{"title":"Mycobacterium thermoresistibile infection leading to wound dehiscence in an immunocompetent host","authors":"Catherine Tu, Arindam Chakravorty","doi":"10.1111/imj.70266","DOIUrl":"10.1111/imj.70266","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145603641","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":"‘Fifty is not the answer’: rethinking platelet thresholds for lumbar puncture and central venous catheter insertion in 2025","authors":"Kamel Kirollos Salah","doi":"10.1111/imj.70255","DOIUrl":"10.1111/imj.70255","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 1","pages":"146-147"},"PeriodicalIF":1.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145603585","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}
Fangzhi (Frank) Jia, Kok How Lee, Timothy Gilbey, Yael Barnett, Martin Jude
{"title":"Neuroleptospirosis as a cause of acute spontaneous loculated multifocal subdural haemorrhages","authors":"Fangzhi (Frank) Jia, Kok How Lee, Timothy Gilbey, Yael Barnett, Martin Jude","doi":"10.1111/imj.70271","DOIUrl":"10.1111/imj.70271","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 12","pages":"2099-2101"},"PeriodicalIF":1.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145603639","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}
Zoe McQuilten, Matthew V. N. O'Sullivan, Damien Purcell, Peta Edler, Niamh Meagher, Kylie Alcorn, Asha Bowen, James Daly, Hong Foo, Susan Goulding, Iain Gosbell, Naomi Hammond, Thomas Hills, Veronica Hoad, Vivekanand Jha, Lyn Li Lim, Grace McPhee, James Molton, Susan Morpeth, Vi Nguyen, David Paterson, Megan Rees, Jason Roberts, Benjamin A. Rogers, Adam Stewart, Joe Sasadeusz, Thomas Snelling, Balasubramanian Venkatesh, Erica Wood, Joshua S. Davis, Steven Y. C. Tong, David J. Price, Justin T. Denholm
Background
Convalscent plasma (CP) was identified as a potential therapy for COVID-19 available early in the pandemic.
Aims
To evaluate CP for the treatment of hospitalised adults with COVID-19 within the Australasian COVID-19 Trial (ASCOT).
Methods
ASCOT is an investigator-initiated, international, open-label, randomised clinical trial. Adult patients hospitalised with confirmed SARS-CoV-2 within 12 days of symptom onset and not receiving intensive respiratory or vasopressor/inotropic support were randomised to two units of CP or standard care. The primary outcome was the proportion of participants who died or required intensive respiratory support (invasive or non-invasive ventilation) or vasopressors/inotropic support in the 28 days after randomisation. The trial steering committee decided to discontinue the study in January 2021 in response to external evidence suggesting the futility of CP.
Results
Between May and November 2020, 33 participants were enrolled from eight sites across Australia and New Zealand. At baseline, nine (53%) in standard care and seven (47%) in CP arms required supplemental oxygen, three participants (all in the CP arm) required non-invasive ventilation or high-flow oxygen and over half were taking dexamethasone. The primary outcome was met by 23.5% (4/17) of standard care and 7% (1/15) of CP participants. One serious adverse event was reported in the CP arm, which was deemed not treatment-related.
Conclusion
Fewer participants allocated to CP died or required new intensive respiratory or vasopressors/inotropic support in the 28 days after randomisation compared to standard care. However, our trial was stopped early in response to external evidence, and our sample size was small, limiting any definitive conclusions regarding the efficacy or safety of CP.
