Internal Medicine Journal最新文献

{"title":"‘Many heads are better than one’: a paradigm shift towards a multidisciplinary infective endocarditis management approach","authors":"Siong H. Hui","doi":"10.1111/imj.70004","DOIUrl":"10.1111/imj.70004","url":null,"abstract":"<p>Infective endocarditis occurs at a frequency of 3–10 episodes per 100 000 person-years.<span><sup>1, 2</sup></span> Despite being uncommon, the associated morbidity is substantial and the in-hospital mortality averages 15%–25% in published series.<span><sup>3, 4</sup></span> The diagnosis and treatment have evolved in recent years, with advances in diagnostic clinical criteria, imaging techniques, microbiologic testing and antimicrobial treatment paradigms.<span><sup>5, 6</sup></span> In spite of this, the global burden of endocarditis (incidence, mortality, disability-adjusted life-years (DALYs)) have increased since the 1990s.<span><sup>7</sup></span> Attributable host and organism factors include progressively ageing and comorbid populations, expanding utilisation of immunosuppressive therapy, increasing deployment of invasive procedures and the emergence of <i>Staphylococcus aureus</i> as the predominant causative organism.<span><sup>7</sup></span></p><p>The diagnosis of infective endocarditis remains challenging due to heterogeneous risk factors, microbiologic aetiology, clinical presentation and complications.<span><sup>8-10</sup></span> Significant expertise in affected organ systems is required for optimal management, for which a single clinician may not be able to fully provide.<span><sup>11</sup></span> Approximately 40%–50% of endocarditis cases require surgical intervention in the acute stage.<span><sup>8</sup></span> While this may confer survival benefit, the perioperative risk may be substantial.<span><sup>10, 12</sup></span> Therefore, the decision regarding surgical management should be discussed in the context of a multi-specialty meeting of clinicians involved in endocarditis treatment. Mestres and colleagues have succinctly described the role of endocarditis surgery with the comment ‘infective endocarditis is a medical-surgical disease in which surgical treatment is part of the therapeutic process rather than a result of the failure of medical treatment’.<span><sup>13</sup></span></p><p>Systemic factors associated with the specialty-based and segregated approach to endocarditis management have also contributed to the rising trend in short- and long-term mortality.<span><sup>14, 15</sup></span> These include delays in diagnosis and treatment, transfer to cardiothoracic surgical centres and treatment and inadequacy of long-term specialist follow-up.<span><sup>14</sup></span> The reasons cited for diagnostic hold-up include admitting team inexperience, diagnostic imaging access issues, absence of positive blood cultures and suboptimal clinical information on transfer.<span><sup>15</sup></span> Diagnostic delays, inaccurate referrals and tertiary centre capacity limitations may impede subsequent transfer.<span><sup>15</sup></span> Failure to perform surgery for endocarditis may stem from diagnostic and transfer delays, prohibitive perioperative mortality and inefficient and time-consuming coordination between multiple specialti","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"349-352"},"PeriodicalIF":1.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482953","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":"Non-invasive ventilation in cystic fibrosis: the Australian experience over the past 24 years","authors":"Astrid Gardiner,&nbsp;Olivia McGuiness,&nbsp;Collette Menadue,&nbsp;Simone Visser,&nbsp;Helen Jo,&nbsp;Veronica Yozghatlian,&nbsp;Tara Aquino-Salomon,&nbsp;Keira Bortoft,&nbsp;Kirsten Hammond,&nbsp;Brendon Yee,&nbsp;Keith Wong,&nbsp;Amanda Piper,&nbsp;Sheila Sivam","doi":"10.1111/imj.16658","DOIUrl":"10.1111/imj.16658","url":null,"abstract":"<p>The role of non-invasive ventilation (NIV) in patients with cystic fibrosis (pwCF) includes use in both the management of hypercapnic respiratory failure and as an adjunct to airway clearance techniques. We performed a retrospective review of the Australian Cystic Fibrosis Data Registry to analyse the characteristics of pwCF requiring NIV. We demonstrated that despite improvements in overall health in pwCF there is still a significant role of NIV in this population.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"530-532"},"PeriodicalIF":1.