Internal Medicine Journal最新文献

{"title":"'No man's land': the journey of young adults with complex care needs, from paediatric to adult healthcare.","authors":"Josephine Thomas, Jemma Anderson, Betty-Jean Dee-Price, Janet Kelly, Kate Turpin","doi":"10.1111/imj.70071","DOIUrl":"https://doi.org/10.1111/imj.70071","url":null,"abstract":"<p><strong>Background: </strong>Transition to adulthood can be a challenging time. For people with complex health needs, there is an additional burden of navigating a fragmented healthcare system.</p><p><strong>Aims: </strong>To identify the challenges faced by young people with complex health needs in the transition journey from their perspective.</p><p><strong>Methods: </strong>Health journey mapping (HJM) methodology and semi-structured interviews were utilised to generate rich, detailed narratives. This article focuses on the perspective of patients and families, reporting on thematic analysis of multiple journey narratives during care as a child and through transition to adult healthcare.</p><p><strong>Results: </strong>Five main themes were identified: transition is a no man's land; the adult health system requires more active navigation; appropriate care is not routine; parent as champion; and healthcare is a hostile environment. In advocating for their unmet needs, the young participants, and their families, were brought into conflict with the healthcare system from early in the journey, an outcome that may harm future healthcare relationships and trust.</p><p><strong>Conclusion: </strong>Despite existing models and policies, the perception of young adults with complex healthcare needs and their families is that transition from paediatric to adult care can be a hostile process and lacks a consistent structured approach. Transition often occurs against a background of prior negative experiences, exacerbating the adversarial relationship with the healthcare system. This study allows us to hear the voices of healthcare consumers and provides an opportunity to reflect on practice. An informed response by healthcare practitioners to advocacy by patients and families that seeks to reduce conflict may reduce harm and enhance future healthcare relationships and trust across the healthcare system.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984925","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":"Outcomes of allogeneic haemopoietic transplant for chronic lymphocytic leukaemia in the modern era.","authors":"Luani Barge, Steven Tran, Glen Kennedy, David Ritchie, David Gottlieb, Sam Milliken, Andrew Spencer, Duncan Purtill, Travis Perera, Richard Doocey, Stephen Larsen, Andrew Butler, Peter Bardy, Matthew Greenwood, Simon Durrant, Cameron Curley, Caroline Stewart, Constantine Tam, Shalini Balendran, Pietro R Di Ciaccio, Sushrut Patil, Min-Hi Han, Nada Hamad","doi":"10.1111/imj.70050","DOIUrl":"https://doi.org/10.1111/imj.70050","url":null,"abstract":"<p><strong>Background: </strong>Allogeneic haemopoietic stem cell transplantation (HSCT) is an effective therapy with curative potential for patients with high-risk or relapsed/refractory chronic lymphocytic leukaemia (CLL). There are limited data on the use and outcomes of HSCT in the modern era of CLL treatment.</p><p><strong>Aims: </strong>The aim of this study was to examine the use of HSCT performed for CLL in Australia and New Zealand, including patients exposed to pathway inhibitors (PIs) prior to transplant.</p><p><strong>Methods: </strong>Data were collected through the Australian and New Zealand Transplant and Cellular Therapy Registry for all patients who underwent HSCT for CLL between January 2009 and December 2018. Transplant outcomes were compared between two 5-year time periods: 2009-2013 and 2014-2018.</p><p><strong>Results: </strong>Ninety-four patients underwent HSCT during 2009-2013 and 50 during 2014-2018. There was a significant reduction in non-relapse mortality (NRM) from 42% (95% confidence interval (CI): 31-52) to 23% (95% CI: 12-35, P = 0.02) between the periods; however, overall survival (OS), progression-free survival (PFS) and relapse were unchanged. Within the 2014-2018 cohort, 22 patients were PI exposed prior to transplant. At 3 years, these patients demonstrated a median OS of 54% (95% CI: 35-82), PFS of 44% (95% CI: 27-71), NRM of 25% (95% CI: 8-45) and cumulative incidence of relapse of 32% (95% CI: 14-52). In multivariate analysis, only disease in complete remission at the time of HSCT was associated with improved OS (hazard ratio: 2.54, 95% CI: 1.04-6.18).</p><p><strong>Conclusion: </strong>Allogeneic HSCT remains a viable treatment option for select patients with CLL.