Internal Medicine Journal最新文献

{"title":"Outcomes of a co-designed clinical decision support tool for inpatient glycaemia management.","authors":"Megan Dharma, Rahul D Barmanray, Andrew Coote, Samantha Plumb, Mervyn Kyi, Spiros Fourlanos, Timothy N Fazio","doi":"10.1111/imj.70655","DOIUrl":"https://doi.org/10.1111/imj.70655","url":null,"abstract":"<p><strong>Background: </strong>Hypo- and hyperglycaemia are major issues for hospital inpatients with diabetes, associated with risk of increased adverse outcomes, including higher mortality and prolonged length of stay.</p><p><strong>Aims: </strong>We investigated whether implementation of a multidisciplinary co-designed, non-interruptive electronic medical record (EMR)-based alert for glycaemia was associated with changes in diabetes medication management in hospital.</p><p><strong>Methods: </strong>This was an observational study from September 2022 to January 2023 comparing 7-week pre-intervention and intervention periods separated by a 4-week non-analysis transition. Non-interruptive alerts for hypo- and hyperglycaemia were deployed through the EMR, which provided management recommendations. The primary outcome was electronic alert acknowledgement. Secondary outcomes included medication changes and adverse glycaemic event recurrence.</p><p><strong>Results: </strong>During the intervention period, rates of alert acknowledgement were very low (hypoglycaemia 1.0% and hyperglycaemia 0.1%). Following alert implementation there was no significant change in medication modification in response to hypoglycaemia (relative risk (RR) 1.42, P = 0.500) or hyperglycaemia (RR 0.64, P = 0.141) events compared with pre-intervention. There was no significant difference in risk for hypoglycaemia recurrence (RR 1.89, P = 0.443), but the risk for hyperglycaemia recurrence was lower (RR 0.79, P = 0.014) during intervention compared to pre-intervention.</p><p><strong>Conclusion: </strong>Despite multidisciplinary co-design, education and implementation, non-interruptive alerts for glycaemia were not electronically acknowledged in most cases. The alert did not change medication management and thus was unlikely to be the cause of reduction in recurrence of adverse glycaemic events. Further research is required to determine barriers, to develop strategies to improve user engagement and to optimise glycaemic-based electronic alerts, aiming to assist health professionals working in acute care.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109311","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":"Advancing general medicine together through allied health and nursing communities of practice.","authors":"Louise Meikle, Aruska D'Souza, Carla Gordon, Melissa Reid, Elizabeth Rochford, Felice Borghmans","doi":"10.1111/imj.70636","DOIUrl":"https://doi.org/10.1111/imj.70636","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109247","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":"Semaglutide in type 2 diabetes and chronic kidney disease in Australia: practical clinical considerations from a multidisciplinary panel.","authors":"Eugenia Pedagogos, Roger Chen, Adam Nelson, Sunil Badve, Roy Rasalam, Richard MacIsaac","doi":"10.1111/imj.70647","DOIUrl":"https://doi.org/10.1111/imj.70647","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) and cardiovascular disease (CVD) are major causes of morbidity and mortality in people with type 2 diabetes (T2D). Contemporary CKD guidelines increasingly support incorporation of glucagon-like peptide-1 receptor agonists (GLP-1RAs) as an additional pillar of cardiorenal therapy alongside renin-angiotensin-aldosterone system (RAAS) blockade, sodium-glucose co-transporter 2 inhibitors (SGLT2i) and finerenone. Semaglutide is the first GLP-1RA with kidney-outcome data from a dedicated trial in T2D-CKD: the Evaluate Renal Function with Semaglutide Once Weekly (FLOW) study. In FLOW, once-weekly subcutaneous semaglutide 1 mg reduced major kidney disease events by 24%, major adverse cardiovascular events by 18% and all-cause mortality by 20% versus placebo on a background of guideline-directed therapy. Here a multidisciplinary expert panel summarises Australian Therapeutic Goods Administration indications and Pharmaceutical Benefits Scheme restrictions, highlights common access barriers and outlines approaches to shared care between primary and tertiary services for use of GLP-1RAs. Guidance is also provided on treatment sequencing of GLP-1RA alongside RAAS blockade, SGLT2i and finerenone. Evidence from key GLP-1RA trials, in addition to FLOW, is reviewed and translated into practical, implementable prescribing strategies for Australian clinicians. The panel also identified priority patient groups for GLP-1RA therapy, including those with residual albuminuria, heart failure with preserved ejection fraction, established CVD, obesity and Aboriginal and Torres Strait Islander peoples at high cardiorenal risk. Remaining evidence gaps, particularly for non-diabetic CKD, advanced CKD, dialysis and transplant populations and equity of access, are identified as priorities for future research and policy.