Internal Medicine Journal最新文献

{"title":"Complete hemifacial paralysis caused by pontine infarct","authors":"Henry Jiang, Leon S. Edwards","doi":"10.1111/imj.70083","DOIUrl":"https://doi.org/10.1111/imj.70083","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"866-867"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949711","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":"The pre-round: what are junior doctors doing before handover?","authors":"Tim Bridgman","doi":"10.1111/imj.70084","DOIUrl":"https://doi.org/10.1111/imj.70084","url":null,"abstract":"<p>Many readers of the <i>Internal Medicine Journal</i> (IMJ) may not be familiar with the term pre-rounding. It is a term that refers to the practice of junior doctors performing reviews, tasks or other preparation directly prior to a ward round from their consultant or other lead clinician.<span><sup>1, 2</sup></span> Pre-rounding is a heterogenous practice that varies between hospitals, departments and even within departments. It may include a traditional full physical round of patients, as is more common in North America, or, more simply, in Australia and New Zealand, it may be a review of key test results, observations and vital signs using the electronic medical record (EMR).<span><sup>2-4</sup></span> Multiple factors affect how pre-rounds occur in each area. Many senior staff may not be aware of what their juniors are doing before the ward round.</p><p>Several factors influence the structure of a junior doctor's pre-round. Each individual will have their own preferred approach and structure, and variation in this between doctors may in part reflect the absence of formal medical school education on pre-rounding.<span><sup>1, 5</sup></span> External factors will also influence structure. Individual senior clinicians will vary in the information that they require from the juniors on the round and the manner in which they wish it presented. This will drive differing pre-rounding practices among the hospital and medical teams. The hospital's systems and EMRs will affect the approach to pre-rounds between hospitals. A junior doctor's job is therefore to be adaptable and pre-round in a manner to maximise efficiency in collating the information that is expected.</p><p>In current practice, getting the full information together in time for the senior round often relies on the junior doctor arriving at the hospital ahead of the prescribed ‘start time’. This is especially the case when the round begins immediately after the start-of-the-day handover. With ever more complex patients and increasing health information in the system, this can lead to earlier and earlier start times. Efficiency is the goal, with the cost of inefficiency being measured in lost minutes of sleep. Simply arriving with the senior medical officer is commonly no longer achievable, particularly during breakneck pace surgical rounds where time at bedside may be measured in seconds. However, as it is with almost every area of healthcare provision currently, time remains a luxury, necessitating efficiency.</p><p>Each consultant or lead clinician for the round will have an expectation on what information the junior staff should have available, varying among case presentations, current vital signs, recent test results and event recorded by the overnight nursing shift. These expectations are often shaped by doctors' personal practice and the information each uses to formulate ongoing management plans. Traditional structured teaching might struggle to provide a ‘one best approach’ with ","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"703-704"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950037","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":"Educating medical trainees about artificial intelligence should not be optional","authors":"Brandon Stretton, Benjamin Cook, Bradley Menz, Matthew Arnold, Christina Gao, Andrew Vanlint, Ishith Seth, Joshua Kovoor, Aashray Gupta, Stephen Bacchi","doi":"10.1111/imj.70082","DOIUrl":"https://doi.org/10.1111/imj.70082","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"871-872"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949719","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":"Thyroid haemorrhage in the setting of acute illness-induced supratherapeutic anticoagulation","authors":"Hitarth Dalal, Noor Lammoza, Maria Hormiz, Ar Kar Aung, Helen McDougall","doi":"10.1111/imj.70079","DOIUrl":"https://doi.org/10.1111/imj.70079","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"868-870"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949720","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":"Australian contribution to the history of amoebic meningitis and encephalitis","authors":"Tony M. Korman","doi":"10.1111/imj.70081","DOIUrl":"https://doi.org/10.1111/imj.70081","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"873"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949721","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":"Rivaroxaban-related nephropathy: an under-reported cause of acute kidney injury","authors":"Lucy Marshall, Naveed Ahmed, Janak R. de Zoysa, Ashik Hayat","doi":"10.1111/imj.70080","DOIUrl":"https://doi.org/10.1111/imj.70080","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"864-865"},"PeriodicalIF":1.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950572","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":"Lessons from implementation of a nephrology key performance indicator programme.","authors":"Adam G Steinberg, Peter F Mount, Maree Branagan, Matthew A Roberts, Nigel D Toussaint","doi":"10.1111/imj.70049","DOIUrl":"https://doi.org/10.1111/imj.70049","url":null,"abstract":"<p><strong>Background: </strong>We review the impact of a nephrology key performance indicator (KPI) program implemented over a ten-year period in Victoria, Australia. The program enabled transparent comparison of performance across nephrology units, however improvement against performance targets was not consistent and better understanding of KPIs is required to promote quality improvement.