Internal Medicine Journal最新文献

{"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}

{"title":"Supporting trainees through flexible, part-time and subspecialised positions","authors":"Laura Cuthbertson","doi":"10.1111/imj.70005","DOIUrl":"10.1111/imj.70005","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"539"},"PeriodicalIF":1.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567128","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":"Efficacy and safety of using cilostazol versus aspirin in secondary stroke prevention: systematic review and meta-analysis of randomised controlled clinical trials","authors":"Ping Zhuang,&nbsp;Yi-min Huang,&nbsp;Zhenyong Zheng,&nbsp;Xiaodie Zhang","doi":"10.1111/imj.16657","DOIUrl":"10.1111/imj.16657","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Secondary stroke prevention is crucial for reducing recurrent events and associated morbidity. Cilostazol, a phosphodiesterase III inhibitor, is considered an alternative to aspirin for patients with ischaemic stroke due to its potentially lower risk of haemorrhagic complications. This meta-analysis evaluates the efficacy and safety of cilostazol versus aspirin for secondary stroke prevention. It provides a basis for drug selection and observation of secondary stroke prevention strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search was conducted in PubMed, Cochrane Library, EMBASE and Web of Science databases for randomised controlled trials comparing cilostazol with aspirin in secondary stroke prevention. Key outcomes included recurrence of ischaemic stroke, intracranial haemorrhage (ICH), death, effective rate and incidence of adverse events. Meta-analysis was performed using a random-effects model, and heterogeneity was assessed using <i>I</i>² statistics and Cochran's <i>Q</i> test. Publication bias was evaluated using Doi plots and Luis Furuya-Kanamori index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen studies involving 8993 participants were included. Cilostazol significantly reduced the recurrence of ischaemic stroke (risk ratio (RR): 0.766, 95% confidence interval (CI): 0.624–0.941) and ICH (RR: 0.392, 95% CI: 0.250–0.616) compared to aspirin. No significant differences were observed in overall mortality or adverse events. Cilostazol increased risks of headache, dizziness, diarrhoea and tachycardia but reduced constipation. Heterogeneity was generally low to moderate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cilostazol is an effective alternative to aspirin for secondary stroke prevention, reducing the risk of recurrent ischaemic stroke and ICH. However, its use is associated with certain adverse effects. Clinicians should consider individual patient profiles and preferences when selecting anti-platelet therapy for stroke prevention. Further research is warranted to optimise cilostazol use in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"483-492"},"PeriodicalIF":1.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16657","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566900","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":"Haematological malignancies during pregnancy: a systematic review of necessary services in the Australian context","authors":"Luke Cassidy,&nbsp;Antonia Shand,&nbsp;Joanne M. Said,&nbsp;Kim Hobbs,&nbsp;Giselle Kidson-Gerber,&nbsp;Campbell Belinda,&nbsp;Briony Cutts,&nbsp;Susan Heath,&nbsp;Antoinette Anazodo,&nbsp;Kylie King,&nbsp;Emma Palfreyman,&nbsp;Pietro Di Ciaccio,&nbsp;Georgia Mills,&nbsp;Catherine Tang,&nbsp;Shane Gangatharan,&nbsp;Anna Johnston,&nbsp;Kirk Morris,&nbsp;Nada Hamad","doi":"10.1111/imj.16651","DOIUrl":"10.1111/imj.16651","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Haematological malignancies diagnosed during pregnancy are rare, with increasing incidence, presenting unique therapeutic, social and ethical challenges for treating teams, patients and their family. There are no national guidelines regarding appropriate referral pathways, resources and services for the management of these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To conduct a systematic review of the literature to identify the multidisciplinary team members required for optimal care of pregnant patients with haematological malignancies. These data will be used to evaluate the capabilities of Australian health networks to provide coordinated care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of the literature in MEDLINE and SCOPUS databases was conducted. Eligible studies focused on pregnant Australian patients with haematological malignancies, exploring care models, specialist teams and services utilised. This was then used to generate a map of Australian hospitals that can service this patient demographic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Essential team members include haematologists, maternal–fetal medicine specialists, anaesthetists, midwives, intensive care specialists, psychologists and social workers. Services utilised include haematology, maternity, intensive care, tertiary imaging, operating theatre, pharmacy and perinatal mental health services. Utilising these data, 25 hospitals can manage these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study identified the necessary healthcare practitioners, services and hospitals available that can manage this patient cohort. Future research should focus on determining ideal treatment regimens, timing of therapy throughout gestation, establishing a national patient registry and implementing a cancer care plan and frameworks for best practice care. A centralised referral pathway leveraging telehealth will allow expedient, multidisciplinary action and equity in access to all women across Australia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"393-406"},"PeriodicalIF":1.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16651","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556659","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":"Pre-rounding in hospital medicine: a narrative review.","authors":"Isaac K S Ng, Arturo Neo, Camilla Roshal, Wilson G W Goh, Chun En Chua, Li Feng Tan, Desmond B S Teo","doi":"10.1111/imj.70008","DOIUrl":"https://doi.org/10.1111/imj.70008","url":null,"abstract":"<p><p>Pre-rounding in hospital medicine is the practice of having junior physicians in the medical team come to work early to pre-clerk new and existing patients in advance, in order to formulate preliminary management plans, draft rounding notes and prepare for ward round presentations when the attending consultant and senior members of the team arrive. While pre-rounding is part of a long-standing tradition in the United States hospital-based practice, its adoption has been highly heterogeneous across the world, due to controversy over its purported benefits in patient care and post-graduate training. In this article, we sought to review the relevant literature on pre-rounding in hospital medicine and examine its current role in postgraduate training and practice, specifically evaluating its clinical and pedagogical utility. From our analyses and discussion, we propose a simple \"PRE-ROUND\" (Prioritise/pre-select patients for physical review, Review of electronic medical record charts/documentations, Escalation of urgent clinical cases, Rounding notes drafting, Organise the sequence of ward rounds, Understand and synthesise pertinent medical issues to practise clinical reasoning, Narrative, structured ward round presentation, Developing a healthy institutional pre-round culture) model that practically encapsulates the key principles required for effective pre-rounds in hospital-based practice that can contribute meaningfully to patient care and post-graduate training, whilst avoiding excessive burden and clinical redundancy on junior physicians.