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Treatment selection and real‐world analysis of immunotherapy with or without chemotherapy in PD‐L1‐high metastatic non‐small cell lung cancer Intern. Med. J. (IF 2.1) Pub Date : 2024-04-16 Samuel Smith, Steven Kao, Michael Boyer, Michael Franco, Melissa Moore
BackgroundLung cancer is the leading cause of cancer death in Australia. Immunotherapy has improved outcomes in patients with metastatic non‐small cell lung cancer (NSCLC). Pembrolizumab is approved in first‐line treatment as single‐agent immunotherapy (SAI) or combination chemoimmunotherapy (CIT). In metastatic NSCLC programmed death‐ligand 1 (PD‐L1) ≥50% either regimen may be used.AimsWe aim to identify
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Oral corticosteroid stewardship: key insights from the Australasian Severe Asthma Registry Intern. Med. J. (IF 2.1) Pub Date : 2024-04-16 John Politis, Li Ping Chung, Ezinne Igwe, Philip Bardin, Peter G. Gibson
BackgroundPeople with severe asthma remain at risk of toxicity from maintenance oral corticosteroid (OCS) use and/or frequent OCS burst therapy. Cumulative exposures above 500–1000 mg prednisolone are associated with adverse effects, and recently OCS stewardship principles were promulgated to guide OCS prescription.AimsTo examine real‐world registry data to quantify OCS burden, ascertain trends over
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Home nursing and self‐administered outpatient parenteral antimicrobial treatment: a comparison of demographics and outcomes from a large regional hospital in Queensland, Australia Intern. Med. J. (IF 2.1) Pub Date : 2024-04-09 Holly Brand, Michael Fryer, Ahmed M. Mehdi, Alex Melon, Bridie Morcombe, Keat Choong, Shradha Subedi
BackgroundOutpatient parenteral antimicrobial treatment (OPAT) is a safe and effective therapy used in several settings across Australia. As OPAT services expand their inclusion criteria to include complex patient populations, there is an increased need for selecting appropriate patients to receive either healthcare‐administered OPAT (H‐OPAT) or self‐administered OPAT (S‐OPAT).AimsTo describe patient
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Epidemiology and clinical significance of carbapenemases in Australia: a narrative review Intern. Med. J. (IF 2.1) Pub Date : 2024-04-08 Abdullah Tarik Aslan, David L. Paterson
Carbapenemase‐producing gram‐negative bacteria (CP‐GNB) infections threaten public health with high mortality, morbidity and treatment costs. Although frequencies remain low in Australia (total number of CP‐GNB infections reported was 907 in 2022), blaIMP‐4 has established low levels of endemicity in many states. Imipenemase metallo‐β‐lactamase types alone accounted for more than half of all carbapenemases
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Implementation of reimbursement for genomic testing in Australia: early successes and the pathway ahead Intern. Med. J. (IF 2.1) Pub Date : 2024-04-05 Andrew J. Mallett, Jodie Ingles, Ilias Goranitis, Zornitza Stark
Genomic sequencing has rapidly emerged as a powerful diagnostic tool in clinical medicine over the past decade. However, incorporation into everyday practice has often been hampered by many different factors, including lack of public reimbursement and inclusion within universal healthcare resourcing. ‘Who pays?’ is a key consideration for equitable access to genomic testing. A major impediment to genomic
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Glycaemic outcomes in hospital with IDegAsp versus BIAsp30 premixed insulins Intern. Med. J. (IF 2.1) Pub Date : 2024-04-05 Joshua R. Walt, Julie Loughran, Spiros Fourlanos, Rahul D. Barmanray, Jasmine Zhu, Suresh Varadarajan, Mervyn Kyi
Background and AimsIDegAsp (Ryzodeg 70/30), a unique premixed formulation of long‐acting insulin degludec and rapid‐acting insulin aspart, is increasing in use. Management of IDegAsp during hospitalisation is challenging because of degludec's ultra‐long duration of action. We investigated inpatient glycaemia in patients treated with IDegAsp compared to biphasic insulin aspart (BIAsp30; Novomix30).MethodsWe
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The paradox of platypnoea–orthodeoxia syndrome Intern. Med. J. (IF 2.1) Pub Date : 2024-04-04 Benjamin A. Leaver, Edward R. S. Cliff, Michael Jefford, Samuel Fogarty, Dominica Zentner
