Internal Medicine Journal最新文献

{"title":"Rapid chronic kidney disease progression in younger, First Nations patients in the Northern Territory","authors":"Winnie Chen,&nbsp;Oyelola Adegboye,&nbsp;Gillian Gorham,&nbsp;Asanga Abeyaratne,&nbsp;Sandawana William Majoni,&nbsp;Sean Taylor,&nbsp;Samuel Heard,&nbsp;Harshana Munasinghe,&nbsp;Matthew J. L. Hare,&nbsp;Alan Cass","doi":"10.1111/imj.70062","DOIUrl":"https://doi.org/10.1111/imj.70062","url":null,"abstract":"<p>This 6-year retrospective cohort study investigated the progression of chronic kidney disease (CKD) among Australian First Nations patients in remote Northern Territory. We found that younger patients (age less than 50 years) were at a higher risk of progression to kidney replacement therapy or death compared to older adults. The results indicate a need to target early CKD intervention efforts to younger patients at risk of rapid progression.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"860-863"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950235","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":"Clinical characteristics and treatment of varicella zoster virus central nervous system infection in an Australian tertiary hospital","authors":"Connie Lam,&nbsp;Eve Chen,&nbsp;Arthur Thevathasan,&nbsp;Terry Yan,&nbsp;Michael Moso,&nbsp;Joe Sasadeusz,&nbsp;Stephen Muhi","doi":"10.1111/imj.70076","DOIUrl":"10.1111/imj.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Varicella zoster virus (VZV) is a neurotropic herpesvirus. With improved access to molecular diagnostics, there is increasing recognition of VZV with central nervous system involvement. This study aimed to describe the demographic, clinical and treatment characteristics of patients admitted to an Australian tertiary hospital with VZV central nervous system infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective study of all adult patients (aged ≥18 years) presenting to an Australian tertiary hospital between November 2010 and May 2023 with a clinical syndrome of or imaging consistent with meningitis or encephalitis and detectable VZV DNA in cerebrospinal fluid using polymerase chain reaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 48 cases of VZV meningitis and 13 cases of VZV encephalitis identified during the study period. The median age of patients with VZV meningitis and encephalitis was 34 years (range 21–86 years) and 73 years (range 22–94 years) respectively. All patients with VZV encephalitis and 37 of 48 (77.1%) with meningitis received intravenous (IV) acyclovir. Eight patients with VZV meningitis were treated with oral antivirals alone and seven were managed without antivirals or with ≤48 h of empiric antiviral therapy only; none of these patients experienced an adverse clinical outcome. Two patients with VZV encephalitis died. Seven patients experienced neurological complications, three with VZV meningitis and four with VZV encephalitis. Age and length of stay were associated with adverse clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VZV encephalitis predominates in older patients while VZV meningitis predominates in younger patients. IV acyclovir remains the standard of care for treatment of VZV encephalitis; however, its role in VZV meningitis is less clear. Controlled trials should be conducted to inform its use, particularly in low-risk patients with VZV meningitis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1152-1160"},"PeriodicalIF":1.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009861","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":"Individual and shared situational awareness in in-hospital cardiac arrest: insights from a real-world observational study.","authors":"Bashaer Salem Alnadwi, Modi Al-Moteri","doi":"10.1111/imj.70064","DOIUrl":"https://doi.org/10.1111/imj.70064","url":null,"abstract":"<p><strong>Background: </strong>Individual and shared situational awareness (SA) are crucial for team performance in high-pressure emergencies like cardiopulmonary resuscitation (CPR). While SA has been extensively studied in simulations, little research has examined its role in real-world in-hospital cardiac arrest (IHCA) settings. This study assessed individual and shared SA among medical emergency team (MET) members during CPR and explored its influence on team structure, communication and outcomes.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted in real-world clinical settings, involving seven METs (n = 40). Individual SA was measured using the Situation Awareness Global Assessment Technique (SAGAT), while shared SA was assessed via a similarity index reflecting the alignment of team members' responses. Associations between SA, team structure, stress levels and clinical performance were analysed.