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556662","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":"Australasian Society of Infectious Diseases updated guidelines for the management of Clostridioides difficile infection in adults and children in Australia and New Zealand","authors":"Anthony Longhitano,&nbsp;Christine Roder,&nbsp;Tim Blackmore,&nbsp;Anita Campbell,&nbsp;Meryta May,&nbsp;Eugene Athan","doi":"10.1111/imj.16638","DOIUrl":"10.1111/imj.16638","url":null,"abstract":"<p><i>Clostridioides difficile</i> infection (CDI) is associated with significant morbidity and mortality within the Australian population. Treatment recommendations for CDI pose challenges at both community and hospital-based levels due to the recurrent, refractory and potentially severe nature of the disease. Since the last published Australasian guidelines in 2016, new therapeutic options are available, prompting a necessary update to management recommendations. On behalf of the Australasian Society of Infectious Diseases, we present the updated guidelines for the management of CDI in adults and children exploring the changes to treatment recommendations – including the replacement of oral metronidazole with vancomycin for initial CDI and the emerging role for fidaxomicin and faecal-microbiota transplant.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"503-513"},"PeriodicalIF":1.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541960","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":"Proactive inpatient diabetes service model of care observed to decrease severe hyperglycaemia and hypoglycaemia in a 'real-world' Australian hospital setting.","authors":"Karen Van, Xiao Wei Ma, Julie Loughran, Alexandra Brown, Sarah Lindsey, Henry Wong, Spiros Fourlanos, Suresh Varadarajan, Mervyn Kyi","doi":"10.1111/imj.70018","DOIUrl":"https://doi.org/10.1111/imj.70018","url":null,"abstract":"<p><strong>Background: </strong>Hyperglycaemia and hypoglycaemia are associated with adverse outcomes in hospitalised patients. A cluster-randomised trial at an Australian quaternary hospital showed that an early intervention model of inpatient diabetes care decreased hyperglycaemia. This model of care was later implemented as a clinical service at Northern Health, where the inpatient diabetes service (IDS) performed virtual glycaemic surveillance and provided proactive bedside consultations for patients with unstable glycaemia.</p><p><strong>Aims: </strong>To assess glycaemic and clinical outcomes of this IDS model of care in a real-world hospital setting.</p><p><strong>Methods: </strong>We compared hospital-wide cross-sectional cohorts of all inpatients with diabetes identified on two census days: in November 2017 (pre-IDS implementation) and in March 2021 (with IDS care in place). Bedside diabetes consultations, capillary glucose measurements and glycaemic treatment plans were compared. Standard glucometric analyses were performed on capillary glucose measurements to assess the incidence of hyperglycaemia and hypoglycaemia.</p><p><strong>Results: </strong>The proactive IDS model significantly increased bedside consultations by the diabetes team (6% pre-IDS vs 47% with IDS care) and increased inpatient insulin prescribing. Compared to the pre-IDS group (n = 126), the IDS group (n = 139) had a lower incidence of severe hyperglycaemia (patient-days with mean glucose >15 mmol/L: 6.5% vs 4.5%, P = 0.03) and level 2 hypoglycaemia (patient-days with glucose <3 mmol/L: 1.1% vs 0.2%, P = 0.01). In patients younger than 75 years with admission HbA1c >7.0%, more patients had diabetes treatment intensification at hospital discharge with IDS care.</p><p><strong>Conclusions: </strong>Following implementation of a proactive IDS model of care, a lower incidence of severe hyperglycaemia and hypoglycaemia was observed.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541968","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":"Access needle gauge and complication rate during central venous catheter insertion: a cohort study","authors":"Julian Yaxley,&nbsp;Tahira Scott","doi":"10.1111/imj.16656","DOIUrl":"10.1111/imj.16656","url":null,"abstract":"<p>Various needle styles are available for percutaneous access during central venous catheter insertion. The impact of needle gauge on the risk of mechanical complications has not been studied. Our retrospective study demonstrated no association between needle gauge and the rate of peri-procedural complications for central venous catheterisation.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"523-525"},"PeriodicalIF":1.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515511","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":"Physician burnout and fatigue: a call to re-focus on work intensity beyond work duration","authors":"Isaac K. S. Ng","doi":"10.1111/imj.70006","DOIUrl":"10.1111/imj.70006","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"537-538"},"PeriodicalIF":1.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499375","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":"A new era in myeloma: the advent of chimeric antigen receptor-T (CAR-T) cells and bispecific antibodies.","authors":"P Joy Ho, Eric W Li","doi":"10.1111/imj.16647","DOIUrl":"https://doi.org/10.1111/imj.16647","url":null,"abstract":"<p><p>T-cell re-directional therapies, including chimeric antigen receptor (CAR)-T cell and bispecific antibodies (BsA), have transformed the treatment landscape to benefit patients with multiple myeloma. A number of these novel therapies has been approved internationally, with CAR-T therapy recently approved in Australia. In this clinical perspective, we describe the development of CAR-T and BsA therapies, highlighting the clinical benefits and risks, together with the significant costs and infrastructure support required for the provision of these therapies to myeloma patients.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483007","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}