Internal Medicine Journal最新文献

{"title":"Fibromyalgia is not a benign disorder: comment on \"Outcomes of rheumatology referrals seen in a general medicine clinic\".","authors":"Richard Kwiatek, Barbara True","doi":"10.1111/imj.70396","DOIUrl":"10.1111/imj.70396","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"733-734"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147511668","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":"Alcohol use disorder: an Australian perspective on screening, diagnosis, treatment and prevention.","authors":"Andrew J Palmer, Jason P Connor, Paul J Clark","doi":"10.1111/imj.70378","DOIUrl":"10.1111/imj.70378","url":null,"abstract":"<p><p>Alcohol is one of Australia's most harmful recreational drugs, contributing more to death, disease and economic harm than all illicit drugs combined. Though it accounts for 4.1% of the national disease burden, it remains under-prioritised in health policy, prevention and treatment. Most of this harm is downstream of hazardous alcohol consumption and untreated alcohol use disorder (AUD), a common but stigmatised condition that is under-recognised and rarely treated with evidence-based therapies. Alcohol-related harm falls disproportionately on First Nations peoples, rural communities and socioeconomically disadvantaged Australians. Epidemiological trends are alarming: hospitalisations for alcohol-related liver disease are rising, and emerging data show a causal link between alcohol and early-onset colorectal cancer. These findings underscore alcohol's role as both a hepatotoxin and a multisystem carcinogen, with harms manifesting at younger ages and lower levels of consumption than previously recognised. Despite clear evidence that no level of alcohol use is safe, misconceptions persist, fuelled by industry influence and inconsistent public health messaging. Evidence-based treatments exist but are underused: only 2.9% of Australians with AUD receive approved pharmacotherapy, and delays to treatment average 18 years. Population-level strategies such as taxation, pricing and marketing restrictions remain the most effective levers, but progress is weak, as illustrated by the repeal of minimum unit pricing in the Northern Territory. Clinicians play a central role in reframing hazardous drinking and AUD as the root cause of alcohol-related disease and in advocating for evidence-based, patient-centred care and policy. Addressing AUD directly offers the clearest path to reducing Australia's alcohol burden.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"521-532"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283751","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":"Associations between sociodemographic characteristics and medical care use during COVID-19: an Australian study.","authors":"Erika Martino, Ang Li, Rebecca Bentley","doi":"10.1111/imj.70380","DOIUrl":"10.1111/imj.70380","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 impacted how, and to what extent, health services were delivered. However, it is unclear to what extent individual and area-level characteristics impacted how people accessed health services and the ways in which health providers delivered such services.</p><p><strong>Aims: </strong>We examined whether individual and area-level sociodemographic characteristics were associated with the delay and cancellation of medical care by patients and providers during COVID-19 in Australia.</p><p><strong>Methods: </strong>Using the Household, Income and Labour Dynamics in Australia (HILDA) survey, logistic regression models examined associations between the delay and cancellation of medical care during COVID-19 and individual and area-level sociodemographic characteristics.</p><p><strong>Results: </strong>The analysis showed that providers delayed or cancelled appointments more than patients (10% vs 6.5% respectively), and delays and cancellations were significantly higher among females than males for both providers (odds ratio (OR) = 1.67, P = 0.00 < 0.05 95% confidence interval (CI): 1.50-1.85)) and patients (OR = 2.11, P = 0.00 < 0.05 (95% CI: 1.85-2.41)). Individuals with lower education were less likely to delay or cancel care (OR = 0.81, P = 0.01 < 0.05 (95% CI: 0.70-0.94)), and persons born in non-English-speaking countries were less likely to experience provider delays or cancellations than those born in Australia (OR = 0.69, P = 0.00 < 0.05 (95% CI: 0.58-0.83)). Older adults were more likely to have had care delayed or cancelled by both the providers and the patients themselves and people in more advantaged areas reported a lower probability of deferring treatment by providers.</p><p><strong>Conclusions: </strong>Delays or avoidance of medical care can increase morbidity and mortality risk, with such findings useful in informing more targeted approaches to service delivery to ensure health equity.