Platypnoea–orthodeoxia is a rare clinical syndrome characterised by dyspnoea and oxygen desaturation in the upright position which improves when supine. It requires two components: a sufficiently sized anatomical vascular defect (typically intra‐cardiac or intra‐pulmonary) combined with a functional component that promotes positional right‐to‐left shunting. We describe the rare occurrence of a patient
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COVID‐19 outcomes in haemopoietic stem cell transplant recipients in Western Australia: the value of vaccination and antiviral therapy Intern. Med. J. (IF 2.1) Pub Date : 2024-04-04 Jacques A. J. Malherbe, Peter Boan, Duncan Purtill, Matthew Wright, Paul Cannell, Shane A. Gangatharan, Hasib Sidiqi, Julian Cooney
Coronavirus‐19 (COVID‐19) mortality rates among haemopoietic stem cell transplant (HSCT) patients are high, ranging between 20% and 40%. We prospectively evaluated the mortality outcomes of COVID‐19 in Western Australian HSCT patients. A total of 32/492 (6.5%) HSCT recipients contracted COVID‐19 during the study, of whom 30/32 (94%) developed mild or asymptomatic disease. Two allogeneic HSCT patients
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Service use and glycaemic control of young people with type 1 diabetes transitioning from paediatric to adult care: a 5‐year study Intern. Med. J. (IF 2.1) Pub Date : 2024-04-04 Lin Perry, Janet Dunbabin, Xiaoyue Xu, Steven James, Julia Lowe, Shamasunder Acharya, Katharine S. Steinbeck
BackgroundRegular contact with specialist care has been linked to better diabetes outcomes for young people with type 1 diabetes (YPwT1D), but evidence is limited to population‐based service usage and outcomes.AimsThis observational 5‐year study sought to capture YPwT1D living in the study catchment area (covering metropolitan, regional and rural Australia) as they transitioned to adult‐based diabetes
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The increasing costs of medicines and their implications for patients, physicians and the health system Intern. Med. J. (IF 2.1) Pub Date : 2024-04-04 Narcyz Ghinea
Most new medicines entering the market are high‐cost speciality drugs. These drugs can cost tens to hundreds of thousands of dollars per course of treatment and in some cases millions of dollars per dose. Approximately half of all spending on medicines is projected to target only 2–3% of patients, raising important questions about resource allocation. While there is no doubt that breakthrough innovations
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Yield of capsule endoscopy and subsequent device‐assisted enteroscopy: Experience at an Australian tertiary centre Intern. Med. J. (IF 2.1) Pub Date : 2024-04-03 Shane Selvanderan, Makiko Noguchi, Xuan Banh, Shara Ket, Gregor Brown
BackgroundSmall bowel capsule endoscopy (SBCE) and device‐assisted enteroscopy (DAE) have an established role in the investigation and management of small bowel pathology. Previous studies have reported on the yield of SBCE (60%) and DAE (57%), but none have been in an Australian setting.AimsTo determine the yield of SBCE and any DAE performed as a direct consequence of SBCE in an Australian referral
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Sleep‐disordered breathing and nocturnal hypoxemia in chronic thromboembolic pulmonary disease Intern. Med. J. (IF 2.1) Pub Date : 2024-04-02 Hui‐Ting Li, Ping Yuan, Rong Jiang, Qin‐Hua Zhao, Yuan‐Yuan Sun, Jian Zhang, Su‐Gang Gong, Jin‐Ling Li, Hong‐Ling Qiu, Wen‐Hui Wu, Ci‐Jun Luo, Jiang Xu, Lan Wang, Jin‐Ming Liu
Background and AimsSleep‐disordered breathing (SDB) and nocturnal hypoxemia were known to be present in patients with chronic thromboembolic pulmonary hypertension (CTEPH), but the difference between SDB and nocturnal hypoxemia in patients who have chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) at rest remains unknown.MethodsPatients who had CTEPH (n =
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Management of malignant pleural effusion and trapped lung: a survey of respiratory physicians and thoracic surgeons in Australasia Intern. Med. J. (IF 2.1) Pub Date : 2024-04-01 Calvin Sidhu, Gavin Wright, Carolyn J. Peddle‐McIntyre, Ai Ling Tan, Yun Chor Gary Lee
BackgroundMalignant pleural effusions (MPEs) are common, and a third of them have underlying trapped lung (TL). Management of MPE and TL is suspected to be heterogeneous. Understanding current practices in Australasia is important in guiding policies and future research.AimsElectronic survey of Australia‐New Zealand respiratory physicians, thoracic surgeons and their respective trainees to determine
