Internal Medicine Journal最新文献

{"title":"Methotrexate toxicity: the need for vigilance in prescribing and monitoring.","authors":"Keeran Shivakumar, Joanne Young, Pratheepan Puvanakumar, Kylie Mason, Sabina Ciciriello","doi":"10.1111/imj.70130","DOIUrl":"https://doi.org/10.1111/imj.70130","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475097","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":"General medicine wards and the mental health crisis: invisible and unsafe.","authors":"Cindy Towns, Kay Hodgetts, Philippa Shirtcliffe, Christina Cameron, Vuk Sekicki, Cathal McCloy, Christopher Giedt, Nicolien Lourens, Tracey Putt","doi":"10.1111/imj.70115","DOIUrl":"https://doi.org/10.1111/imj.70115","url":null,"abstract":"<p><p>The behavioural and psychological symptoms of dementia (BPSD) are common and include physical and sexual aggression. Unlike delirium, BPSD is a purely psychiatric presentation with no additional medical condition requiring treatment. New Zealand has a paucity of psychiatry beds for older adults, but despite the ageing population, limited attention has been given to this growing problem. BPSD patients present acutely to hospital when their behaviour becomes unmanageable. They need specialist attention and facilities. However, despite inappropriate design and no resourcing, hospitals routinely expect medical wards to accept these patients when no psychogeriatric bed is available even when the presentation is complicated by physical or sexual violence. The authors contend that this practice is unsafe and unethical. It breaches the Code of Rights for all patients and places physicians at medico-legal risk.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475096","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":"Variation in clinical presentation, complications and outcomes for Māori and Pacific peoples among hospitalised adults with COVID-19 in 2022, Aotearoa New Zealand.","authors":"Michael J Maze, Haylea Rodgers, Jonathan Williman, Rebekah Anstey, Emma Best, Hasan Bhally, Aliya Bryce, Catherina Chang, Kevin Chen, Jack Dummer, Michael Epton, William Good, Jennifer Goodson, Corina Grey, Kate Grimwade, Robert J Hancox, Redzuan Hassan, Thomas Hills, Sandra Hotu, Colin McArthur, Susan Morpeth, David R Murdoch, Fiona Pease, Romana Pylypchuk, Nigel Raymond, Stephen Ritchie, Deborah Ryan, Vanessa Selak, Malina Storer, Tony Walls, Rachel Webb, Conroy Wong, Karen Wright","doi":"10.1111/imj.70114","DOIUrl":"10.1111/imj.70114","url":null,"abstract":"<p><strong>Background: </strong>Pacific region-specific data on the clinical course of COVID-19 are limited. We aimed to describe clinical features and outcomes from Aotearoa New Zealand patients, focusing on Māori and Pacific peoples.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study among adults (≥16 years) hospitalised due to COVID-19 at 11 hospitals from January to May 2022. We included all Māori and Pacific patients and every second non-Māori, non-Pacific (NMNP) patient using data from chart review and national datasets.</p><p><strong>Results: </strong>Of 2319 patients, 582 (25%) were Māori, 914 (39%) Pacific peoples and 862 NMNP (median age 52, 57 and 63 years respectively). Vaccination coverage (≥2 doses) was 73.4% (n = 437) for Māori, 76.7% (n = 701) for Pacific peoples (n = 701) and 84.8% (n = 731) for NMNP. Among 832 (35.9%) with complications, Māori had a greater risk than NMNP of acute kidney injury (risk ratio (RR) 1.87, P < 0.001), cardiac arrhythmia (RR = 1.60, P = 0.023), shock (RR = 2.64, P = 0.005), myocardial infarction (RR 2.21, P = 0.042), cardiac arrest (RR 2.68, P = 0.046) and acute respiratory distress syndrome (RR = 2.81, P = 0.008). Pacific patients experienced a greater risk than NMNP of acute kidney injury (RR = 2.18, P < 0.001) and pneumonia (RR = 1.32, P = 0.047) and a lower risk of thromboembolism (RR = 0.35, P = 0.004) and myocarditis/pericarditis (RR = 0.23, P = 0.003). During admission, 23 (3.3%) Māori, 36 (3.9%) Pacific and 28 (3.2%) NMNP patients died, with no difference in age-standardised mortality.</p><p><strong>Conclusions: </strong>The clinical course of patients hospitalised by COVID-19 varied between ethnic groups, likely reflecting differential access to social determinants of health. Healthcare services that respond to this variability are needed to achieve the highest attainable health for all.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340068","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":"Multifactorial analysis of clinical prognosis in patients with anti-N-methyl-D-aspartate receptor encephalitis: a single-centre cohort study.","authors":"Chunxia Zhao, Han Zhao, Futang Xie, Cao Jiang, Decai Tian, Wangshu Xu, Chen Li","doi":"10.1111/imj.70129","DOIUrl":"10.1111/imj.70129","url":null,"abstract":"<p><strong>Background: </strong>This retrospective cohort study investigated the clinical characteristics, treatment regimens and prognostic factors of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in a single-centre setting between January 2019 and December 2024.