Internal Medicine Journal最新文献

{"title":"Antimicrobial stewardship in regional hospitals: a human factors evaluation of barriers and facilitators and the role of technology.","authors":"Bethany A Van Dort, Jane E Carland, Jonathan Penm, Angus Ritchie, Kate Morton, Nathan Chahoud, Melissa T Baysari","doi":"10.1111/imj.70142","DOIUrl":"https://doi.org/10.1111/imj.70142","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial stewardship (AMS) programmes aim to optimise antimicrobial prescribing. Regional hospitals have reduced access to resources that are essential for conducting AMS initiatives. Technology has the potential to reduce these challenges if implemented and used effectively.</p><p><strong>Objective: </strong>Identify the barriers and facilitators to successful AMS programmes in two regional hospitals in Australia and explore the role technology played in supporting AMS.</p><p><strong>Methods: </strong>A contextual inquiry methodological approach was used, including observations and semi-structured interviews with AMS team members in two regional hospitals in Australia.</p><p><strong>Results: </strong>Observations were conducted for 27.5 h and interviews were performed with all AMS team members (n = 4). Electronic medication management and an antimicrobial dashboard were reported to make AMS processes efficient and information accessible. The use of multiple computerised systems and poor interoperability hindered AMS work processes. Executive support, resourcing and building rapport through in-person interactions were reported to influence the success of AMS programmes. Passionate and motivated infectious diseases (ID) consultants drove AMS programmes by building rapport with stakeholders and advocating for resources. COVID-19 was viewed as a facilitator of AMS as it increased the visibility of ID consultants, resulting in improved relationships and additional resources.</p><p><strong>Conclusions: </strong>Using a small number of interoperable systems can enhance AMS, with tools such as an antimicrobial dashboard proving beneficial for remotely accessing information and reviewing antimicrobials in peripheral hospitals. Essential components for effective AMS programmes include supportive hospital executives and adequate staff resources. Sustaining AMS in regional settings relies on committed ID doctors and strong interdepartmental relationships.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583782","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":"Call for a Pacific Centre for Disease Control!","authors":"George P. Drewett,&nbsp;Shivani Bhatt,&nbsp;William Naughton,&nbsp;Scott Abbinga","doi":"10.1111/imj.70141","DOIUrl":"10.1111/imj.70141","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583783","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":"Author reply to Iqbal et al.","authors":"Camille La Brooy,&nbsp;Hana Sabanovic,&nbsp;Susan J. Méndez,&nbsp;Jongsay Yong,&nbsp;Anthony Scott,&nbsp;Adam Elshaug,&nbsp;Khic-Houy Prang","doi":"10.1111/imj.70140","DOIUrl":"10.1111/imj.70140","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553439","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":"Effect of positive airway pressure treatment on pulmonary artery pressure in obstructive sleep apnoea and/or obesity hypoventilation syndrome with pulmonary hypertension: a systematic review and meta-analysis","authors":"Shobiga Sarvananda,&nbsp;Stan Earnshaw,&nbsp;Ian Hughes,&nbsp;Pathmanathan Sivakumaran,&nbsp;Krishna Bajee Sriram","doi":"10.1111/imj.70137","DOIUrl":"10.1111/imj.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with obstructive sleep apnoea (OSA) and/or obesity hypoventilation syndrome (OHS) are at increased risk of developing pulmonary hypertension (PH). The presence of PH is associated with a worse prognosis. The primary treatment for most patients with OSA/OHS is positive airway pressure (PAP). The aim of this study was to systematically review the effects of PAP therapy on pulmonary artery (PA) pressure in patients with OSA/OHS and PH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Does PAP therapy improve pulmonary artery pressure in patients with OSA/OHS and PH?</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two independent investigators searched studies in MEDLINE, Embase and Cochrane Library. A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included studies involving adult OSA/OHS patients treated with CPAP/BPAP, with PA pressure ≥20 mmHg before treatment. Data synthesis utilised random-effects meta-analysis to estimate treatment effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search identified 1373 studies, with eight meeting inclusion criteria. Baseline characteristics of patients with PH were a mean age of 53 years, 86% male, a mean apnoea-hypopnea index (AHI) of 64 events/h and a mean BMI of 33 kg/m². Meta-analysis revealed a reduction in PA pressure after PAP therapy (mean difference −8.62 mmHg, 95% CI: 4.01–13.22, <i>P</i> &lt; 0.001). However, there was considerable between-study heterogeneity (<i>I</i>² = 97.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study indicates that PAP therapy reduces PA pressure in patients with OSA/OHS, indicating potential benefits in managing PH. Further research is warranted to elucidate optimal PAP therapy protocols and long-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 8","pages":"1281-1292"},"PeriodicalIF":1.