Internal Medicine Journal最新文献

{"title":"Safety, efficacy and post-endoscopic retrograde cholangiopancreatography survival in nonagenarians: a retrospective cohort study","authors":"Amirah Etchegaray,&nbsp;Sanjivan Mudaliar,&nbsp;Kimberley Ryan,&nbsp;Karen Hay,&nbsp;Jason Hwang,&nbsp;Benedict Devereaux,&nbsp;Mark Appleyard,&nbsp;Florian Grimpen","doi":"10.1111/imj.16652","DOIUrl":"10.1111/imj.16652","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Increasing numbers of older patients with pancreatobiliary disease are undergoing endoscopic retrograde cholangiopancreatography (ERCP). Older patients may be at higher risk of ERCP-related adverse events due to their age and comorbidities; however, data are sparse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to evaluate long-term mortality, procedural outcomes and safety of ERCP in nonagenarians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated consecutive patients aged ≥90 years who underwent ERCP at a tertiary hospital over 12 years. The primary outcome was survival. Secondary outcomes included procedural success and adverse events. Logistic regression was used to analyse procedural outcomes, and factors predictive of survival were identified using a Cox proportional hazard model visualised by Kaplan–Meier plot.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 159 consecutive ERCPs were performed in 115 nonagenarian patients. The mean age of the cohort was 92.3 (standard deviation ± 2.1) years. Choledocholithiasis (78.6%) was the most common indication, followed by malignant biliary obstruction (MBO, 18.9%) and bile leak (2.5%). Survival following ERCP for MBO at 30 days, 3 months and 1 year was 78%, 52% and 9%, respectively, compared to 98%, 94% and 89% for choledocholithiasis (<i>P</i> &lt; 0.001). Procedural success was achieved in 91% of ERCPs (benign or malignant). ERCPs performed for MBO were more likely to fail (<i>P</i> &lt; 0.001). Adverse events occurred in 5% of procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Therapeutic ERCP in select nonagenarians is a clinically relevant intervention for both malignant and benign pathology. Age does not constitute a barrier to the performance of ERCP in appropriately selected patients. Nonagenarians may be counselled for a success and adverse event rate equivocal to younger populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"435-443"},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585705","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":"Filling the gaps to empower regional centres to manage myelodysplastic syndrome and acute myeloid leukaemia leading to wider cancer healthcare delivery and access to clinical trials.","authors":"Michael Ashby, Shaun Fleming, Andrew Spencer, Anne Woollett, Tricia Wright","doi":"10.1111/imj.70011","DOIUrl":"https://doi.org/10.1111/imj.70011","url":null,"abstract":"<p><strong>Background: </strong>The management of patients with haematological malignancies in rural and regional Australia is different to that in metropolitan centres due to many factors. Lower-intensity and easier-to-access treatments that are now available for acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) have improved the deliverability of treatment options for these disorders. Despite the challenges, urgent work is required to allow the care and outcomes of these patients to mirror those living in metropolitan centres.</p><p><strong>Aims: </strong>To highlight the challenges in management of AML and MDS in regional Victoria.</p><p><strong>Methods: </strong>Four clinical cases describing the difficulties faced in the management of AML/MDS patients in regional Victoria.</p><p><strong>Results: </strong>We describe limitations in inpatient services, supportive care, blood product access and both specialised diagnostics and specialist workforce. Access to clinical trials is limited but vital to allow the availability of all therapeutic options.</p><p><strong>Conclusions: </strong>Limitations in management of AML/MDS patients exist in regional centres. We utilised focused clinical fellows in a partnership between Latrobe Regional Health and Alfred Health in Victoria to improve treatment options for these patients. Moreover, we demonstrate future areas of focus, which will further enable rural and regional healthcare providers to bridge the gap in the care of patients with haematological malignancies.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585682","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":"Preventive medication deprescribing in advanced cancer patients approaching end of life","authors":"Jane McKenzie,&nbsp;Catherine Dunn,&nbsp;Grace Gard,&nbsp;Brian Le,&nbsp;Peter Gibbs","doi":"10.1111/imj.70013","DOIUrl":"10.1111/imj.70013","url":null,"abstract":"<p>Previous reports indicated many patients with advanced cancer and limited life expectancy have ongoing preventive medication prescription (PMP) of uncertain benefit and increased risk. Our review of palliative care oncology admissions found high rates of PMP (69%) at time of first palliative care admission, despite high rates of inpatient deprescription (88%) and death at a median of 16 days (interquartile range 10–45) following admission. Rates of PMPs did not vary by time from last systemic treatment (<i>P</i> = 0.29) or by prior palliative care involvement (<i>P</i> = 0.82). Physicians and the wider multidisciplinary care team may be missing deprescription opportunities for terminally ill patients.