Internal Medicine Journal最新文献

{"title":"Ambulance transport to hospital in patients with a palliative ambulance management plan.","authors":"Jessica Luey, Sinead Donnelly","doi":"10.1111/imj.70101","DOIUrl":"https://doi.org/10.1111/imj.70101","url":null,"abstract":"<p><p>The palliative ambulance management plan (AMP) is a document that assists paramedics in the acute care of patients with life-limiting illness. We retrospectively examined ambulance attendances for 111 patients with an AMP in the Hutt Valley, New Zealand. Ambulances attended 46 patients on 67 occasions with 40% transported to an acute hospital. Transport preferences were followed in 70% of attendances and 48% of transports to the hospital. Although uncontrolled symptoms were the most common indications for ambulance attendance, most of these attendances did not result in transport to hospital. AMPs provide paramedics with the ability to recognise a patient's wishes to remain at home and provide care that can enable this.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150385","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":"Symptomatic hypocalcaemia after administration of denosumab and iron infusion in patients with normal and impaired renal function.","authors":"Lai-Ming Kathleen Pak, Amanda Cox, Leon A Bach","doi":"10.1111/imj.70091","DOIUrl":"https://doi.org/10.1111/imj.70091","url":null,"abstract":"<p><p>Osteoporosis and iron deficiency anaemia are common coexisting comorbidities in an ageing population. To facilitate timely administration of disease-modifying therapy, denosumab and iron infusions are often given concurrently on the day of discharge from an inpatient admission following fracture. It is becoming increasingly recognised that close administration of both can result in profound hypocalcaemia and/or hypophosphataemia due to disruption of calcium, phosphate and bone remodelling homeostasis. Our case series describes three cases of clinically significant, symptomatic hypocalcaemia in the setting of this potential drug-drug interaction, with symptoms including atraumatic femoral fracture, subacute cognitive decline and non-sustained ventricular tachycardia. While most previous case reports described hypocalcaemia in patients with advanced chronic kidney disease, two out of three of our cases had normal renal function, and one patient developed hypocalcaemia despite having calcium and cholecalciferol supplementation before and after denosumab administration. The optimal safe period between administration of the two medications has not been clearly established; one of our patients developed electrolyte disturbances despite having the medications 10 weeks apart.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149448","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 models for infectious diseases require evidence generation and regulation.","authors":"Christina Gao, Shirajh Satheakeerthy, Christina Guo, Alyssa Pradhan, Andrew E C Booth, Weng Onn Chan, Sanjat Kanjilal, Matthew Blake Roberts, Camille Kotton, Stephen Bacchi","doi":"10.1111/imj.70072","DOIUrl":"https://doi.org/10.1111/imj.70072","url":null,"abstract":"<p><p>Large language models (LLMs) offer significant potential in healthcare, especially in the Australian infectious diseases (ID) context, where a great deal of information must be gathered and synthesised. To maximise benefits, the use of evidence-based medicine principles, robust trials, thorough regulatory frameworks and timely guidelines statements are necessary. Additionally, proactive strategies utilising artificial intelligence architectures such as retrieval-augmented generation can help minimise risks, while optimising the benefits of LLM in ID.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150386","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":"Frailty and geriatric assessments in older patients diagnosed with acute myeloid leukaemia: an Australasian Leukaemia and Lymphoma Group consensus statement.","authors":"Briony Shaw, Victoria Yee-May Ling, Ruth E Hubbard, Ashish Bajel, Devendra Hiwase, Paula Marlton, Sushrut Patil, Travis Perera, Jacinta Perram, Shuh Ying Tan, Xuan Ni Tan, Andrew Wei, Nada Hamad, Chong Chyn Chua","doi":"10.1111/imj.70086","DOIUrl":"https://doi.org/10.1111/imj.70086","url":null,"abstract":"<p><p>The treatment of acute myeloid leukaemia (AML) is rapidly changing, and treatment decisions are more complex, with increasing therapeutic options available for those 'unfit' for