Internal Medicine Journal最新文献

{"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}

{"title":"Clearing the air: smoking status in kidney transplantation assessment – a question of risk or equity?","authors":"Nasir Ali Shah,&nbsp;Kenneth Yong","doi":"10.1111/imj.70105","DOIUrl":"10.1111/imj.70105","url":null,"abstract":"&lt;p&gt;Over the past two decades, the number of individuals receiving treatment for end-stage kidney disease (ESKD) in Australia has doubled. Although the prevalence of kidney transplantation also increased twofold during this period,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; the kidney transplant waiting list has remained long due to persistent disparities between organ supply and demand. Between 2018 and 2023, the national median waiting time for kidney transplantation increased from 2.1 to 2.5 years.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; As a result, 1330 patients remained on the kidney transplant waiting list in 2023.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Amid this growing need, the eligibility of active smokers has remained a subject of ongoing debate.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Internal Medicine Journal&lt;/i&gt; in a retrospective study conducted within a local health district in New South Wales (NSW) Australia, Hazim &lt;i&gt;et al&lt;/i&gt;. examined a cohort of 333 patients receiving maintenance dialysis, of whom ~25% were identified as current smokers.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Among the overall cohort, 150 individuals were referred for transplant assessment. Smoking was cited as the primary reason for exclusion from the transplant waitlist in 14.4% of cases. Of the 89 patients who were current smokers, 48 were not referred for transplant assessment. Within this subgroup, smoking status alone accounted for exclusion in 10 cases, while both smoking and the presence of comorbidities contributed to exclusion in 38 cases. The outcomes of smokers who did receive pre-transplant assessment were not discussed. This study found that patients who were active smokers tended to be younger (47.8 years vs. 52.1 years) and had a lower burden of comorbid conditions compared to those excluded for other reasons. Specifically, individuals excluded due to smoking had a lower prevalence of diabetes mellitus, coronary artery disease, peripheral vascular disease and heart failure. In addition to the retrospective analysis, the study incorporated a national survey of Australian transplant units, which revealed that approximately 30% of centres did not exclude patients from waitlisting solely because of active smoking. The survey also identified substantial variability in clinical practice related to the assessment and management of smoking, including differences in the use of self-reported smoking status versus biochemical verification (serum cotinine measurements) and assistance for smoking cessation. The authors concluded that rigid smoking policies may inadvertently exclude individuals who would otherwise be suitable transplant candidates, potentially contributing to inequities in access to care – particularly among populations with lower socioeconomic status or indigenous background.&lt;/p&gt;&lt;p&gt;It is well established that tobacco use is a leading and preventable cause of mortality in the general population. In the Global Burden of Disease study, there were an estimated 6.18 million (9.1%) deaths attributable to smoking","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"882-884"},"PeriodicalIF":1.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225346","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":"Indigenous bronchiectasis assessment scale - the 'IBAS': a proposed new tool to assess bronchiectasis severity in adult Indigenous Australians.","authors":"Timothy Howarth, Lisa Sorger, Helmi Ben Saad, Payi L Ford, Subash S Heraganahally","doi":"10.1111/imj.70118","DOIUrl":"https://doi.org/10.1111/imj.70118","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of a comprehensive bronchiectasis severity assessment tool specific for Indigenous people that corrects for normative references established for the non-Indigenous population.</p><p><strong>Aims: </strong>An innovative bronchiectasis assessment tool is developed for use in adult Indigenous patients - the Indigenous bronchiectasis assessment scale '(IBAS)'.</p><p><strong>Methods: </strong>A total of 454 adult Indigenous Australian patients, with chest CT confirmed bronchiectasis diagnosed between 2011 and 2020, were included. Age, sex, residence location, body mass index, radiological findings, sputum microbiology, lung function parameters and medical comorbidities were utilised to predict 5-year all-cause mortality and 5-year hospitalisations. Scores of parameters with P < 0.20 from univariate Cox regressions were derived.</p><p><strong>Results: </strong>The resultant IBAS included age (<30, 30-50, 50-70 and 70+ years), urban residence, forced vital capacity (% predicted) (>50%, 30%-50% and <30%), right lower lobe involvement, history of Haemophilus spp., Pseudomonas spp., yeast spp. or Moraxella spp., 2-year respiratory condition hospitalisation history (<2, 2 and 3+ admissions), and comorbid chronic obstructive pulmonary disease, asthma and arterial hypertension. The maximum score was 18, with thresholds at 0-4 (mild, n = 78, 34.4%), 5-7 (moderate, n = 111, 48.9%) and ≥ 8 (severe, n = 38, 16.7%). The area under the curve for 5-year mortality was 0.743 (95% confidence interval (CI) 0.683, 0.803). The IBAS score demonstrated significant delineation in mortality between mild and moderate (moderate hazard ratio (HR) 3.45 (95% CI 1.57, 7.58)) and between moderate and severe (severe HR 2.43 (95% CI 1.45, 4.07)).