Internal Medicine Journal最新文献

{"title":"Call for a Pacific Centre for Disease Control!","authors":"George P Drewett, Shivani Bhatt, William Naughton, Scott Abbinga","doi":"10.1111/imj.70141","DOIUrl":"https://doi.org/10.1111/imj.70141","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583783","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 Iqbal et al.","authors":"Camille La Brooy, Hana Sabanovic, Susan J. Méndez, Jongsay Yong, Anthony Scott, Adam Elshaug, Khic-Houy Prang","doi":"10.1111/imj.70140","DOIUrl":"10.1111/imj.70140","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553439","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":"Effect of positive airway pressure treatment on pulmonary artery pressure in obstructive sleep apnoea and/or obesity hypoventilation syndrome with pulmonary hypertension: a systematic review and meta-analysis.","authors":"Shobiga Sarvananda, Stan Earnshaw, Ian Hughes, Pathmanathan Sivakumaran, Krishna Bajee Sriram","doi":"10.1111/imj.70137","DOIUrl":"https://doi.org/10.1111/imj.70137","url":null,"abstract":"<p><strong>Background: </strong>Patients with obstructive sleep apnoea (OSA) and/or obesity hypoventilation syndrome (OHS) are at increased risk of developing pulmonary hypertension (PH). The presence of PH is associated with a worse prognosis. The primary treatment for most patients with OSA/OHS is positive airway pressure (PAP). The aim of this study was to systematically review the effects of PAP therapy on pulmonary artery (PA) pressure in patients with OSA/OHS and PH.</p><p><strong>Aims: </strong>Does PAP therapy improve pulmonary artery pressure in patients with OSA/OHS and PH?</p><p><strong>Methods: </strong>Two independent investigators searched studies in MEDLINE, Embase and Cochrane Library. A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included studies involving adult OSA/OHS patients treated with CPAP/BPAP, with PA pressure ≥20 mmHg before treatment. Data synthesis utilised random-effects meta-analysis to estimate treatment effect.</p><p><strong>Results: </strong>The search identified 1373 studies, with eight meeting inclusion criteria. Baseline characteristics of patients with PH were a mean age of 53 years, 86% male, a mean apnoea-hypopnea index (AHI) of 64 events/h and a mean BMI of 33 kg/m². Meta-analysis revealed a reduction in PA pressure after PAP therapy (mean difference -8.62 mmHg, 95% CI: 4.01-13.22, P < 0.001). However, there was considerable between-study heterogeneity (I² = 97.5%).</p><p><strong>Conclusion: </strong>This study indicates that PAP therapy reduces PA pressure in patients with OSA/OHS, indicating potential benefits in managing PH. Further research is warranted to elucidate optimal PAP therapy protocols and long-term outcomes.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553440","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":"Are Australians living with dementia ready for new therapies?","authors":"Sean Maher,&nbsp;Ranjeev Chrysanth Pulle","doi":"10.1111/imj.70139","DOIUrl":"10.1111/imj.70139","url":null,"abstract":"&lt;p&gt;The Therapeutics Goods Administration (TGA) recently approved donanemab for the treatment of early symptomatic Alzheimer's disease (AD), which encompasses mild cognitive impairment (MCI) and mild Alzheimer's disease dementia (ADD).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; A timely survey of memory clinic capabilities by Michaelian &lt;i&gt;et al&lt;/i&gt;. in this issue of the Internal Medicine Journal highlights the significant challenges Australia faces to deliver this new therapy.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Dementia is the most common cause of death in women in Australia and the second leading cause of death, and disease burden, overall. Over 411 000 Australians had a dementia diagnosis in 2023, and that prevalence will more than double by 2058.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Specialist assessment of people with cognitive change is undertaken by geriatricians, neurologists and psychiatrists in health service-linked memory clinics or private settings. Cognitive and functional assessments facilitated by allied health, education, carer support, linkage to community supports and advice about related issues such as driving are provided. Diagnosis, management of comorbidities, mood and behavioural issues, lifestyle advice to preserve cognition and, where appropriate, trials of medication are undertaken.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The increasing prevalence of dementia means that wait times for assessments are increasing, commonly more than 6 months in metropolitan centres and longer in regional and remote areas.&lt;/p&gt;&lt;p&gt;Pharmacological treatment of ADD has been limited to acetylcholinesterase inhibitors and memantine, which may provide symptomatic relief but don't affect the disease process. Most people with a diagnosis of ADD have a mix of neuropathologies, with pathognomonic amyloid beta (Aβ) plaques and neuronal tau tangles, combined with vascular change, alpha-synuclein inclusions and transactive response DNA binding protein 43.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; The ‘amyloid hypothesis’ has dominated research into AD and possible therapies: Aβ gradually accumulates over 10–20 years before a tipping point is reached where microglia are no longer able to ingest Aβ, and a proinflammatory state ensues with synaptic dysfunction, hyperphosphorylation of tau protein, destabilisation of microtubules, tangle formation and neuronal death. Cognitive symptoms arise at this point, progressing from MCI to mild ADD once impairment impacts on everyday functioning.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Hypothetically, early detection and treatment might avert this cascade.