</p><p><strong>Results: </strong>Findings showed substantial variability in individual SA, with only 25% achieving full SA. Shared SA scores ranged from 0.95 ± 0.046 to 0.78 ± 0.144, with higher scores significantly associated with improved team structure (P = 0.034) and resuscitation success (P = 0.048). Mental work stress during CPR was linked to lower individual SA (P = 0.004), highlighting cognitive overload's impact on SA.</p><p><strong>Conclusions: </strong>This study identifies critical SA gaps, affecting both individual performance and team coordination. Shared SA is a key predictor of resuscitation success and should be enhanced through structured SA training, high-frequency simulations and algorithm-driven protocols to improve team synchronisation, decision-making and patient outcomes in IHCA settings.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990697","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":"Hyperammonaemia during allogeneic stem cell transplantation: distinct aetiology, importance of recognition and proposed treatment algorithm","authors":"Jeremy D. Clark,&nbsp;James R. Anstey,&nbsp;David Ritchie,&nbsp;Timothy Fazio","doi":"10.1111/imj.70052","DOIUrl":"https://doi.org/10.1111/imj.70052","url":null,"abstract":"<p>Hyperammonaemia during stem cell transplant is a distinct biochemical and clinical entity. It has a different pathological driver from other common forms of hyperammonaemia. Early recognition of this pathology and an understanding of its biochemical, pathological and microbiological aspects inform an aggressive management algorithm.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 5","pages":"846-851"},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949885","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":"Racial equity in healthcare: turning Martin Luther King Jr's dream of racial equality into a 21st century reality","authors":"Louis William Wang","doi":"10.1111/imj.70059","DOIUrl":"10.1111/imj.70059","url":null,"abstract":"<p>Racial equity should be a universal goal in health. Unfortunately, people may not have the same opportunity for good health, but they should have equal rights to good healthcare. Overcoming inequities and improving a sense of diversity, community and belonging for all cultural groups remains an ongoing priority for the health system. This article discusses the different forms of racial inequity that may exist within any given health system, offers examples that may signal its presence within healthcare institutions and highlights interventions that aim to reduce racial inequity at both a systems level and for individual healthcare workers.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"1033-1036"},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021577","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":"Incidence, prevalence and mortality of rheumatoid arthritis in Canterbury, Aotearoa New Zealand","authors":"Hamish J. Farquhar,&nbsp;Tania Huria,&nbsp;Lutz Beckert,&nbsp;Christopher M. A. Frampton,&nbsp;Janine Haslett,&nbsp;Lisa K. Stamp","doi":"10.1111/imj.70068","DOIUrl":"10.1111/imj.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is relatively little research regarding the frequency of rheumatoid arthritis (RA) in Canterbury and no previous studies comparing the mortality of RA in Aotearoa New Zealand to a general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To determine the incidence, prevalence and mortality of RA in Canterbury, Aotearoa New Zealand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical records of persons attending the Christchurch Hospital rheumatology service between 1 January 2006 and 31 December 2008 (Period 1) and between 1 January 2011 and 31 December 2013 (Period 2) were reviewed to identify individuals who met the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. Medical records for persons treated by private sector rheumatologists were also reviewed. The period prevalence and average annual incidence for each time period were calculated. Prevalence and incidence rates for the total population were age- and sex-adjusted based on the usually resident population from the 2013 national Census. Standardised mortality ratios (SMRs) compared to the general population were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The annual incidence was 24.40 per 100 000 (95% confidence interval (CI): 21.36–27.43) for Period 1 and 22.06 per 100 000 (95% CI: 19.32–24.81) for Period 2. The period prevalence was 442.65 per 100 000 (95% CI: 420.08–465.04) for Period 1 and 448.66 per 100 000 (95% CI: 427.31–470.01) for Period 2. The all-cause SMR for individuals with incident RA was 1.25 (95% CI: 0.95–1.60). The SMR for all prevalent RA during Period 1 was 2.01 (95% CI: 1.85–2.19) and for Period 2 was 1.87 (95% CI: 1.69–2.06).