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Use of kidney failure risk equation as a tool to evaluate referrals from primary care to specialist nephrology care Intern. Med. J. (IF 2.1) Pub Date : 2024-03-27 Katherine Li, Saiyini Pirabhahar, Max Thomsett, Kylie Turner, Marina Wainstein, Jeff T. Ha, Ivor Katz
BackgroundWith rising costs and burden of chronic kidney disease (CKD), timely referral of patients to a kidney specialist is crucial. Currently, Kidney Health Australia (KHA) uses a ‘heat map’ based on severity and not future risk of kidney failure, whereas the kidney failure risk equation (KFRE) score predicts future risk of progression.AimsEvaluate whether a KFRE score assists with timing of CKD
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Utility of mean nocturnal baseline impedance and post‐reflux swallow‐induced peristaltic wave index in clinical pH‐impedance reflux study Intern. Med. J. (IF 2.1) Pub Date : 2024-03-26 Bianca Angelica, Marcus Tippett, Amanda Lim, Stephanie Wong, Paul Kuo
Background and AimsAnalysis of mean nocturnal baseline impedance (MNBI) and post‐reflux swallow‐induced peristaltic wave index (PSPWi) have been proposed to increase the diagnostic yield of pH‐impedance studies in reflux disease. However, routine use of these indices in clinical studies is yet to be established, particularly with PSPWi, which requires laborious manual analysis. Our study aimed to assess
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Effect of a person‐centred goals‐of‐care form and clinical communication training on shared decision‐making and outcomes in an acute hospital: a prospective longitudinal interventional study Intern. Med. J. (IF 2.1) Pub Date : 2024-03-23 Andrew P. Tierney, Sharyn Milnes, Anita Phillips, Nicholas Simpson, Michael Bailey, Charlie Corke, Neil R. Orford
BackgroundPatients with a life‐limiting illness (LLI) requiring hospitalisation have a high likelihood of deterioration and 12‐month mortality. To avoid non‐aligned care, we need to understand our patients' goals and values.AimTo describe the association between the implementation of a shared decision‐making (SDM) programme and documentation of goals of care (GoC) for hospitalised patients with LLI
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Telehealth during COVID‐19 restrictions in patients with cardiovascular disease: impact on medication prescriptions and patient satisfaction Intern. Med. J. (IF 2.1) Pub Date : 2024-03-20 Nestor Gahungu, Nick S. R. Lan, Sameera Gamalath, Jane Phan, Vikas Bhat, Rhys Spencer, Sarah A. Hitchen, James M. Rankin, Girish Dwivedi, Abdul Rahman Ihdayhid
Background and AimsTelehealth plays an integral part in healthcare delivery. The impact of telehealth and the COVID‐19 pandemic on medication prescribing and patient satisfaction with telehealth in cardiology clinics remains unknown.MethodsA retrospective study of cardiology clinic patients at an Australian tertiary hospital was conducted; 630 patients seen before the COVID‐19 pandemic (0.6% telehealth)
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The cascade of care for hepatitis C in Victoria, Australia: a data linkage cohort study Intern. Med. J. (IF 2.1) Pub Date : 2024-03-20 Kathryn Snow, Jennifer H. MacLachlan, Stacey Rowe, Nasra Higgins, Benjamin C. Cowie
BackgroundHighly effective hepatitis C therapies are available in Australia. However, people living with hepatitis C face various barriers to accessing care and treatment.AimsTo identify gaps in the cascade of care for hepatitis C and generate estimates of the number living with untreated infection according to population group, using a representative longitudinal study population.MethodsWe linked
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Pulmonary embolism response teams. A description of the first 36-month Australian experience Intern. Med. J. (IF 2.1) Pub Date : 2024-03-18 Bapti Roy, Jin-Gun Cho, Luke Baker, Liza Thomas, Jennifer Curnow, John J. Harvey, Paul Geenty, Ashoke Banerjee, Kevin Lai, Mauro Vicaretti, Odette Erksine, Jane Li, Rafid Alasady, Vanessa Wong, Jian E. Tai, Caitlin Thirunavukarasu, Imran Haque, Jimmy Chien
High/intermediate-risk pulmonary embolism (PE) confers increased risk of cardiovascular morbidity and mortality. International guidelines recommend the formation of a PE response team (PERT) for PE management because of the complexity of risk stratification and emerging treatment options. However, there are currently no available Australian data regarding outcomes of PE managed through a PERT.