</p><p><strong>Aims: </strong>The study aimed to identify independent factors affecting prognosis and to provide guidance for clinical practice.</p><p><strong>Methods: </strong>The study included 72 patients diagnosed with anti-NMDAR encephalitis. Clinical data - including demographic information, clinical manifestations, laboratory findings and treatment outcomes - were systematically collected. Patients were categorised into good prognosis (mRS ≤ 2) and poor prognosis (mRS ≥ 3) groups based on their 6-month follow-up modified Rankin Scale scores. Statistical analyses comprised univariate analysis and multivariate logistic regression to identify prognostic factors.</p><p><strong>Results: </strong>Of the 72 patients, 67 (93.1%) had a good prognosis, and five (6.9%) had a poor prognosis. The mean age was 32.72 years, with an equal gender distribution. Significant differences between outcome groups were observed in tumour presence (P < 0.001), blood tumour necrosis factor (TNF) levels (P = 0.0303), cerebrospinal fluid (CSF), interleukin (IL)-8 levels (P = 0.0013) and serum immunoglobulin (Ig) G levels (P = 0.00047). Psychiatric abnormalities were reported in 76.4% of patients and cognitive impairment in 87.5%. Only 29.2% of patients received immunotherapy. The multivariate analysis revealed no significant independent predictors among gender, age, psychiatric abnormality and cognitive impairment, possibly due to the limited sample size in the poor prognosis group.</p><p><strong>Conclusions: </strong>The study identified tumour coexistence, elevated inflammatory markers (serum TNF, CSF IL-8) and increased serum IgG levels as substantial factors associated with poor prognosis in anti-NMDAR encephalitis. These findings underscore the importance of early tumour screening and inflammatory marker monitoring in clinical management. However, larger multicentre studies are required to validate these results and provide more comprehensive guidance for clinical practice.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340066","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 rheumatology workforce in Australia: current and projected shortfalls.","authors":"Alice M Terrett, Arvin Damodaran, Simon Burnet, Davinder Singh-Grewal, Rachelle Buchbinder, John Glover, Tracey Rudd, Susan Lester, Samuel Whittle, Claire Barrett, Helen I Keen, Catherine L Hill","doi":"10.1111/imj.70123","DOIUrl":"10.1111/imj.70123","url":null,"abstract":"<p><strong>Aim: </strong>To determine the status of the current rheumatology workforce and model projections for the future rheumatology workforce in Australia.</p><p><strong>Background: </strong>The rheumatology workforce in Australia is currently facing a significant shortage. Identification of the optimal number of rheumatologists for the Australian population is challenging, and requires assessment of the current workforce.</p><p><strong>Methods: </strong>A survey of Australian Rheumatology Association (ARA) full members was undertaken in 2021, collecting demographic data, information about type and location of rheumatology practice and other clinical and non-clinical work, work intentions and job satisfaction. Descriptive statistics and multivariable regression analyses were performed. The clinical full-time equivalent (cFTE) was estimated based on the reported number of half-days worked in clinical rheumatology practice. Using the age and gender distribution of rheumatology specialists from the Department of Health Workforce Data Tool, workforce projections were produced for the period from 2018 to 2038.</p><p><strong>Results: </strong>A total of 81% (323/404) of full members of the ARA completed the survey. The median (interquartile range (IQR)) rheumatology clinical half-days worked/week was 6 (4-8). Adjusted to survey response, the reported clinical workload equates to the cFTE of 231 adult and 13 paediatric rheumatologists. A current shortfall of 302 adult rheumatologists and 41 paediatric rheumatologists exists relative to optimal care estimates. Furthermore, 38% of rheumatologists are considering reducing clinical hours temporarily or permanently, predominantly within the next 2 years. Based on current supply models, the shortfall will improve but will not reach optimal levels by 2038.</p><p><strong>Conclusion: </strong>Australia has an undersupply of both adult and paediatric rheumatologists compared to optimal care ideals. An ageing workforce, many part-time, and the significant number planning to reduce hours within 2 years will exacerbate this undersupply unless the supply of rheumatologists is substantially increased.