Internal Medicine Journal最新文献

{"title":"Selection into Advanced Training in Rheumatology in Australia: towards a programmatic and theory-informed model.","authors":"Narainraj Kamalaraj, Andrew Lim, Arvin Damodaran, Louise Ward, E Michael Shanahan","doi":"10.1111/imj.70479","DOIUrl":"10.1111/imj.70479","url":null,"abstract":"<p><p>Selection into vocational medical specialty programmes such as Advanced Training in Rheumatology in Australia is fraught with complexity. Selection panels must identify suitable trainees while navigating eligibility standards set by the Royal Australasian College of Physicians (RACP), complying with state-based employment legislation and responding to broader social and political expectations. While functional, this federated system exhibits variation in selection strategy, methodology, governance, transparency and panel composition. Evidence for selection into vocational medical training is limited, and practice is mainly derived from medical student selection research, with no published studies evaluating the predictive validity of Rheumatology Advanced Training selection methods in Australia. The recent shift towards programmatic assessment across the RACP has prompted a major revision of the rheumatology curriculum in 2026. This transition presents an opportunity to evaluate current selection strategies and their alignment with key competencies. Drawing on national workshops convened by the Australian Rheumatology Association and contemporary validity theory, this article proposes a theory-informed framework for selection into Advanced Training in Rheumatology. Rheumatology is therefore well positioned to develop a defensible, evidence-informed and socially accountable approach to specialty selection within the RACP.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":"1654-1659"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940937","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":"Stigmatising substance-related language in the electronic health records of hospitalised patients after addiction consult service implementation.","authors":"Ryder Cuppett, Justin Birge, Kristin Daniel, Alëna A Balasanova","doi":"10.1111/imj.70619","DOIUrl":"https://doi.org/10.1111/imj.70619","url":null,"abstract":"<p><strong>Objectives: </strong>Stigmatising language about patients with substance use disorders (SUD) is common in healthcare settings and negatively impacts patient care. Addiction consult services are associated with improved clinician attitudes and less stigmatising views towards patients with SUD. We investigated whether implementation of an addiction consult service at a large urban medical centre was associated with changes in prevalence of stigmatising language in the electronic health record (EHR) of hospitalised patients and examined these changes across medical training levels.</p><p><strong>Methods: </strong>We performed a retrospective analysis of all inpatient notes in the EHR 5 years before and after Addiction Consult Service implementation. Notes were queried using string term searches for stigmatising language related to SUD. Data were aggregated by author profile type and training level focusing on medical students, residents/fellows and attending physicians. We used chi-squared tests to compare changes in the prevalence of stigmatising language.</p><p><strong>Results: </strong>Overall percentage of notes containing stigmatising language decreased significantly from 7.70% before Addiction Consult Service implementation to 7.43% after (P < 0.001). Among physicians in training, medical students had a 3.11% (P < 0.001) decrease in notes containing stigmatising language and residents/fellows saw a 1.31% (P < 0.001) decrease. In contrast, stigmatising language in attending physician notes increased by 0.84% (P < 0.001).</p><p><strong>Conclusions: </strong>Implementation of an Addiction Consult Service was temporally associated with decreased stigmatising language in documentation by medical students and residents/fellows, suggesting that exposure and education provided by an Addiction Consult Service may have positively influenced documentation practices. Increased stigmatising language in attending physician notes highlights the need for ongoing anti-stigma education and training for practicing clinicians. These findings support the potential role of Addiction Consult Services in reshaping institutional culture around SUD.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818211","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 timeliness of lung cancer care through a rapid assessment clinic.","authors":"Shakti V Dabholkar, Shalini Vinod, Zinta Harrington, Benjamin Kolevski, Beth Ivimey, Joseph Descallar, Jonathan P Williamson","doi":"10.1111/imj.70602","DOIUrl":"https://doi.org/10.1111/imj.70602","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis and treatment of lung cancer improve survival. Guidelines from Australia and worldwide stipulate timeframes of care from referral. The Rapid Lung Assessment Clinic (RLAC) was established to fast-track the diagnostic and treatment pathway, with a subsequent quality improvement initiative based on the initial analysis of timeliness of care.</p><p><strong>Aim: </strong>This study evaluated the performance of RLAC before and after the quality improvement initiative and identified patient and system factors, which affect timeliness of care.</p><p><strong>Methods: </strong>This was a retrospective, observational cohort study evaluating RLAC. The clinic was established in 2018 as a weekly clinic serviced by respiratory physicians associated with the hospital's lung cancer multidisciplinary team. In 2020, the service gained access to a dedicated nurse coordinator who organised pre-clinic positron emission tomography scan and/or other investigations prior to clinic appointment.