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"673-676"},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585660","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":"Incorporating the Clinical Frailty Scale into routine outpatient nephrology practice: a 3-year follow-up of outcomes and associations.","authors":"Nicholas Pizzino, Matthew Pugliese, Michelle Soye, Aron Chakera, Anuttara Panchali W Kumarasinghe","doi":"10.1111/imj.70009","DOIUrl":"https://doi.org/10.1111/imj.70009","url":null,"abstract":"<p><strong>Background: </strong>There remains a lack of evidence based guidelines regarding the benefit of applying scoring systems in the outpatient nephrology setting. As such, we set out to investigate and follow-up the utility of the Clinical Frailty Scale (CFS) for the ongoing management of patients with end stage kidney disease.</p><p><strong>Aims: </strong>To explore the association between frailty, as measured by a Clinical Frailty Score (CFS) 5-8, and long-term outcomes in a cohort of patients with chronic kidney disease (CKD).</p><p><strong>Methods: </strong>This was a 3-year follow-up analysis of a prospective cohort study. This study included participants of age >50 years and with CKD with an estimated glomerular filtration rate <30 mL/min/1.73 m². The primary outcome included actual end-stage kidney disease (ESKD) management at 3 years (transplantation, haemodialysis, peritoneal dialysis or supportive care). The secondary outcomes include all-cause mortality, hospitalisation rates, and ESKD- and dialysis-related complications.</p><p><strong>Results: </strong>Seventy-nine of 81 patients from the initial study were included; two were lost to follow-up. After 3 years, 18 patients remained on conservative management, 20 on hospital haemodialysis and 13 on peritoneal dialysis. Non-frail patients (CFS 1-4) were twice as likely to have ESKD treatment changes by 3 years. This may carry clinical importance despite not achieving statistical significance (44% (n = 22) vs 22% (n = 4), P = 0.11). Hospitalisation rates were similar between groups (77.8% (n = 14) frail vs 82.0% (n = 41) non-frail; P = 0.74). Mortality was higher in patients living with frailty at baseline (56% (n = 10) vs 8% (n = 4); P ≤ 0.001).</p><p><strong>Conclusions: </strong>Of older adults screened for frailty, those not identified to be frail (CFS 1-4) were twice as likely to have changes in ESKD management as frail patients (CFS 5-8). Three-year mortality was seven times higher (56%) in patients identified as frail at baseline. There were no statistically significant differences in hospitalisation rates or dialysis-related or ESKD-related complications.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585685","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":"Enhancing utilisation of Hospital in the Home for intravenous diuretic therapy: a retrospective study of barriers and estimated bed substitution in general medicine inpatients with decompensated heart failure","authors":"Elizabeth Potter,&nbsp;Sharon Joy,&nbsp;Philippa Lock,&nbsp;Helen Richards,&nbsp;Benjamin Rogers","doi":"10.1111/imj.16655","DOIUrl":"10.1111/imj.16655","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ambulatory treatment of decompensated heart failure (HF) with intravenous (IV) furosemide through Hospital in the Home (HITH) is safe, effective and reduces costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We hypothesised that this service was underutilised by general medicine and aimed to examine potential barriers and bed-day utilisation implications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this multi-site, retrospective observational study, we identified general medicine inpatients admitted with heart failure (HF) between November 2021 and October 2022. Those who required intravenous (IV) furosemide for &gt;24 h were selected and included if clinically stable. Patients were grouped by ‘no barriers’, ‘relative barriers’ and ‘absolute barriers’ to Hospital in the Home (HITH). We estimated potential brick-and-mortar hospital bed-days that could be transferred to HITH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1856 admissions coded as HF, 694 met our criteria. Of these, 311 (45%) were clinically stable, while only four were transferred to HITH. Of the remaining 307 patients, 27 (9%), 129 (42%) and 151 (49%) exhibited no, relative and absolute barriers to HITH respectively. Those with no or relative barriers (<i>n</i> = 156, 51% or 22% of those treated with IV furosemide) had two (interquartile range (IQR) 1–3) additional medical diagnoses and spent 4 (IQR 3–6) days in hospital while clinically stable. A 36% reduction in brick-and-mortar hospital bed-day utilisation by transferring care to HITH was estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our health service, general medicine patients are rarely referred to HITH for IV diuresis for decompensated HF. Overcoming barriers relating to the ability of the model of care to support greater acute medical complexity could result in increased utilisation of HITH and deliver a significant reduction in brick-and-mortar hospital bed-day utilisation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"407-414"},"PeriodicalIF":1.