&lt;/p&gt;&lt;p&gt;Many unsuccessful therapies aimed at Aβ, including monoclonal antibodies (mAbs), have been trialled. However, Phase III trials of lecanemab (CLARITY AD)&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; and donanemab (TRAILBLAZER-ALZ2)&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; reduced Aβ on positron emission tomography (PET) scans, improved markers of neurodegeneration in cerebrospinal fluid (CSF) and slowed cognitive decline. They are considered disease-modifying and have be","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1059-1062"},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540073","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":"Design, implementation and evaluation of a model of care for patients with germline predisposition to haematological malignancy and bone marrow failure syndromes.","authors":"Lucy C Fox, Erin Goode, Nicole Den Elzen, Lin Cheng, Laura Barth, Kelsey Man, Anna Jarmolowicz, Mary Panjari, Stephanie Best, Karin Thursky, Paul James, Ashish Bajel, David Ritchie, Piers Blombery","doi":"10.1111/imj.70125","DOIUrl":"https://doi.org/10.1111/imj.70125","url":null,"abstract":"<p><strong>Background: </strong>The bone marrow failure syndromes (BMFS) are clinically heterogeneous conditions with both inherited and acquired etiologies. Optimal care is often challenged by the complexity of these disorders and gaps in healthcare delivery. The Evaluating Multidisciplinary Bone maRrow fAilure CarE (EMBRACE) study is a multi-stage hybrid implementation-effectiveness study designed to explore the nature of issues faced by patients with BMFS and their physicians, and to develop, implement, and evaluate a comprehensive model of care.</p><p><strong>Methods: </strong>To identify barriers to optimal BMFS care, we conducted semi-structured interviews with patients and patient advocates, followed by a nationwide survey of physicians involved in BMFS management. Thematic analysis was performed on interview data, and survey responses were analysed to identify common challenges and areas for improvement.</p><p><strong>Results: </strong>Interview themes elicited included: (i) limited disease-specific awareness and resources, (ii) challenges in attaining genetic care, (iii) the ongoing impact of complex care needs, (iv) the perceived value of genetic testing, and (v) the importance of specialised healthcare professionals. Physician surveys indicated a desire for affordable genomic testing, assistance with result interpretation and genetic counselling/cascade testing of extended kindred, a forum for complex case discussion and advice regarding management strategies. Responses from patients, advocates and physicians, along with existing best-practice guidelines, were then used to develop a 10-component model of care aimed at addressing identified issues.</p><p><strong>Conclusions: </strong>The EMBRACE study has established a stakeholder-informed, multidisciplinary care framework for patients with BMFS. This care programme continues to undergo evaluation and audit consistent with principles of an implementation-effectiveness study to determine both patient and physician satisfaction, and iterative refinement to provide optimum care.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540074","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":"Re-defining 'clinical reasoning'.","authors":"Isaac Ks Ng, Li Feng Tan, Desmond B Teo, Sarah Hf Lim, Chia Meng Teoh","doi":"10.1111/imj.70104","DOIUrl":"https://doi.org/10.1111/imj.70104","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540075","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":"Wait times in diagnosis and treatment of obstructive sleep apnoea at a major tertiary centre","authors":"Hamza Azam,&nbsp;Vriti Shukla,&nbsp;Benjamin Gerhardy","doi":"10.1111/imj.70132","DOIUrl":"10.1111/imj.70132","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1214-1215"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527813","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":"Improving the timeliness of care for regional lung cancer patients through the implementation of a web-based lung cancer referral pathway.","authors":"Zulfiquer Otty, Sarah Larkins, Rebecca Evans, Amy Brown, Sabe Sabesan","doi":"10.1111/imj.70138","DOIUrl":"https://doi.org/10.1111/imj.70138","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer remains a significant public health problem and a leading cause of cancer-related mortality worldwide. The delays in the diagnosis of lung cancer are more pronounced for rural and regional Australians compared to their urban counterparts. Implementing an online HealthPathway is one way to reduce delays in the diagnosis of lung cancer.</p><p><strong>Aim: </strong>The Townsville Lung Cancer Referral Pathway (TLCRP) was implemented to guide local general practitioners (GPs) in the referral process of people with suspected lung cancer. The aim of the study was to compare the time interval from initial GP consultation of the person with suspected lung cancer to the first specialist referral and from the first specialist referral to the initial specialist appointment, before and after implementation of TLCRP. Other lung cancer service outcomes were also compared between the pre- and post-implementation groups.</p><p><strong>Methods: </strong>A retrospective cohort study of 316 participants was conducted, and descriptive statistical analysis of the data was used to discern any difference in timelines and other clinical outcomes in the pre-pathway implementation group compared to the post-pathway implementation group.