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Chronic hepatitis B care in regional Australia: implications for clinical practice and public health policy Intern. Med. J. (IF 2.1) Pub Date : 2024-03-16 Chaw Han, Rozemary Karamatic, Josh Hanson
BackgroundAustralia is struggling to meet its National Hepatitis B Strategy care targets, particularly in nonmetropolitan settings. It is vital to engage priority populations and improve their access to recommended care to reach these targets.AimsThis retrospective study examined people living with chronic hepatitis B (CHB) in regional North Queensland, Australia, and determined whether their care
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Improving the performance of machine learning penicillin adverse drug reaction classification with synthetic data and transfer learning Intern. Med. J. (IF 2.1) Pub Date : 2024-03-14 Viera Stanekova, Joshua M. Inglis, Lydia Lam, Antoinette Lam, William Smith, Sepehr Shakib, Stephen Bacchi
BackgroundMachine learning may assist with the identification of potentially inappropriate penicillin allergy labels. Strategies to improve the performance of existing models for this task include the use of additional training data, synthetic data and transfer learning.AimsThe aims of this study were to investigate the use of additional training data and novel machine learning strategies, namely synthetic
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Pleural empyema caused by Filifactor alocis in a man with periodontitis Intern. Med. J. (IF 2.1) Pub Date : 2024-03-13 Kok T. Tan, Peter Boan, Christopher H. Heath
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A case of fulminant severe Clostridioides difficile colitis managed with faecal microbial transplantation Intern. Med. J. (IF 2.1) Pub Date : 2024-03-13 Michael Sangiorgio, Christopher Middleton, Mark Wilson, William Osler, Ashwin Patwardan
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Illusion of control recognition may promote early palliative care engagement Intern. Med. J. (IF 2.1) Pub Date : 2024-03-13 Stephen Bacchi, Sheryn Tan, Brandon Stretton, Joshua Kovoor, Aashray Gupta, Keith McNeil, Gregory Crawford
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Progressive ataxia and palatal tremor Intern. Med. J. (IF 2.1) Pub Date : 2024-03-13 Tony Zhang, Bernard Liem, Neil E. Anderson
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The early history of dengue in Australia Intern. Med. J. (IF 2.1) Pub Date : 2024-03-13 John Aaskov, G. Dennis Shanks
Although reports of outbreaks of dengue‐like diseases in the Asia Pacific region were frequent from about 1870, the disease probably did not become endemic in Australia until about 1885. Several seminal discoveries about this disease were made in Queensland and later in Sydney. These included a refined case definition for dengue, identification of the mosquito vector, demonstration of a viraemia and
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Impact of a general medicine consultant‐led ward round in the emergency department Intern. Med. J. (IF 2.1) Pub Date : 2024-03-11 Nupur Bajaj, Tushar Goyal, Ken Teo, Gary Yip
BackgroundPatients requiring admission to the general medicine wards in a public hospital are usually assessed by a medical registrar. This study is based at a metropolitan public hospital in Melbourne where the majority of general medicine patients in the emergency department (ED) are not seen by a consultant physician until they are transferred to the ward.AimsTo assess the impact of general medicine
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Association between famine exposure during infancy and childhood and the risk of chronic kidney disease in adulthood Intern. Med. J. (IF 2.1) Pub Date : 2024-03-11 Xiao Liu, Junhui Sun, Bing Ge, Chi Pan, Hongxuan Yan, Xiaohui Sun, Jiahui Peng, Weijing Wang, Yongfeng Lin, Dongfeng Zhang, Feng Ning
BackgroundFamine exposure in childhood is proven to be associated with multiple chornic disease in adult but has not been studied with chronic kidney disease (CKD).AimsThis study was conducted to identify the relationship between famine exposure during infancy and childhood – specifically, the Chinese famine of 1959–1961 – and the risk of adult‐onset chronic kidney disease (CKD) among Chinese individuals
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Utilising organs from hepatitis C virus PCR‐positive donors in Western Australia Intern. Med. J. (IF 2.1) Pub Date : 2024-03-07 Peter Boan, Jagadish Jamboti, Michael Musk, Melanie Lavender, Jeremy P. Wrobel, Felicity Lee, Amit Shah, Lynette A. Pereira, J. Owen Robinson, Ashley Irish