intensive cytotoxic therapy. With the median age of 69 years at diagnosis, frailty is expected to be highly prevalent in patients with AML. An individualised approach is required, accounting for disease biology, chronological age, functional status, social factors, patient-directed goals of care and co-morbidities. This Australasian Leukaemia and Lymphoma Group (ALLG) consensus statement aims to highlight the importance of performing geriatric and frailty assessments (FAs) in older patients diagnosed with AML and provide practical recommendations on integrating FAs into routine clinical practice within the Australian and New Zealand context. We recommend FAs be widely implemented and tailored to the resources of individual centres to provide an objective measure of fitness of older patients with AML to assist therapeutic decisions at diagnosis as well as at serial timepoints throughout the disease course. Deficits in domains identified by FAs can specifically be targeted through supportive care interventions aiming to improve tolerance of therapy. FAs should be incorporated into clinical trials and be prioritised for funding and resources.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127418","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":"Hyperuricaemia in type 1 Gaucher disease: is uric acid a biomarker for disease severity?","authors":"Zufit Hexner-Erlichman, Salmas Watad, Jeff Szer, Nayaf Habashi, Hanna Rosenbaum","doi":"10.1111/imj.70102","DOIUrl":"https://doi.org/10.1111/imj.70102","url":null,"abstract":"<p><strong>Background: </strong>Elevated serum uric acid (SUA) levels were observed in Gaucher disease type 1 (GD1) patients followed for two decades in northern Israel. There are no previous reports regarding hyperuricaemia in GD1 patients.</p><p><strong>Aims: </strong>We aimed to evaluate the frequency of hyperuricaemia in GD1 patients and its correlation to disease severity, lymphoproliferative neoplasms and other malignancies.</p><p><strong>Methods: </strong>Clinical and laboratory data of 69 GD1 patients, 25 treatment-naïve and 44 on enzyme replacement therapy (ERT), were evaluated for SUA levels, biomarkers and the presence of lymphoproliferative neoplasms and other malignancies.</p><p><strong>Results: </strong>In 36 females and 33 males, the mean age was 51.6 ± 16.2 years, and the mean severity score index was 8.94. SUA levels were significantly higher in patients with severe disease compared to patients with mild disease. ERT had no significant effect on SUA levels. A linear correlation between SUA levels and disease severity was found. A linear correlation was also detected between acid phosphatase (AP) levels and SUA. Among patients with severe disease, 11% presented with a lymphoproliferative neoplasm, compared to 4% in patients with mild disease. A statistically significant difference in malignancy frequency between the two patient groups was not found.</p><p><strong>Conclusion: </strong>SUA levels are significantly elevated in severe GD1 patients and correlate with AP levels. AP was used in GD as a clinical biomarker, especially tartrate-resistant acid phosphatase, which reflects GD macrophage activity and inflammation status, thus associated with disease severity. No correlation between SUA levels and lymphoproliferative neoplasms was found. SUA levels may be helpful in estimating Gaucher cell burden and GD1 severity.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110834","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":"Comparing glycaemic outcomes of digital and paper-based hospitals (GOOD study).","authors":"Peter Donovan, Clair Sullivan, Benjamin Sly, Brent Knack, Teyl Engstrom, Andrew Jones, Elizabeth McCourt, Syndia Lazarus, Jason Pole","doi":"10.1111/imj.70097","DOIUrl":"https://doi.org/10.1111/imj.70097","url":null,"abstract":"<p><strong>Background: </strong>Digital technologies in healthcare are seen as mechanisms to improve and optimise management of health conditions.</p><p><strong>Aim: </strong>To assess the impact of digitisation on clinical outcomes and medication errors for patients with diabetes.</p><p><strong>Methods: </strong>This repeated cross-sectional study used data collected from the Queensland Inpatient Diabetes Survey (QuIDS), which was conducted in 2019 and 2021 at digital and paper-based hospitals in Queensland. Relevant data were collected from patients with diabetes admitted to participating hospitals during a single day of the study week. Outcomes and error rates of patients who were admitted to digital versus paper-based hospitals were compared. Regression determined the factors that contributed to 'good diabetes days' and 'no hypoglycaemic days'. Prescribing and management errors were compared.