</p><p><strong>Results: </strong>The time interval from initial GP presentation to initial referral to specialist appointment was significantly reduced in the post-pathway group (15 days) compared to the pre-pathway group (8 days, P = 0.03). However, the time interval from GP referral to initial appointment with a specialist increased in the post-pathway group (15 and 20 days, P = 0.03). Many of the Cancer Australia lung cancer optimal care pathway referral guidelines were not met. Only 40% of the pre-pathway group and 34% of the post-pathway group were seen in the specialist clinic within 2 weeks of GP referral. Significant proportions of patients in both groups did not have chest x-rays ordered by the GP, and the proportion of participants who were appropriately referred to the respiratory clinic did not improve after implementation of TLCRP (76% and 72%). Nearly 30% of participants in both groups were diagnosed after emergency presentation.</p><p><strong>Conclusions: </strong>TLCRP improved the time interval from initial GP consultation to specialist referral, thus meeting its primary objective. However, better strategies are required to improve other timelines and meet Cancer Australia's lung cancer optimal care pathway guidelines.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527812","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":"Effect of adherence on asthma control: more patient knowledge, more adherence, more control.","authors":"Zeynep Celebi Sozener, Omur Aydin, Gulfem Elif Celik, Dilsad Mungan","doi":"10.1111/imj.70135","DOIUrl":"https://doi.org/10.1111/imj.70135","url":null,"abstract":"<p><strong>Background: </strong>Low adherence rates in addition to inhaler misuse is a crucial problem in asthma management.</p><p><strong>Aims: </strong>To investigate medication adherence and correct inhaler use and the relationship between adherence, asthma control and disease severity.</p><p><strong>Methods: </strong>In this cross-sectional study, demographic characteristics of patients with asthma, asthma control and severe asthma rates were recorded. Patients were categorised as non-adherent, adherent to one component (either subjectively or objectively adherent), adherent to two components or full adherent based on objective, subjective and correct inhaler device use.</p><p><strong>Results: </strong>The study included 304 patients with a mean age of 50.21 ± 12.53 years and disease duration of 12.67 ± 9.47 years. The rate of objective adherence, subjective adherence and correct inhaler use was 45.3%, 67.7% and 56.5% respectively. Overall, we found that 26% of the patients were non-adherent, 18.7% showed subjective or objective adherence, 28.8% adhered to two components, and 27% demonstrated full adherence. The risk of non-adherence was 3.1 times higher in uncontrolled patients, and regular clinician visits reduced the risk of non-adherence by 66%. Adherence was negatively associated with severe asthma rates in our cohort. The rate of correct inhaler device use was lower in patients with systemic comorbidities, while there was no difference in objective adherence, subjective adherence or full adherence.</p><p><strong>Conclusion: </strong>The results of this study revealed that correct, consistent and regular use of inhalers in accordance with clinician recommendations is important in achieving control in patients with asthma. To increase adherence in asthma, regular clinician visits and repeat training should be encouraged.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527811","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 seen by psychiatrists in a multidisciplinary clinic for disorders of gut-brain interaction.","authors":"Evangelia Dendrinos, Hannah Kim, Daniel Hubik, Jessica Green, Linda Yang, Annalise Stanley, Michael Salzberg, Michael A Kamm, Chamara Basnayake","doi":"10.1111/imj.70134","DOIUrl":"https://doi.org/10.1111/imj.70134","url":null,"abstract":"<p><strong>Background: </strong>Patients with disorders of gut-brain interaction (DGBIs) presenting to specialist care have a high prevalence of psychiatric morbidity. Psychiatrists can provide effective treatments for these disorders; however, care is rarely delivered in an integrated manner.</p><p><strong>Aims: </strong>This study aimed to characterise patients seen by psychiatrists in a multidisciplinary gastrointestinal (GI) clinic, describe the treatment provided and examine clinical outcomes.</p><p><strong>Methods: </strong>In a single-centre multidisciplinary gastroenterology clinic, clinical records were retrospectively evaluated for patients with DGBIs seen by a psychiatrist. Patient demographics, medical and psychiatric history, records of adverse childhood experiences (ACEs) and adult trauma were collected. GI and mental health symptom outcomes were assessed using a five-point scale.</p><p><strong>Results: </strong>Ninety-seven patients (median age, 35 years; 77% female) were seen by the psychiatrist (median treatment duration 2.5 months) between January 2017 and November 2021. Fifty-six per cent had irritable bowel syndrome and 18% had functional dyspepsia. Common psychiatric comorbidities were anxiety (51%) and depression (43%). Seventy-seven per cent had a history of ACEs and 26% had a history of sexual trauma. Seventy-five per cent had previously seen a psychiatrist or psychologist. DGBI-Clinic psychiatrists provided a range of treatments including psychoeducation (64%), insight-oriented psychotherapy (39%), medication changes (27%) and cognitive behavioural therapy (19%). A majority of patients had improvement (46%) or resolution (11%) in GI symptoms. Forty per cent experienced improvement in mental health symptoms. Improvement in GI and mental health symptoms were correlated (P = 0.002).</p><p><strong>Conclusions: </strong>A majority of patients with DGBI who were seen by psychiatrists within a multidisciplinary clinic demonstrated improvement in GI and mental health symptoms.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505601","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}