Internal Medicine Journal最新文献

{"title":"Bone health in adults with non-ambulatory neuromuscular disorders: scoping review of risk factors, diagnosis and management.","authors":"Thomas Bailey, Carolyn Droste, John A Eisman, Steven G Faux, Arnagretta Hunter","doi":"10.1111/imj.70409","DOIUrl":"https://doi.org/10.1111/imj.70409","url":null,"abstract":"<p><strong>Background: </strong>Non-ambulatory adults have an increased risk of osteoporosis and fractures due to reduced weight-bearing and diminished neuromuscular stimulation, resulting in substantial morbidity and mortality.</p><p><strong>Aims: </strong>This scoping review aimed to systematically evaluate risk factors, diagnostic indicators and management strategies for optimising bone health in adults with non-ambulatory neuromuscular disorders.</p><p><strong>Methods: </strong>A structured search was conducted in Scopus, MEDLINE, Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, Embase and Web of Science. Inclusion criteria defined adults with non-ambulatory neuromuscular conditions and reported outcomes on bone mineral density (BMD), osteoporosis or fracture incidence. Screening was performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-Scoping Review guidelines.</p><p><strong>Results: </strong>Twenty-nine studies met the inclusion criteria. The most significant risk factor associated with bone disease was reduced weight-bearing and immobility, followed by a history of past fractures and wheelchair dependence. Dual-energy X-ray absorptiometry was the primary diagnostic modality to assess BMD, while biochemical markers showed limited diagnostic utility. Management strategies such as neuromuscular electrical stimulation and passive bone loading demonstrated minimal efficacy. Bisphosphonate therapy was supported in specific subgroups, including Duchenne muscular dystrophy and spinal cord injury. No consensus on evidence-based management was identified for the target population.</p><p><strong>Conclusions: </strong>Current evidence to guide diagnosis and management in this population is limited. Adults with non-ambulatory neuromuscular disorders represent a small, heterogeneous group with variability in disease aetiology, onset, distribution and progression. This is reflected within the sparse literature, making it challenging to stratify risk factors, establish standardised outcome measures and develop robust, evidence-based strategies to improve bone health.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770641","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":"Hypocomplementaemic urticarial vasculitis with mesangioproliferative glomerulonephritis, interstitial nephritis and absent immune staining.","authors":"Cindy-Anne T Bach, David A Power, David S Williams, Peter F Mount","doi":"10.1111/imj.70447","DOIUrl":"https://doi.org/10.1111/imj.70447","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769665","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 Hayes et al: Autonomy and consent in goals of care.","authors":"Claire Michel, Ranjana Srivastava, Ashwin Subramaniam","doi":"10.1111/imj.70441","DOIUrl":"https://doi.org/10.1111/imj.70441","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770583","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":"'Real time, real change': the role of artificial intelligence in providing real-time language translation services in regional medicine.","authors":"Oliver Leslie, Alasdair Leslie, Brandon Stretton, Domenico Barbaro, Daniel Zweck, Josh Andrews","doi":"10.1111/imj.70446","DOIUrl":"https://doi.org/10.1111/imj.70446","url":null,"abstract":"<p><p>Artificial intelligence (AI) is rapidly evolving worldwide, enabling greater flexibility and applicability to the field of language translation within healthcare. Australia is currently one of the most culturally and linguistically diverse countries in the world, creating a growing pressure on translators to ensure there is equitable and culturally safe access to healthcare services. Emerging research supports the use of AI as an adjunct to the current translator framework in being able to support low-risk communication tasks, such as appointment coordination or simple instructions, but it should be avoided in high-stakes contexts including informed consent or complex management discussions. Importantly, human oversight is needed to ensure clinical accuracy and patient safety during all translations.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770333","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 Neilson et al: re Beyond beds and band aids.","authors":"Cindy Towns, Philippa Shirtcliffe, Nicolien Lourens, Chris Cameron, Kay Hodgetts, Vuk Sekicki, Cathal McCloy","doi":"10.1111/imj.70423","DOIUrl":"https://doi.org/10.1111/imj.70423","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770566","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":"Palliative forequarter amputation for intractable cancer pain in a patient with poor performance status.","authors":"Lynn N Lim, Nik Nathasha Nik Isahak","doi":"10.1111/imj.70438","DOIUrl":"https://doi.org/10.1111/imj.70438","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728604","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":"Caring for Australians and New ZealandeRs with kidney Impairment guideline commentary on kidney disease: improving global outcomes 2025 guidelines