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16658","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483041","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":"Use of sodium–glucose cotransporter-2 inhibitors among Aboriginal people with type 2 diabetes in remote Northern Territory: 2012 to 2020","authors":"Matthew J. L. Hare,&nbsp;Winnie Chen,&nbsp;Thomas Berhane,&nbsp;Sumaria M. Corpus,&nbsp;Louise J. Maple-Brown","doi":"10.1111/imj.16653","DOIUrl":"10.1111/imj.16653","url":null,"abstract":"<p>Aboriginal people in remote Northern Territory communities experience the highest burden of type 2 diabetes (T2D) globally. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) improve cardiac and renal outcomes in selected populations. However, safety in this context is unknown. We investigated SGLT2i use and outcomes in remote Aboriginal people with T2D between 2012 and 2020.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"518-522"},"PeriodicalIF":1.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16653","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483058","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":"Treatment of obesity: will incretin agonists make bariatric surgery a thing of the past?","authors":"Siehoon Lah,&nbsp;Samantha L. Hocking","doi":"10.1111/imj.16625","DOIUrl":"10.1111/imj.16625","url":null,"abstract":"<p>The prevalence of obesity continues to increase worldwide. Obesity is associated with an increased risk of cardiometabolic and other diseases, reduced quality of life and shortened life expectancy. Highly effective therapies are required to achieve meaningful and sustained weight reduction to prevent, slow or reverse disease associated with obesity. Bariatric surgery is a highly effective intervention to induce weight loss, with observational data demonstrating durability of weight loss over 10 or more years. In addition, bariatric surgery improves cardiometabolic risk factors, including hyperglycaemia and type 2 diabetes, hypertension and dyslipidaemia. Observational data have shown a reduction in all-cause mortality, cardiovascular events and mortality and a reduction in cancer risk and mortality in patients who have undergone bariatric surgery compared to matched patients who did not have surgery. The emergence of newer incretin agonists, particularly semaglutide and tirzepatide, have demonstrated remarkable efficacy in inducing and maintaining weight loss with ongoing use. As for bariatric surgery, incretin agonist therapies also improve type 2 diabetes outcomes, cardiovascular mortality and other obesity-related complications, with new evidence emerging and long-term outcome data awaited. This perspective compares bariatric surgery and incretin agonist therapy, assessing their relative efficacies in weight reduction, impact on obesity-related complications, their respective risk profiles and considerations of cost-effectiveness and equity of access. These comparisons seek to evaluate whether these increasingly popular medications could make bariatric surgery a thing of the past.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"369-375"},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16625","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467975","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":"Clinical characteristics and economic impact of acute hospitalisations due to bronchiectasis exacerbations among adult Indigenous Australians in the Top End Northern Territory","authors":"Thomas Berhane,&nbsp;Anna-Louise Bayfield,&nbsp;Timothy Howarth,&nbsp;Karlie James,&nbsp;Aruna Muthumala,&nbsp;Lin Mo,&nbsp;Kaspar Willson,&nbsp;Subash S. Heraganahally","doi":"10.1111/imj.16654","DOIUrl":"10.1111/imj.16654","url":null,"abstract":"<p>This cross-sectional study assessed the clinical and economic costs (Inpatient Activity Database) associated with hospitalisations due to bronchiectasis exacerbations among adult indigenous patients in the Top End, Northern Territory. Twenty case episodes from 15 indigenous patients with a mean age of 51.8 ± 12.7 years were recorded in a 3-month study window. The estimated cost was AUD 400 579.9, with cost per patient AUD 26 705 over 3 months and average cost per admission AUD 20 029. Extrapolating cost data across a 10-year period gave a conservative estimate of AUD 28 million.