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340067","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":"Proton pump inhibitors and peritoneal dialysis-associated peritonitis: a cohort study in Newcastle, Australia.","authors":"Kate Richards, Eswari Vilayur","doi":"10.1111/imj.70128","DOIUrl":"10.1111/imj.70128","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD)-associated peritonitis results in poor outcomes, including hospitalisation, PD discontinuation and death. Proton pump inhibitors (PPIs) have been linked to an increased risk of organism-specific and/or overall peritonitis in prior studies, yet they are commonly prescribed in the dialysis population.</p><p><strong>Aims: </strong>To evaluate whether PPIs are associated with an increased risk of overall peritonitis in a local cohort.</p><p><strong>Methods: </strong>We retrospectively identified patients with incident PD at a single Australian centre between 2012 and 2021. Baseline comorbidities, medications and PD outcomes were recorded. Patients were stratified by PPI exposure. We assessed whether PPI use affected time to first peritonitis using multivariate Cox proportional hazard modelling. The overall rate of peritonitis per patient-year was compared between groups.</p><p><strong>Results: </strong>Of 219 patients, 94 were exposed to PPIs, of whom 40 of 94 (42.6%) developed peritonitis, compared to 56 of 125 (44.8%) of the unexposed group. PPI use was not associated with time to first peritonitis in a multivariate Cox analysis (hazard ratio 0.78 (95% confidence interval 0.51-1.18), P = 0.2). The peritonitis rate was marginally lower in the PPI group. Atherosclerotic vascular disease was associated with peritonitis in an exploratory analysis.</p><p><strong>Conclusions: </strong>PPI use was not associated with peritonitis risk in this cohort. Further work is needed to explain the discrepant findings between studies to date, including whether PPIs modulate the risk of peritonitis caused by specific organisms.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336497","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":"A single-institution study of allograft outcomes for chronic lymphocytic leukaemia over 20 years.","authors":"Rory Bennett, Thomas Frawley, Philip A Thompson, Ashley Whitechurch, Amit Khot, Andrew W Roberts, John F Seymour, Mary Ann Anderson, David Ritchie","doi":"10.1111/imj.70124","DOIUrl":"10.1111/imj.70124","url":null,"abstract":"<p><strong>Background: </strong>Allogeneic stem cell transplantation (alloSCT) is an established potentially curative therapy for patients with high-risk chronic lymphocytic leukaemia (CLL). Future availability of chimeric antigen receptor T-cell therapies and bispecific antibodies may further reduce utilisation of alloSCT.</p><p><strong>Aim: </strong>This retrospective analysis sought to describe institutional outcomes for alloSCT for CLL, to which future outcomes following immunotherapies may be compared locally.</p><p><strong>Methods: </strong>Patients with CLL in the institutional alloSCT database were identified. Kaplan-Meier estimates were used to assess survival outcomes, and Gray's competing incidence analyses were used for cumulative incidence of relapse (CIR) and non-relapse mortality (NRM).</p><p><strong>Results: </strong>Sixty-two patients with CLL of median age 54 years (range 25-75), including 17 with prior Richter transformation, underwent alloSCT between 2000 and 2022. A total of 39% and 35.4% of tested patients harboured complex karyotype and del(17p) respectively. Median follow-up for survivors was 9.2 years. Two-year progression-free survival (PFS), overall survival (OS), CIR and NRM rates were 57.7%, 74%, 16.3% and 18.2% respectively. Ten-year PFS and OS were 38.2% and 50.8% respectively. Twenty-nine deaths occurred during follow-up, including 14 without prior CLL relapse. Del(17p) abnormality was associated with inferior PFS, and age ≥54 years at alloSCT was associated with inferior OS.</p><p><strong>Conclusions: </strong>Survival outcomes from this study align with prospective and retrospective data published from the chemoimmunotherapy era of CLL treatment. Although more recent data suggest improved post-alloSCT survival outcomes, data assessing the impact of novel agents distinct from improved alloSCT care are lacking. Our recommendations for the current role of alloSCT in CLL therapy are summarised.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336495","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":"Online tool for cross-sectional and longitudinal comparison of socio-economic status indices based on postcodes in Australia.","authors":"Andrzej S Januszewski, Rachel L O'Connell, Liping Li, David R Sullivan, Alicia J Jenkins, Anthony C Keech","doi":"10.1111/imj.70117","DOIUrl":"10.1111/imj.70117","url":null,"abstract":"<p><strong>Background: </strong>Socio-economic status (SES) is strongly associated with health outcomes, yet it remains relatively difficult to measure, particularly for longitudinal comparisons.</p><p><strong>Aim: </strong>We have developed an interactive online tool (available at bit.ly/SEIFA-POA) that facilitates SES assessment based on postcodes (POA).