{"title":"Convalescent plasma in hospitalised patients with COVID-19","authors":"Zoe McQuilten, Matthew V. N. O'Sullivan, Damien Purcell, Peta Edler, Niamh Meagher, Kylie Alcorn, Asha Bowen, James Daly, Hong Foo, Susan Goulding, Iain Gosbell, Naomi Hammond, Thomas Hills, Veronica Hoad, Vivekanand Jha, Lyn Li Lim, Grace McPhee, James Molton, Susan Morpeth, Vi Nguyen, David Paterson, Megan Rees, Jason Roberts, Benjamin A. Rogers, Adam Stewart, Joe Sasadeusz, Thomas Snelling, Balasubramanian Venkatesh, Erica Wood, Joshua S. Davis, Steven Y. C. Tong, David J. Price, Justin T. Denholm","doi":"10.1111/imj.70253","DOIUrl":"10.1111/imj.70253","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Convalscent plasma (CP) was identified as a potential therapy for COVID-19 available early in the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate CP for the treatment of hospitalised adults with COVID-19 within the Australasian COVID-19 Trial (ASCOT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ASCOT is an investigator-initiated, international, open-label, randomised clinical trial. Adult patients hospitalised with confirmed SARS-CoV-2 within 12 days of symptom onset and not receiving intensive respiratory or vasopressor/inotropic support were randomised to two units of CP or standard care. The primary outcome was the proportion of participants who died or required intensive respiratory support (invasive or non-invasive ventilation) or vasopressors/inotropic support in the 28 days after randomisation. The trial steering committee decided to discontinue the study in January 2021 in response to external evidence suggesting the futility of CP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May and November 2020, 33 participants were enrolled from eight sites across Australia and New Zealand. At baseline, nine (53%) in standard care and seven (47%) in CP arms required supplemental oxygen, three participants (all in the CP arm) required non-invasive ventilation or high-flow oxygen and over half were taking dexamethasone. The primary outcome was met by 23.5% (4/17) of standard care and 7% (1/15) of CP participants. One serious adverse event was reported in the CP arm, which was deemed not treatment-related.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fewer participants allocated to CP died or required new intensive respiratory or vasopressors/inotropic support in the 28 days after randomisation compared to standard care. However, our trial was stopped early in response to external evidence, and our sample size was small, limiting any definitive conclusions regarding the efficacy or safety of CP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 12","pages":"2024-2032"},"PeriodicalIF":1.5,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573665","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}
Rheumatology outpatient clinics are facing increasing referral volumes, including new and long-term patients. International studies suggest that initial assessments by non-rheumatologists can be effective.
Aim
This study evaluates the role of a general medicine clinic in managing patients initially referred to rheumatology at an Australian tertiary hospital.
Methods
We retrospectively reviewed rheumatology referrals diverted to the general medicine clinic at The Northern Hospital, Victoria, from 1 January 2023 to 30 June 2024. Data included patient demographics, referral reasons, investigations and clinical outcomes. Multiple indications were recorded where applicable. Ethics approval was obtained.
Results
Fifty-three referrals were redirected to general medicine. Common referral reasons included arthritis (41.5%) and abnormal pathology (17%). Rheumatology-specific histories were documented in 86.3% of patients, with 34.1% showing positive findings. Rheumatological exams were performed in 60%, with positive findings in 19.2%. Two patients did not attend appointments. Following review, 60.8% underwent repeat pathology and 45.1% had radiology. Ten (19.6%) patients were initiated on treatment in general medicine. Nine (17%) were referred to rheumatology, with seven receiving a rheumatological diagnosis. The most common diagnoses made in general medicine were benign conditions such as musculoskeletal injuries (34%) and fibromyalgia (20.8%).
Conclusion
General medicine clinics may effectively triage and manage patients initially referred to rheumatology, potentially reducing unnecessary specialist consultations. In our cohort, only 17% required rheumatology referral, supporting the role of general medicine in preliminary rheumatologic evaluation within the Australian healthcare context.