We transplanted six solid organs from three hepatitis C virus (HCV) polymerase chain reaction (PCR)‐positive donors during 2018–2023. Recipients were treated with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir for 4–12 weeks, with all six achieving sustained virological response without significant adverse events. As occurs in other jurisdictions, solid organ transplants from HCR PCR‐positive donors
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Prevalence of frailty and pain in hospitalised cancer patients: implications for older adult care Intern. Med. J. (IF 2.1) Pub Date : 2024-03-07 Heather Lane, Rosemary Saunders, Kate Crookes, Seng G. M. Ang, Caroline Bulsara, Max K. Bulsara, Beverley Ewens, Olivia Gallagher, Karen Gullick, Sue Haydon, Jeff Hughes, Kim‐Huong Nguyen, Karla Seaman, Christopher Etherton‐Beer
A hospital‐wide point prevalence study investigated frailty and pain in patients with a cancer‐related admission. Modifiable factors associated with frailty in people with cancer were determined through logistic regression. Forty‐eight patients (19%) with cancer‐related admissions were 2.65 times more likely to be frail and 2.12 more likely to have moderate pain. Frailty and pain were highly prevalent
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Diagnosis and subtyping of idiopathic inflammatory myopathies: caution required in the use of myositis autoantibodies Intern. Med. J. (IF 2.1) Pub Date : 2024-03-06 Hamish T. Anderson, John L. O'Donnell, Paul Tustin, Richard Steele
Detection of myositis autoantibodies (MAs) has utility in both the diagnosis and subtyping of idiopathic inflammatory myopathies (IIMs). Multiplex assays such as the Euroimmun line immunoassay (LIA) have significant limitations in rare diseases like IIM. A retrospective cohort study was performed on positive MA detected on LIA in 171 patients using the manufacturer's recommended cut‐off. Only 16.7%
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COVID-19 vaccination: are more jabs needed or are we now immune? Intern. Med. J. (IF 2.1) Pub Date : 2024-02-27 Michelle L. Giles, Katie L. Flanagan
As the COVID-19 pandemic has progressed, it has become apparent that COVID-19 vaccination has limited impact on SAR-CoV-2 transmission and provides only short-term protection against acquiring infection, but more robust protection against severe disease and death. As a result, vaccinated people remain susceptible to SARS-CoV-2 infection but are less likely to experience severe outcomes. Studies show
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The impact of coronavirus-19 vaccination on anti-nuclear cytoplasmic antibody vasculitis hospitalisations in a Sydney health network Intern. Med. J. (IF 2.1) Pub Date : 2024-02-25 Dane Turner, Grant Luxton, Kenneth Yong, Anthony Sammel
There have been reports of COVID-19 vaccination triggering anti-nuclear cytoplasmic antibody (ANCA)-associated vasculitis (AAV), but no robust studies have examined the link. This retrospective cohort study assessed the impact of COVID vaccination on the rate of denovo and relapsed AAV in a Sydney Local Health District from 2018 to 2022. Despite more than 95% of the population receiving vaccination
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Cushing syndrome and tertiary adrenal insufficiency from prolonged concomitant use of budesonide and posaconazole Intern. Med. J. (IF 2.1) Pub Date : 2024-02-25 Andrew Grigg
Budesonide is a ‘non-absorbable’ corticosteroid often used for gut graft versus host disease. Systemic exposure is usually minimal because of metabolism by cytochrome (CYP) 3A4 in enterocytes and the liver. However, concomitant use of posaconazole and voriconazole, inhibitors of CYP3A4 commonly used as antifungal prophylaxis in allograft patients receiving immunosuppression, can lead to substantial
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Clinical practice guidelines: Their utility, dissemination and monitoring at Colonial War Memorial Hospital: A mixed methods study from Fiji Intern. Med. J. (IF 2.1) Pub Date : 2024-02-24 Ashnita A. Krishna, Sinead Kado, Alok Dubey, Cameron Grant, Joseph Kado
BackgroundClinical practice guidelines (CPGs) improve patient care by standardising medical practice. However, little is known about their applicability in low‐resource settings. Since 2010, Fiji has introduced guidelines to increase the application of evidence‐based practice.AimsWe describe the dissemination, utility and monitoring of guideline implementation in Fiji, a low‐resource setting in the
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The ‘loneliness’ epidemic: a new social determinant of health? Intern. Med. J. (IF 2.1) Pub Date : 2024-02-22 Isaac K. S. Ng