</p><p><strong>Methods: </strong>By utilising percentiles of socio-economic indices for areas (SEIFA) derived from postcode-based rankings across Australia, this tool enables comparisons of SEIFA indices provided by the Australian Bureau of Statistics (ABS) censuses from 1986 through to 2021. A percentile-based methodology preserves the relative socio-economic position of areas over time, thereby circumventing the methodological inconsistencies inherent in SEIFA calculations across different census periods. The tool simplifies SES assessment, offering researchers and policymakers a practical solution for both cross-sectional and longitudinal studies.</p><p><strong>Results: </strong>In 6051 participants of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial from Australia, we demonstrated that favourable SES is associated with a lower frequency of vascular complications in the participants' medical history. The absence of an observed association between SES and on-trial complications may be attributed to the relatively short 5-year average time horizon of the analysis.</p><p><strong>Conclusion: </strong>Our SES assessment tool provides a more nuanced understanding of SES disparities and their implications for health and well-being.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336496","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":"Melanoma update: is a cure now in sight?","authors":"Samrin Liaqat, Muhammad Adnan Khattak","doi":"10.1111/imj.70085","DOIUrl":"https://doi.org/10.1111/imj.70085","url":null,"abstract":"<p><p>Melanoma, one of the most aggressive skin cancers, poses a significant global health concern due to its high metastatic potential and resistance to conventional treatments. This review explores recent advancements in melanoma treatment, particularly the impact of targeted therapies and immunotherapies which have significantly extended survival and improved the quality of life for advanced melanoma patients. Additionally, the innovative combination and sequential strategies, with immune checkpoint inhibitors and cancer vaccines or targeted therapies against BRAF mutations, mark a promising direction. Recent advances in tumour infiltrating lymphocytes and oncolytic virus therapy and personalised cancer vaccine development are also covered, highlighting the role of precision medicine in achieving tailored, effective treatments. Despite these advancements, challenges persist, including drug resistance and the need for reliable biomarkers to predict treatment response and select patients. This review underscores the ongoing efforts in research and clinical trials to refine therapeutic strategies, improve treatment outcomes for a larger population detection and, ultimately, advance towards a cure for melanoma.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325592","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":"Methodological and reporting quality of Thoracic Society of Australia and New Zealand clinical guidance documents^†.","authors":"William C L Soon, Yvonne Ng, Daniel Seow, Arwel W Jones, Yet H Khor","doi":"10.1111/imj.70090","DOIUrl":"https://doi.org/10.1111/imj.70090","url":null,"abstract":"<p><p>The Thoracic Society of Australia and New Zealand (TSANZ) is the leading Australasian professional society for respiratory medicine that develops clinical practice guidelines and position papers to advance lung health through improved clinical care and research efforts. Published TSANZ clinical guidance documents were identified from the online society repository until March 2023. Each document was independently scored using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and the Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklists for methodological and reporting quality respectively. Twenty-eight position papers and seven clinical practice guidelines were evaluated. The median overall methodological quality score for the AGREE II checklist was four out of a maximum of seven (interquartile range (IQR) 3.5-4.75). The majority of documents (97%) were recommended for use with or without modifications. The median overall reporting rate using the RIGHT checklist was 46% (IQR 40-54). Low-scoring items were rigour of evidence synthesis, focus on clinical implementation, conflict of interest declaration and clarity of methodology. Clinical practice guidelines scored significantly higher overall reporting quality than position papers (57% vs. 43%, P = 0.05), but not for the methodological quality scores (median number of high-scoring domains (>70%): 2 vs. 1, P = 0.13). Documents developed with methodologist involvement had significantly increased reporting (71% vs. 43%, P = 0.02) and methodological quality (median high-scoring domains: 4 vs. 1, P = 0.007), compared to those without. Based on AGREE II, most TSANZ clinical guidance documents are recommended for use, or for use with modifications. Applicability, stakeholder involvement and conflict of interest declarations are identified as areas for improvement in future documents.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325593","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}