 95% CI:0.8-1.1, P = 0.28), angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists (aOR:1.0; 95% CI:0.9-1.2, P = 0.85) and beta blockers (aOR:0.9;95% CI:0.8-1.1, P = 0.41) prescriptions. First Nations peoples were more likely to achieve BP <1.8 in similar proportions (35.2% vs 36.9%, P = 0.16) but less likely to have HDL-C >1.0 mmol/L (57.5% vs 73.7%, P < 0.001), triglycerides<2.0 mmol/L (61.7% vs 76.0%, P < 0.001) and HbA1C ≤ 53 mmol/mol (7.0%) (67.7% vs 82.1%, P < 0.001). A higher proportion of First Nations people had HbA1c measured (75.7% vs 66.6%, P < 0.001).Conclusion: First Nations peoples with CHD under active primary care management received similar secondary prevention medications and achieved BP and LDL-C targets as frequently as non-indigenous Australians. A focus on easier access to facilitate attending primary care is needed to close the gap as well as addressing social determinants of health and structural inequities.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700384","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}

引用次数: 0

Utilisation of mobile X-ray services by residents of long-term care facilities.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-24 DOI: 10.1111/imj.70034

Maria C Inacio, Robert N Jorissen, Virginie Gaget, David R Tivey, Joanne Dollard, Renuka Visvanathan, Guy J Maddern

{"title":"Utilisation of mobile X-ray services by residents of long-term care facilities.","authors":"Maria C Inacio, Robert N Jorissen, Virginie Gaget, David R Tivey, Joanne Dollard, Renuka Visvanathan, Guy J Maddern","doi":"10.1111/imj.70034","DOIUrl":"https://doi.org/10.1111/imj.70034","url":null,"abstract":"Background: Access to mobile X-ray imaging (MXR) by long-term care facility (LTCF) residents could potentially reduce emergency department transfers. To encourage MXR use, the Australian Government Medicare Benefits Schedule introduced an MXR service subsidy in November 2019.Aims: To examine the (i) MXR utilisation rate in LTCFs between 1 November 2019 and 30 June 2020; and (ii) individual and LTCF characteristics associated with accessing MXR compared to community-based X-rays.Methods: A cross-sectional study of non-indigenous LTCF residents, ≥65 years old, between 1 November 2019 and 30 June 2020 in five geographical regions was conducted. Access to mobile and community-based X-rays was the outcome of interest. Descriptive statistics and monthly sex- and age-standardised utilisation rates were employed. Characteristics associated with the X-ray type accessed were estimated using generalised estimating equation logistic regression models.Results: 149 389 LTCF episodes, by 127 002 individuals, in 1449 facilities were studied. The median age of the studied individuals was 85 years (interquartile range 79-90) and 63.4% (n = 94 692) were women. There were 5458 (3.7%) episodes that accessed an MXR service. MXR usage increased 75%, from 6.6/1000 (95% confidence interval (CI) 6.1-7.2) to 11.6/1000 (95% CI 10.9-12.3) person-months over the study period. Compared to community-based X-ray recipients, MXR recipients were older, more likely to have dementia, but less likely to have a higher number of health conditions, be in transition or respite care, be in a not-for-profit LTCF and be outside a major city.Conclusions: A small but increasing use of government-subsidised MXR services was observed. Individuals accessing MXRs are those that likely benefit most from them. LTCF differences in service utilisation indicate gaps in service access.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692172","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}

引用次数: 0

Large language model-supported interactive case-based learning: a pilot study.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-24 DOI: 10.1111/imj.70030

Haelynn Gim, Benjamin Cook, Jasmin Le, Brandon Stretton, Christina Gao, Aashray Gupta, Joshua Kovoor, Christina Guo, Matthew Arnold, Galina Gheihman, Stephen Bacchi

引用次数: 0

Impact of a multidisciplinary team model on discharge efficiency and accuracy in internal medicine resident teams.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-22 DOI: 10.1111/imj.70033