Introduction In May 2023, the US Surgeon General declared ‘loneliness’ as a new epidemic,1 and in November 2023, the World Health Organization (WHO) launched an International Commission to look into loneliness as a pressing global health threat.2 The rising prevalence of loneliness is indeed a major cause of concern, as many studies over the past 2 decades have shown that loneliness is associated with
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DRESS syndrome with multiorgan involvement and HHV-6 reactivation in the absence of a drug trigger Intern. Med. J. (IF 2.1) Pub Date : 2024-02-21 Yi Tong Vincent Aw, Meidelynn Ooi, Adel Ekladious
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction where patients present with fever, morbilliform rash and multiorgan manifestations, which may include acute renal failure, acute respiratory distress syndrome and eosinophilic myocarditis. We present a case of a 60-year-old woman with acute heart failure, DRESS syndrome features and human herpesvirus 6 reactivation
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Lurbinectedin in small cell lung cancer: real‐world experience of a multicentre national early access programme Intern. Med. J. (IF 2.1) Pub Date : 2024-02-19 Marliese Alexander, Jennifer Rogers, Sagun Parakh, Paul Mitchell, Timothy D. Clay, Steven Kao, Brett G. M. Hughes, Malinda Itchins, Benjamin Y. Kong, Nick Pavlakis, Benjamin J. Solomon, Thomas John
Background and AimsLurbinectedin is a novel oncogenic transcription inhibitor active in several cancers, including small cell lung cancer (SCLC). We aimed to describe the first Australian experience of the clinical efficacy and tolerability of lurbinectedin for the treatment of SCLC after progression on platinum‐containing therapy.MethodsMulticentre real‐world study of individuals with SCLC initiating
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Heart failure and the cost of dying: must the ferryman always be paid? Intern. Med. J. (IF 2.1) Pub Date : 2024-02-13 Vithoosharan Sivanathan, Natasha Smallwood, Jeffrey Ong, Elin Wee, Dominica Zentner
Provision of palliative care in chronic heart failure (CHF) can support complex decision-making, significantly improve quality of life and may lower healthcare costs.
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Clinician perceptions of research priorities for the management of noncritically ill patients admitted to hospital with SARS-CoV-2 infection Intern. Med. J. (IF 2.1) Pub Date : 2024-02-13 Methma M. Bandara, Lauren A. Barina, Grace M. McPhee, Susan R. Goulding, Justin T. Denholm, Susan C. Morpeth, Steven Y. C. Tong
The changing phenotype of coronarvirus disease 2019 (COVID-19) may quickly render guideline-recommended interventions obsolete. We developed a 40-question clinician survey in consultation with the Australasian COVID-19 Trial site investigators. The survey was designed to assess clinician perceptions of the current treatment strategies and future research priorities in the management of non-critically
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Do physicians need tragic optimism? Intern. Med. J. (IF 2.1) Pub Date : 2024-02-13 Susannah Ward
In 2016, as a trainee doctor, I wrote a paper on changing the culture of medicine. I felt the medical system was broken back then, and it seems even less functional now, with higher rates of burnout, dropout and staff shortages nationally. As a result of a lack of resources, it feels impossible to provide the care to our communities expected of us, making our work challenging and disheartening. Until
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Ultrasound for acute pyelonephritis: a systematic review and meta-analysis Intern. Med. J. (IF 2.1) Pub Date : 2024-02-09 Jessica Yu, Muhuntha Sri-Ganeshan, De Villiers Smit, Biswadev Mitra
There is little consensus regarding the indications and utility of urinary tract imaging and type of imaging to perform in patients presenting with acute pyelonephritis (APN).
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Sex differences in stroke reperfusion therapy in Aotearoa (New Zealand) Intern. Med. J. (IF 2.1) Pub Date : 2024-02-07 Michal R. Fridman, Stephanie G. Thompson, Alicia Tyson, P. A. Barber, Alan Davis, Teddy Wu, John Fink, Darren Heppell, Martin N. M. Punter, Anna Ranta
Stroke is a leading cause of death in Aotearoa (New Zealand), and stroke reperfusion therapy is a key intervention. Sex differences in stroke care have previously been asserted internationally. This study assessed potential differences in stroke reperfusion rates and quality metrics by sex in Aotearoa (New Zealand).
