Internal Medicine Journal最新文献

Multiparametric flow cytometry (MFC) enables rapid and sensitive quantification of measurable residual disease (MRD) in patients with acute myeloid leukaemia (AML), providing valuable prognostic information and guiding post-remission therapeutic strategies. Given the clinical utility of MFC AML MRD assessment and its inherent technical and analytical complexity, inter-laboratory standardisation is essential to ensure consistency of practice, diagnostic accuracy and reproducibility of results. However, limited options for external quality assessment exist. Representatives from all diagnostic laboratories in Australia and New Zealand currently performing AML MRD testing were invited to attend an in-person workshop to review site-specific practices and develop harmonisation processes. All six participating laboratories demonstrated a high level of concordance with respect to pre-analytical testing; however, greater variation was observed in post-analytical reporting, and a number of consensus recommendations were formulated for harmonisation. Ongoing meetings have also been established to promote continued sharing of expertise between AML MRD laboratories, align analytical strategies and enhance assay validation in accordance with regulatory requirements. These collaborative efforts provide guidance to existing MRD laboratories and those seeking to establish a new MRD service, facilitating sustainable provision of a high-quality regional MFC AML MRD testing network to meet current and anticipated increases in clinical demand.

Background: The inaugural Australian National Oncology Mentorship Program 2023 (NOMP23) demonstrated that virtual matching of trainee oncologists (mentees) with senior clinicians (mentors) for a 1-year mentorship programme was associated with significant reductions in burnout and improved professional fulfilment.

Aims: This sub-study sought to determine the bidirectional benefits of the programme for both mentees and mentors and unpack themes discussed at mentorship meetings to provide an insight into the benefit of top-down-led mentorship programmes.

Methods: The NOMP23 programme methodology has been previously reported. Additionally, participants were invited to partake in semi-structured interviews that were transcribed and thematic analyses conducted to assess benefits, themes discussed and future directions to improve NOMP.

Results: Of 112 participants enrolled, 86% completed the baseline questionnaire, 62% completed the mid-programme questionnaire and 54% completed the end-of-programme questionnaire. Nine participants - four mentors and five mentees - were interviewed at NOMPs conclusion. A high level of connection between matched pairs with adequate ability for pairs to meet was identified. The most common topics discussed were career planning, professional fulfilment, research and time management. The benefits of the mentoring relationship fell into five themes: (i) professional guidance; (ii) personal connection; (iii) support and reassurance; (iv) external perspectives; and (v) future perspectives. Benefits of providing mentorship fell into two themes: (i) personal connection and (ii) future-proofing oncology as a profession.

Conclusion: Qualitative analyses of the NOMP23 programme demonstrated a positive effect on trainee and mentor well-being with benefits including personal guidance for trainees, fulfilment for mentors and instilling hope for the future.

Patients with newly diagnosed multiple myeloma and considered transplant ineligible (TIE) because of age, frailty and/or comorbidities now have access to highly effective therapies that can achieve deep and/or durable remission. TIE patients are a highly heterogeneous population whose biological and chronological age can vary substantially. The treatment of these patients can be challenging in clinical practice and requires a frailty-adapted, individualised approach with an emphasis on treatment deliverability and tolerability to optimise patient outcomes. Here, we summarise recommendations for TIE patients, including pre-treatment considerations, induction and maintenance therapies, and supportive care management.

Background: Direct oral anticoagulants (DOACs) have changed the paradigm of atrial fibrillation (AF) management in preventing ischaemic cerebrovascular accidents (CVAs). They are safe and effective in this aim. Their dosing is simpler than the vitamin K antagonist warfarin; however, there are certain nuances in dosing adjustments which clinicians must be aware of before initiating changes.

Aim: We sought to investigate the role of inappropriate DOAC underdosing in contributing to the development of ischaemic CVAs.

Methods: A retrospective cohort study was performed on all ischaemic CVA presentations to an Australian tertiary centre in the 12 months of 2023. We analysed all those already on DOAC therapy and the significance of inappropriate DOAC underdosing. This was compared to all DOAC prescriptions, without associated ischaemic CVA complication, within the centre during the same period and whether underdosing played a significant role.

Results: Seventy-two patients presented to our centre with an ischaemic CVA, already prescribed and taking DOAC therapy. Underdosing of DOAC therapy, away from established guidelines, was the most common attributable factor found. Underdosing of DOACs had an overall odds ratio of 4.31, with a 95% confidence interval (95% CI) of 2.49-7.46, of suffering an ischaemic CVA. The periprocedural period was also found to be high risk for patients undergoing DOAC therapy.

Conclusions: Underdosing of DOAC therapy has a significant impact on whether individuals develop ischaemic CVAs. Clinicians must be stringent in applying dose reductions based on established guidelines and must be aware to review dosing for all their DOAC patients.

Introduction: Giant cell arteritis (GCA) is the most common vasculitis of the elderly. Delayed diagnosis or inadequate treatment can lead to severe and irreversible consequences. There are limited data on diagnosis and management practices of rheumatologists and rheumatology trainees in Australia. This study aimed to determine practices and views of Australian rheumatologists/rheumatology trainees in the diagnosis and management of GCA.

Methods: An online survey was completed by Australian rheumatologists/trainees. The survey gathered data on the respondent demographics and a range of topics related to the diagnosis and management of GCA, including the use of temporal artery biopsy (TAB) and imaging, confidence in ultrasound, use of steroid-sparing medication, and approaches to aortic aneurysm screening and referral back to primary care.

Results: There were 58 respondents (52 rheumatologists, six trainees). On average, respondents used TAB alone (56% of respondents), imaging alone (19%), both (15%) or neither (10%). The majority of respondents (79%) rarely or never made a diagnosis of GCA without TAB. Only 40% expressed confidence in GCA diagnosis by temporal artery ultrasound from their preferred radiology provider. Management approaches following the end of government-funded tocilizumab varied. Only 12% of respondents reported that >50% of their GCA patients were able to cease prednisolone by 12 months.

Conclusions: Australian rheumatologists and trainees have low confidence in ultrasound and rarely make a diagnosis of GCA without a TAB. Variable practice would support the need to develop Australian clinical care standards for GCA.

Introduction: Type 1 diabetes (T1D) is associated with an increased risk of cardiovascular disease (CVD), yet many patients do not attain recommended lipid targets.

Aims: We aimed to identify patient and clinician factors affecting lipid management.

Methods: Anonymous online surveys were developed to assess perspectives from adults with T1D and prescribing doctors. Participants were recruited from three Australian centres. Patients were asked about their understanding of CVD risk, cholesterol and cholesterol-lowering medications. Doctors were surveyed on CVD risk assessment and lipid management.

Results: Among 547 patients, ~1 in 2 reported their doctor had not discussed CVD risk, they preferred lifestyle changes over medications and viewed glucose as more important than cholesterol for CVD risk reduction. Whilst ~1 in 2 statin-naïve patients would take statins if recommended, ~1 in 6 expressed concerns about side effects. All 41 clinicians believed that CVD risk should be routinely assessed; however, ~1 in 3 often had inadequate time to discuss dyslipidaemia and prioritised glycaemia before considering statins. Doctors identified adherence, concerns about side effects, negative beliefs/attitudes about statins and future pregnancy as barriers to lipid management.

Conclusion: The identified patient- and clinician-related factors should be addressed in future studies and in clinics to optimise lipid management in T1D.