Christina Chong, Travis Watai, Jatinder Lachar, Yoshito Nishimura

{"title":"Impact of a multidisciplinary team model on discharge efficiency and accuracy in internal medicine resident teams.","authors":"Christina Chong, Travis Watai, Jatinder Lachar, Yoshito Nishimura","doi":"10.1111/imj.70033","DOIUrl":"https://doi.org/10.1111/imj.70033","url":null,"abstract":"Background: Efficient discharge planning is crucial for improving hospital capacity and patient care. Multidisciplinary rounds (MDRs) have been shown to enhance communication and coordination, yet their impact on resident teaching teams' discharge efficiency is less studied.Aims: To examine how embedding dedicated case managers (CMs) and social workers (SWs) into internal medicine (IM) resident teams impacts discharge efficiency.Methods: We conducted a retrospective cross-sectional study at The Queen's Medical Center comparing two resident multidisciplinary teaching (MDT) teams that included dedicated CMs and SWs with two resident standard care teams over an 8-month period (October 18 2023-June 25 2024). The outcomes assessed included length of stay (LOS), expected discharge date (EDD) accuracy, readmission rates and the rate of conditional discharge orders placed.Results: A total of 1944 patients were included. The MDT teams showed significantly improved EDD accuracy (72.0% vs 66.7%, P = 0.0120) and more frequently placed conditional discharge orders (61.7% vs 43.8%, P < 0.0001) compared to standard care teams. No significant difference was observed in LOS or readmission rates.Conclusion: Embedding dedicated CMs and SWs within resident teams improved EDD accuracy and the rate of conditional discharge orders placed, suggesting an opportunity to integrate MDRs as a standard within IM residency training to enhance discharge planning efficiency.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676564","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}

引用次数: 0

Characteristics of Australian and New Zealand patients with chronic lymphocytic leukaemia: a lymphoma and related diseases registry report.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-21 DOI: 10.1111/imj.70037

Arina Martynchyk, Cameron Wellard, Eliza Chung, Simran K Bhopal, Zoe K McQuilten, Stephen P Mulligan, Stephen Opat, Erica M Wood, Eliza A Hawkes, Mary A Anderson

{"title":"Characteristics of Australian and New Zealand patients with chronic lymphocytic leukaemia: a lymphoma and related diseases registry report.","authors":"Arina Martynchyk, Cameron Wellard, Eliza Chung, Simran K Bhopal, Zoe K McQuilten, Stephen P Mulligan, Stephen Opat, Erica M Wood, Eliza A Hawkes, Mary A Anderson","doi":"10.1111/imj.70037","DOIUrl":"https://doi.org/10.1111/imj.70037","url":null,"abstract":"Background: Treatment of chronic lymphocytic leukaemia (CLL) has evolved significantly with the advent of targeted agents. Real-world analysis of patients with CLL provides a better understanding of treatment efficacy and toxicity and informs planning of future trials; however, Australasian studies are limited.Aims: Here we describe the demographics, disease characteristics, treatment and outcome for CLL patients enrolled in the Australia and New Zealand Lymphoma and Related Diseases Registry (LaRDR).Methods: This study included 365 patients aged ≥18 years with CLL diagnosed between January 2016 and May 2023.Results: Median age at diagnosis was 68 years, with 65% being male. Median follow-up was 15.2 months (range 0-78). 11q, 13q, 17p deletions and trisomy 12 were detected in 12%, 54%, 11% and 14% respectively. During the period of follow-up, 38% of patients commenced first-line therapy. The use of Bruton's Tyrosine Kinase inhibitors and B-cell lymphoma 2 inhibitors increased more than 10-fold following regulatory approval in 2020. Two-year progression-free and overall survival, measured from commencement of first-line therapy, were 67% (95% CI 55-76) and 87% (95% CI 78-93) respectively.Conclusion: The increasing use of targeted agents largely reflected availability; however, continuing use of chemoimmunotherapy following regulatory approval of targeted agents was noted in 29% of patients in 2022.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673845","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}

引用次数: 0

Survivorship following myocardial infarction in a contemporary Australian cohort: defining cardiac versus non-cardiac mortality.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-20 DOI: 10.1111/imj.70027

James Nguyen, Nicole Chan, Christopher Hammett, Peter Stewart, William Vollbon, Michael Mallouhi, John J Atherton, Sandhir B Prasad

{"title":"Survivorship following myocardial infarction in a contemporary Australian cohort: defining cardiac versus non-cardiac mortality.","authors":"James Nguyen, Nicole Chan, Christopher Hammett, Peter Stewart, William Vollbon, Michael Mallouhi, John J Atherton, Sandhir B Prasad","doi":"10.1111/imj.70027","DOIUrl":"https://doi.org/10.1111/imj.70027","url":null,"abstract":"Background and aims: Progress in the management of myocardial infarction (MI) has led to reductions in cardiac mortality. The aim of this study was to describe the temporal trends in the relative proportions of cardiac death (CD) and non-cardiac death (NCD) in an Australian cohort with MI following in-hospital stay, then at 6 and 12 months as well as long-term follow-up.Methods: Retrospective study at a single large tertiary referral hospital in Queensland. Outcome data were obtained from the state births/deaths/marriages registry. A total of 3464 consecutive patients with MI were included.Results: The mean age of patients was 63.3 ± 13.8 years, 70.6% were males, and 28.2% were ST-elevation MIs. At a median follow-up of 4.5 years, there were 551 deaths (15.9%), with 200 (5.8%) classified as CD, 332 (9.6%) classified as NCD and 20 (0.5%) classified as indeterminate. In-hospital death occurred in 75 patients (2.2%). The relative proportions of cumulative CD to NCD in those with classifiable deaths (CD:NCD ratio) following in-hospital stay, then at 6, 12 and 18 months as well as long-term follow-up were: 79%:21%, 62%:38%, 53%:47% and 38%:62% respectively. Of those patients who survived their index hospitalisation, subsequent cardiac deaths accounted for only 29.7% of total deaths.Conclusions: NCD outstrips CD at long-term follow-up in contemporary patients with MI, with the majority of deaths beyond hospital discharge attributable to NCD. The long-term risk of residual cardiac mortality was less than 30% in hospital survivors. Similar to considering the impact of cardiac events in cancer survivorship, the burden of non-cardiac events in MI survivorship needs to be considered.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663170","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}

