Internal Medicine Journal最新文献

{"title":"Charting the course: a scoping review on telehealth research trends in Australia.","authors":"Alasdair Leslie, Ahan Majmudar, Isabella Semaan, Dana Spajic, Oliver Mountain, Brandon Stretton, Joshua Kovoor, Aashray Gupta, Stephen Bacchi","doi":"10.1111/imj.16601","DOIUrl":"https://doi.org/10.1111/imj.16601","url":null,"abstract":"<p><p>This review of telehealth research describes the landscape of Australian digital health and telehealth research from 1999 to 2022, focusing on outlining past, present and future trends. A scoping review was conducted using the Joanna Briggs Institute methodology and PRISMA extension for scoping reviews framework, which identified 495 primary research studies of digital or telehealth interventions aimed at improving health outcomes. Data were charted according to technological modality, health focus, professional representation, participant location, year and size. Findings demonstrated are as follows: increase in the volume and rate of publications over time; over-representation of participants from Australia's east coast; key focus areas of mental health and primary care; live video conferencing as the dominant emerging technology modality; and audio-only interventions remain highly relevant. Despite increasing interest in digital and telehealth interventions, the rural and remote populations that stand to benefit the greatest are under-represented in the literature. Future research should focus on these groups, using both emerging and established technologies, and digital and telehealth interventions should be adopted by a wider breadth of health professions.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the COVID-19 pandemic on hospital presentations in adults with gastrointestinal infections at a tertiary centre in Australia.","authors":"Max Gottlieb, Philip Jakanovski, Sam Harding-Forrester, Alexander Mitchell, Sue Liu, Eva Zhang, Aysha Al-Ani, Jonathan Segal, Britt Christensen","doi":"10.1111/imj.16597","DOIUrl":"https://doi.org/10.1111/imj.16597","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic resulted in the enactment of substantial public health measures aimed at reducing the transmission of respiratory viruses. The impact of these measures on gastrointestinal (GI) infections remains unexplored.</p><p><strong>Aims: </strong>To determine whether there was a change in the number of patients presenting to The Royal Melbourne Hospital with GI infections during the COVID-19 pandemic compared to the year prior.</p><p><strong>Methods: </strong>We conducted a retrospective, single-centre case-control study comparing the incidence and characteristics of hospitalisations with GI infections from March to August 2019 and across the same months in 2020, corresponding to periods immediately prior to and during the COVID pandemic.</p><p><strong>Results: </strong>Of 430 presentations with GI infections across both time periods, there was a 51.9% decrease in hospitalisations with GI infections during the pandemic. Patients admitted during the pandemic were more likely to be admitted to the intensive care unit (0.71% vs 3.4%, P < 0.04) and to be prescribed antibiotics (21.9% vs 36.1%, P < 0.01). Length of stay and mortality were unchanged. There was a decline in the number and proportion of patients with positive faecal cultures in 2020, primarily attributed to a significant reduction in Norovirus cases (28% vs 4%) (odds ratio (OR) = 0.093, P < 0.01). Conversely, the proportion of patients presenting with Clostridioides difficile was higher in 2020 (22% vs 44%) (OR = 2.4, P = 0.01).</p><p><strong>Conclusion: </strong>There was a substantial decrease in hospital admissions with GI infections, particularly Norovirus, during the COVID-19 pandemic. Admissions because of Clostridioides increased. Stringent public health measures reducing interpersonal contact and increased antibiotic prescribing respectively may explain these changes, while an increased reluctance to seek medical care may also have contributed to the sharp overall decrease in hospitalisations.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854091","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":"Prevalence of heart failure pharmacotherapy utilisation, frailty and adverse drug events among hospitalised adults older than 75 years: a multicentre cross-sectional study.","authors":"Mai H Duong, Danijela Gnjidic, Andrew J McLachlan, Kevin Winardi, Alexandra A Bennett, Fiona Blyth, David Le Couteur, Sarah N Hilmer","doi":"10.1111/imj.16612","DOIUrl":"https://doi.org/10.1111/imj.16612","url":null,"abstract":"<p><strong>Background: </strong>Optimal heart failure (HF) pharmacotherapy (guideline-directed medical therapy and diuretics) in older people with frailty is uncertain due to limited evidence.</p><p><strong>Aims: </strong>To evaluate utilisation of HF pharmacotherapy and prevalence of polypharmacy, adverse drug events (ADEs), falls, delirium, renal impairment and duration of hospitalisation in older inpatients, according to frailty.</p><p><strong>Methods: </strong>A retrospective cross-sectional study of the TO HOME cohort of 2000 inpatients ≥75 years admitted for ≥48 h to rehabilitation, geriatric or general medicine from 1 July 2016 to 30 June 2017 across six hospitals in Sydney, Australia. Data were collected from electronic medical records. