Internal Medicine Journal最新文献

{"title":"Impact of a multidisciplinary diabetes care programme on glycaemic and metabolic outcomes in regional and First Nations communities: a retrospective observational study.","authors":"Akash Konantambigi, Majid Al-Abbood, Belinda Weich, Debbie Barra, Matthew Hiskens, Chinmay Marathe, Usman Malabu, Harshal Deshmukh","doi":"10.1111/imj.16639","DOIUrl":"https://doi.org/10.1111/imj.16639","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) poses a significant public health challenge in Australia, particularly among underserved populations such as First Nations people and rural communities. In response, the Together Strong Connected Care (TSCC) programme was developed to address these disparities by offering a culturally appropriate, multidisciplinary approach to diabetes management in a regional hospital setting.</p><p><strong>Aims: </strong>The aim of the study was to assess the impact of the TSCC programme on glycaemic and metabolic control in people living with diabetes.</p><p><strong>Methods: </strong>This was a retrospective observational study. Baseline characteristics, including age, gender, ethnicity and clinical measures, were collected. The primary outcome was the change in HbA1c over 12 months. Statistical analysis included descriptive analysis, univariate comparative analysis, paired t-tests for change in outcomes and multivariate linear regression analysis.</p><p><strong>Results: </strong>The study included 119 patients, divided into those who participated in the TSCC programme (n = 68) and those who declined participation (n = 51). The study participants had a mean age of 55.71 years, with 58.82% identifying as female. The mean baseline HbA1c was 8.25% (SD = 2.60) and mean baseline weight was 97.38 kg (SD = 28.81). People in the TSCC group had significantly greater reductions in HbA1c (-1.65%, P < 0.001) compared to the no-TSCC group (+0.02%, P < 0.001). After adjusting for confounders, TSCC participation remained independently associated with improved glycaemic control (β = -0.78, P < 0.001), particularly in patients with T2DM.</p><p><strong>Conclusions: </strong>The TSCC programme significantly improved glycaemic control in regional First Nations patients, supporting the effectiveness of culturally appropriate, multidisciplinary care models in managing diabetes in underserved communities. Further research is warranted to evaluate long-term outcomes of similar interventions.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004570","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 we disadvantaging smokers by excluding them from kidney transplantation? A single-centre experience and survey of kidney transplantation units.","authors":"Humam Hazim, Matthew Rowlandson, Cynthia Chang, Amy Poon, Sheridan Ward, Peter Howley, Bruce Mackinnon","doi":"10.1111/imj.16627","DOIUrl":"https://doi.org/10.1111/imj.16627","url":null,"abstract":"<p><strong>Background: </strong>Smoking has been shown to have detrimental effects on KT outcomes and survival. Most units and guidelines advocate for the cessation of smoking prior to a kidney transplant and consider it a general contraindication to listing. Smoking prevalence is higher in disadvantaged groups. Smoking cessation is complex and often takes many years. For those suffering from the burden of chronic kidney disease, a delay in transplantation with a longer dialysis time may result in worse outcomes and accentuate the difficulty of cessation.</p><p><strong>Aim: </strong>The objective of this study was to describe the cohort of excluded smokers for kidney transplantation (KT) and further examine the current practices regarding smoking and KT waitlisting.</p><p><strong>Methods: </strong>We undertook a retrospective observational study of dialysis patients in Hunter New England Local Health District 2013-2023 <65 years old and assessed but not listed for KT. We examined the reasons for non-transplant listing and divided them into two categories, smoking versus others (comorbidities, patient preference and cancer). We compared the categories in terms of demography, comorbidities and dialysis modality. We also conducted a survey of KT units across Australia and New Zealand regarding their policies towards smoking.</p><p><strong>Results: </strong>We reviewed the records of 333 patients (142 female), 89 of whom were smokers. Patients not listed due to smoking were less comorbid than those rejected for another reason (83% vs 40% having ≤1 comorbid condition, P < 0.001). Patients rejected due to smoking were younger than those rejected for other reasons (47.8 vs 52.1, P = 0.007). There was no difference between the two groups in terms of sex or dialysis modality. All the acute KT units were surveyed (response rate 100%); 72% of units do not list current smokers for KT.</p><p><strong>Conclusion: </strong>Patients not listed for KT due to smoking are generally younger and less comorbid than those not listed for other reasons. Our survey shows variation in practice between units. As smoking is more prevalent in marginalised communities, not listing these patients for KT may be an equity-of-access-to-treatment issue.