Internal Medicine Journal最新文献_第5页

Opportunistic screening for diabetes among urban Aboriginal adults during emergency department attendance. 城市原住民成人在急诊科就诊时的机会性糖尿病筛查。

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-25 DOI: 10.1111/imj.70078

William Yu, Kyaw Phone Myint, Uchechukwu Levi Osuagwu, Nathan Jones, Richard Cracknell, Anau Speizer, David Simmons, Milan Piya

{"title":"Opportunistic screening for diabetes among urban Aboriginal adults during emergency department attendance.","authors":"William Yu, Kyaw Phone Myint, Uchechukwu Levi Osuagwu, Nathan Jones, Richard Cracknell, Anau Speizer, David Simmons, Milan Piya","doi":"10.1111/imj.70078","DOIUrl":"https://doi.org/10.1111/imj.70078","url":null,"abstract":"Background: Aboriginal people have a high risk of type 2 diabetes (T2DM). Routine opportunistic testing using glycated hemoglobin (HbA1c) for diabetes in the emergency department (ED) offers an opportunity to detect undiagnosed diabetes and evaluate glycaemia for pre-existing diabetes.Aims: To evaluate the prevalence of pre-existing diabetes and assess random blood glucose (RBG) and HbA1c as screening tools for undiagnosed diabetes in Aboriginal people attending the ED.Methods: Demographic and RBG data were extracted for all Aboriginal adults presenting to a Sydney hospital ED over 6 months. Practitioners requested blood tests as per routine care, and in the final 3 months, HbA1c was automatically added to routine venous sampling. The primary outcome was change in diabetes diagnosis with the addition of HbA1c.Results: Overall, 1640 adult Aboriginal patients presented to the ED over 6 months (4.1% of all presentations), including 734 unique individuals tested during routine care. The prevalence of pre-existing T2DM was 12.0% (n = 88). Among those without known diabetes, 1.4% (n = 9) had glucose readings ≥11.1 mmol/L and 14.3% (n = 90) had glucose readings 7.0-11.0 mmol/L. For those without known diabetes with HbA1c measurement, there were 2.7% (n = 8) with HbA1c ≥6.5% and 4% (n = 12) with HbA1c 6.0%-6.4%. There was no overlap between those who had an HbA1c ≥6.5% and RBG ≥11.1 mmol/L.Conclusions: There was a high prevalence of pre-existing diabetes among Aboriginal adults attending the ED. New diabetes diagnosis in the ED based on RBG or HbA1c was not common. Confirmatory testing for diabetes should be recommended to the general practitioners of patients in whom elevated HbA1c or RBG are identified.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009864","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}

引用次数: 0

Efficacy of pro-haemostatic agents in the management of factor Xa inhibitor-associated intracranial haemorrhages. 促止血剂对Xa因子抑制剂相关颅内出血的治疗效果。

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-23 DOI: 10.1111/imj.70074

Sara Shu-Ling Ng, Hashim Noori, Diem Nguyen, Zhengbang Wang, Danny Hsu

{"title":"Efficacy of pro-haemostatic agents in the management of factor Xa inhibitor-associated intracranial haemorrhages.","authors":"Sara Shu-Ling Ng, Hashim Noori, Diem Nguyen, Zhengbang Wang, Danny Hsu","doi":"10.1111/imj.70074","DOIUrl":"https://doi.org/10.1111/imj.70074","url":null,"abstract":"Background: An increasing number of patients in Australia are taking direct oral anticoagulants for a variety of indications since their introduction in the treatment landscape. There has always been some concern about the optimal management approach in the setting of major and/or life-threatening bleeding. In particular, patients who present with factor Xa inhibitor-associated intracranial haemorrhages are associated with high morbidity and mortality.Aim: To determine the efficacy of pro-haemostatic agents in the management of factor Xa inhibitor-related intracranial haemorrhages.Methods: A retrospective audit of rivaroxaban and apixaban-associated intracranial haemorrhages was performed between January 2015 and December 2021, inclusive.Results: The bleeding-related mortality was similar between the patients who received pro-haemostatic agents versus patients who did not receive pro-haemostatic agents (90% vs 93% respectively). The mean volume expansion for those who received pro-haemostatic agents was +1.0mL versus -6.8 mL for patients who did not receive pro-haemostatic agents (P = 0.51, 95% confidence interval: -11.7 to +5.9).Conclusion: Patients who presented with intracranial haemorrhages in the presence of clinically significant direct oral anticoagulant levels had a higher risk of mortality that does not appear to change with the use of prohaemostatic agents. The efficacy of prohaemostatic agents may not be as clinically significant based on real-world experience in contrast to previously reported studies.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994651","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}

引用次数: 0

The ‘nephrotoxins’ were stopped: what is in a name and its impact on kidney and cardiac health? “肾毒素”被停止了：它的名字是什么？它对肾脏和心脏健康的影响是什么？