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Variation in approaches to acute ANCA-associated vasculitis in Australia and New Zealand: rituximab, plasma exchange and glucocorticoids Intern. Med. J. (IF 2.1) Pub Date : 2024-02-07 Justin C. M. Chua, Laura V. Dentrinos, Arthur R. Kitching, Jessica Ryan
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare autoimmune disease which is managed by a range of specialities. There are limited data on treatment practices in Australia and New Zealand.
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Impact of the COVID-19 pandemic on provision of interventional cardiology and cardiac surgery services in Australia: a review of Medicare claims data Intern. Med. J. (IF 2.1) Pub Date : 2024-02-07 Hari P. Sritharan, Aditya Bhat, Justin Chia, Usaid K. Allahwala, Ravinay Bhindi
The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted healthcare service provision worldwide. There is limited information on changes in invasive cardiovascular services during the pandemic, particularly in Australia.
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Development of a list of Australian potentially inappropriate medicines using the Delphi technique Intern. Med. J. (IF 2.1) Pub Date : 2024-02-02 Kate N. Wang, Christopher D. Etherton-Beer, Frank Sanfilippo, Amy T. Page
Older people are at high risk of medicines-related harms. otentially inappropriate medicines (PIMs) list has been developed to assist clinicians and researchers to identify medicines with risks that may potentially outweigh their benefits in order to improve medication management and safety.
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Quality use of publicly subsidised tapentadol in Australia: a population-based analysis Intern. Med. J. (IF 2.1) Pub Date : 2024-02-01 Ximena Camacho, Andrea L. Schaffer, Jonathan Brett, Nicole Pratt, Nicholas A. Buckley, David Henry, Sallie-Anne Pearson
Sustained-release (SR) tapentadol was listed on Australia's Pharmaceutical Benefits Scheme (PBS) in 2014 for chronic severe pain requiring long-term opioid treatment. Dispensings have increased since listing despite declining trends in other PBS-listed opioids. Preferential prescribing of SR opioids may increase the risk of dependence and accidental overdose, particularly when used to treat acute pain
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Medical Emergency Team call within 24 h of medical admission with a focus on sepsis: a retrospective review Intern. Med. J. (IF 2.1) Pub Date : 2024-01-30 James Nolan, Ian Mackay, Timothy Nolan, Julian de Looze
Clinical deterioration within the first 24 h of patient admission triggering a Medical Emergency Team (MET) call is a common occurrence. A greater understanding of these events, with a focus on the recognition and management of sepsis, could lead to quality improvement interventions.
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Substance use during hospitalisation requiring an urgent clinical response: an opportunity for intervention Intern. Med. J. (IF 2.1) Pub Date : 2024-01-23 Emily Nash, Andrew H. Dawson, Paul Haber, Robert Gribble, Anastasia Volovets
There are few reports on drug use in patients while hospitalised and none regarding management or clinical outcomes.
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General physicians and perioperative medicine. What is on the horizon? Intern. Med. J. (IF 2.1) Pub Date : 2024-01-24 Amy F. Osborne, Ar Kar Aung, Douglas Johnson, Catherine L. Gibb, Alison M. Mudge
Background Surgical care has been an essential component of health care worldwide for more than a century. Surgery is the preferred or only treatment to prevent mortality, relieve pain or restore normal structure or function in many conditions, ranging from trauma and intra-abdominal emergencies to cancer and osteoarthritis. While surgical procedures are intended to improve lives, complications from
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Statement of the Rehabilitation Medicine Society of Australia and New Zealand for the therapeutic use of botulinum toxin A in spasticity management Intern. Med. J. (IF 2.1) Pub Date : 2024-01-24 Anupam Datta Gupta, Ian Baguley, John Estell, Saul Geffon, Kong Goh, Barry Rawicki, Stephen de Graaf, John Olver
The Rehabilitation Medicine Society of Australia and New Zealand advocates the safe, effective and evidence-based use of botulinum toxin type A for spasticity management. The process requires appropriate training, alongside considerable knowledge and skills, to maximise efficacy. The processes before and after injection contribute to effectiveness. The gold standard of managing spasticity is for assessment
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Prescribing of antivirals for COVID-19 in a South Australian local health network according to statewide guidelines Intern. Med. J. (IF 2.1) Pub Date : 2024-01-24 Hiba Al Naji, Joshua M. Inglis, Emily Tucker, Debra Rowett, Rebecca Larcombe, Sophie Medlin, Arduino A. Mangoni, Tilenka Thynne
Antiviral drugs were rapidly implemented into clinical practice for the treatment of high-risk patients with COVID-19, prompting the development of statewide guidelines. This South-Australian study reviewed guideline adherence, assessed prescribing patterns and highlighted the inappropriate management of relative drug–drug interactions and dosing for renal function. Additionally, it evaluated the impact
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A 6-year experience of Zephyr endobronchial valves for severe emphysema in an Australian single-centre cohort Intern. Med. J. (IF 2.1) Pub Date : 2024-01-22 Michael V. Brown, Arash Badiei, Hubertus Jersmann, Andrew Fon, Chong G. Chew, Brett Lorraine, Phan Nguyen
Endobronchial valve (EBV) insertion for lung volume reduction is a management option for patients with severe emphysema. One-way valves cause lobar deflation and improve lung function, exercise capacity and quality of life.