</p><p><strong>Results: </strong>Median times from referral to specialist review (11 vs 10 days, P = 0.02 (before vs after intervention)), diagnosis (28 vs 21 days, P = 0.5) and treatment (63 vs 51 days, P = 0.001) were all reduced after intervention. Before and after the intervention, 71% (before intervention) versus 74% (after intervention) of patients had specialist review within 14 days, and 29% versus 40% commenced treatment within 42 days. Earlier stage of disease, need for surgical treatment and greater number of diagnostic investigations was associated with longer times to treatment.</p><p><strong>Conclusion: </strong>Our intervention reduced delays to treatment of lung cancer in a rapid assessment clinic. The majority of patients were still not treated within recommended timeframes, raising the question of whether guideline timeframes are realistic given the modern-day complexities of lung cancer work-up.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812940","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":"Using artificial intelligence in clinical practice: Royal Australasian College of Physicians position statement.","authors":"Ian A Scott, Christian White, Tim Shaw, Christine Slade, Tai Tak Wan, Rahul Barmanray, Craig Coorey, Sandra L J Johnson, Lana Bell, Michael Herd, Kudzai Kanhutu, Clair M Sullivan","doi":"10.1111/imj.70594","DOIUrl":"https://doi.org/10.1111/imj.70594","url":null,"abstract":"<p><p>The Royal Australasian College of Physicians (RACP) has recently issued a position statement titled 'Using artificial intelligence in clinical practice', which provides a framework for the safe and ethical integration of artificial intelligence (AI) into physician practice. The statement outlines core principles for implementing, interacting with and monitoring AI tools to ensure they enhance rather than replace clinical judgement, protect patient safety and privacy and abide by ethical and regulatory standards. It identifies important benefits, such as increased administrative efficiency and improved support for clinical decision-making, while cautioning against risks such as algorithmic bias, data breaches and medicolegal liabilities. The statement also offers enabling strategies to overcome various barriers such as biased or inaccurate tools, professional and public resistance to the use of AI and adverse environmental impacts. The RACP advocates for physicians to engage in AI development and implementation using an agile human-in-the-loop approach that prioritises patient safety, clinical governance, professional training and collaboration with stakeholders.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808711","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":"Dealing with aggressive patients.","authors":"Bruce Boman","doi":"10.1111/imj.70622","DOIUrl":"https://doi.org/10.1111/imj.70622","url":null,"abstract":"<p><p>Workplace-related abuse, threats and assault are globally recognised as a significant risk for healthcare workers. This paper briefly reviews systemic factors contributing to aggression and violence before focussing on techniques first to identify high-risk patients and then sufficiently defuse their behaviour to enable a clinical assessment to be undertaken. General guidance is offered to enable compliance with relevant guardianship and mental health acts. Emphasis is placed on the importance of post-incident debriefing and, where necessary, counselling and for there to be systems in place to ensure supportive and efficient reporting. Training in the management of such patients should be included in both junior medical officer and specialty training programmes.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808684","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":"Stress hyperglycaemia ratio and post-operative delirium after cardiac surgery: a retrospective cohort study of the MIMIC-IV database.","authors":"Duolikun Mutailifu, Abudousaimi Aini, Malike Mutailipu, Wenzhe Li, Abudunaibi Maimaitiaili","doi":"10.1111/imj.70611","DOIUrl":"https://doi.org/10.1111/imj.70611","url":null,"abstract":"<p><strong>Background: </strong>Post-operative delirium is a serious neurocognitive complication of cardiac surgery. The stress hyperglycaemia ratio (SHR), which adjusts acute glucose levels to baseline glycaemia using glycated haemoglobin, has demonstrated superior prognostic value in critical care; however, its association with delirium remains under-investigated.</p><p><strong>Aims: </strong>This study's primary aim was to investigate the association between the SHR and post-operative delirium. The secondary aim was to develop machine-learning models for early risk stratification.</p><p><strong>Methods: </strong>This retrospective study analysed 8346 adult patients from the Medical Information Mart for Intensive Care IV database. The SHR was calculated using the peak glucose level within the first 24 h after intensive care unit admission. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Multivariable Cox regression and restricted cubic splines evaluated associations, while six machine-learning models were constructed using Boruta-selected features.</p><p><strong>Results: </strong>Delirium incidence was significantly higher in the high-ratio group than in the low-ratio group (18% vs 11%; P < 0.001). After multivariable adjustment, each one-unit increase in the ratio was associated with a 60% increased delirium risk (hazard ratio, 1.60; 95% confidence interval, 1.29-1.99). A high ratio independently predicted delirium (hazard ratio, 1.54; 95% confidence interval, 1.31-1.82), with restricted cubic splines confirming a linear dose-response relationship (P for non-linearity = 0.203). The support vector machine model achieved the best discriminative performance (area under the curve = 0.8042).</p><p><strong>Conclusions: </strong>An elevated SHR is an independent risk factor for post-operative delirium. These machine-learning models may facilitate timely perioperative risk stratification.