Internal Medicine Journal最新文献

Background: People with human immunodeficiency virus (HIV) (PWH) are experiencing a normalisation in life expectancy, but with an increasing burden of chronic comorbidities and end-stage organ disease. Hence, demand for solid organ transplantation (SOT) is increasing.

Aim: We aimed to explore knowledge about and barriers to organ receipt and donation for PWH among Australian healthcare providers (HCPs).

Methods: An online survey was developed. Clinicians involved in the care of PWH, and those involved in the care of people with advanced organ disease and organ transplantation were invited to participate. Survey questions were multiple choice or five-point Likert scale and assessed knowledge, perceptions, motivations and concerns around organ transplantation for PWH. The survey was disseminated via professional networks, mailing lists and newsletters in Australia.

Results: There were 132 respondents, including 45.5% HIV specialists, 45.5% organ specialists and 9% other clinicians. While 110 of 128 (86%) HCPs thought PWH could be organ recipients, only 36 of 118 (30%) thought PWH could donate. Misconceptions about the risk of complications following SOT for PWH were observed. Over half of HCPs (57%) indicated that comorbidities were the greatest barrier to SOT receipt, while 49% reported HIV and 31% felt legislation was the main barrier to donation.

Conclusion: While most HCPs were aware that PWH could receive organs, knowledge of their ability to donate was low. We identified several misconceptions among HCPs, including the belief that legislative barriers exist that preclude organ donation for PWH in Australia. Despite this, HCPs were supportive of PWH registering their interest in donation and potentially donating organs.

Background: Rheumatoid arthritis (RA) disproportionately affects women globally. This study evaluates trends in RA burden in Australia from 2000 to 2021 using the GBD (Global Burden of Disease GB) study 2021.

Methods: Age-standardised disability-adjusted life-years (DALYs) and prevalence for RA were collected from the GBD 2021 data set, stratified by sex and age. Age- and sex-specific ratios were calculated. Trends were analysed using linear regression and compared with US and UK GBD data.

Results: In Australia, female age-standardised DALY rates were 2.45 to 2.65 times higher than male rates over the 21-year time period. Prevalence ratios were similar (2.74-2.79). The highest female burden was in those aged 60 to 79 years, while males showed a lower burden across all ages. DALY rates for both sexes decreased, but the female-to-male ratio remained stable. Similar consistent disparities were observed in the United States (DALY ratio: 2.48-2.65) and the United Kingdom (2.20-2.32) across the time period.

Conclusion: A consistent and noticeable sex disparity in RA burden persists in Australia and other developed countries, despite overall improvements. This disparity is largely due to higher female prevalence and greater burden in older ages. The findings suggest prioritising targeted sex- and age-based management strategies to guide clinical decision-making and resource allocation.

Background: A considerable proportion of medical emergency team (MET) calls involves dying patients. Little is known regarding the quality of care for these patients and whether MET involvement in a dying patient is preventable.

Aims: To analyse a cohort of patient deaths at a metropolitan teaching hospital and compare the characteristics of those patients who received a MET review during their last admission with those who did not.

Methods: A retrospective analysis was conducted of all deaths occurring on general wards during 2022. Patients admitted for palliative care or those cared for solely in the intensive care unit or emergency departments were excluded. Demographics, comorbidities, frailty scores and resuscitation status were ascertained. For the patients who had a MET call during their last admission the number and aetiology of calls, intensive care unit (ICU) admission and time between last MET review and death were also recorded.

Results: Of 605 deaths, 567 (93.7%) fulfilled the inclusion criteria, of which 320 patients (56.3%) had a MET call. Patients receiving a MET call were less likely to have prior treatment limitations documented, and few were admitted to the ICU. Patients who received a MET call had a shorter time between treatment limitation and death.

Conclusions: Over half the patients who died on general wards had a MET call. These patients often had multiple reviews, and were less likely to have prior treatment limitations. Our study suggests that early review of treatment goals on admitted patients is warranted.

Reflection is essential to physician development, yet too often it is treated as a mandatory exercise in continuing professional education. This article reframes reflection through two fresh lenses. First, drawing on autonomic physiology, it argues that reflection flourishes in parasympathetic 'rest-and-digest' states that promote psychological safety. Second, using optics, it shows how the choice of 'light' and 'mirror' shapes perspectives and the insights gained during reflection. Individual, pairwise and group reflection activities carry different benefits and risks; these all require specific safeguards and boundaries. By reframing reflection, this article offers useful strategies to integrate authentic reflection into clinical training and medical practice.