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The frequency of RA in the Canterbury population is comparable to other regions. Mortality for all individuals with prevalent RA was approximately two times higher than the general population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1161-1168"},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004207","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":"Dual-energy X-ray absorptiometry and anti-osteoporotic medication use in Australian patients with early rheumatoid arthritis using data from the Australian Rheumatology Association Database","authors":"Andrea Lyon,&nbsp;Susan Lester,&nbsp;Jessica Stanhope,&nbsp;Tom Lynch,&nbsp;Rachel Black,&nbsp;Claire Barrett,&nbsp;Marissa Lassere,&nbsp;Rachelle Buchbinder,&nbsp;Lyn March,&nbsp;Oscar Russell,&nbsp;Catherine Hill","doi":"10.1111/imj.70065","DOIUrl":"10.1111/imj.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>People with rheumatoid arthritis (RA) are at increased risk of osteoporosis. The Australian Rheumatology Association RA Clinical Care Standard recommends fracture risk assessment at RA diagnosis and as clinically indicated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study was to evaluate the use of dual-energy X-ray absorptiometry (DEXA) for osteoporosis screening among Australian patients with early RA enrolled in the Australian Rheumatology Association Database (ARAD). We also aimed to assess the dispensing patterns of anti-osteoporotic medications in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ARAD participants aged ≥18 years with a RA diagnosis from 2011 onwards and linked 2011–2023 Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data were included (<i>n</i> = 306). Time to first DEXA and anti-osteoporotic medication dispensing was assessed using Kaplan–Meier failure functions and multivariable Cox regression. Covariates included age, sex, BMI, alcohol use, smoking and glucocorticoid use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median time to first DEXA was 3 years (IQR 0, 10) following RA diagnosis. Predictors for DEXA included female sex (HR 1.6, 95% CI 1.1, 2.4), age ≥50 (HR 2.6, 95% CI 1.8, 3.9) and glucocorticoid use (HR 1.7, 95% CI 1.3, 2.4). DEXA was less likely with BMI ≥25 (HR 0.68, 95% CI 0.48, 0.96). By 8 years after RA diagnosis, 25% of participants received anti-osteoporotic medication, predicted by age ≥50 (HR 6.7, 95% CI 2.1, 21.4) and glucocorticoid use (HR 2.8, 95% CI 1.5, 5.0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings reveal delays and variability in osteoporosis screening for individuals with RA, despite higher fracture risk. Screening practices were influenced by age, glucocorticoid use and BMI, with significant gaps, particularly after diagnosis. These gaps highlight the need for standardised screening protocols to ensure timely DEXA scans and treatment, ultimately improving osteoporosis management and reducing fracture burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1127-1135"},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021515","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":"Assessment of knowledge and practices of non-steroidal anti-inflammatory drug hypersensitivity among healthcare workers: a cross-sectional case-based survey.","authors":"Yan Teo, Mohammed Faizal Bakhtiar, Zareen Aidah Yahya, Siew Mei Sim, Nor Asiah Muhamad, Min Moon Tang","doi":"10.1111/imj.70066","DOIUrl":"https://doi.org/10.1111/imj.70066","url":null,"abstract":"<p><strong>Background: </strong>Non-steroidal anti-inflammatory drugs hypersensitivity reactions (NHRs) are one of the most common drug hypersensitivity reactions encountered in clinical practice. The ability of healthcare workers (HCWs) to recognise, classify and manage NHRs is important for patients' safety.</p><p><strong>Aims: </strong>The study aimed to assess HCWs' knowledge and practices (KPs) on NHRs.</p><p><strong>Methods: </strong>This was a cross-sectional online questionnaire case-based study on NHRs, involving clinical HCWs at two tertiary hospitals in Malaysia.</p><p><strong>Results: </strong>A total of 247 respondents comprising 217 doctors and 30 clinical pharmacists, aged between 24 and 49 years, were recruited. Overall, only 15.8% of the HCWs had adequate KPs on NHRs. Years of clinical experience (≤10 vs >10 years) were significantly associated with adequacy of NHR knowledge (odds ratio: 0.17 (confidence interval: 0.08-0.35), P < 0.05). On average, the dermatology-specialised doctors scored better than other groups, with 58.7% (n = 25) answering correctly. Comparatively, this group also performed better in diagnosing and categorising NHRs, at 81.9%. When compared to the dermatology-specialised group, clinical pharmacists, non-dermatology specialised doctors and non-specialised doctors were six, 16 and 41 times more likely to have inadequate knowledge on NHRs respectively. The overall knowledge on the management of NHRs was poor across the groups (31%, n = 77). Interestingly, 57.1% (n = 141) of overall respondents thought that prescribing adrenaline autoinjectors was needed for anaphylaxis secondary to drugs, and 29.6% were still unaware of the utilisation of serum tryptase in confirming anaphylaxis.