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010640","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":"Complete hemifacial paralysis caused by pontine infarct","authors":"Henry Jiang,&nbsp;Leon S. Edwards","doi":"10.1111/imj.70083","DOIUrl":"https://doi.org/10.1111/imj.70083","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"866-867"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949711","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 pre-round: what are junior doctors doing before handover?","authors":"Tim Bridgman","doi":"10.1111/imj.70084","DOIUrl":"https://doi.org/10.1111/imj.70084","url":null,"abstract":"&lt;p&gt;Many readers of the &lt;i&gt;Internal Medicine Journal&lt;/i&gt; (IMJ) may not be familiar with the term pre-rounding. It is a term that refers to the practice of junior doctors performing reviews, tasks or other preparation directly prior to a ward round from their consultant or other lead clinician.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Pre-rounding is a heterogenous practice that varies between hospitals, departments and even within departments. It may include a traditional full physical round of patients, as is more common in North America, or, more simply, in Australia and New Zealand, it may be a review of key test results, observations and vital signs using the electronic medical record (EMR).&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt; Multiple factors affect how pre-rounds occur in each area. Many senior staff may not be aware of what their juniors are doing before the ward round.&lt;/p&gt;&lt;p&gt;Several factors influence the structure of a junior doctor's pre-round. Each individual will have their own preferred approach and structure, and variation in this between doctors may in part reflect the absence of formal medical school education on pre-rounding.&lt;span&gt;&lt;sup&gt;1, 5&lt;/sup&gt;&lt;/span&gt; External factors will also influence structure. Individual senior clinicians will vary in the information that they require from the juniors on the round and the manner in which they wish it presented. This will drive differing pre-rounding practices among the hospital and medical teams. The hospital's systems and EMRs will affect the approach to pre-rounds between hospitals. A junior doctor's job is therefore to be adaptable and pre-round in a manner to maximise efficiency in collating the information that is expected.&lt;/p&gt;&lt;p&gt;In current practice, getting the full information together in time for the senior round often relies on the junior doctor arriving at the hospital ahead of the prescribed ‘start time’. This is especially the case when the round begins immediately after the start-of-the-day handover. With ever more complex patients and increasing health information in the system, this can lead to earlier and earlier start times. Efficiency is the goal, with the cost of inefficiency being measured in lost minutes of sleep. Simply arriving with the senior medical officer is commonly no longer achievable, particularly during breakneck pace surgical rounds where time at bedside may be measured in seconds. However, as it is with almost every area of healthcare provision currently, time remains a luxury, necessitating efficiency.&lt;/p&gt;&lt;p&gt;Each consultant or lead clinician for the round will have an expectation on what information the junior staff should have available, varying among case presentations, current vital signs, recent test results and event recorded by the overnight nursing shift. These expectations are often shaped by doctors' personal practice and the information each uses to formulate ongoing management plans. Traditional structured teaching might struggle to provide a ‘one best approach’ with ","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"703-704"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950037","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":"Educating medical trainees about artificial intelligence should not be optional","authors":"Brandon Stretton,&nbsp;Benjamin Cook,&nbsp;Bradley Menz,&nbsp;Matthew Arnold,&nbsp;Christina Gao,&nbsp;Andrew Vanlint,&nbsp;Ishith Seth,&nbsp;Joshua Kovoor,&nbsp;Aashray Gupta,&nbsp;Stephen Bacchi","doi":"10.1111/imj.70082","DOIUrl":"https://doi.org/10.1111/imj.70082","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"871-872"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949719","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":"Thyroid haemorrhage in the setting of acute illness-induced supratherapeutic anticoagulation","authors":"Hitarth Dalal,&nbsp;Noor Lammoza,&nbsp;Maria Hormiz,&nbsp;Ar Kar Aung,&nbsp;Helen McDougall","doi":"10.1111/imj.70079","DOIUrl":"https://doi.org/10.1111/imj.70079","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"868-870"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949720","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":"Australian contribution to the history of amoebic meningitis and encephalitis","authors":"Tony M. Korman","doi":"10.1111/imj.70081","DOIUrl":"https://doi.org/10.1111/imj.70081","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"873"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949721","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":"Rivaroxaban-related nephropathy: an under-reported cause of acute kidney injury","authors":"Lucy Marshall,&nbsp;Naveed Ahmed,&nbsp;Janak R. de Zoysa,&nbsp;Ashik Hayat","doi":"10.1111/imj.70080","DOIUrl":"https://doi.org/10.1111/imj.70080","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"864-865"},"PeriodicalIF":1.