Internal Medicine Journal最新文献

T-cell re-directional therapies, including chimeric antigen receptor (CAR)-T cell and bispecific antibodies (BsA), have transformed the treatment landscape to benefit patients with multiple myeloma. A number of these novel therapies has been approved internationally, with CAR-T therapy recently approved in Australia. In this clinical perspective, we describe the development of CAR-T and BsA therapies, highlighting the clinical benefits and risks, together with the significant costs and infrastructure support required for the provision of these therapies to myeloma patients.

The role of non-invasive ventilation (NIV) in patients with cystic fibrosis (pwCF) includes use in both the management of hypercapnic respiratory failure and as an adjunct to airway clearance techniques. We performed a retrospective review of the Australian Cystic Fibrosis Data Registry to analyse the characteristics of pwCF requiring NIV. We demonstrated that despite improvements in overall health in pwCF there is still a significant role of NIV in this population.

Aboriginal people in remote Northern Territory communities experience the highest burden of type 2 diabetes (T2D) globally. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve cardiac and renal outcomes in selected populations. However, safety in this context is unknown. We investigated SGLT2i use and outcomes in remote Aboriginal people with T2D between 2012 and 2020.

The prevalence of obesity continues to increase worldwide. Obesity is associated with an increased risk of cardiometabolic and other diseases, reduced quality of life and shortened life expectancy. Highly effective therapies are required to achieve meaningful and sustained weight reduction to prevent, slow or reverse disease associated with obesity. Bariatric surgery is a highly effective intervention to induce weight loss, with observational data demonstrating durability of weight loss over 10 or more years. In addition, bariatric surgery improves cardiometabolic risk factors, including hyperglycaemia and type 2 diabetes, hypertension and dyslipidaemia. Observational data have shown a reduction in all-cause mortality, cardiovascular events and mortality and a reduction in cancer risk and mortality in patients who have undergone bariatric surgery compared to matched patients who did not have surgery. The emergence of newer incretin agonists, particularly semaglutide and tirzepatide, have demonstrated remarkable efficacy in inducing and maintaining weight loss with ongoing use. As for bariatric surgery, incretin agonist therapies also improve type 2 diabetes outcomes, cardiovascular mortality and other obesity-related complications, with new evidence emerging and long-term outcome data awaited. This perspective compares bariatric surgery and incretin agonist therapy, assessing their relative efficacies in weight reduction, impact on obesity-related complications, their respective risk profiles and considerations of cost-effectiveness and equity of access. These comparisons seek to evaluate whether these increasingly popular medications could make bariatric surgery a thing of the past.

This cross-sectional study assessed the clinical and economic costs (Inpatient Activity Database) associated with hospitalisations due to bronchiectasis exacerbations among adult indigenous patients in the Top End, Northern Territory. Twenty case episodes from 15 indigenous patients with a mean age of 51.8 ± 12.7 years were recorded in a 3-month study window. The estimated cost was AUD 400 579.9, with cost per patient AUD 26 705 over 3 months and average cost per admission AUD 20 029. Extrapolating cost data across a 10-year period gave a conservative estimate of AUD 28 million.

Recent studies challenge the assumption that human-artificial intelligence (AI) collaboration is universally optimal, highlighting tasks where AI alone outperforms combined efforts. This viewpoint discusses the reasons behind these findings, explores influences on synergy and emphasises the importance of identifying when clinicians add net benefit to AI performance. Maximising patient outcomes may require accepting AI autonomy in certain scenarios within healthcare practice.

Patients with large infarct cores on imaging at hospital presentation who are then treated with endovascular thrombectomy achieved functional independence rates ranging from 14%-30% in randomised controlled trials. We describe our 'real-world' experience with these patients. About one-third were independent at day 90, similar to trial results. This was associated with higher rates of complications and double the length of stay.

Education of Basic Physician Trainees (BPTs) in preparation for their Royal Australasian College of Physician Divisional Examinations requires time contribution by senior medical staff towards formal teaching activities. This study, conducted at a major metropolitan teaching hospital, sought to quantify the time commitment of senior medical staff towards teaching of BPTs in one clinical year, as well as the perceptions of those staff regarding time commitments through anonymous questionnaire. Senior medical staff involved in formal teaching activities provided a mean of 10 h; questionnaire respondents indicated a mean contribution of 20 h. This study highlights the significant time contribution of senior medical staff to formal teaching activities for BPTs, as well as identifies possible unmeasured teaching contributions.