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553440","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":"Are Australians living with dementia ready for new therapies?","authors":"Sean Maher,&nbsp;Ranjeev Chrysanth Pulle","doi":"10.1111/imj.70139","DOIUrl":"10.1111/imj.70139","url":null,"abstract":"<p>The Therapeutics Goods Administration (TGA) recently approved donanemab for the treatment of early symptomatic Alzheimer's disease (AD), which encompasses mild cognitive impairment (MCI) and mild Alzheimer's disease dementia (ADD).<span>¹</span> A timely survey of memory clinic capabilities by Michaelian <i>et al</i>. in this issue of the Internal Medicine Journal highlights the significant challenges Australia faces to deliver this new therapy.<span>²</span></p><p>Dementia is the most common cause of death in women in Australia and the second leading cause of death, and disease burden, overall. Over 411 000 Australians had a dementia diagnosis in 2023, and that prevalence will more than double by 2058.<span>³</span></p><p>Specialist assessment of people with cognitive change is undertaken by geriatricians, neurologists and psychiatrists in health service-linked memory clinics or private settings. Cognitive and functional assessments facilitated by allied health, education, carer support, linkage to community supports and advice about related issues such as driving are provided. Diagnosis, management of comorbidities, mood and behavioural issues, lifestyle advice to preserve cognition and, where appropriate, trials of medication are undertaken.<span>⁴</span> The increasing prevalence of dementia means that wait times for assessments are increasing, commonly more than 6 months in metropolitan centres and longer in regional and remote areas.</p><p>Pharmacological treatment of ADD has been limited to acetylcholinesterase inhibitors and memantine, which may provide symptomatic relief but don't affect the disease process. Most people with a diagnosis of ADD have a mix of neuropathologies, with pathognomonic amyloid beta (Aβ) plaques and neuronal tau tangles, combined with vascular change, alpha-synuclein inclusions and transactive response DNA binding protein 43.<span>⁵</span> The ‘amyloid hypothesis’ has dominated research into AD and possible therapies: Aβ gradually accumulates over 10–20 years before a tipping point is reached where microglia are no longer able to ingest Aβ, and a proinflammatory state ensues with synaptic dysfunction, hyperphosphorylation of tau protein, destabilisation of microtubules, tangle formation and neuronal death. Cognitive symptoms arise at this point, progressing from MCI to mild ADD once impairment impacts on everyday functioning.<span>⁶</span> Hypothetically, early detection and treatment might avert this cascade.</p><p>Many unsuccessful therapies aimed at Aβ, including monoclonal antibodies (mAbs), have been trialled. However, Phase III trials of lecanemab (CLARITY AD)<span>⁷</span> and donanemab (TRAILBLAZER-ALZ2)<span>⁸</span> reduced Aβ on positron emission tomography (PET) scans, improved markers of neurodegeneration in cerebrospinal fluid (CSF) and slowed cognitive decline. They are considered disease-modifying and have be","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1059-1062"},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540073","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":"Design, implementation and evaluation of a model of care for patients with germline predisposition to haematological malignancy and bone marrow failure syndromes","authors":"Lucy C. Fox,&nbsp;Erin Goode,&nbsp;Nicole Den Elzen,&nbsp;Lin Cheng,&nbsp;Laura Barth,&nbsp;Kelsey Man,&nbsp;Anna Jarmolowicz,&nbsp;Mary Panjari,&nbsp;Stephanie Best,&nbsp;Karin Thursky,&nbsp;Paul James,&nbsp;Ashish Bajel,&nbsp;David Ritchie,&nbsp;Piers Blombery","doi":"10.1111/imj.70125","DOIUrl":"10.1111/imj.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The bone marrow failure syndromes (BMFS) are clinically heterogeneous conditions with both inherited and acquired etiologies. Optimal care is often challenged by the complexity of these disorders and gaps in healthcare delivery. The Evaluating Multidisciplinary Bone maRrow fAilure CarE (EMBRACE) study is a multi-stage hybrid implementation-effectiveness study designed to explore the nature of issues faced by patients with BMFS and their physicians, and to develop, implement, and evaluate a comprehensive model of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To identify barriers to optimal BMFS care, we conducted semi-structured interviews with patients and patient advocates, followed by a nationwide survey of physicians involved in BMFS management. Thematic analysis was performed on interview data, and survey responses were analysed to identify common challenges and areas for improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Interview themes elicited included: (i) limited disease-specific awareness and resources, (ii) challenges in attaining genetic care, (iii) the ongoing impact of complex care needs, (iv) the perceived value of genetic testing, and (v) the importance of specialised healthcare professionals.