for diagnosis and management of autosomal polycystic kidney disease.","authors":"Mia E Abdy, Kitty St Pierre, Emily Major, Stephen I Alexander, Brydee Cashmore, Helen Coolican, Vanessa Cullen, Jessica Dawson, Kelly Lambert, Vincent W Lee, Amali Mallawaarachi, Gopala Rangan, Judy Savige, Santosh Varughese, David J Tunnicliffe, Andrew J Mallett","doi":"10.1111/imj.70411","DOIUrl":"https://doi.org/10.1111/imj.70411","url":null,"abstract":"<p><p>Autosomal polycystic kidney disease (ADPKD) is the most common form of inherited kidney disease. The international guideline developer, Kidney Disease: Improving Global Outcomes (KDIGO), published a 2025 clinical practice guideline reflecting advances in genetic testing and the first disease-modifying agent, tolvaptan. However, KDIGO guidelines do not address healthcare access or equity issues relevant to the needs of our populations in Australia and New Zealand. The Caring for Australians and New ZealandeRs with kidney Impairment (CARI) Guidelines Working Group has provided a regional commentary to contextualise the KDIGO 2025 ADPKD guideline. This commentary aims to support clinicians in applying the KDIGO ADPKD 2025 guidance within our local health systems and highlights challenges in the implementation, including public subsidy limitations for recommended genetic testing and treatments. It also addresses equity concerns such as rural and remoteness, ensuring guidance is relevant to Australia and New Zealand.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728532","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":"Development and implementation of a computerised clinical decision support system for hospital-in-the-home patient identification.","authors":"Seok Ming Lim, Thomas Kitt-Thompson, Douglas Forsyth Johnson, Michael Turner, Adam Boulton, Samantha Plumb, Daniel Capurro, Wen-Kwang Lim","doi":"10.1111/imj.70420","DOIUrl":"https://doi.org/10.1111/imj.70420","url":null,"abstract":"<p><strong>Background: </strong>Identification of appropriate patients for hospital-in-the-home (HITH) remains a significant challenge. We hypothesise that a human-centred design (HCD) approach can assist in developing a computerised clinical decision support system (CDSS) to address this issue via leveraging data within the electronic medical record (EMR).</p><p><strong>Aims: </strong>We describe the design, development, validation and implementation outcomes of the HITH Eligibility Identifier (HEI), a CDSS for identifying inpatients suitable for HITH in Melbourne, Australia.</p><p><strong>Methods: </strong>Approaches include: (a) describing digital algorithmic design and workflow development via the iterative HCD process; (b) validation of the HEI algorithm, interface and performance using Message Understanding Conference and Miettinen-Nurminen analyses; and (c) evaluation of system impact and outcomes post-implementation.</p><p><strong>Results: </strong>The HEI CDSS integrates algorithmic decision support with clinician judgement through an interactive user interface embedded within the EMR. It ranks hospitalised patients from most to least likely eligible for HITH using administrative data, clinical information and markers of illness severity. Validation of HEI performance found that high-ranking patients were twice as likely to be eligible for HITH (improvement in eligibility probability of 46%; 95% confidence interval: 38%-54%). Post-implementation metrics show improvements in HITH utilisation, service delivery and efficiency.</p><p><strong>Conclusions: </strong>The HEI CDSS illustrates the importance of an HCD approach in ensuring local relevancy and clinical adoption of digital healthcare projects. Principles from its design and implementation can improve patient identification for HITH programs and be adapted for other CDSSs relevant to hospitalised patient cohorts.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770605","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":"Case for caution in expanding attention deficit hyperactivity disorder prescribing.","authors":"Max Hankin, Anthony Hew, Shalini Arunogiri, Thileepan Naren","doi":"10.1111/imj.70431","DOIUrl":"https://doi.org/10.1111/imj.70431","url":null,"abstract":"<p><p>Expanding psychostimulant prescribing to general practitioners (GPs) addresses Australia's attention deficit hyperactivity disorder (ADHD) access crisis, but risks significant unintended consequences. This article highlights the cumulative risks of long-term stimulant use and the danger of fragmented care models. We argue that inconsistent training and the rise of vertically integrated telehealth platforms threaten to reduce ADHD care to a volume-based pharmacological service. To protect public health, Australia requires a national framework prioritising mandatory education, shared care pathways and periodic reviews. Success must be measured by the quality of holistic care, not merely script volume.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722669","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":"Intracerebral haemorrhage as a target for preventive neurology: evidence from a national stroke cohort.","authors":"Daniel Jesudason, Amal Abou-Hamden","doi":"10.1111/imj.70425","DOIUrl":"https://doi.org/10.1111/imj.70425","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728590","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}