</p><p><strong>Conclusion: </strong>The proposed IBAS tool could be of aid in assessing bronchiectasis severity in Indigenous patients.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208467","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":"Medicinal cannabis: is current use clinically justified?","authors":"Russ J Scott, Ian A Scott","doi":"10.1111/imj.70094","DOIUrl":"https://doi.org/10.1111/imj.70094","url":null,"abstract":"<p><p>Cannabis products are increasingly perceived and advertised as natural and safe treatments for a variety of conditions, including chronic non-cancer pain (CNCP). The number of prescriptions for medicinal cannabis (MC) currently averages >80 000 per month for >1 million Australians. Although over 800 different cannabis products are available to prescribe in Australia, only two are registered on the Australian Register of Therapeutic Goods and approved by the Therapeutic Goods Administration for specific clinical indications. Using treatment for CNCP as an example, evidence of efficacy across nine systematic reviews was inconsistent and/or of low quality and, with the exception of neuropathic pain, was unable to identify patient phenotypes in whom a specific type and dosing of cannabis product can reliably provide sustained symptomatic relief. Professional bodies do not endorse unregulated or first-line use of cannabis for CNCP. Harm from cannabis is under-reported but adverse effects include impaired cognitive function, dizziness, sedation, confusion, psychosis and arrhythmias, potentially more so in older patients. Healthcare professionals must inform patients of the significant limitations of current evidence of efficacy and safety for cannabis use in CNCP and other conditions and resist media and industry pressures for greater access to and prescribing of MC.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215728","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":"All that jitters is not alcoholic liver disease","authors":"Manik Kumaranayake,&nbsp;Rhona Boyle,&nbsp;Shashwat Mishra,&nbsp;Jonathan Mitchell","doi":"10.1111/imj.70107","DOIUrl":"10.1111/imj.70107","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"1045-1046"},"PeriodicalIF":1.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198989","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":"2025 Guidelines for direct oral anticoagulants: a practical guidance on the prescription, laboratory testing, peri-operative and bleeding management","authors":"Huyen A. Tran,&nbsp;Eileen Merriman,&nbsp;Ross Baker,&nbsp;Jennifer Curnow,&nbsp;Laura Young,&nbsp;Chee Wee Tan,&nbsp;Simon McRae,&nbsp;Sanjeev D. Chunilal","doi":"10.1111/imj.70103","DOIUrl":"10.1111/imj.70103","url":null,"abstract":"<p>Direct oral anticoagulants (DOACs) are widely prescribed to prevent and treat venous and arterial thromboembolism, supported by published evidence, and are preferred over warfarin in many guidelines. Although the risk of major bleeding, in particular intracranial haemorrhage (ICH), is decreased with DOACs, gastrointestinal bleeding is increased with some DOACs, and the case fatality rate of bleeding remains high. Therefore, it is important to (i) prescribe DOACs appropriately, (ii) have strategies to manage major bleeding including the use of specific reversal agents and (iii) interrupt and resume DOACs for procedures. The main recommendations are as follows: (i) Select the appropriate dose of DOAC according to indications and consider patient factors to minimise bleeding risks; (ii) DOACs do not require routine laboratory testing; (iii) for life-threatening uncontrollable bleeding, specific agents can be used to reverse the anticoagulant effects of DOACs; and (iv) DOACs can be interrupted for planned procedures without the need for ‘bridging’ with low-molecular-weight heparin (LMWH). The anticoagulant effects of DOACs can be reversed with specific agents, such as andexanet for apixaban and rivaroxaban and idarucizumab for dabigatran. If not available, pro-haemostatic agents such as prothrombin complex concentrates or activated prothrombin complex concentrates can be considered. DOACs can be interrupted and resumed for procedures without the need for ‘bridging’ with LMWH.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1174-1183"},"PeriodicalIF":1.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191753","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":"Isolated gastrointestinal Langerhans cell histiocytosis in an elderly female ex-smoker","authors":"Max Gottlieb,&nbsp;Siddhartha Deb,&nbsp;Britt Christensen","doi":"10.1111/imj.70111","DOIUrl":"10.1111/imj.70111","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"1047-1048"},"PeriodicalIF":1.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191754","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":"Climate stewardship in healthcare: start with eradicating low-value, environmentally unfriendly medical services","authors":"Isaac K. S. Ng,&nbsp;Charisse Loh,&nbsp;Wilson G. W. Goh,&nbsp;Desmond B. Teo,&nbsp;Li Feng Tan","doi":"10.1111/imj.70106","DOIUrl":"10.1111/imj.70106","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"1049-1050"},"PeriodicalIF":1.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186905","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}