</p>\u0000 \u0000 <p>Physician surveys indicated a desire for affordable genomic testing, assistance with result interpretation and genetic counselling/cascade testing of extended kindred, a forum for complex case discussion and advice regarding management strategies.</p>\u0000 \u0000 <p>Responses from patients, advocates and physicians, along with existing best-practice guidelines, were then used to develop a 10-component model of care aimed at addressing identified issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The EMBRACE study has established a stakeholder-informed, multidisciplinary care framework for patients with BMFS. This care programme continues to undergo evaluation and audit consistent with principles of an implementation-effectiveness study to determine both patient and physician satisfaction, and iterative refinement to provide optimum care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 8","pages":"1350-1359"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540074","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":"Re-defining ‘clinical reasoning’","authors":"Isaac KS Ng,&nbsp;Li Feng Tan,&nbsp;Desmond B Teo,&nbsp;Sarah HF Lim,&nbsp;Chia Meng Teoh","doi":"10.1111/imj.70104","DOIUrl":"10.1111/imj.70104","url":null,"abstract":"&lt;p&gt;Clinical reasoning is an archetypal feature of the medical profession that has garnered increasing attention in recent years, due to the high prevalence of diagnostic errors in real-world clinical practice.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; As Professor Ian Scott aptly described in a previous article, flaws in clinical decision-making ‘are (often) not due to incompetence or inadequate knowledge, but (rather attributed) to frailty of human thinking under conditions of complexity, uncertainty, and pressure of time’.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;While medical practitioners will readily agree on the importance of clinical reasoning to be taught and assessed in medical education,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; ironically, most will be stumped when asked to provide a proper definition of clinical reasoning as a concept. In 1991, Kassirer and Kopelman defined clinical reasoning as ‘strategies… to combine and synthesise diverse data into … diagnostic hypotheses, make the complex trade-offs between the benefits and risks of tests and treatment, and formulate plans for patient management’.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Two decades later, clinical reasoning remains vaguely defined as ‘thinking and decision-making processes associated with clinical practice’,&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; with some also recognising the need to consider ‘both conscious and unconscious cognitive operations interacting with contextual factors’.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; As Yazdani correctly pointed out, despite decades of research since the 1980s, clinical reasoning has remained a ‘challenging, promising, complex, multidimensional, mostly invisible, and poorly understood process’.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; This naturally creates a major problem with downstream development and implementation of curricular pedagogy.&lt;/p&gt;&lt;p&gt;Therefore, in this article, we sought to revisit the concept of clinical reasoning by discussing it through three lenses: first, as a practice-defining model construct underpinning medical decision-making; second, as a learnable skill attained through deliberate practice and dialectical instruction in naturalistic settings; and, third, as the ultimate medicolegal yardstick for the professional standard of care.&lt;/p&gt;&lt;p&gt;In practical terms, clinical reasoning is a highly sophisticated process by which physicians arrive at medical decisions in real-world practice, which involves cognitive processing of clinical information, psychoemotional cues and situational/contextual attributes.&lt;/p&gt;&lt;p&gt;To date, the most popular theory of clinical reasoning is Kahneman's dual-process model of intuitive (&lt;i&gt;thinking fast&lt;/i&gt;) and analytical (&lt;i&gt;thinking slow&lt;/i&gt;) thought patterns.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; In brief, intuitive thought processes are fast, unconscious and reliant on heuristics or pattern recognition, whereas analytical thinking is slow, conscious, reasoned and systematic.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; However, in recent years, some have argued that clinical reasoning is predominantly intuitive du","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 8","pages":"1228-1231"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540075","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":"Wait times in diagnosis and treatment of obstructive sleep apnoea at a major tertiary centre","authors":"Hamza Azam,&nbsp;Vriti Shukla,&nbsp;Benjamin Gerhardy","doi":"10.1111/imj.70132","DOIUrl":"10.1111/imj.70132","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1214-1215"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527813","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":"Improving the timeliness of care for regional lung cancer patients through the implementation of a web-based lung cancer referral pathway","authors":"Zulfiquer Otty,&nbsp;Sarah Larkins,&nbsp;Rebecca Evans,&nbsp;Amy Brown,&nbsp;Sabe Sabesan","doi":"10.1111/imj.70138","DOIUrl":"10.1111/imj.70138","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Lung cancer remains a significant public health problem and a leading cause of cancer-related mortality worldwide. The delays in the diagnosis of lung cancer are more pronounced for rural and regional Australians compared to their urban counterparts. Implementing an online HealthPathway is one way to reduce delays in the diagnosis of lung cancer.