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16655","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572808","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":"Connective tissue disease-associated interstitial lung disease: an approach to treatment amidst an expanding evidence base.","authors":"Michael Hong, Elizabeth Veitch, Sandhya Limaye","doi":"10.1111/imj.70026","DOIUrl":"https://doi.org/10.1111/imj.70026","url":null,"abstract":"<p><p>Connective tissue disease-associated interstitial lung disease (CTD-ILD) comprises a heterogenous group of conditions characterised by immune-mediated fibro-inflammatory pulmonary injury. Although the disease course is variable, CTD-ILD can progress to respiratory failure and thus has a profound impact on morbidity and mortality. Systemic sclerosis (SSc), rheumatoid arthritis, idiopathic inflammatory myositis, Sjogren disease systemic lupus erythematosus and mixed connective tissue disease can all manifest or present with ILD. Histological injury in CTD-ILD is diverse and pharmacological management, when indicated, is typically centred around corticosteroids and various immunosuppressive or anti-fibrotic agents. Until recently, treatment decisions have been extrapolated from the evidence base available for SSc-related ILD. Many recent trials and prospective studies have evaluated treatment options in a range of CTD-ILD, thus guiding therapeutic intervention. Amidst an expanding evidence base, this comprehensive review describes new management strategies in CTD-ILD with a focus on evidence from clinical trials. Supportive care and minimising treatment-associated adverse effects remains paramount in this population with complex respiratory pathology and frequent co-morbidities.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572907","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":"Ratifying the efficacy and safety of intensive induction chemotherapy for acute myeloid leukaemia by the Australasian Leukaemia & Lymphoma Group consensus approach.","authors":"Aditya Tedjaseputra, Amanda Tey, Anastasios Nalpantidis, George Grigoriadis, Shaun Fleming, Shahla Vilcassim, Pasquale L Fedele, Michael Sze Yuan Low, Paul Yeh, Michael Gilbertson, Ashwini Bennett, Gareth P Gregory, Danielle Oh, Donna Gairns, Zane Kaplan, Sanjeev D Chunilal, Susan Brown, Stephen Opat, Chong C Chua, Jake Shortt","doi":"10.1111/imj.70010","DOIUrl":"https://doi.org/10.1111/imj.70010","url":null,"abstract":"<p><strong>Background: </strong>After pharmaceutical benefits scheme approval of midostaurin for fms-like tyrosine kinase 3 (FLT3)-mutated acute myeloid leukaemia (AML) in 2018, the Australasian Leukaemia & Lymphoma Group (ALLG) proposed a consensus approach to AML induction with 7+3 chemotherapy (7 days of infusional cytarabine with three doses of anthracycline) to align with future clinical trial protocols.</p><p><strong>Aims: </strong>To determine the efficacy and safety of idarubicin-based 7+3 induction ± midostaurin (per ALLG recommendations) in a real-world, tertiary hospital setting.</p><p><strong>Methods: </strong>Data were prospectively collected for all patients assessed for front-line AML treatment. Disease risk and response assessments were defined by European LeukaemiaNet 2017 guidelines. Efficacy and safety endpoints included complete remission (CR) rates, composite CR rates, event-free survival (EFS), overall survival (OS), induction mortality, duration of cytopenias and intensive care unit (ICU) utilisation. Analysis was planned following completion of ≥50 inductions and 5-year aggregated experience.</p><p><strong>Results: </strong>Between 2018 and 2023, 58 patients (median age 49 years) received 7+3 induction with CR and induction mortality rates of 88% (95% confidence interval (95% CI): 77-95%) and 1.7% (95% CI: 0-9%) respectively. At a median of 24.6 months of follow-up, median OS was 17.6 months for adverse-risk versus not reached for non-adverse-risk patients (P = 0.03). FLT3-mutated patients demonstrated an 89% CR rate (95% CI: 67%-99%) with comparable 4-year EFS (65%) and OS (68%) to FLT3-wild-type patients. Safety across 58 induction and 139 consolidation cycles was acceptable, with a single death and a 21% ICU admission rate (95% CI: 11%-33%) during induction.</p><p><strong>Conclusions: </strong>Idarubicin-based 7+3 induction with contemporary supportive care yields good safety and CR rates, including in midostaurin-treated FLT3-mutated patients. Survival outcomes for adverse-risk AML patients remain suboptimal.