Introduction: The epidemiology of inflammatory bowel disease (IBD) in New Zealand (NZ) has been explored in regional studies but not at a national level. This study aimed to use administrative data to define the first nationwide IBD population and estimate the incidence, prevalence and mortality of IBD in NZ.

Methods: The Integrated Data Infrastructure (IDI) is a statistical database linking population-level health data. An IBD population was created within the IDI using hospital discharge information by International Classification of Diseases, Tenth Revision code. Incidence and prevalence rates were calculated for 16 years (2006/07-2021/22) by age, sex, ethnicity and urban/rural location. Age-sex-standardised mortality was measured annually from 2012 to 2022.

Results: Between 1 July 2021 and June 30 2022, 19 566 people in the IDI were identified as having IBD, giving a prevalence of 391.4 (95% confidence interval (CI) 386.0-396.9) per 100 000 people. The prevalence of Crohn's disease (CD), 206.9 (95% CI 203.0-211.0), was similar to that of ulcerative colitis (UC), 213.2 (95% CI 209.2-217.2), both per 100 000 people. In the same year, 1407 new cases of IBD were observed, giving an incidence rate of 28.1 (95% CI 26.7-29.7) per 100 000 person-years. The 2012-2022 standardised mortality ratio for IBD was 1.69 (95% CI 1.60-1.79).

Conclusions: A high incidence and prevalence of IBD were seen in NZ, and increased all-cause mortality rates were observed. Despite the limitations of using hospital data, this work established the value of IDI data for IBD epidemiological studies and produced national estimates of IBD burden.

Prolonged waiting times for respiratory and sleep care can cause mortality and morbidity. Our audit of the Northern Adelaide Local Health Network (NALHN) Respiratory Unit showed delays in outpatient assessment and failure to meet guideline-based recommendations, with potentially associated harm including emergency department presentations and mortality. Improvements are needed to reduce waiting times, especially for conditions with poorer prognoses and to address health inequity in lower socioeconomic populations.

This study presents a retrospective audit of new referrals to three tertiary gender clinics in Victoria, Australia, from 2020 to 2024. It finds a plateau and slight reduction in referrals, in contrast to previous increases over the preceding decade. The reduction may stem from a shift to primary and community-based services. These findings suggest decentralising care could ease strain on tertiary clinics while maintaining access, informing models for the delivery of genderaffirming care in Australia.

Background: Voluntary assisted dying (VAD) is an evolving area of end-of-life care in Australia. Internationally, over 300 individuals have donated organs after accessing VAD.

Aims: To explore Australian VAD clinicians' attitudes, knowledge and experiences regarding organ and tissue donation and to identify barriers and enablers to integrating donation into VAD practice.

Methods: We conducted a cross-sectional, mixed-methods online survey from September 2024 to April 2025 across Victoria, New South Wales, Queensland and South Australia. Participants included 244 health professionals involved in VAD care -- coordinating and consulting practitioners, nurses, and support staff -- recruited via state-based VAD navigation services, professional networks and registries.

Results: Respondents represented ~23% of the VAD workforce in the participating states. Most supported organ (98%) and tissue (98%) donation, with 91% personally willing to donate. Only 39% had received prior donation training, and 37% were aware of existing donation-after-VAD guidelines. While 90% agreed donation should be discussed when clinically appropriate, only 63% supported routinely raising the topic in VAD contexts. Key barriers included limited training, time constraints, ethical concerns (e.g. coercion, conflicts of interest) and assumptions about donation feasibility. Most respondents (84%) expressed interest in further education, particularly on eligibility criteria and navigating donation conversations.

Conclusions: Australian VAD clinicians strongly support organ and tissue donation but face significant knowledge, logistical and ethical challenges. Targeted education, clear clinical guidance, structural supports and the development of national guidelines bridging both VAD and organ donation sectors are essential to ensure safe, ethical and patient-centred donation practices.

Human albumin (HA) infusion has demonstrated benefits for patients with uncomplicated ascites, but implementation of this evidence is limited by critical logistical and budget issues relating to long-term HA infusion. In this pilot feasibility study of 14 hospital patients with uncomplicated ascites, participants were administered weekly HA by home-based nursing staff. Results suggest that home-based HA infusions are safe and feasible, effective and associated with high levels of patient satisfaction and lower relative cost.