引用次数: 0

Dying at home: a prospective comparative study of home death rates in a private health insured palliative care community programme.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-20 DOI: 10.1111/imj.70031

Dominic Eu, Amanda Fischer, Alison Griffin, Matthew Lancaster, Phillip Good

{"title":"Dying at home: a prospective comparative study of home death rates in a private health insured palliative care community programme.","authors":"Dominic Eu, Amanda Fischer, Alison Griffin, Matthew Lancaster, Phillip Good","doi":"10.1111/imj.70031","DOIUrl":"https://doi.org/10.1111/imj.70031","url":null,"abstract":"Background: Despite preferring end-of-life care at home, only a small percentage of deaths in Australia occur in private homes.Aim: This study evaluates a private health insurance-funded support programme (provided in addition to the standard level of community palliative care), the rates of home death, the percentage of patients who died in their preferred location and the satisfaction with the care provided.Methods: This prospective study enrolled patients in two cohorts: the Medibank cohort (with private health insurance, a prognosis of less than 3 months, a preference for home death) and the standard cohort (publicly funded patients, with no limitation to prognosis or preferred place of death). Demographics and preferences for place of death were collected.Results: The first 12 months of the study are reported here with 132 patients (Medibank cohort, n = 67; standard cohort, n = 65). Medibank patients that died had significantly shorter contact with the service compared with the standard cohort (median 13.5 days vs 39 days), a higher home death rate (79% vs 44%) and a higher rate of preference for a home death (97% vs 59%). The proportion of deaths in the patients' preferred location was similar for both groups.Conclusion: The high home death rate observed in the Medibank cohort highlights the potential benefit of enhanced palliative care support at the end of life. This support should be dedicated, accessible and resourced with in-home nursing assistance and allied health interventions.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663169","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}

引用次数: 0

Central nervous system tuberculosis in Western Sydney: a 10-year retrospective cohort study.

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-03-19 DOI: 10.1111/imj.70017

Hayden Zhang, Tasnim Hasan, Ravindra Dotel, Evan Ulbricht, Nicole Gilroy, Susan Maddocks

{"title":"Central nervous system tuberculosis in Western Sydney: a 10-year retrospective cohort study.","authors":"Hayden Zhang, Tasnim Hasan, Ravindra Dotel, Evan Ulbricht, Nicole Gilroy, Susan Maddocks","doi":"10.1111/imj.70017","DOIUrl":"https://doi.org/10.1111/imj.70017","url":null,"abstract":"Background: Central nervous system tuberculosis (CNS-TB) is a rare complication of tuberculosis. There is a lack of data surrounding investigation and management of this in Australia.Aim: To review CNS-TB cases in Western Sydney, Australia, and understand the epidemiology, investigation, diagnosis, management and outcomes in a low-prevalence setting.Methods: Retrospective cohort study of all CNS-TB patients managed in Western Sydney from 2013 to 2022. Demographics, risk factors, clinical presentation, investigations and management were reviewed. Clinical outcomes like hospital length-of-stay, adverse drug reactions, paradoxical reactions, functional disability and treatment outcomes, including cure, treatment failure, loss to follow-up and death, were also measured.Results: Thirty-nine CNS-TB cases were identified, with 16 (41%) confirmed by nucleic acid amplification test or culture of CNS specimens and 23 (59%) diagnosed presumptively without CNS microbiological confirmation. The median age was 32 years. Thirty-seven (95%) were overseas-born; 27 (69%) had no comorbidities. Presenting symptoms included fever (82%), headache (64%) and weight loss (51%). Twenty-five (64%) used fluoroquinolones and nine (23%) used high-dose rifampicin. Steroids were used in all patients. Six (15%) were prescribed aspirin for primary stroke prevention. Twenty-eight (73%) completed treatment, with one requiring re-treatment for presumed treatment failure. Six (15%) were lost to follow-up, and five (13%) died during their treatment course. Twenty-one (54%) experienced an adverse drug reaction.Conclusion: Tuberculosis is an ongoing public health issue in Australia, with CNS-TB being its most devastating form, and all clinicians to be aware of this rare complication. The efficacy of newer treatment options requires further study.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657184","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}

引用次数: 0