{"title":"Outcomes of rheumatology referrals seen in a general medicine clinic","authors":"Sam Shan, Shereen Oon, Andrew Foote","doi":"10.1111/imj.70261","DOIUrl":"10.1111/imj.70261","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rheumatology outpatient clinics are facing increasing referral volumes, including new and long-term patients. International studies suggest that initial assessments by non-rheumatologists can be effective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study evaluates the role of a general medicine clinic in managing patients initially referred to rheumatology at an Australian tertiary hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed rheumatology referrals diverted to the general medicine clinic at The Northern Hospital, Victoria, from 1 January 2023 to 30 June 2024. Data included patient demographics, referral reasons, investigations and clinical outcomes. Multiple indications were recorded where applicable. Ethics approval was obtained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-three referrals were redirected to general medicine. Common referral reasons included arthritis (41.5%) and abnormal pathology (17%). Rheumatology-specific histories were documented in 86.3% of patients, with 34.1% showing positive findings. Rheumatological exams were performed in 60%, with positive findings in 19.2%. Two patients did not attend appointments. Following review, 60.8% underwent repeat pathology and 45.1% had radiology. Ten (19.6%) patients were initiated on treatment in general medicine. Nine (17%) were referred to rheumatology, with seven receiving a rheumatological diagnosis. The most common diagnoses made in general medicine were benign conditions such as musculoskeletal injuries (34%) and fibromyalgia (20.8%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>General medicine clinics may effectively triage and manage patients initially referred to rheumatology, potentially reducing unnecessary specialist consultations. In our cohort, only 17% required rheumatology referral, supporting the role of general medicine in preliminary rheumatologic evaluation within the Australian healthcare context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 12","pages":"2053-2058"},"PeriodicalIF":1.5,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573646","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}
Susan Welch, Rebekah J. Moles, Alexander Viardot, Pauline Deweerd, Scott Daly, Sonia Robinson, Kylie Harwood, Carolyn Woods, Shivangi Chand, Kylie Lee
Background
Chronic disease disproportionately affects Aboriginal and/or Torres Strait Islander Peoples. More is needed to enhance prevention, detection and chronic disease care.
Aims
To describe and quantify chronic disease markers and reasons for hospital admission in a cross-sectional cohort of Aboriginal and/or Torres Strait Islander Peoples.
Methods
Retrospective medical record review (paper-based and electronic) in a metropolitan tertiary referral, Level 1 trauma hospital in Sydney, New South Wales, Australia. A cohort discharged from the study hospital (January–December 2017) was identified using admission and discharge data. Records were selected for inclusion sequentially based on discharge. Main outcome measures were primary outcomes demographics, reasons for admission, presence of chronic disease and chronic disease markers.
Results
The patient cohort (n = 300) was young (mean age: 45 years (range: 16–79 years)), and primarily male (n = 191/300, 64%), with high levels of multiple chronic diseases and related complications. Nearly four in 10 had no general practitioner (n = 116/300, 39%). Nearly one in five (n = 54/300, 18%) had no fixed address. The cohort was often admitted more than once, and admissions were most often for substance use or mental health.
Conclusions
Findings quantify previously unpublished levels of chronic disease markers and reasons for hospital admission of Aboriginal and/or Torres Strait Islander Peoples. Findings highlight missed care opportunities, within hospital for all chronic diseases and on transitions of care to the community. More is needed to make hospital system changes that encourage clinicians to provide holistic care. Further research using continuous quality improvement methods could help rethink these systems.