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080479","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":"Preventing infections after CD19-directed chimeric antigen receptor T-cell therapies for lymphoma: a consensus practice statement.","authors":"Aine Hurley, Philip George, Gemma Reynolds, Adam Stewart, Hang Quach, Nicole O'Leary, Zoe McQuilten, Andrea S Henden, Lynette Chee, Chan Y Cheah, Olivia Bupha-Intr, Emily Blyth, Ben Teh, Monica Slavin, Michael Dickinson, Robert Weinkove","doi":"10.1111/imj.70644","DOIUrl":"https://doi.org/10.1111/imj.70644","url":null,"abstract":"<p><p>Chimeric antigen receptor (CAR) T-cell therapies directed against cluster of differentiation 19 (CD19) are a standard of care for relapsed or refractory B-cell lymphomas. Infection is the leading cause of non-relapse mortality, and this risk may persist for years after CAR T-cell receipt. Recipients of CAR T-cells can present in various clinical settings, and few trials have prospectively assessed prevention and management of infection in this group. This position statement provides Australian and New Zealand clinicians with a rational approach to preventing, investigating and managing infections after CD19-directed CAR T-cell therapy for lymphoma.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109241","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":"Clopidogrel and proton pump inhibitors: evaluating the clinical significance of their interaction.","authors":"Sabrina Hanin, Mason Crossman, Stephen Bacchi, Rudy Goh","doi":"10.1111/imj.70551","DOIUrl":"https://doi.org/10.1111/imj.70551","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060668","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":"Economic evaluations of remifentanil versus fentanyl for analgo-sedation in mechanically ventilated adult ICU patients: a systematic review.","authors":"Sushma Ashwin, Lisa Gold, Arvind Rajamani, Ashwin Subramaniam","doi":"10.1111/imj.70632","DOIUrl":"https://doi.org/10.1111/imj.70632","url":null,"abstract":"<p><p>The use of opioid and sedative infusions to relieve pain and anxiety is common among patients receiving invasive mechanical ventilation (IMV) in the intensive care unit (ICU). Although remifentanil-based sedation is feasible, evidence regarding its economic impact remains limited. We systematically identified, synthesised and critically appraised economic evaluations of remifentanil in mechanically ventilated ICU patients. Ovid MEDLINE, Ovid Embase and the Cochrane Library were searched for full-text original English-language studies published between 1997 and 2023. Reporting quality was assessed using the 24-item Consolidated Health Economic Evaluation Reporting Standards checklist. Of 169 records identified, 103 remained after duplicate removal, eight underwent full-text review and only two single-centre studies, involving 285 patients, met the inclusion criteria. The studies differed substantially in their methodology, including the outcomes assessed, cost components, analytical perspectives and time horizons. Reporting quality was rated as good (59%) in the study by Muellejans et al. and very good (81%) in the study by Al et al. Both studies reported shorter durations of IMV and ICU stay with remifentanil; however, their economic findings were inconsistent. Al et al. reported that remifentanil may reduce costs, whereas Muellejans et al. found similar total costs between treatment groups, largely because of the higher acquisition cost of remifentanil. This systematic review identified limited and heterogeneous evidence regarding the economic impact of remifentanil in mechanically ventilated ICU patients. Given the substantial costs of intensive care, high-quality economic evaluations using contemporary clinical practice, comprehensive cost measurement and appropriate time horizons are needed to determine whether remifentanil provides value for money.