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950572","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":"Lessons from implementation of a nephrology key performance indicator programme.","authors":"Adam G Steinberg, Peter F Mount, Maree Branagan, Matthew A Roberts, Nigel D Toussaint","doi":"10.1111/imj.70049","DOIUrl":"https://doi.org/10.1111/imj.70049","url":null,"abstract":"<p><strong>Background: </strong>We review the impact of a nephrology key performance indicator (KPI) program implemented over a ten-year period in Victoria, Australia. The program enabled transparent comparison of performance across nephrology units, however improvement against performance targets was not consistent and better understanding of KPIs is required to promote quality improvement.</p><p><strong>Aim: </strong>We aimed to review the impact of the Victorian nephrology KPI programme over a 10-year period.</p><p><strong>Methods: </strong>The KPI programme involved six KPIs related to the continuum of care for kidney replacement therapy: pre-dialysis education, vascular access at first haemodialysis, home dialysis rates, peritonitis rates, pre-emptive kidney transplantation and rates of transplantation/waitlisting. Data were collected monthly from the 10 Victorian nephrology services using a purpose-designed website portal. Results were analysed and reported every 3 months. We present a summary of each KPI and discuss changes over the 10-year period.</p><p><strong>Results: </strong>KPI data demonstrated significant differences in performance across KPIs after implementation, particularly in rates of home dialysis and transplant waitlisting. Changes within units were sometimes significant, but across Victoria, performance was relatively static. Over 10 years, there was a lack of significant improvement in clinical performance in several indicators and multiple changes to KPI targets were made.</p><p><strong>Conclusion: </strong>The KPI programme enabled comparison of performance across nephrology units, but improvement in performance targets was not consistent over the 10-year period and the programme served as a means for benchmarking perhaps, rather than a quality improvement tool. Better understanding of each KPI and resources available for quality improvement is crucial for the success of a KPI programme.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991808","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":"Terminal heart failure care for women: better or more of the same?","authors":"Vithoosharan Sivanathan, Natasha Smallwood, Dominica Zentner","doi":"10.1111/imj.70077","DOIUrl":"https://doi.org/10.1111/imj.70077","url":null,"abstract":"<p><strong>Background: </strong>Women with chronic heart failure (CHF) experience an increased symptom burden, activity impairment and frailty. Although receiving palliative care services has been shown to improve the quality of life of people with CHF, few patients access this in a timely manner.</p><p><strong>Aim: </strong>Explore whether there were differences in either referral to specialist palliative care or provision of elements of palliative care to women and men with CHF during their terminal admission in Australia.</p><p><strong>Methods: </strong>This is a retrospective review of medical records for all admissions resulting in death from chronic heart failure (July 2011 to December 2019).</p><p><strong>Results: </strong>The cohort (n = 439) was elderly (median age 83.7 years, IQR = 77.6-88.7) and composed of 199 (45.1%) women. There was no association between sex and receiving an inpatient referral to specialist palliative care (P = 0.80). Women were less likely to receive life-sustaining interventions (intubation, inotropes, resuscitation, ICU stay) (odds ratio [OR] = 1.71, 1.04-2.83; P = 0.04) compared to men. Women were more likely to receive terminal symptom-related management (opioids or benzodiazepines) (OR = 3.19, 1.54-6.63; P = 0.01) or a palliative approach (OR = 1.68, 1.14-2.45; P < 0.01). Women were less likely to present to the emergency department (OR = 0.50, 0.31-0.79; P = 0.04) or be referred to an outpatient chronic disease programme (OR = 0.58, 0.34-0.98; P = 0.04) in the 12 months prior to death compared to men.</p><p><strong>Conclusion: </strong>Given accepted differences in the timeliness of cardiac care for women, the apparent finding of better end-of-life care for women is intriguing and merits further research.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985383","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}