{"title":"Uncovering missed opportunities to provide holistic care for a cross-sectional cohort of Aboriginal and/or Torres Strait Islander Peoples in a metropolitan hospital","authors":"Susan Welch, Rebekah J. Moles, Alexander Viardot, Pauline Deweerd, Scott Daly, Sonia Robinson, Kylie Harwood, Carolyn Woods, Shivangi Chand, Kylie Lee","doi":"10.1111/imj.70256","DOIUrl":"10.1111/imj.70256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic disease disproportionately affects Aboriginal and/or Torres Strait Islander Peoples. More is needed to enhance prevention, detection and chronic disease care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To describe and quantify chronic disease markers and reasons for hospital admission in a cross-sectional cohort of Aboriginal and/or Torres Strait Islander Peoples.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective medical record review (paper-based and electronic) in a metropolitan tertiary referral, Level 1 trauma hospital in Sydney, New South Wales, Australia. A cohort discharged from the study hospital (January–December 2017) was identified using admission and discharge data. Records were selected for inclusion sequentially based on discharge. Main outcome measures were primary outcomes demographics, reasons for admission, presence of chronic disease and chronic disease markers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The patient cohort (<i>n</i> = 300) was young (mean age: 45 years (range: 16–79 years)), and primarily male (<i>n</i> = 191/300, 64%), with high levels of multiple chronic diseases and related complications. Nearly four in 10 had no general practitioner (<i>n</i> = 116/300, 39%). Nearly one in five (<i>n</i> = 54/300, 18%) had no fixed address. The cohort was often admitted more than once, and admissions were most often for substance use or mental health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings quantify previously unpublished levels of chronic disease markers and reasons for hospital admission of Aboriginal and/or Torres Strait Islander Peoples. Findings highlight missed care opportunities, within hospital for all chronic diseases and on transitions of care to the community. More is needed to make hospital system changes that encourage clinicians to provide holistic care. Further research using continuous quality improvement methods could help rethink these systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 12","pages":"2072-2082"},"PeriodicalIF":1.5,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573712","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}
Annabel S. Jones, Devaang Kevat, I-Lynn Lee, Kylie Goh, Christopher J. Yates
Background
Management of glucokinase-maturity-onset diabetes of the young (GCK-hyperglycaemia, or GCK-MODY) GC in pregnancy relies on knowledge of foetal genotype, which is traditionally estimated by foetal ultrasound measurements with poor diagnostic accuracy. Non-invasive pre-natal testing for GCK-MODY genotype (NIPT-GCK) has recently been developed (Exeter, United Kingdom) and is highly accurate but not currently available in Australia.
Aim
We aimed to investigate the clinical and health economic impact of NIPT-GCK MODY testing in Australia.
Methods
A case series of two pregnancies affected by GCK-MODY in pregnancy was conducted. Case 1 had NIPT undertaken at Exeter University, United Kingdom, while case 2 was managed per standard care with ultrasound estimation of foetal genotype. Clinical outcomes and health system costs were obtained from medical and health system records.
Results
Case 1 (42-year-old female, G8P1) had GCK-NIPT at 19 weeks, with the baby confirmed to have GCK-MODY. Management was tailored to this result, with a reduced physical and psychological burden of the disease. Case 2 (33-year-old female, gravida 2 para 1) declined NIPT because of cost and had genotype estimated from serial ultrasound methods with post-partum genetic testing required. After adjustment for additional maternal co-morbidities and standardisation of care setting, the GCK-MODY NIPT was cost-effective (−$266) and patient concern and care burden were significantly reduced.
Conclusions
NIPT has the potential to improve diagnostic uncertainty associated with the management of GCK-MODY in pregnancy, reduce the economic and personal burden of intensive foetal monitoring and improve perinatal outcomes.
