Internal Medicine Journal最新文献

{"title":"Cost-consequence analysis of models of general medicine perioperative care in Victorian hospitals.","authors":"Geoffrey Lester, Amy Osborne, Rona Zhao, Rajesh Gounder, Eldho Paul, Richard Coates, David Lau, Edward Ritchie, Ronan O'Donnabhain, Douglas Johnson, Arunbalaji Muthusamy, Vinita Rane, Elizabeth Potter, Ashwin Subramaniam, Ar Kar Aung","doi":"10.1111/imj.70606","DOIUrl":"https://doi.org/10.1111/imj.70606","url":null,"abstract":"<p><p>Australian general medicine perioperative services provide care to surgical patients with complex comorbidities, for a wide range of medical conditions. Heterogeneous models of care exist; however, their cost-consequence has not been evaluated. Cost analysis was conducted using nationally standardised cost weights for length of stay, medical emergency team call costs and labour costs. Proactive models of general medicine perioperative care likely save approximately $7500 per patient compared with reactive models.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792580","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":"Anticoagulation stewardship team oversight of enoxaparin-warfarin bridging delivered by Hospital in the Home: a pre- and post-implementation study.","authors":"Suebsakul Pripanapong, Sing Ning Yeoh, Jahan Zaib, Simon Lim, Nadishani Ratnayake, Simone Taylor, Emma Leitinger, Benjamin Rogers, Elizabeth Potter","doi":"10.1111/imj.70590","DOIUrl":"https://doi.org/10.1111/imj.70590","url":null,"abstract":"<p><strong>Background: </strong>Initiation or re-initiation of warfarin often requires enoxaparin bridging, a period associated with increased bleeding risk. Anticoagulation stewardship (ACS) teams may improve the safety of anticoagulant management; however, their impact on bridging delivered by Hospital in the Home (HITH) is unknown.</p><p><strong>Aims: </strong>To determine the impact of ACS-guided anticoagulation management on bleeding, thrombosis and other outcomes in patients admitted to HITH for enoxaparin-warfarin bleeding.</p><p><strong>Methods: </strong>We conducted a pre- (November 2020-November 2022) and post-implementation (April 2023-November 2024) comparative cohort study of patients referred to HITH for warfarin-enoxaparin bridging. In the post-implementation phase, the ACS team provided individualised bridging plans and weekly chart reviews. The primary outcome was a composite of bleeding (major or minor), thrombosis (venous thrombo-embolism, stroke, acute myocardial infarction) or anticoagulation-related readmission prior to HITH discharge. Secondary outcomes included the primary outcome assessed at 30 days following discharge and incidence of supratherapeutic international normalised ratio (INR).</p><p><strong>Results: </strong>A total of 373 patients were identified, with 231 bridging episodes in the pre-implementation period (59% male, median age 64 (50-77) years) and 205 bridging episodes in the post-implementation period (59% male, median age 66 (54-77) years). Overall, there was no significant difference in the primary composite outcome following implementation, with rates of 10% and 12% respectively (P = 0.46). After implementation, major bleeding was reduced (2.2% vs 0%, P = 0.03), as was supratherapeutic INRs during warfarin titration (33% vs 21%, P = 0.01). No significant outcome differences were observed in the 30 days after discharge from HITH.</p><p><strong>Conclusions: </strong>ACS-guided anticoagulation plans and routine reviews did not reduce a composite of bleeding, thrombosis or anticoagulation-related rehospitalisation in patients managed in HITH. ACS may be associated with less major bleeding and fewer episodes of supratherapeutic INR.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758860","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":"Sustained clinical outcomes at long-term follow-up after peroral endoscopic myotomy for achalasia: a multicentre cohort study.","authors":"Varan Perananthan, Lucy Bracken, Andrea Huang, Fiona Jones, Francesco Vito Mandarino, Brian Lam, Julia Gauci, Clarence Kerrison, Sunil Gupta, Anthony Whitfield, Nicholas Burgess, Spiro Raftopoulos, Bronte A Holt, Luke F Hourigan, Michael J Bourke","doi":"10.1111/imj.70609","DOIUrl":"https://doi.org/10.1111/imj.70609","url":null,"abstract":"<p><strong>Background: </strong>Peroral endoscopic myotomy (POEM) is an established treatment for achalasia, achieving >90% short-term clinical success. However, long-term durability remains less clear. This study evaluates POEM outcomes beyond 5 years in a multi-centre cohort.