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-22 DOI: 10.1111/imj.70060

Catherine Mao, Bobby Chacko

{"title":"The ‘nephrotoxins’ were stopped: what is in a name and its impact on kidney and cardiac health?","authors":"Catherine Mao, Bobby Chacko","doi":"10.1111/imj.70060","DOIUrl":"10.1111/imj.70060","url":null,"abstract":"The term ‘nephrotoxin’ is often imprecisely applied to medications that are not inherently toxic to the kidneys, including renin-angiotensin-aldosterone system inhibitors, sodium-glucose co-transporter 2 inhibitors, diuretics and metformin. These drugs are frequently included in ‘sick day rules’ and may be prematurely discontinued during acute illness or acute kidney injury (AKI). However, these medications offer substantial benefits, such as preserving cardiac and kidney function and reducing mortality. Discontinuing them without appropriate clinical judgement can lead to unintended harm. Clinicians should adopt a patient-specific, evidence-based approach when managing medications in AKI and chronic kidney disease, informed by pharmacology and individualised risk assessment. Patients may overinterpret advice to ‘stop nephrotoxic medications’ as a permanent measure, leading to hesitation in restarting necessary treatments. This misconception can create barriers to optimal care and complicate decision-making, as patients may prioritise avoiding perceived harm over addressing their full medical needs. This manuscript emphasises the need for nuanced and informed decision-making in the management of medications in kidney-related conditions.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"1037-1041"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003252","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}

引用次数: 0

Advances in management of pulmonary fibrosis. 肺纤维化的治疗进展。

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-22 DOI: 10.1111/imj.70051

Julia A Lachowicz, Daniel P Steinfort, Natasha E Smallwood, Jyotika D Prasad

引用次数: 0

Rapid chronic kidney disease progression in younger, First Nations patients in the Northern Territory 在北领地的年轻原住民患者中慢性肾病的快速进展

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-22 DOI: 10.1111/imj.70062

Winnie Chen, Oyelola Adegboye, Gillian Gorham, Asanga Abeyaratne, Sandawana William Majoni, Sean Taylor, Samuel Heard, Harshana Munasinghe, Matthew J. L. Hare, Alan Cass

引用次数: 0

Clinical characteristics and treatment of varicella zoster virus central nervous system infection in an Australian tertiary hospital. 澳大利亚某三级医院水痘带状疱疹病毒中枢神经系统感染的临床特点及治疗。

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-21 DOI: 10.1111/imj.70076

Connie Lam, Eve Chen, Arthur Thevathasan, Terry Yan, Michael Moso, Joe Sasadeusz, Stephen Muhi

{"title":"Clinical characteristics and treatment of varicella zoster virus central nervous system infection in an Australian tertiary hospital.","authors":"Connie Lam, Eve Chen, Arthur Thevathasan, Terry Yan, Michael Moso, Joe Sasadeusz, Stephen Muhi","doi":"10.1111/imj.70076","DOIUrl":"https://doi.org/10.1111/imj.70076","url":null,"abstract":"Background and aim: Varicella zoster virus (VZV) is a neurotropic herpesvirus. With improved access to molecular diagnostics, there is increasing recognition of VZV with central nervous system involvement. This study aimed to describe the demographic, clinical and treatment characteristics of patients admitted to an Australian tertiary hospital with VZV central nervous system infection.Methods: Retrospective study of all adult patients (aged ≥18 years) presenting to an Australian tertiary hospital between November 2010 and May 2023 with a clinical syndrome of or imaging consistent with meningitis or encephalitis and detectable VZV DNA in cerebrospinal fluid using polymerase chain reaction.Results: There were 48 cases of VZV meningitis and 13 cases of VZV encephalitis identified during the study period. The median age of patients with VZV meningitis and encephalitis was 34 years (range 21-86 years) and 73 years (range 22-94 years) respectively. All patients with VZV encephalitis and 37 of 48 (77.1%) with meningitis received intravenous (IV) acyclovir. Eight patients with VZV meningitis were treated with oral antivirals alone and seven were managed without antivirals or with ≤48 h of empiric antiviral therapy only; none of these patients experienced an adverse clinical outcome. Two patients with VZV encephalitis died. Seven patients experienced neurological complications, three with VZV meningitis and four with VZV encephalitis. Age and length of stay were associated with adverse clinical outcomes.Conclusion: VZV encephalitis predominates in older patients while VZV meningitis predominates in younger patients. IV acyclovir remains the standard of care for treatment of VZV encephalitis; however, its role in VZV meningitis is less clear. Controlled trials should be conducted to inform its use, particularly in low-risk patients with VZV meningitis.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009861","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}

引用次数: 0

Individual and shared situational awareness in in-hospital cardiac arrest: insights from a real-world observational study. 医院内心脏骤停中的个人和共享情境意识：来自现实世界观察性研究的见解