{"title":"Clinical and cost-effectiveness of non-invasive cell-free DNA testing to optimise foetal outcomes for women with monogenic diabetes due to inactivating glucokinase gene mutations: a case series","authors":"Annabel S. Jones, Devaang Kevat, I-Lynn Lee, Kylie Goh, Christopher J. Yates","doi":"10.1111/imj.70262","DOIUrl":"10.1111/imj.70262","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Management of glucokinase-maturity-onset diabetes of the young (<i>GCK</i>-hyperglycaemia, or <i>GCK</i>-MODY) <i>GC</i> in pregnancy relies on knowledge of foetal genotype, which is traditionally estimated by foetal ultrasound measurements with poor diagnostic accuracy. Non-invasive pre-natal testing for <i>GCK</i>-MODY genotype (NIPT-<i>GCK</i>) has recently been developed (Exeter, United Kingdom) and is highly accurate but not currently available in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We aimed to investigate the clinical and health economic impact of NIPT-<i>GCK</i> MODY testing in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A case series of two pregnancies affected by <i>GCK</i>-MODY in pregnancy was conducted. Case 1 had NIPT undertaken at Exeter University, United Kingdom, while case 2 was managed per standard care with ultrasound estimation of foetal genotype. Clinical outcomes and health system costs were obtained from medical and health system records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Case 1 (42-year-old female, G8P1) had <i>GCK</i>-NIPT at 19 weeks, with the baby confirmed to have <i>GCK</i>-MODY. Management was tailored to this result, with a reduced physical and psychological burden of the disease. Case 2 (33-year-old female, gravida 2 para 1) declined NIPT because of cost and had genotype estimated from serial ultrasound methods with post-partum genetic testing required. After adjustment for additional maternal co-morbidities and standardisation of care setting, the <i>GCK</i>-MODY NIPT was cost-effective (−$266) and patient concern and care burden were significantly reduced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NIPT has the potential to improve diagnostic uncertainty associated with the management of <i>GCK</i>-MODY in pregnancy, reduce the economic and personal burden of intensive foetal monitoring and improve perinatal outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 12","pages":"2059-2064"},"PeriodicalIF":1.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563747","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}
Bridget C. Strasser, Andrew L. H. Huynh, Zoe Yang, Lena von Heimendahl, Beatriz Arakawa Martins, Nicholas J Radcliffe, Paul A. Yates
Background and Aims
The FRAIL-NH scale assesses frailty in people residing in residential aged care homes (RACHs). Residential InReach (RIR) is a service that provides acute assessment and intervention for RACH residents. We examined whether FRAIL-NH predicts mortality, hospital presentation and RIR involvement for people living in RACHs who require RIR input.
Setting and Participants
Single-centre, retrospective, observational cohort study reviewed by RIR between April 2020 and November 2021 in Melbourne, Australia.
Methods
FRAIL-NH scores were collected for residents seen by RIR. The data were collated retrospectively via medical records. The association between FRAIL-NH scores and outcomes of mortality, all-cause hospitalization and RIR re-referral was assessed for 28 days, 6 months and 12 months from RIR review.
Results
Of 414 patients, 86% were considered frail. FRAIL-NH≥8 was associated with mortality at 28 days, 6 months and 12 months (adjusted hazard ratio (HR), 28 days: 2.00 (95% confidence interval (CI), 1.26–3.17), P = 0.003; 6 months: HR, 2.19 (95% CI, 1.56–3.08, P < 0.001); 12 months: HR, 1.91 (95% CI, 1.44–2.55), P < 0.001). For each increase of one point in FRAIL-NH score, the risk of mortality increased by 13% (28 days: HR, 1.13 (95% CI, CI), P = 0.002), 15% (6 months: HR, 1.15 (95% CI, CI) P < 0.001) and 14% (12 months: HR, 1.14 (95% CI, XX) P < 0.01). FRAIL-NH did not predict all-cause hospitalisation/RIR review at 28 days and 6 months (P = 0.918 and P = 0.121 respectively).
Conclusions
This study confirms the utility of the FRAIL-NH score as being independently associated with mortality. Results demonstrate the potential benefits of screening for frailty in clinical services providing acute care to vulnerable populations. Identifying frail residents could assist in tailoring care/interventions, prioritising advance care planning/goals of care discussions and allocation of resources.