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004640","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":"Access to cardiac imaging after ischaemic stroke in Australia: a national survey","authors":"Carlos Garcia-Esperon,&nbsp;Helen Badge,&nbsp;Lauren Christie,&nbsp;Faraz Pathan,&nbsp;Octavio Garcia Silva,&nbsp;Mark W. Parsons","doi":"10.1111/imj.16619","DOIUrl":"10.1111/imj.16619","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"171-172"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004577","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":"Cerebellar stroke secondary to ovarian stimulation and patent foramen ovale","authors":"Owen Ka Lung Chan,&nbsp;Johnny Zhang,&nbsp;Bruce James Brew","doi":"10.1111/imj.16622","DOIUrl":"10.1111/imj.16622","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"167-168"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004621","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":"Palliative care clinical trials research in regional settings: green fields of opportunity","authors":"Miriam Ferres,&nbsp;Lisa Mounsey,&nbsp;Joyce Chua,&nbsp;Peter Eastman,&nbsp;David Campbell,&nbsp;Brian Le,&nbsp;Ian M. Collins,&nbsp;Jennifer Philip","doi":"10.1111/imj.16618","DOIUrl":"10.1111/imj.16618","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"173-174"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004704","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":"Acute kidney injury in acute leukaemia: there is more to this than meets the eye","authors":"Humam Hazim,&nbsp;Bobby Chacko","doi":"10.1111/imj.16620","DOIUrl":"10.1111/imj.16620","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"165-166"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004618","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":"Patient-driven personal importation in the face of cost barriers to care: can we do better?","authors":"Narcyz Ghinea,&nbsp;Hazel Heal,&nbsp;Mark Danta","doi":"10.1111/imj.16569","DOIUrl":"10.1111/imj.16569","url":null,"abstract":"<p>Australia has a robust public health system that helps to make medicines affordable. However, evidence shows that a significant proportion of Australians still cannot afford medicines prescribed to them and that some patients import medicines from abroad as a result. The strongest predictor of whether patients import medicines is whether they have discussed it with their doctor. In this article we explore options available to patients and physicians for access to unapproved medicines when approved medicines are unaffordable. Although personal importation is the most obvious option, regulation leaves scope for other possibilities. We propose that guidance should be developed to help physicians address cost-related medicine non-adherence in practice and to help them understand their options and how to navigate them at the individual, speciality and professional levels.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"130-133"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004651","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":"2024 IMJ REVIEWERS*","authors":"","doi":"10.1111/imj.16640","DOIUrl":"https://doi.org/10.1111/imj.16640","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"9-11"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143115346","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":"Perspectives on the perceived complexities of modern patient care","authors":"Isaac K. S. Ng,&nbsp;Li Feng Tan,&nbsp;Wilson G. W. Goh,&nbsp;Desmond B. Teo","doi":"10.1111/imj.16621","DOIUrl":"10.1111/imj.16621","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"169-170"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004657","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":"Impact of distance from liver transplant centre on outcomes following liver transplantation: an Australian single-centre study.","authors":"Simone Chin, Charlotte Kench, Rena Cao, Christina Lee, Karen Waller, Susan Virtue, Claire West, Talal Valliani, David G Bowen, Rachael Jacob, Madeleine Gill, Carlo Pulitano, Michael Crawford, Simone I Strasser, Geoffrey W McCaughan, Ken Liu","doi":"10.1111/imj.16631","DOIUrl":"https://doi.org/10.1111/imj.16631","url":null,"abstract":"<p><strong>Background: </strong>Access to liver transplantation (LT) is affected by geographic disparities. Higher waitlist mortality is observed in patients residing farther from LT centres, but the impact of distance on post-LT outcomes is unclear.</p><p><strong>Aims: </strong>To evaluate whether the distance LT recipients reside from their LT centre affects graft and patient outcomes.</p><p><strong>Methods: </strong>We retrospectively studied consecutive adult patients who received deceased donor LT at a statewide LT referral centre, Royal Prince Alfred Hospital (RPAH), 2006-2021. The primary outcome was overall patient survival.</p><p><strong>Results: </strong>A total of 973 patients who underwent LT during the study period were analysed. The median distance from patient residence to RPAH was 44.9 km (interquartile range 21.9-168.0). Of these, 64.2% lived ≤100 km from RPAH. Compared to patients living ≤100 km from RPAH, those living >100 km away were less likely to be male, have chronic hepatitis B as their cause of liver disease or have hepatocellular carcinoma as their primary indication for LT. Living >100 km from RPAH was associated with fewer face-to-face clinic visits in the first year after LT (10 vs 11 visits, P < 0.001) and fewer readmissions to RPAH (32.4% vs 67.6%, P < 0.001). Distance from RPAH, regional code and socioeconomic code did not affect long-term graft or patient survival based on Kaplan-Meier survival analysis (log-rank P > 0.1).</p><p><strong>Conclusion: </strong>In our single-centre Australian study, patients living farther from their LT centre had different demographics. Distance from the LT centre was not associated with long-term inferior graft or patient survival after LT.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970557","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}