</p><p><strong>Results: </strong>Data on 1942 patient admissions (6977 patient bed days) were collected. Of these, 1076 patient admissions (55%) were at a digital hospital, while 866 patient admissions (45%) were at a paper-based hospital. Using regression, it was found that being admitted to a digital hospital increased the odds of a 'good diabetes day' by 45% (P < 0.001), but there was no change in 'no hypoglycaemic days' (P = 0.183). There was a reduction in the proportion of patients with at least one error type across all error categories amongst those admitted to a digital hospital (P < 0.001).</p><p><strong>Conclusion: </strong>Admission to a digital hospital improves the odds of experiencing a good diabetes day but does not change the occurrence of hypoglycaemia. There are potential quality and safety considerations for those hospitals still delivering paper-based diabetes care.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110832","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":"Can we predict mortality of older patients with advanced chronic kidney disease?","authors":"Angela Chou, Sanjay Farshid, Mark A Brown, Kelly Chenlei Li","doi":"10.1111/imj.70089","DOIUrl":"https://doi.org/10.1111/imj.70089","url":null,"abstract":"<p><strong>Background: </strong>Studies have shown that patients with advanced chronic kidney disease (CKD) desire to know their prognosis. Although many predictive tools exist, they are not widely used in clinical practice as their applicability is not clear, particularly for older patients.</p><p><strong>Aim: </strong>To evaluate the validity of existing prognostic tools in older patients with advanced CKD.</p><p><strong>Methods: </strong>This was a single-centre retrospective validation cohort study on patients aged ≥65 years with grade 4 or 5 CKD between 2009 and 2018. The Ivory, Schmidt and Cohen models were tested by comparing predicted and actual mortality outcomes. Discriminatory ability was measured by area under the receiver operating characteristic curve (AUC), and calibration was assessed by the Hosmer-Lemeshow statistic. The global performance of the predictive regression models was assessed using the measure of goodness of fit with the coefficient of determination Nagalkerke R².</p><p><strong>Results: </strong>A total of 387 patients with a median age of 80 years (IQR 74-85) were included in the study. For the Ivory and Schmidt models, the c-statistic was 0.617 (95% CI 0.47-0.74) and 0.60 (95% CI 0.47-0.71) respectively, indicating poor discrimination. The Hosmer-Lemeshow statistic was 1.42 (P = 0.22) and 1.59 (P = 0.15) respectively, indicating reasonable calibration. The Cohen model had an overall poor predictive value.</p><p><strong>Conclusion: </strong>Existing prognostication tools demonstrate overall suboptimal performance in our validation cohort of older patients. Further research is needed for the development of a prognostic tool specific to the older advanced CKD population.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093529","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":"Use of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosing giant cell arteritis in a Western Australian tertiary centre: a 36-month analysis.","authors":"Madeleine Venables, Andrew Taylor, Julia Murdoch, Jean-Louis De Sousa, Helen Keen","doi":"10.1111/imj.70096","DOIUrl":"https://doi.org/10.1111/imj.70096","url":null,"abstract":"<p><strong>Background: </strong>Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has been established as a beneficial diagnostic tool in large vessel vasculitis. There have been limited studies of its use in real-world clinical practice. We examined patients at Royal Perth Hospital (RPH) with suspected giant cell arteritis (GCA) from January 2019 to 2022 who had 18F-FDG-PET/CT, and analysed its diagnostic accuracy compared to temporal artery biopsy (TAB) and clinical diagnosis at 6 months.</p><p><strong>Methods: </strong>Patients referred to RPH Rheumatology with suspected GCA from January 2019 to 2022 were identified as having had 18F-FDG-PET/CT for diagnostic evaluation. 18F-FDG-PET/CT results were dichotomous into positive (consistent with GCA) or negative, and compared to TAB and clinical diagnosis of GCA at 6 months by a consultant rheumatologist.