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The Townsville Lung Cancer Referral Pathway (TLCRP) was implemented to guide local general practitioners (GPs) in the referral process of people with suspected lung cancer. The aim of the study was to compare the time interval from initial GP consultation of the person with suspected lung cancer to the first specialist referral and from the first specialist referral to the initial specialist appointment, before and after implementation of TLCRP. Other lung cancer service outcomes were also compared between the pre- and post-implementation groups.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A retrospective cohort study of 316 participants was conducted, and descriptive statistical analysis of the data was used to discern any difference in timelines and other clinical outcomes in the pre-pathway implementation group compared to the post-pathway implementation group.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The time interval from initial GP presentation to initial referral to specialist appointment was significantly reduced in the post-pathway group (15 days) compared to the pre-pathway group (8 days, &lt;i&gt;P&lt;/i&gt; = 0.03). However, the time interval from GP referral to initial appointment with a specialist increased in the post-pathway group (15 and 20 days, &lt;i&gt;P&lt;/i&gt; = 0.03).&lt;/p&gt;\u0000 \u0000 &lt;p&gt;Many of the Cancer Australia lung cancer optimal care pathway referral guidelines were not met. Only 40% of the pre-pathway group and 34% of the post-pathway group were seen in the specialist clinic within 2 weeks of GP referral. Significant proportions of patients in both groups did not have chest x-rays ordered by the GP, and the proportion of participants who were appropriately referred to the respiratory clinic did not improve after implementation of TLCRP (76% and 72%). Nearly 30% of participants in both groups were diagnosed after emergency presentation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;TLCRP improved the time interval from initial GP consultation to specialist referral, thus meeting its primar","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 9","pages":"1474-1482"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527812","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":"Effect of adherence on asthma control: more patient knowledge, more adherence, more control","authors":"Zeynep Celebi Sozener,&nbsp;Omur Aydin,&nbsp;Gulfem Elif Celik,&nbsp;Dilsad Mungan","doi":"10.1111/imj.70135","DOIUrl":"10.1111/imj.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low adherence rates in addition to inhaler misuse is a crucial problem in asthma management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate medication adherence and correct inhaler use and the relationship between adherence, asthma control and disease severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, demographic characteristics of patients with asthma, asthma control and severe asthma rates were recorded. Patients were categorised as non-adherent, adherent to one component (either subjectively or objectively adherent), adherent to two components or full adherent based on objective, subjective and correct inhaler device use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 304 patients with a mean age of 50.21 ± 12.53 years and disease duration of 12.67 ± 9.47 years. The rate of objective adherence, subjective adherence and correct inhaler use was 45.3%, 67.7% and 56.5% respectively. Overall, we found that 26% of the patients were non-adherent, 18.7% showed subjective or objective adherence, 28.8% adhered to two components, and 27% demonstrated full adherence. The risk of non-adherence was 3.1 times higher in uncontrolled patients, and regular clinician visits reduced the risk of non-adherence by 66%. Adherence was negatively associated with severe asthma rates in our cohort. The rate of correct inhaler device use was lower in patients with systemic comorbidities, while there was no difference in objective adherence, subjective adherence or full adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results of this study revealed that correct, consistent and regular use of inhalers in accordance with clinician recommendations is important in achieving control in patients with asthma. To increase adherence in asthma, regular clinician visits and repeat training should be encouraged.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 9","pages":"1483-1490"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527811","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}