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808687","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":"Development and application of a frailty index derived from patient-reported outcome measures and comorbidities in oncology patients.","authors":"Divya Mathew, Heather Lane, David Ward, Rosemary Saunders, Lesley Millar, Christopher Etherton-Beer","doi":"10.1111/imj.70599","DOIUrl":"https://doi.org/10.1111/imj.70599","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence supports the use of a frailty index as an objective measure of frailty. We constructed a frailty index from patient-derived outcome measures, as well as self-reported comorbidity data, and tested its correlation with survival.</p><p><strong>Method: </strong>Data from 464 patients with lung, breast and colorectal cancer were obtained from the Continuous Improvement in Care - Cancer Project database, and a 42-variable frailty index was generated by dividing the total number of deficits present by the total number assessed and expressed as a ratio between 0 and 1. Frailty was defined as a frailty index of >0.2. Its association with survival was assessed using Cox proportional hazards models.</p><p><strong>Results: </strong>Frailty index scores ranged from 0.00 to 0.58 (mean = 0.16, standard deviation = 0.12) and approximated a gamma distribution. Each year of patient age was associated with a small but significant increase in frailty index scores (0.001 points, P = 0.035). Among patients with lung or colorectal cancer, women had significantly higher scores than men (mean difference = 0.06, P = 0.003). Every 0.1 increase in the frailty index significantly increased the risk of death. The probability of mortality, after adjusting for age, sex and cancer type, was higher in the frail cohort compared to the non-frail cohort (hazard ratio 1.96, P = 0.027).</p><p><strong>Conclusion: </strong>Our data suggest that a self-reported patient-reported outcome measure and comorbidity-derived frailty index constitute a feasible measure of frailty. This offers practical advantages especially in oncology and geriatric care, where time and resources are limited and patient-centric care is critical.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792535","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.","authors":"Helen Luo, Paul Finlay, Garun S Hamilton, Paul T King, Daniel J Tan","doi":"10.1111/imj.70614","DOIUrl":"https://doi.org/10.1111/imj.70614","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792632","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":"From exclusion to engagement and enrolment: single institutional experience of recruiting Aboriginal and Torres Strait Islander peoples for a genomic sequencing study.","authors":"Michail Charakidis, Halli Waran, Yat Ming Lau, David Thomas, Lucille Sebastian, Maree Toombs","doi":"10.1111/imj.70620","DOIUrl":"https://doi.org/10.1111/imj.70620","url":null,"abstract":"<p><p>Indigenous peoples remain under-represented in genomic research and clinical trials. This reflects historical exclusion, mistrust and health system barriers. In this article, we describe a single Australian institution's experience in improving engagement and enrolment of Aboriginal and Torres Strait Islander patients in a cancer genomic sequencing study. We reflect on challenges related to rapport, consent and enrolment and outline practical strategies including relationship-building, targeted resources and a tailored enrolment pathway. We contend that equitable participation in genomic research requires sustained, trust-based and culturally specific engagement, rather than reliance on purely technical or procedural solutions.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792574","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":"Tigecycline combination therapy for fulminant Clostridioides difficile infection: an Australian experience.","authors":"Emma Bishop, Tanya Ravipati, Steven Mileto, Eugene Athan, Dena Lyras, Ravindranath Tiruvoipati","doi":"10.1111/imj.70603","DOIUrl":"https://doi.org/10.1111/imj.70603","url":null,"abstract":"<p><strong>Background: </strong>Recent European Society of Clinical Microbiology and Infection and Australasian Society of Infectious Diseases Clostridioides difficile infection (CDI) management guidelines endorse the addition of intravenous tigecycline in patients who are progressing to fulminant infection. However, there are very limited data regarding clinical outcomes with this approach.</p><p><strong>Aims: </strong>We aimed to evaluate mortality and adverse outcomes after tigecycline combination therapy was commenced at the time of fulminant CDI.</p><p><strong>Methods: </strong>This retrospective single-site observational study included patients between January 2018 and December 2022 treated with adjunctive intravenous tigecycline for fulminant CDI in addition to oral vancomycin and intravenous metronidazole. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included clinical cure, partial response, in-hospital CDI-attributable and 90-day all-cause mortality, colectomy and adverse events.</p><p><strong>Results: </strong>Eighteen patient episodes occurred, with median age 67.5 years, requiring intensive care admission and inotropic support in 66.7% and 50% of episodes respectively. All-cause mortality at 30 days was 22.2%. Clinical cure occurred at 14 days in 16.7% of cases and partial response requiring further oral therapy in 55.6%. There was one colectomy and two serious adverse events, including a hyperkalaemic cardiac arrest in a haemodialysis patient and one significant intra-abdominal bleeding episode requiring surgery.</p><p><strong>Conclusions: </strong>Tigecycline combination therapy resulted in improved all-cause 30-day mortality in high-risk CDI patients versus historical data, without the use of faecal microbiota transplantation. Poor outcomes were seen in three patients with pre-existing renal failure, and we question the efficacy and safety of tigecycline in this group. This is a useful salvage strategy, but monitoring for toxicity is essential.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792572","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}