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"598-604"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270942","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 length of hospital admissions by implementing same-day general physician review in the emergency department of an Australian tertiary hospital.","authors":"Charlotte Blacketer, Andrew E C Booth, Arthas Flabouris, Samuel Gluck, Stephen Bacchi, Toby Gilbert","doi":"10.1111/imj.70343","DOIUrl":"10.1111/imj.70343","url":null,"abstract":"<p><strong>Background: </strong>The presence of a general physician assessing patients upon referral in the emergency department (ED) may improve patient outcomes compared with the traditional model of post-take ward rounds.</p><p><strong>Aim: </strong>This study examines the impact of such an intervention on patient discharge rates and readmissions in a single centre.</p><p><strong>Methods: </strong>From July 2019 to June 2020, a general physician was rostered to review patients on the day of referral from the ED. Four cohorts were compared: pre-intervention, intervention, concurrent controls (admitted during the intervention period but not reviewed) and post-intervention. Multivariate analyses evaluated the association between same-day consultant review and the likelihood of same-day discharge, as well as other variables including median length of stay (LoS) and readmission rate.</p><p><strong>Results: </strong>Among 22 620 admissions, median LoS was shorter in the intervention period than in the before or after period (87 h vs. 97 and 93 h (P < 0.001)). Same-day general physician assessment increased the odds of day zero discharge by fivefold compared with before the intervention (adjusted odds ratio (aOR) 5.47, 95% confidence interval (CI): 3.62-8.26, P < 0.001). This effect was not sustained after the intervention ended (aOR 0.47, 95% CI 0.27-0.80, P < 0.006). Lower triage acuity and younger age were associated with discharge on day zero. Notably, longer ED decision time correlated with higher day zero discharge (aOR 1.09, 95% CI: 1.03-1.15), possibly reflecting appropriate consultant involvement in cases with an unclear disposition. Day zero discharge rates varied among individual general physicians (range 4.1%-14.0%). Increased day zero discharges did not lead to higher 7-day readmission rates.</p><p><strong>Conclusions: </strong>This large trial showed that early general physician review was associated with decreased median LoS and increased rate of day zero discharge, with no increase in readmission rates or mortality. Variability between physicians suggests potential for further optimisation in practice.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"668-674"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113010","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":"Ethics of patient participation in long case assessments.","authors":"Adi Kaufman, Euzebiusz Jamrozik","doi":"10.1111/imj.70388","DOIUrl":"10.1111/imj.70388","url":null,"abstract":"<p><p>The long case is a key hurdle in the assessment of medical students and physician trainees. They involve detailed interviews with volunteer patients and presentation of their health issues by the interviewing trainee. There is a paucity of research focussed on patients' experiences and on the ethical issues of patient participation in long cases specifically. This commentary presents preliminary analysis of the ethics of patient participation in physician long cases, with the goal of stimulating further research in this area. Long cases reportedly have high educational value and should remain as an assessment tool. Long cases can also promote respect and patient autonomy and have the potential to bridge gaps within patients' medical care. We argue that long cases can become more beneficial to the participating patients. Future studies should explore patients' experience of participation in long cases specifically and what impact it had on their healthcare and prognosis.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"696-700"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147573891","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":"Steroid refractory desquamative interstitial pneumonia responsive to intravenous cyclophosphamide.","authors":"Lin Mo, Filipe Vilas Boas, Shileigh Martin, Sonja Klebe","doi":"10.1111/imj.70372","DOIUrl":"10.1111/imj.70372","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"720-721"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283772","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":"More effort needs to be put into automated alerts to optimise heart failure and atrial fibrillation guideline-directed medical therapy in Australian healthcare.","authors":"Rakila Kurugalage, Alasdair Leslie, Brandon Stretton, Stephen Bacchi","doi":"10.1111/imj.70412","DOIUrl":"https://doi.org/10.1111/imj.70412","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591814","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 rural lung cancer referral pathways: an assessment of a general practitioner referral pathways programme for patients with lung cancer.","authors":"Shanuka Samaranayake, Gordon Hagerman, Bliegh Mupunga, Patrick Dwyer","doi":"10.1111/imj.70356","DOIUrl":"10.1111/imj.70356","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer diagnosis requires multiple investigations, with delays causing increased mortality. To reduce diagnostic delays, a general practitioner (GP) referral pathway programme was developed in 2016 within a rural Australian health district to assist GPs in referring patients with suspected lung cancer for further management.