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"526-529"},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16654","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467974","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":"Better off alone? Artificial intelligence can demonstrate superior performance without clinician input","authors":"Joshua Kovoor,&nbsp;Daksh Tyagi,&nbsp;Ashley Hopkins,&nbsp;James Gorcilov,&nbsp;Brandon Stretton,&nbsp;Aashray Gupta,&nbsp;Stephen Bacchi","doi":"10.1111/imj.70007","DOIUrl":"10.1111/imj.70007","url":null,"abstract":"<p>Recent studies challenge the assumption that human–artificial intelligence (AI) collaboration is universally optimal, highlighting tasks where AI alone outperforms combined efforts. This viewpoint discusses the reasons behind these findings, explores influences on synergy and emphasises the importance of identifying when clinicians add net benefit to AI performance. Maximising patient outcomes may require accepting AI autonomy in certain scenarios within healthcare practice.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"533-536"},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467972","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":"Real-world outcomes after endovascular thrombectomy in patients with large infarct cores","authors":"Daniel James Wellington,&nbsp;Joseph Donnelly,&nbsp;Jae Beom Hong,&nbsp;William K. Diprose,&nbsp;P. Alan Barber","doi":"10.1111/imj.16608","DOIUrl":"10.1111/imj.16608","url":null,"abstract":"<p>Patients with large infarct cores on imaging at hospital presentation who are then treated with endovascular thrombectomy achieved functional independence rates ranging from 14%–30% in randomised controlled trials. We describe our ‘real-world’ experience with these patients. About one-third were independent at day 90, similar to trial results. This was associated with higher rates of complications and double the length of stay.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"514-517"},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448899","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":"Endoscopy volume and outcomes after the COVID-19 pandemic: results from a tertiary Australian centre","authors":"Matthew Peverelle,&nbsp;Ryan Hirsch,&nbsp;William Slifirski,&nbsp;Vinny Ea,&nbsp;Georgia Sun,&nbsp;Nikhita Sane,&nbsp;Andrew Nguyen,&nbsp;Dina Erceg,&nbsp;Andrew Wang,&nbsp;Samuel Tucker,&nbsp;Elaine Koh,&nbsp;Tony Long,&nbsp;Simon Hew","doi":"10.1111/imj.16642","DOIUrl":"https://doi.org/10.1111/imj.16642","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 2","pages":"337-338"},"PeriodicalIF":1.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397127","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":"Teaching contributions of senior clinicians in a Basic Physician Trainee training programme","authors":"Rhiannon L. Holdsworth,&nbsp;Harry Petropoulos,&nbsp;Michael C. Spies","doi":"10.1111/imj.16476","DOIUrl":"https://doi.org/10.1111/imj.16476","url":null,"abstract":"<p>Education of Basic Physician Trainees (BPTs) in preparation for their Royal Australasian College of Physician Divisional Examinations requires time contribution by senior medical staff towards formal teaching activities. This study, conducted at a major metropolitan teaching hospital, sought to quantify the time commitment of senior medical staff towards teaching of BPTs in one clinical year, as well as the perceptions of those staff regarding time commitments through anonymous questionnaire. Senior medical staff involved in formal teaching activities provided a mean of 10 h; questionnaire respondents indicated a mean contribution of 20 h. This study highlights the significant time contribution of senior medical staff to formal teaching activities for BPTs, as well as identifies possible unmeasured teaching contributions.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 2","pages":"297-299"},"PeriodicalIF":1.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396789","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":"Reducing hospitalisations of older adults towards the end of life","authors":"Isaac K. S. Ng,&nbsp;Desmond B. Teo,&nbsp;Li Feng Tan","doi":"10.1111/imj.16643","DOIUrl":"https://doi.org/10.1111/imj.16643","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 2","pages":"339"},"PeriodicalIF":1.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397054","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}