</p><p><strong>Aims: </strong>This study evaluates POEM outcomes beyond 5 years in a multi-centre cohort.</p><p><strong>Methods: </strong>Patients with achalasia who underwent POEM across four Australian tertiary centres (January 2014-January 2020) were prospectively enrolled. Eckardt scores were recorded pre-treatment and at multiple intervals up to ≥5 years after POEM. Primary outcome was clinical success at ≥5 years, defined as Eckardt score ≤3 without need for re-intervention. Secondary outcomes included risk factors for failure and management strategies.</p><p><strong>Results: </strong>Of 221 eligible patients, 153 (69.2%) had ≥5-year follow-up data available, with median follow-up of 6.5 years (interquartile range (IQR) 5.6-7.6). Achalasia subtypes included type I (23.5%), type II (62.1%) and type III (14.4%). Among the patients, 52.3% were treatment-naïve; prior therapies included laparoscopic Heller myotomy (14.3%), botulinum toxin (17.0%) and pneumatic balloon dilation (30.7%). Clinical success at ≥5 years was observed in 118 (77.1%) patients. Median Eckardt scores improved from 8.0 (IQR 6.0-10.0) before POEM to 0.0 (IQR 0.0-1.0) at 3-6 months, 1.0 (IQR 0.0-2.0) at 2 years and 2.0 (IQR 0.0-3.0) at 5 years. Sustained success was associated with lower baseline Eckardt scores (P = 0.033). Prior lower oesophageal sphincter (LOS)-directed therapy predicted failure (odds ratio 3.80, P < 0.001). Age, achalasia subtype, myotomy characteristics and post-POEM endoscopy findings were not predictive.</p><p><strong>Conclusion: </strong>POEM provides durable symptom relief beyond 5 years for achalasia. Higher pre-POEM symptom burden and prior LOS-directed interventions are associated with reduced long-term success.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758902","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":"Dose escalation for secondary loss of response in inflammatory bowel disease: 3-year outcomes and treatment persistence.","authors":"Faris Gondal, Maddison Terlato, Omar Salehi, Leshni Pillay, Clarissa Rentsch, Stephanie Dimovski, Joshua Haron Abasszade, Finlay Macrae, Jonathan P Segal","doi":"10.1111/imj.70604","DOIUrl":"https://doi.org/10.1111/imj.70604","url":null,"abstract":"<p><strong>Background: </strong>Dose escalation of biologic therapies is commonly used to manage secondary loss of response in inflammatory bowel disease, although long-term real-world outcomes remain limited.</p><p><strong>Aims: </strong>To evaluate long-term clinical outcomes and treatment persistence following biologic dose escalation for secondary loss of response in inflammatory bowel disease.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients with inflammatory bowel disease who underwent dose escalation of infliximab, adalimumab or vedolizumab at a tertiary referral centre between 2018 and 2024. Outcomes included clinical disease activity scores, biochemical markers and treatment persistence, assessed at 3-12 months and annually up to 36 months following escalation.</p><p><strong>Results: </strong>A total of 155 patients were included (median age 31 years; 46% female), of whom 76% had Crohn's disease. A total of 89 patients received infliximab, 48 adalimumab and 18 vedolizumab. Dose escalation was undertaken for secondary loss of response in 68% and low drug concentrations in 42%. Infliximab escalation was associated with improvement in disease activity scores at 3 months, sustained to 36 months, with reductions in C-reactive protein across follow-up. Adalimumab escalation improved Harvey-Bradshaw Index at 3, 12 and 24 months, with reduction in faecal calprotectin at 3 months. Vedolizumab escalation improved Simple Clinical Colitis Activity Index at 3 months only. Treatment persistence at 36 months was 58% for infliximab, 65% for adalimumab and 73% for vedolizumab. Nine patients experienced minor adverse events.</p><p><strong>Conclusions: </strong>Biologic dose escalation was associated with improvement in disease activity and modest treatment persistence following secondary loss of response in inflammatory bowel disease.