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016648","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":"Direct transition to a streamlined rheumatoid arthritis clinic improves outcomes after discharge from an early arthritis clinic environment.","authors":"Hyunjun Jonathan Kim, Mitsi Blazos, Kevin Yen Chia Su, Ranjeny Thomas, Helen Benham","doi":"10.1111/imj.70649","DOIUrl":"https://doi.org/10.1111/imj.70649","url":null,"abstract":"<p><strong>Background: </strong>The treat-to-target (T2T) strategy for the management of rheumatoid arthritis (RA) achieves remission or low disease activity in many patients. However, RA T2T is challenging in real-world clinical environments. In this two-stage audit, we evaluated the impact of transferring patients from a T2T intensive early arthritis clinic (EAC) to a general rheumatology (GR) clinic, then assessed outcomes of a clinical redesign to facilitate direct transfer from EAC to a dedicated RA clinic.</p><p><strong>Methods: </strong>We retrospectively audited 216 patients attending an EAC in Brisbane, Australia, who were discharged to a GR clinic (cohort 1, 2004-2015) and 122 patients who were discharged directly to a dedicated, streamlined RA clinic (cohort 2, 2019-2023). EAC discharge occurred when patients reached low disease activity or remission.</p><p><strong>Results: </strong>Median 28-joint disease activity scores (DAS28) of 2.91, 95% confidence interval (2.38-3.26) (cohort 1) and 2.80 (2.37-3.28) (cohort 2) were achieved within 12 months in EAC. In cohort 1 patients returning to the GR clinic, median C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) rose and disease-modifying anti-rheumatic drug (DMARD) doses decreased significantly. In contrast, cohort 2 transited without delay to the RA clinic, and there were no changes in CRP, ESR or DMARD doses.</p><p><strong>Conclusions: </strong>Compared to GR, establishing a streamlined RA clinic with a model of direct transfer of care reduced delayed follow-up and improved medication adherence and maintenance of low disease activity after transition from EAC.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024693","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":"Transjugular intrahepatic portosystemic shunt: patient characteristics and predictors of adverse outcomes from a quaternary referral centre.","authors":"Oliver Nilsen, Nirbaanjot Walia, Ernest Cheung, Jonathan Abdelmalak, Jessica Spurio, Monique Fernandez, Thomas Freeman, Penelope Hey, Karl Vaz, Marie Sinclair, Avik Majumdar, Adam Testro","doi":"10.1111/imj.70628","DOIUrl":"https://doi.org/10.1111/imj.70628","url":null,"abstract":"<p><strong>Background: </strong>Transjugular intrahepatic portosystemic shunt (TIPS) placement remains a key intervention for managing complications of portal hypertension. Regular assessment of patient characteristics and outcomes is required to inform ongoing patient selection.</p><p><strong>Aim: </strong>To describe the characteristics, indications and outcomes of patients undergoing TIPS and to identify risk factors for post-TIPS hepatic encephalopathy (HE) and mortality.</p><p><strong>Methods: </strong>This was a retrospective study of patients who underwent TIPS between 2011 and 2024 at a quaternary liver transplant centre. Demographics, indications for TIPS and outcomes were collected. Multivariable Cox regression analysis was used to identify predictors of 90-day HE and mortality post-TIPS.</p><p><strong>Results: </strong>In this cohort, TIPS was performed in 143 patients (median age 55 years interquartile range 48-62). Alcohol-related liver disease (ARLD) was the most common aetiology in 57 (40.0%), followed by metabolic dysfunction-associated steatotic liver disease (MASLD) in 26 (18.2%). Indications included ascites and/or hepatic hydrothorax in 76 (53.1%), followed by variceal haemorrhage in 53 (37.1%). Within 90 days, 43.8% developed HE and 18.6% died. Type 2 diabetes mellitus (subdistribution hazard ratio (HR) = 1.99, 95% confidence interval (CI): 1.17-3.38, P = 0.012) was independently associated with HE within 90 days of TIPS, while age (HR = 1.07, 95% CI: 1.02-1.13, P = 0.009), model for end-stage liver disease (MELD) (HR 1.12, 95% CI: 1.05-1.19, P < 0.001) and salvage TIPS for variceal bleeding (HR = 3.77, 95% CI: 1.40-10.15, P = 0.009) were independently associated with 90-day mortality.