{"title":"Outcomes of FRAIL-NH in an acute residential aged care geriatric medicine InReach service","authors":"Bridget C. Strasser, Andrew L. H. Huynh, Zoe Yang, Lena von Heimendahl, Beatriz Arakawa Martins, Nicholas J Radcliffe, Paul A. Yates","doi":"10.1111/imj.70246","DOIUrl":"10.1111/imj.70246","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>The FRAIL-NH scale assesses frailty in people residing in residential aged care homes (RACHs). Residential InReach (RIR) is a service that provides acute assessment and intervention for RACH residents. We examined whether FRAIL-NH predicts mortality, hospital presentation and RIR involvement for people living in RACHs who require RIR input.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Participants</h3>\u0000 \u0000 <p>Single-centre, retrospective, observational cohort study reviewed by RIR between April 2020 and November 2021 in Melbourne, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>FRAIL-NH scores were collected for residents seen by RIR. The data were collated retrospectively via medical records. The association between FRAIL-NH scores and outcomes of mortality, all-cause hospitalization and RIR re-referral was assessed for 28 days, 6 months and 12 months from RIR review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 414 patients, 86% were considered frail. FRAIL-NH≥8 was associated with mortality at 28 days, 6 months and 12 months (adjusted hazard ratio (HR), 28 days: 2.00 (95% confidence interval (CI), 1.26–3.17), <i>P</i> = 0.003; 6 months: HR, 2.19 (95% CI, 1.56–3.08, <i>P</i> < 0.001); 12 months: HR, 1.91 (95% CI, 1.44–2.55), <i>P</i> < 0.001). For each increase of one point in FRAIL-NH score, the risk of mortality increased by 13% (28 days: HR, 1.13 (95% CI, CI), <i>P</i> = 0.002), 15% (6 months: HR, 1.15 (95% CI, CI) <i>P</i> < 0.001) and 14% (12 months: HR, 1.14 (95% CI, XX) <i>P</i> < 0.01). FRAIL-NH did not predict all-cause hospitalisation/RIR review at 28 days and 6 months (<i>P</i> = 0.918 and <i>P</i> = 0.121 respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study confirms the utility of the FRAIL-NH score as being independently associated with mortality. Results demonstrate the potential benefits of screening for frailty in clinical services providing acute care to vulnerable populations. Identifying frail residents could assist in tailoring care/interventions, prioritising advance care planning/goals of care discussions and allocation of resources.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 12","pages":"2042-2052"},"PeriodicalIF":1.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549021","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}
The discovery of pathogenic bacteria in the late 19th century led librarians to ask whether their books might spread disease. Microbiological investigations over the following decades found that certain bacteria could be isolated at low levels from books used by persons carrying infections. UK public health legislation prohibited the return of library books from households where a case of notifiable disease had dwelt, and this idea was taken up to varying degrees in Australian states and New Zealand. Libraries enthusiastically promoted themselves as hygienic and many put in place likely ineffective formaldehyde fumigation of returned books. Each new pandemic reignites this concern, but no evidence has been found that library users or staff are at risk of acquiring infections from books.
{"title":"Do pathogens lurk in library books?","authors":"Mark J. Ferson","doi":"10.1111/imj.70270","DOIUrl":"10.1111/imj.70270","url":null,"abstract":"<p>The discovery of pathogenic bacteria in the late 19th century led librarians to ask whether their books might spread disease. Microbiological investigations over the following decades found that certain bacteria could be isolated at low levels from books used by persons carrying infections. UK public health legislation prohibited the return of library books from households where a case of notifiable disease had dwelt, and this idea was taken up to varying degrees in Australian states and New Zealand. Libraries enthusiastically promoted themselves as hygienic and many put in place likely ineffective formaldehyde fumigation of returned books. Each new pandemic reignites this concern, but no evidence has been found that library users or staff are at risk of acquiring infections from books.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 1","pages":"128-132"},"PeriodicalIF":1.5,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534517","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}
Sarah S. J. Clark, Matthew D. M. Rawlins, Paul R. Ingram, Laurens A. Manning
{"title":"Tolerability of subcutaneous teicoplanin administration in an Australian tertiary hospital clinical setting","authors":"Sarah S. J. Clark, Matthew D. M. Rawlins, Paul R. Ingram, Laurens A. Manning","doi":"10.1111/imj.70245","DOIUrl":"10.1111/imj.70245","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 12","pages":"2104-2105"},"PeriodicalIF":1.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495406","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}
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