Internal Medicine Journal最新文献

{"title":"Gender-affirming care.","authors":"Mike McDonough","doi":"10.1111/imj.70043","DOIUrl":"https://doi.org/10.1111/imj.70043","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752326","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":"Short course antiviral therapy to prevent donor-derived hepatitis C virus infection.","authors":"Peter Boan, Kate Proudmore, Ashley Irish, Jagadish Jamboti, Lynette A Pereira, J Owen Robinson","doi":"10.1111/imj.70038","DOIUrl":"https://doi.org/10.1111/imj.70038","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752414","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":"Author reply to McDonough.","authors":"Brendan J Nolan, Ada S Cheung","doi":"10.1111/imj.70040","DOIUrl":"https://doi.org/10.1111/imj.70040","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751906","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":"Current practice and attitudes in emergency department management of primary spontaneous pneumothorax in Australia and New Zealand: a scenario-based/survey.","authors":"Anne-Maree Kelly, Sanjeevan Muruganandan, Peter Jones, Gerben Keijzers, Fran Kinnear, Peter Cameron, Arash Badiei, Yc Gary Lee, Julian A Smith, Emma Ball, Ethan Bacon, Roland Bammer, Diana Egerton-Warburton","doi":"10.1111/imj.70054","DOIUrl":"https://doi.org/10.1111/imj.70054","url":null,"abstract":"<p><strong>Background: </strong>Management of primary spontaneous pneumothorax (PSP) has long been contentious.</p><p><strong>Aims: </strong>To identify the factors influencing interventional versus conservative management and to assess current practice patterns for moderate-to-large PSP in emergency department (ED) patients.</p><p><strong>Methods: </strong>Anonymous online survey of emergency medicine, respiratory medicine and thoracic surgery specialists and trainees in Australia and New Zealand. Data collected included rating the decision-making importance of potential drivers of interventional versus conservative management for PSP, initial management preference for stable patients with moderate-large PSP based on three X-ray-based scenarios (one moderate-large, one almost total collapse without mediastinal shift and one large with mediastinal shift) and awareness of evidence and current guidelines for the management of PSP.</p><p><strong>Results: </strong>There were 456 responses; 85.5% were from Australia. The most commonly reported factors influencing treatment decision-making were vital signs (96.7%) and patient-reported dyspnoea (84.3%). There was variation between specialty groups in initial treatment preference for all scenarios (P < 0.001) and a reduction in preference for conservative treatment as the magnitude of radiological features increased (93.8% vs 61.5% vs 32.1% respectively). Guideline recommendation awareness was low except for the 2023 British Thoracic Society guideline (60.4%).</p><p><strong>Conclusion: </strong>This study demonstrates variation of opinion regarding the initial management of stable patients with moderate to large PSP and an increasing preference for intervention as the magnitude of radiological features increases. Guideline awareness was low, highlighting the need for an evidence-based approach to PSP management in the ED that is widely understood and accepted across speciality groups and that prioritises patient symptoms over X-ray findings.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752307","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":"Challenges for implementing generative artificial intelligence (GenAI) into clinical healthcare.","authors":"Lynden J Roberts, Rajiv Jayasena, Sankalp Khanna, Leslie Arnott, Paul Lane, Chris Bain","doi":"10.1111/imj.70035","DOIUrl":"https://doi.org/10.1111/imj.70035","url":null,"abstract":"<p><p>Generative artificial intelligence (GenAI) is a form of deep learning AI based on inference that offers significant potential in healthcare. It has versatile capabilities: GenAI excels in complex human language communication, synthesising information from large and diverse datasets and performing broad, complex tasks reliably. Other important capabilities include scalability, 'always on' and cost effectiveness. Taken together, GenAI technology appears to possess considerable potential for healthcare. However, the implementation poses several challenges, including technological problems, regulatory considerations, workforce impact and building trust. Using evidence and expert opinion to explore these issues, the review aims to inform clinical experts about this rapidly evolving field.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709776","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":"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":"<p><strong>Background: </strong>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.</p><p><strong>Aims: </strong>We sought to determine how risk factors predicted shorter-term and longer-term mortality across the age spectrum in adults.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","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}

{"title":"Echocardiography in diagnosing ovarian carcinoid: linking tricuspid valve dysfunction, elevated gastrin and Gallium-68 DOTATATE positron emission tomography.","authors":"Mehmet R Sonsöz, Duygu Inan, Gulden Güven, Alev Kılıçgedik","doi":"10.1111/imj.70046","DOIUrl":"https://doi.org/10.1111/imj.70046","url":null,"abstract":"","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":"143700383","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":"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":"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>To assess secondary prevention of CHD in First Nations people in primary care in Australia.</p><p><strong>Methods: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","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}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","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}

{"title":"Large language model-supported interactive case-based learning: a pilot study.","authors":"Haelynn Gim, Benjamin Cook, Jasmin Le, Brandon Stretton, Christina Gao, Aashray Gupta, Joshua Kovoor, Christina Guo, Matthew Arnold, Galina Gheihman, Stephen Bacchi","doi":"10.1111/imj.70030","DOIUrl":"https://doi.org/10.1111/imj.70030","url":null,"abstract":"<p><p>Large language models (LLMs) have been proposed as a means to augment case-based learning but are prone to generating factually incorrect content. In this study, an LLM-based tool was developed, and its performance evaluated. In response to student-generated questions, the LLM adhered to the provided screenplay in 832/857 (97.1%) instances, and in the remaining instances, it was medically appropriate in 24/25 (96.0%) cases. Use of LLM appears to be feasible for this purpose, and further studies are required to examine their educational impact.</p>","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":"143692168","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}