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764444","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 consensus recommendations for the management of increased meningococcal infection risk in adults with neurological diseases treated with complement inhibitors.","authors":"Katherine A Buzzard, Michael Barnett, Heidi Beadnall, Mirasol Forcadela, Lesley-Ann Hall, Victoria G Hall, Todd Hardy, Danny Hsu, Paul Kinsella, Mastura Monif, Sudarshini Ramanathan, Stephen W Reddel, Sean Riminton, Douglas F Johnson","doi":"10.1111/imj.70610","DOIUrl":"https://doi.org/10.1111/imj.70610","url":null,"abstract":"<p><p>Complement inhibitor therapy carries a risk of serious infections, including meningococcal disease. Here we provide evidence-based recommendations and expert consensus for immunisation and prophylactic treatment of patients receiving, or planning to receive, complement inhibitors for neurological conditions in the Australian setting. The primary aim of these consensus recommendations is to minimise the risk of vaccine-preventable infections and to outline alternative infection-prevention strategies where vaccination is problematic. We address disease-specific risks and propose timing considerations, including a pragmatic approach to clinical implementation.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764637","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":"Adjunctive metformin therapy in type 1 diabetes in pregnancy: insights from an Australian cohort.","authors":"Mauli Govinna, Joanna Gong, Jessica Triay, Dev Kevat","doi":"10.1111/imj.70607","DOIUrl":"https://doi.org/10.1111/imj.70607","url":null,"abstract":"<p><p>Metformin has gained attention as a potential adjunct therapy in pregnant women with type 1 diabetes mellitus (T1DM), although evidence is limited. We present the first reported experience of metformin use in pregnant women living with T1DM who used continuous glucose monitoring to monitor glycaemic outcomes. In our multicentre case series, metformin use was associated with an increased time in range and reduced glycaemic variability, supporting potential use in pregnant women with T1DM.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758949","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 effect of socioeconomic background on fatigue burden in Inflammatory Bowel Disease.","authors":"Nishani Kulendiran","doi":"10.1111/imj.70613","DOIUrl":"10.1111/imj.70613","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764649","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":"Utility of the Clinical Frailty Scale, Charlson Comorbidity Index and ACS NSQIP Surgical Risk Calculator in major lower limb orthopaedic surgery.","authors":"Alexa Yao, Emily Schembri, Ejoy Zhang, Raphael Hau, Christopher Fong","doi":"10.1111/imj.70598","DOIUrl":"https://doi.org/10.1111/imj.70598","url":null,"abstract":"<p><strong>Background: </strong>With major lower limb orthopaedic surgery performed in increasingly older and comorbid patients, accurate risk prediction is essential to guide perioperative management and shared decision-making.</p><p><strong>Aims: </strong>To compare the Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP Calculator) in predicting complications following major lower limb orthopaedic surgery.</p><p><strong>Methods: </strong>We conducted an audit assessing the clinical utility of the CFS, CCI and ACS NSQIP Calculator at an Australian tertiary hospital (2023-2024). Scores were calculated retrospectively using admission documentation, and complications were identified prospectively.</p><p><strong>Results: </strong>We recruited 302 patients with a mean age of 75.1 ± 12.7 years. Patients underwent surgery for hip fracture (n = 100), elective total knee (n = 103) and hip (n = 69) arthroplasty and other indications (n = 30). During index hospitalisation, 27.5% (n = 83) experienced a serious complication (Clavien-Dindo Grade ≥ II). All tools demonstrated moderate discrimination for serious in-hospital complications; the CFS, CCI and ACS NSQIP Calculator had area under the receiver operating characteristic curves of 0.77 (95% confidence interval (CI) 0.71-0.83), 0.71 (95% CI 0.64-0.77) and 0.76 (95% CI 0.70-0.82) respectively. The CFS was the fastest tool to administer, and the ACS NSQIP Calculator was the most time-consuming (median time 9.5 s (interquartile range (IQR) 7-13) vs 98.5 s (IQR 73-165), P < 0.001).</p><p><strong>Conclusion: </strong>The CFS and ACS NSQIP Calculator demonstrated similar predictive performance in this cohort. Given its faster administration, the CFS may represent a practical tool for routine perioperative risk stratification, though prospective validation is required to confirm performance in real-time clinical workflows.