</p><p><strong>Aims: </strong>To assess the effectiveness of this GP cancer referral programme, and the impact on high-risk patient populations.</p><p><strong>Methods: </strong>Patients who underwent curative intent radiotherapy for lung cancer at the North NSW Cancer Institute between 2012 and 2022 were included in the study. Patients were stratified based on Eastern Cooperative Oncology Group (ECOG) performance status, stage of malignancy and level of rurality. Comparison was performed between patients diagnosed between 2012-2016, 2017-2019 and 2020-2022. The diagnostic pathway was split into four steps, and the time taken between each point was mapped. Chi-squared analysis was used to assess for demographic differences. Mann Whitney U test was used to assess for differences between the three time periods and between high-risk groups for each step within the diagnostic pathway.</p><p><strong>Results: </strong>There were 214 patients in the study cohort. There were no demographic differences between the three time periods (P > 0.05). ECOG performance status and level of rurality did not impact any step of the diagnostic timeline (P > 0.05). There was an improvement in diagnostic timelines for stage III patients compared to stage I/II patients from 2017 onwards, through multiple steps of the diagnostic pathway (P < 0.05).</p><p><strong>Conclusion: </strong>Implementation of a local GP intervention improves diagnostic timelines for patients with advanced stages of disease.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"651-658"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142230","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":"Insights into omalizumab use in Auckland City Hospital's immunology 2023 chronic spontaneous urticaria cohort.","authors":"Nathaniel Triffitt, Karen Lindsay","doi":"10.1111/imj.70354","DOIUrl":"10.1111/imj.70354","url":null,"abstract":"<p><p>This review of omalizumab use in chronic spontaneous urticaria (CSU) in Auckland City Hospital's immunology department in 2023 showed that rates of baseline investigations were high but did not clearly improve CSU management. There were associations between raised C-reactive protein and higher doses of omalizumab, and lower C-reactive protein and CSU remission. Most patients had angioedema and atopy. Median symptom duration was 5 years and the majority needed at least 1 year of omalizumab treatment. Fewer Māori/Pasifika patients in this cohort may reflect barriers to accessing health care.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"706-709"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283742","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":"Can Australia afford the costs of cardiology guidelines? True costs and strategies for reduction.","authors":"Jacob Y Cao, David S Celermajer","doi":"10.1111/imj.70369","DOIUrl":"10.1111/imj.70369","url":null,"abstract":"<p><strong>Aim: </strong>To estimate the 10-year Australian healthcare system cost of full implementation of evidence-based guidelines across five common cardiovascular conditions.</p><p><strong>Background: </strong>Healthcare spending in Australia continues to rise as the population ages and treatment options become increasingly advanced and costly. However, assessment of cost remains conspicuously absent from national and international clinical guidelines, and the implications of such costs for the equity and sustainability of healthcare have not been evaluated in the Australian context.</p><p><strong>Methods: </strong>Using national population estimates and Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data, we modelled the projected 10-year cost of full guideline implementation for all eligible or indicated Australians across five common cardiovascular conditions: dyslipidaemia, hypertension, obesity, type 2 diabetes with heart failure or chronic kidney disease, and atrial fibrillation/flutter. These costs were compared against PBS/MBS expenditure from 2024 to 2025.</p><p><strong>Results: </strong>In total, the projected 10-year cost for only these five cardiovascular conditions is estimated at $45-50 billion (at 2025 prices), which is 3.4-3.9 times higher than the current national expenditure for these conditions. This also highlights the poor uptake of, or access to, evidence-based care among certain Australian populations.</p><p><strong>Conclusions: </strong>Our analysis highlights the complex balance between efficacy, cost and equity in healthcare. We propose two practical strategies to address these challenges: embedding cost-effectiveness analyses into guideline formulation and promoting greater use of generic medications. Through these measures, we hope to prioritise cost-effective, evidence-based care and make it accessible to all Australians, while maintaining the long-term financial sustainability of the healthcare system.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"605-612"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146219587","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}