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A system for developing reasonable adjustments to the application of the National Safety and Quality Health Service Standards for adult patients with intellectual disability in Australian hospital settings Intern. Med. J. (IF 2.1) Pub Date : 2024-01-22 Robyn A. Wallace
The Australian Commission of Safety and Quality in Health Care mandates the application of the eight National Safety and Quality Health Service Standards to minimise high-risk adverse events in hospital settings for all Australian patients. It acknowledges that adults with intellectual disability require reasonable adjustments to the application of the standards to optimise the impact of the quality
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Serum lipase in acute pancreatitis associated with hypertriglyceridaemia Intern. Med. J. (IF 2.1) Pub Date : 2024-01-15 Adam Morton
The incidence of hypertriglyceridaemic pancreatitis is increasing. Hypertriglyceridaemia may be associated with false lowering of serum amylase and lipase in vitro. A retrospective study of serum lipase levels in 26 individuals who had acute pancreatitis diagnosed based on clinical criteria together with changes on computer tomography in the setting of severe hypertriglyceridaemia over a 5-year period
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Use of a type 1 genetic risk score for classification of diabetes type in young Australian adults: the Fremantle Diabetes Study Phase II Intern. Med. J. (IF 2.1) Pub Date : 2024-01-15 Timothy M. E. Davis, Kirsten E. Peters, Wendy Davis
The applicability of a UK-validated genetic risk score (GRS) was assessed in 158 participants in the Fremantle Diabetes Study Phase II diagnosed between 20 and <40 years of age with type 1 or type 2 diabetes or latent autoimmune diabetes of adults (LADA). For type 1 versus type 2/LADA, the area under the receiver operating characteristic curve (AUC) was highest for serum C-peptide (0.93) and lowest
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The Journal in 2023 Intern. Med. J. (IF 2.1) Pub Date : 2024-01-13 Jeff Szer
I think the theme of this editorial in the context of Internal Medicine Journal (IMJ) may well be best represented by the word ‘change’. Change in the way academic publishing is heading, change in the way readers consume information and change in the mechanics of producing a journal. The traditional model of issue-based publishing (to which we still adhere) may well be joining cash and over-the-air
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Transitioning patients from intravenous to subcutaneous infliximab and vedolizumab for inflammatory bowel disease: what is the opportunity cost of improving access to healthcare? Intern. Med. J. (IF 2.1) Pub Date : 2024-01-12 Patrick Hilley, Darren Wong, Ronald Ma, Adam Peterson, Peter De Cruz
Biologic drugs are highly effective for inflammatory bowel disease (IBD) management but are key drivers of costs of care especially when administered intravenously (i.v.). Availability of subcutaneous (SC) formulations has increased convenience for patients and improved access to care, but at the cost of revenue to health services.
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Fabry-specific treatment in Australia: time to align eligibility criteria with international best practices Intern. Med. J. (IF 2.1) Pub Date : 2024-01-11 Kathleen Nicholls, Charles Denaro, Michel Tchan, Carolyn Ellaway, Drago Bratkovic, Sheridan Campbell, Megan Fookes, Mark Thomas
Disease-specific therapy aims to improve symptoms, stabilise current disease and delay progression in patients with Fabry disease. In Australia, treatment access is subject to eligibility criteria initially established in 2004. Patients and their clinicians question why these criteria have remained unchanged despite significant progress in disease understanding.