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712159","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":"A nationwide snapshot of Hospital in the Home service provision in Australia.","authors":"Iftah Amith, Michael Montalto, Natalie Bransgrove, Jenny Hutchison, Ru Hui New, Penelope Bryant, Rebecca Clarke, Benjamin A Rogers","doi":"10.1111/imj.70588","DOIUrl":"10.1111/imj.70588","url":null,"abstract":"<p><strong>Background: </strong>Hospital in the Home (HITH) has been formally recognised in Australia for more than 30 years and continues to expand nationally. Despite this growth, there is limited contemporary information regarding the structure, workforce, governance and models of care provided by Australian HITH services.</p><p><strong>Aims: </strong>To provide a national description of public HITH services across Australia.</p><p><strong>Methods: </strong>A national cross-sectional survey of Australian public HITH services was conducted between 1 October and 31 December 2024. A census approach was used to identify and survey all known public HITH services. Data relating to service characteristics, workforce, governance, activity, technologies and models of care were collected and analysed descriptively.</p><p><strong>Results: </strong>Of 164 Australian health services identified as providing HITH, 101 (62%) were represented in the study, corresponding to 84 discrete HITH services. HITH was most commonly delivered as an acute adult service (69/84, 82%), while acute paediatric HITH was less frequently available (23/84, 27%). HITH was delivered in every state and territory of Australia, predominantly in metropolitan areas (51/82, 62%). Workforce findings demonstrate strong alignment with internal medicine, but clinical governance and use of technology remain diverse.</p><p><strong>Conclusions: </strong>This study provides the first comprehensive national description of public HITH services in Australia. Substantial variation exists in governance arrangements, workforce composition, models of care and technological capability, highlighting opportunities for greater national consistency and informing future policy, service planning and research.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706424","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":"Maintenance intravenous immunoglobulin in chronic inflammatory demyelinating polyneuropathy: trends from an Australian tertiary centre","authors":"Kristina T. Pidd,&nbsp;Anthony Khoo","doi":"10.1111/imj.70480","DOIUrl":"10.1111/imj.70480","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic inflammatory demyelinating polyneuropathy (CIDP) is commonly treated with long-term intravenous immunoglobulin (IVIg). Individual dosing requirements and duration of IVIg differ among patients, leading to significant heterogeneity in IVIg utilisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to report on IVIg treatment trends in CIDP patients at our centre and sought to determine whether any clinical or demographic factors were predictive of a successful treatment wean.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study included adults receiving maintenance IVIg for CIDP over a 5-year period across a hospital network in South Australia. Overall, IVIg maintenance requirements were described across the cohort. Patient characteristics, investigations and IVIg usage were recorded. These factors were compared between those who had successfully weaned IVIg and those who had not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two patients were included, with 82% meeting European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) criteria for definite CIDP. Seventeen had typical CIDP, with a mean age of 58 and a male-to-female ratio of 2:1. Average body mass index was 30 kg/m^<i>2</i>. Mean cerebrospinal fluid (CSF) protein was 0.8 g/L. Mean maintenance IVIg was 0.6 g/kg every 4 weeks, with a mean duration of 64 months (range 3–152). Five out of six who had an IVIg wean successfully withdrew from IVIg completely. Exploratory analysis was limited by a small sample size; however, no significant association between clinical factors and successful IVIg wean were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Clinical stability was achieved for most patients on ≤0.6 g/kg/4 weeks of IVIg. Many individuals did not undergo an IVIg wean, highlighting the need for more proactive consideration of dose reduction or treatment cessation trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 8","pages":"1378-1384"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029802","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}