</p><p><strong>Aim: </strong>We aimed to review the impact of the Victorian nephrology KPI programme over a 10-year period.</p><p><strong>Methods: </strong>The KPI programme involved six KPIs related to the continuum of care for kidney replacement therapy: pre-dialysis education, vascular access at first haemodialysis, home dialysis rates, peritonitis rates, pre-emptive kidney transplantation and rates of transplantation/waitlisting. Data were collected monthly from the 10 Victorian nephrology services using a purpose-designed website portal. Results were analysed and reported every 3 months. We present a summary of each KPI and discuss changes over the 10-year period.</p><p><strong>Results: </strong>KPI data demonstrated significant differences in performance across KPIs after implementation, particularly in rates of home dialysis and transplant waitlisting. Changes within units were sometimes significant, but across Victoria, performance was relatively static. Over 10 years, there was a lack of significant improvement in clinical performance in several indicators and multiple changes to KPI targets were made.</p><p><strong>Conclusion: </strong>The KPI programme enabled comparison of performance across nephrology units, but improvement in performance targets was not consistent over the 10-year period and the programme served as a means for benchmarking perhaps, rather than a quality improvement tool. Better understanding of each KPI and resources available for quality improvement is crucial for the success of a KPI programme.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991808","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":"Terminal heart failure care for women: better or more of the same?","authors":"Vithoosharan Sivanathan,&nbsp;Natasha Smallwood,&nbsp;Dominica Zentner","doi":"10.1111/imj.70077","DOIUrl":"10.1111/imj.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Women with chronic heart failure (CHF) experience an increased symptom burden, activity impairment and frailty. Although receiving palliative care services has been shown to improve the quality of life of people with CHF, few patients access this in a timely manner.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Explore whether there were differences in either referral to specialist palliative care or provision of elements of palliative care to women and men with CHF during their terminal admission in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective review of medical records for all admissions resulting in death from chronic heart failure (July 2011 to December 2019).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort (<i>n</i> = 439) was elderly (median age 83.7 years, IQR = 77.6–88.7) and composed of 199 (45.1%) women. There was no association between sex and receiving an inpatient referral to specialist palliative care (<i>P</i> = 0.80). Women were less likely to receive life-sustaining interventions (intubation, inotropes, resuscitation, ICU stay) (odds ratio [OR] = 1.71, 1.04–2.83; <i>P</i> = 0.04) compared to men. Women were more likely to receive terminal symptom-related management (opioids or benzodiazepines) (OR = 3.19, 1.54–6.63; <i>P</i> = 0.01) or a palliative approach (OR = 1.68, 1.14–2.45; <i>P</i> &lt; 0.01). Women were less likely to present to the emergency department (OR = 0.50, 0.31–0.79; <i>P</i> = 0.04) or be referred to an outpatient chronic disease programme (OR = 0.58, 0.34–0.98; <i>P</i> = 0.04) in the 12 months prior to death compared to men.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Given accepted differences in the timeliness of cardiac care for women, the apparent finding of better end-of-life care for women is intriguing and merits further research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1098-1104"},"PeriodicalIF":1.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985383","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":"Opportunistic screening for diabetes among urban Aboriginal adults during emergency department attendance","authors":"William Yu,&nbsp;Kyaw Phone Myint,&nbsp;Uchechukwu Levi Osuagwu,&nbsp;Nathan Jones,&nbsp;Richard Cracknell,&nbsp;Anau Speizer,&nbsp;David Simmons,&nbsp;Milan Piya","doi":"10.1111/imj.70078","DOIUrl":"10.1111/imj.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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% (<i>n</i> = 88). Among those without known diabetes, 1.4% (<i>n</i> = 9) had glucose readings ≥11.1 mmol/L and 14.3% (<i>n</i> = 90) had glucose readings 7.0–11.0 mmol/L. For those without known diabetes with HbA1c measurement, there were 2.7% (<i>n</i> = 8) with HbA1c ≥6.5% and 4% (<i>n</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1146-1151"},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70078","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of pro-haemostatic agents in the management of factor Xa inhibitor-associated intracranial haemorrhages","authors":"Sara Shu-Ling Ng,&nbsp;Hashim Noori,&nbsp;Diem Nguyen,&nbsp;Zhengbang Wang,&nbsp;Danny Hsu","doi":"10.1111/imj.70074","DOIUrl":"10.1111/imj.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine the efficacy of pro-haemostatic agents in the management of factor Xa inhibitor-related intracranial haemorrhages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective audit of rivaroxaban and apixaban-associated intracranial haemorrhages was performed between January 2015 and December 2021, inclusive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>P</i> = 0.51, 95% confidence interval: −11.7 to +5.9).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1114-1119"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70074","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}