</p><p><strong>Results: </strong>A total of 32 patients had 18F-FDG-PET/CT for diagnostic purposes; nine of 32 18F-FDG-PET/CT scans were positive. Compared to TAB, 18F-FDG-PET/CT had a sensitivity of 50%, a specificity of 93%, a positive predictive value (PPV) of 86%, a negative predictive value (NPV) of 68% and accuracy of 61.5%. Compared to clinical diagnosis, 18F-FDG-PET/CT had a sensitivity of 41%, a specificity of 100%, a PPV of 100%, an NPV of 44% and accuracy of 59.4%. Only one 18F-FDG-PET/CT (11%) had cranial artery involvement. The median time taking glucocorticoids (GCs) was 7 days (interquartile range (IQR) 0-22.5 days) for positive 18F-FDG-PET/CT scans, versus 13 days (IQR 8-39 days) for negative 18F-FDG-PET/CT scans. The median time from request to scan was 29 days (IQR 31.5-77 days) for 18F-FDG-PET/CT on 14 or more days of GCs.</p><p><strong>Conclusion: </strong>18F-FDG-PET/CT is more likely to be positive if it is performed within 7 days of steroid commencement. 18F-FDG-PET/CT had lower sensitivity and higher specificity than reported in clinical studies. In clinical practice, the significant delays from steroid start to scan time may reduce diagnostic sensitivity. A negative 18F-FDG-PET/CT scan did not negate the need for further investigations.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965634","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":"Primary Sjögren disease patients of Asian and Middle Eastern ancestry have early-onset but similar disease activity","authors":"Ming Wei Lin,&nbsp;Sarah Volk,&nbsp;Adrian Y. S. Lee","doi":"10.1111/imj.70075","DOIUrl":"https://doi.org/10.1111/imj.70075","url":null,"abstract":"<p>Sjögren disease (SjD) is a commonly encountered systemic autoimmune disease. We performed a single-centred study of 147 patients with primary SjD and found that SjD patients of Asian and Middle Eastern ancestry had earlier onset disease than Caucasian patients. It is likely that genetic factors dictate disease characteristics and future studies to dissect the biological basis for these differences are warranted.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"856-859"},"PeriodicalIF":1.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949886","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":"Economic burden of sickle cell disease in Australia.","authors":"Steve Nwokeocha, Helen E Haysom, Cameron Wellard, Tracy Roberts, Mwayi Kachapila, Melissa Chee, Dennis Petrie, Zoe K McQuilten, Neil Waters, Anthea Greenway, Kylie Mason, Anna Nelson, Zane Kaplan, P Joy Ho, Erica M Wood, Adam Irving","doi":"10.1111/imj.70092","DOIUrl":"https://doi.org/10.1111/imj.70092","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell disease (SCD) is an inherited condition that impairs red blood cell function, posing a substantial health burden on patients. As the prevalence of SCD in Australia rises due to migration, discussions surrounding treatment and management strategies are becoming more prominent.</p><p><strong>Aims: </strong>Australia lacks a dedicated study on the prevalence and economic implications of SCD. In this study, we estimate the economic burden of SCD in Australia from the perspective of the Australian healthcare system.</p><p><strong>Methods: </strong>We performed a cost-of-illness study by using a bottom-up approach to estimate resource use per patient from a national registry with unit costs from national sources, and a top-down estimate of the prevalence of SCD in Australia using stratification by ancestry.</p><p><strong>Results: </strong>We estimated the prevalence of SCD in Australia in 2021 to be 8485 patients, the cost per patient per year to be AU$13 975 and the total cost to the Australian healthcare system to be approximately AU$119 million per year. Factors influencing costs were age, interventions and frequency of hospital visits for vaso-occlusive crises. Prevalence had the greatest influence on results in the sensitivity analysis.</p><p><strong>Conclusions: </strong>While the estimated prevalence of SCD in Australia resulted in a relatively small total cost, the per patient annual cost of SCD remains high. This cost of SCD is anticipated to increase alongside migration and improved treatment. There are policies that could enhance patients' quality of life, thereby mitigating both economic and health burdens.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970388","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}