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification identified HF diagnosis, ADEs and frailty using hospital frailty risk score. Outcomes included utilisation of HF pharmacotherapy; polypharmacy; ADEs, falls, delirium, renal and impairment; and duration of hospitalisation.</p><p><strong>Results: </strong>Among 439 (22.0% of TO HOME cohort) patients with undifferentiated HF, 284 (69.5%) had intermediate or high risk of frailty, and 412 (94%) took ≥1 HF pharmacotherapy, with 357 (81.3%) patients on loop diuretics. Patients with high frailty risk frequently continued beta-blockers (70%) and discontinued renin-angiotensin system inhibitors (57%). Most patients experienced polypharmacy (n = 426, 97.0%). Renal impairment prevalence was 67%-76% across frailty groups. Increasing frailty risk (low, intermediate and high) was associated with increasing prevalence of ADEs (31%, 56% and 84%), falls (12%, 25% and 46%) and delirium (8%, 27% and 49%) and longer hospitalisation.</p><p><strong>Conclusions: </strong>Frailty, HF-pharmacotherapy changes in hospital and ADEs were common among older inpatients with HF. The association of adverse outcomes according to frailty needs further investigation. Poor documentation of HF phenotype may be a barrier to medication optimisation in older inpatients.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854088","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":"Kidney transplant outcomes of Māori and Pasifika people receiving transplantation in Australia: an Australia and New Zealand Dialysis and Transplant Registry study.","authors":"Laura De Souza, Dev Jegatheesan, Kuinileti Chang-Wai, David W Johnson, Scott B Campbell, Andrea K Viecelli, Yeoungjee Cho, Ryan Gately, Nicole Isbel","doi":"10.1111/imj.16606","DOIUrl":"https://doi.org/10.1111/imj.16606","url":null,"abstract":"<p><strong>Background: </strong>The numbers of Māori and Pasifika peoples with kidney failure living in Australia are rising. However, data describing outcomes of those proceeding to transplantation are limited. This study describes clinical outcomes of Māori and Pasifika peoples who received a kidney transplant in Australia.</p><p><strong>Aims: </strong>This study describes clinical outcomes of Maori and Pasifika peoples who received a kidney transplant in Australia.</p><p><strong>Methods: </strong>A retrospective review was conducted of kidney transplant recipients aged ≥18 years receiving their first graft between 1 January 2002 and 31 December 2021, as recorded in the Australia and New Zealand Dialysis and Transplant Registry. The primary outcome was death-censored graft survival. Secondary outcomes included delayed graft function (DGF), rejection and patient survival.</p><p><strong>Results: </strong>Of 12 543 transplant recipients, mean age was 50 years and the majority identified as male sex. A total of 89 patients identified as Māori and 313 as Pasifika. Māori and Pasifika patients were more likely to have diabetic kidney disease or obesity at time of transplantation (body mass index > 30 kg/m²) and be current or former smokers compared to other ethnicities. Times to graft loss were shorter for Māori (adjusted hazard ratio (HR) 2.06, 95% confidence interval (CI) 1.36-3.11) and Pasifika (adjusted HR 1.78, 95% CI 1.39-2.029, P < 0.001) people compared to other ethnicities. The incidences of DGF were significantly higher in the Māori (30%) and Pasifika groups (28%) compared with 22% for other ethnicities (P < 0.005). Overall patient survival was comparable (Māori HR 0.93, 95% CI 0.57-1.49, P = 0.75; Pasifika HR 1.18, Cl 0.88-1.60, P = 0.26).</p><p><strong>Conclusions: </strong>Times to graft loss for Māori and Pasifika kidney transplant patients were shorter than for other ethnicities.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854156","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":"Ownership of genomic data.","authors":"Jane Nielsen, Carolyn Johnston","doi":"10.1111/imj.16573","DOIUrl":"https://doi.org/10.1111/imj.16573","url":null,"abstract":"<p><p>This article considers claims to ownership over genomic data and implications for data sharing and research. There are various arguments for vesting ownership in individuals, but little supporting authority. However, policies such as privacy law and informed consent provide alternative methods of protecting individuals. The conclusions highlight the importance of clear channels of communication with patients.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824289","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":"Statewide neurology inpatient whole body and brain 18F-fluorodeoxyglucose positron emission tomography utilisation patterns demonstrate avenues for optimisation.","authors":"Rudy Goh, Jamie Bellinge, Haelynn Gim, Sarah Howson, Shaddy El-Masri, James Triplett, Wilson Vallat, Sandy Patel, Stephen Bacchi","doi":"10.1111/imj.16598","DOIUrl":"https://doi.org/10.1111/imj.16598","url":null,"abstract":"<p><p>18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) can provide unique insights; however, access may be difficult. In this 2-year statewide study of all neurology inpatient admissions, 27.9% (41/147) of PET (any field of view) demonstrated significant abnormalities. At sites without on-site PET access, the proportion of patients receiving PET was lower (P < 0.01), and the time from admission to receiving PET was longer (P = 0.018), as compared to those with on-site access. Investigation of strategies to improve access is warranted.