</p><p><strong>Conclusions: </strong>The overall KPs of HCWs' on NHRs were found to be inadequate, specifically in their management. Increased efforts on periodic educational programmes for HCWs on NHRs are urgently needed.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014789","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 scoping review of work patterns of junior medical officer tasks in hospital out of hours","authors":"Ben Tucker,&nbsp;Catherine Prowse,&nbsp;Josephine Thomas","doi":"10.1111/imj.70055","DOIUrl":"10.1111/imj.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of Junior Medical Officers (JMOs) is pivotal in ensuring the delivery of patient care in hospitals. The challenges of providing medical care for patients out of hours (OOH) fall disproportionately to the JMO group, with implications for supervision and well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim was to identify and map the available evidence on the work patterns of hospital JMOs OOH, including tools for measuring tasks and workload; barriers to JMO well-being; factors which impact on the safety of care and strategies to reduce JMO workload OOH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review following Arksey and O'Malley and the Joanna Briggs Institute framework was performed. A total of 2446 articles were identified, and 49 individual articles were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Work performed during non-standard working hours (evenings, nights and weekends) has impacts on both patient safety (morbidity, mortality, intensive care unit readmission, procedural complications). The OOH period is associated with reduced training quality and diminished JMO well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Strategies to reduce workload and maximise supervision are key to improving OOH care and JMO experience. A more detailed account of JMO work OOH is needed. Tools for studying workload should include direct observation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"968-974"},"PeriodicalIF":1.8,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010246","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":"Outcome measures after attending a specialist-led diabetes mellitus model of care in regional Victoria, Australia","authors":"Reinhardt Dreyer,&nbsp;Suzanne Clayden,&nbsp;James Gome","doi":"10.1111/imj.70063","DOIUrl":"10.1111/imj.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Providing diabetes mellitus care to regional Australia remains a significant challenge due to limited access, workforce and travel. While primary care is essential, some patients require specialised care that necessitates adapted models of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The study assessed the effect on diabetes mellitus metrics in patients attending a multidisciplinary centre in regional Victoria. We assessed changes in HbA1c over 6 months. Secondary outcomes included biometrics, drug combinations, insulin initiation and the proportion achieving diabetes care targets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a longitudinal cohort study for all adult patients receiving multidisciplinary diabetes care at South West Healthcare between 1 July 2020 and 30 June 2022. Participants who had followed up over 6 months at three-monthly intervals (V1, V2 and V3) were included, excluding haemodialysis or transplant care or failure to attend three visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We assessed 90 participants with a balanced demographic with a generally low comorbidity burden. There was a significant decrease in HbA1c at 3 months (OR = −1.2 (95% CI: −1.6 to −1.1), <i>P</i> &lt; 0.001) and 6 months (OR = −1.8 (95% CI: −2.2 to −1.5), <i>P</i> &lt; 0.001) for all groups. Attendance within the cohort significantly increased for multidisciplinary services, including optometry, cDNE, dietetics and podiatry, but no change in drug regimens or insulin initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights the impact of an adapted model of care for diabetes mellitus at South West Healthcare, focusing on a regional population. Among 90 patients over 6 months, there was a significant reduction in HbA1c levels and improved multidisciplinary engagement. This approach has successfully increased access to specialist and multidisciplinary diabetes care in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 6","pages":"985-992"},"PeriodicalIF":1.8,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977922","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}