</p><p><strong>Conclusion: </strong>TIPS insertion was most often performed for fluid-related indications, with ARLD and MASLD being the common underlying aetiologies. Type 2 diabetes predicted HE, whereas age, MELD and salvage TIPS for variceal haemorrhage were associated with increased mortality.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016646","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":"When patients seek information about voluntary assisted dying in an institutional non-participating specialist palliative care service: outcomes and learnings.","authors":"Alexander Kochi, Amanda Fischer, Phillip Good","doi":"10.1111/imj.70648","DOIUrl":"https://doi.org/10.1111/imj.70648","url":null,"abstract":"<p><strong>Background: </strong>Voluntary assisted dying (VAD) legislation has been implemented across all Australian states iteratively since 2019, yet the interface between VAD and palliative care remains contentious, particularly within healthcare organisations that hold policies of institutional non-participation (INP). A paucity of data exists on the experience of patients who pursue VAD when under the care of specialist palliative care services (SPCSs) operating under INP.</p><p><strong>Aim: </strong>To determine the incidence, characteristics and outcomes of patients accessing VAD information within a SPCS with a policy of INP.</p><p><strong>Methods: </strong>This single-centre retrospective cohort study included adult patients who enquired about or engaged with VAD between 1 January 2023 and 31 December 2025.</p><p><strong>Results: </strong>Of 2647 deaths of SPCS patients, 208 (8%) enquired about VAD and 85 (3%) died via VAD. Patients dying via VAD were predominantly older (median 76 years), male (61%), with malignant disease (80%) and died at home (62%). Motivations for VAD were multifactorial, most commonly being poor quality of life and autonomy. Documentation and communication of VAD assessments and administration methods were incomplete. Where known, the VAD process was often rapid: median of 9 days from first assessment to death, 36% using an expedited pathway and 37% having VAD on the day of final assessment.</p><p><strong>Conclusions: </strong>INP SPCS play a meaningful role in providing palliative care to patients who seek information on the VAD process. These findings demonstrate a need to improve documentation and communication frameworks, explore clinician experiences in INP settings and clarify the relationship between palliative care needs and VAD engagement.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024698","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":"COVID-19 impacts on lung cancer diagnosis, management and timeliness in Victoria.","authors":"Luc Te Marvelde, Margaret Brand, Dani Samankula, Sue M Evans, John R Zalcberg, Rob G Stirling","doi":"10.1111/imj.70621","DOIUrl":"https://doi.org/10.1111/imj.70621","url":null,"abstract":"<p><strong>Background: </strong>The state of Victoria, Australia, had significant lockdowns to prevent spread of COVID-19.</p><p><strong>Aim: </strong>To describe its impact on lung cancer incidence, stage at diagnosis, treatment utilisation and timeliness of care in Victoria, Australia.</p><p><strong>Methods: </strong>Population-wide Victorian Cancer Registry data (1982-2019) were used to predict expected number of lung cancer diagnoses in 2020 and 2021, which were compared with observed diagnoses. Data from the Victorian Lung Cancer Registry were used to study changes in stage and treatment (receipt, guideline concordance and timeliness) comparing the pre-COVID period (1 January 2019-31 March 2020) with the COVID era (1 Apr 2020-31 Dec 2021).</p><p><strong>Results: </strong>In the COVID era, 298 (95% CI 217-379) fewer Victorians were diagnosed with lung cancer than expected. Comparing the COVID era with the pre-COVID period, no differences were detected in clinical stage at diagnosis, proportion receiving treatment, guideline concordance and timeliness measures.</p><p><strong>Conclusions: </strong>Compared to the expected number of diagnoses, 5% fewer lung cancer diagnoses were observed in 2020 and 2021 combined. Although the healthcare system in Victoria had many disruptions following COVID restrictions, no major negative impacts on treatment utilisation or timeliness were observed.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012238","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}