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824309","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":"Comparison of cardiovascular risk prediction in type 1 diabetes: an Australian viewpoint.","authors":"Savindi Wimalarathne, Yuhan A Goh, P Gerry Fegan, Bu B Yeap, Nick S R Lan","doi":"10.1111/imj.16599","DOIUrl":"https://doi.org/10.1111/imj.16599","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) is a significant burden in individuals with type 1 diabetes mellitus (T1DM). Yet the optimal method of CVD risk stratification remains uncertain. We found that the new Australian CVD risk calculator could overestimate risk category compared with the Steno Type 1 Risk Engine and underestimate risk category compared with the new Swedish/Scottish prediction tool, both of which were validated for T1DM. More research is needed to derive a CVD risk assessment pathway for individuals with T1DM in Australia.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824279","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":"Characteristics of paracetamol poisoning in a local health network and consistency of hospital management with national guidelines.","authors":"Simon P Hurley, Chris Horwood, Jake Mallon, Arduino A Mangoni, Joshua M Inglis","doi":"10.1111/imj.16592","DOIUrl":"https://doi.org/10.1111/imj.16592","url":null,"abstract":"<p><p>The management of paracetamol poisoning in our local health network and consistency with national guidelines is unclear. We conducted a 4-month retrospective study of all paracetamol poisonings identified in two South Australian hospitals. Most presentations were deliberate self-poisoning (90.7%) with immediate-release formulations (88.0%). Although most were managed in accordance with national guidelines, there were deficiencies in documentation of the poisoning details and patient weight as well as cases of underdosing of the antidote. Quality improvement initiatives are needed.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817930","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":"Clinical outcomes of patients with non-tuberculous mycobacterial pulmonary disease in Auckland, New Zealand.","authors":"Charlotte Chen, Rebecca Davies, Christopher Lewis, Jennifer Paynter, Timothy Christmas, Mitzi Nisbet","doi":"10.1111/imj.16570","DOIUrl":"https://doi.org/10.1111/imj.16570","url":null,"abstract":"<p><p>This review of non-tuberculous mycobacterial pulmonary disease over an 11-year period identified 87 patients (74% women, mean age 66 years). Mycobacterium avium complex was isolated in 86% of patients. Antibiotics were commenced in 52% of patients; however, treatment was poorly tolerated with 36% terminating prematurely. Mortality was significant; death occurred in 31% of patients, with no relationship between death and treatment.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of obstructive sleep apnoea on post-operative outcomes.","authors":"Nicole Hersch, Samira Girgis, Guy Barrington Marks, Frances Smith, Peter R Buchanan, Jonathan P Williamson, Frances Garden, Hima Vedam","doi":"10.1111/imj.16595","DOIUrl":"https://doi.org/10.1111/imj.16595","url":null,"abstract":"<p><strong>Background: </strong>Unrecognised obstructive sleep apnoea (OSA) has been associated with adverse cardiorespiratory perioperative outcomes. However, with changing anaesthetic and perioperative management, there is ongoing uncertainty about the importance of OSA as a risk factor for post-operative complications.</p><p><strong>Methods: </strong>A cohort study involving subjects undergoing elective surgery was conducted. OSA was diagnosed with a limited channel sleep monitor. In subjects undergoing routine perioperative care, complications were identified based on the assessment of the attending clinical team. The primary outcome was a composite end-point of cardiorespiratory outcomes comprising myocardial infarction, atrial fibrillation, other arrhythmias, bradycardia, need for inotropic support, unplanned intensive care unit admission, pneumonia or respiratory failure.</p><p><strong>Results: </strong>Four hundred seventy-two subjects were recruited, with 356 being included in the analyses; 281 (79%) had OSA and 66 (19%) had severe OSA. Subjects with OSA did not have a significantly higher incidence of complications (5.7%) compared to those without (2.7%, adjusted relative risk 1.89 (0.23-15.67)). Additionally, complications were not increased in those with severe OSA.</p><p><strong>Conclusions: </strong>Unrecognised OSA was not associated with an increase in clinically evident cardiorespiratory complications in this cohort. The lower complication rates compared with earlier studies suggest that increased use of less invasive surgical techniques, improved pain management and increased awareness of OSA have had an impact in reducing postoperative complications in this group. Further research is needed to clarify the impact of severe OSA on post-operative outcomes in different surgical cohorts with varying risk profiles in order to develop optimal perioperative pathways.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806993","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}