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-15 DOI: 10.1111/imj.70064

Bashaer Salem Alnadwi, Modi Al-Moteri

{"title":"Individual and shared situational awareness in in-hospital cardiac arrest: insights from a real-world observational study.","authors":"Bashaer Salem Alnadwi, Modi Al-Moteri","doi":"10.1111/imj.70064","DOIUrl":"https://doi.org/10.1111/imj.70064","url":null,"abstract":"Background: Individual and shared situational awareness (SA) are crucial for team performance in high-pressure emergencies like cardiopulmonary resuscitation (CPR). While SA has been extensively studied in simulations, little research has examined its role in real-world in-hospital cardiac arrest (IHCA) settings. This study assessed individual and shared SA among medical emergency team (MET) members during CPR and explored its influence on team structure, communication and outcomes.Methods: A cross-sectional observational study was conducted in real-world clinical settings, involving seven METs (n = 40). Individual SA was measured using the Situation Awareness Global Assessment Technique (SAGAT), while shared SA was assessed via a similarity index reflecting the alignment of team members' responses. Associations between SA, team structure, stress levels and clinical performance were analysed.Results: Findings showed substantial variability in individual SA, with only 25% achieving full SA. Shared SA scores ranged from 0.95 ± 0.046 to 0.78 ± 0.144, with higher scores significantly associated with improved team structure (P = 0.034) and resuscitation success (P = 0.048). Mental work stress during CPR was linked to lower individual SA (P = 0.004), highlighting cognitive overload's impact on SA.Conclusions: This study identifies critical SA gaps, affecting both individual performance and team coordination. Shared SA is a key predictor of resuscitation success and should be enhanced through structured SA training, high-frequency simulations and algorithm-driven protocols to improve team synchronisation, decision-making and patient outcomes in IHCA settings.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990697","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}

引用次数: 0

Hyperammonaemia during allogeneic stem cell transplantation: distinct aetiology, importance of recognition and proposed treatment algorithm 同种异体干细胞移植期间的高氨血症：不同的病因，识别的重要性和提出的治疗算法

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-15 DOI: 10.1111/imj.70052

Jeremy D. Clark, James R. Anstey, David Ritchie, Timothy Fazio

引用次数: 0

Incidence, prevalence and mortality of rheumatoid arthritis in Canterbury, Aotearoa New Zealand. 新西兰坎特伯雷地区类风湿关节炎的发病率、患病率和死亡率。

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-15 DOI: 10.1111/imj.70068

Hamish J Farquhar, Tania Huria, Lutz Beckert, Christopher M A Frampton, Janine Haslett, Lisa K Stamp

{"title":"Incidence, prevalence and mortality of rheumatoid arthritis in Canterbury, Aotearoa New Zealand.","authors":"Hamish J Farquhar, Tania Huria, Lutz Beckert, Christopher M A Frampton, Janine Haslett, Lisa K Stamp","doi":"10.1111/imj.70068","DOIUrl":"https://doi.org/10.1111/imj.70068","url":null,"abstract":"Background: There is relatively little research regarding the frequency of rheumatoid arthritis (RA) in Canterbury and no previous studies comparing the mortality of RA in Aotearoa New Zealand to a general population.Aims: To determine the incidence, prevalence and mortality of RA in Canterbury, Aotearoa New Zealand.Methods: Clinical records of persons attending the Christchurch Hospital rheumatology service between 1 January 2006 and 31 December 2008 (Period 1) and between 1 January 2011 and 31 December 2013 (Period 2) were reviewed to identify individuals who met the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. Medical records for persons treated by private sector rheumatologists were also reviewed. The period prevalence and average annual incidence for each time period were calculated. Prevalence and incidence rates for the total population were age- and sex-adjusted based on the usually resident population from the 2013 national Census. Standardised mortality ratios (SMRs) compared to the general population were calculated.Results: The annual incidence was 24.40 per 100 000 (95% confidence interval (CI): 21.36-27.43) for Period 1 and 22.06 per 100 000 (95% CI: 19.32-24.81) for Period 2. The period prevalence was 442.65 per 100 000 (95% CI: 420.08-465.04) for Period 1 and 448.66 per 100 000 (95% CI: 427.31-470.01) for Period 2. The all-cause SMR for individuals with incident RA was 1.25 (95% CI: 0.95-1.60). The SMR for all prevalent RA during Period 1 was 2.01 (95% CI: 1.85-2.19) and for Period 2 was 1.87 (95% CI: 1.69-2.06).Conclusions: The frequency of RA in the Canterbury population is comparable to other regions. Mortality for all individuals with prevalent RA was approximately two times higher than the general population.","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004207","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}

引用次数: 0

Racial equity in healthcare: turning Martin Luther King Jr's dream of racial equality into a 21st century reality 医疗保健中的种族平等：将马丁·路德·金的种族平等梦想变为21世纪的现实。

IF 1.8 4区医学

Internal Medicine Journal Pub Date : 2025-04-15 DOI: 10.1111/imj.70059

Louis William Wang

引用次数: 0