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572812","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":"Hyperhidrosis: don't sweat it.","authors":"Mitchell J Lycett, Karl Ng","doi":"10.1111/imj.70019","DOIUrl":"https://doi.org/10.1111/imj.70019","url":null,"abstract":"<p><p>Hyperhidrosis is an under-reported and under-treated condition that causes significant patient morbidity. Secondary causes require consideration, but the vast majority of cases are idiopathic. The condition is encountered by a range of clinicians, including neurologists, dermatologists and endocrinologists, and it pays to be familiar with the range of highly effective treatment options available for the treatment of both focal and generalised sweating disorders. We outline the treatment options and therapeutic approach to the most common hyperhidrosis phenotypes, with illustrative cases.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572810","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":"Non-invasive screening for coronary artery disease: current perspectives, patient, public health and ethical considerations in evaluating symptomatic and asymptomatic individuals","authors":"Louis W. Wang","doi":"10.1111/imj.16585","DOIUrl":"10.1111/imj.16585","url":null,"abstract":"<p>Coronary artery disease (CAD) is a leading cause of morbidity worldwide. Although non-invasive testing for CAD aims at reducing future disease burden, testing can often be associated with significant economic and other health-related costs, at both an individual and societal level. Although there is an established role for screening symptomatic patients for CAD, there is still considerable debate as to the best approach for individuals who are asymptomatic. In this review, various non-invasive tests commonly used in clinical practice will be discussed, including their potential utility, known limitations, and other considerations regarding their use. The use of such testing requires careful consideration of their diagnostic accuracy, availability, cost and patient-specific factors that may limit their utility and safety. Future recommendations for CAD screening, especially for lower-risk or asymptomatic individuals, should offer clinicians and patients some degree of flexibility and take into account the nuanced clinical approach that is often required to address the variability of each individual patient's biopsychosocial context and other factors relating to the suitability and accessibility of screening (e.g. financial cost and geographic location). Recommendations that are well suited to certain geographic locations or societal groups may be less appropriate for other populations, especially those that are marginalised, less well resourced or experiencing significant socioeconomic disadvantage. Screening for CAD should therefore endeavour to ensure equity and aim to improve outcomes in all patient groups, including those who are disadvantaged and most at risk.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"555-563"},"PeriodicalIF":1.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567125","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":"Impact of a specialised pleural medicine unit in the management of pleural infection.","authors":"Wai Yiu, Liam M Hannan, Mark Tacey, Mani Suleiman, Sanjeevan Muruganandan","doi":"10.1111/imj.70028","DOIUrl":"https://doi.org/10.1111/imj.70028","url":null,"abstract":"<p><strong>Background: </strong>Managing pleural infection can be complex and costly and demonstrates considerable healthcare utlilisation.</p><p><strong>Aims: </strong>To describe the influence of a specialised pleural medicine unit (SPMU) on outcomes for people with pleural infection at a metropolitan health service.</p><p><strong>Methods: </strong>Administrative data were used to identify cases of pleural infection, which were classified into (i) empyema, (ii) parapneumonic effusion and (iii) clinical suspicion of pleural infection. Two cohorts were compared: Period 1 (pre-SPMU from January 2016 to August 2018) and Period2 (post-SPMU from August 2018 to October 2020).</p><p><strong>Results: </strong>In total, 213 individuals were managed for pleural infection across the two time periods (Period 1 (n = 108), Period 2 (n = 105)). Intrapleural therapy (IPT) was utilised more frequently in Period 2 (0% vs 15.2%, P = <0,001) with earlier intervention (76.8 vs 47.5 h, P = 0.17). These observations were associated with a significant reduction in surgical intervention rate (25.9% vs 7.6%, P < 0.001) without any significant difference in the median length of stay from diagnosis to discharge (9.4 days (interquartile range (IQR) 5.1-15.9) days in Period 1 vs 7.3 days (IQR 4.3-13.1 days) in Period 2 (P = 0.13)). Outcomes at 90 days (mortality and pleural-related readmissions) were not different between the two cohorts. In a subgroup analysis comparing patients who received advanced therapies (either surgery or IPT), there was shorter hospitalisation time (15.8 vs 12.5 days, P = 0.084) and lower inpatient costs ($79 663.9 vs $56 513.6, P = 0.016) during Period 2 without a rise in adverse events or mortality.</p><p><strong>Conclusion: </strong>The introduction of an SPMU was associated with increased utilisation of IPT and a reduction in surgical interventions for the management of pleural infections.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567111","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}