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: In Australia, the number of colonoscopies performed each year is increasing, placing stress on the resources of the health system.

Aim: Our aim is to assess the diagnostic yield of repeat colonoscopies performed within 3 years of a prior colonoscopy and adherence to the National Health and Medical Research Council (NHMRC) surveillance colonoscopy guidelines.

Methods: We performed a retrospective analysis of colonoscopies performed in 2021, repeated within 3 years of the previous colonoscopy at a tertiary hospital in Western Australia. We extracted data from index and repeat colonoscopies regarding patient demographics, referrer, indications, histopathology, colonoscopy findings, proceduralist specialty and recommendations. We sought associations between indications and diagnostic yield and adherence to NHMRC surveillance guidelines.

Results: Out of the 5838 total colonoscopies performed, 951 (16.3%) were repeats within 3 years. For polyp surveillance, 56.2% were adherent to the guidelines. Colonoscopies performed for poor bowel preparation or colorectal cancer syndromes mostly occurred within the recommended time frame (>80%). Considering all repeat colonoscopy indications, high-risk conventional adenomas were detected in 84 (8.8%), advanced sessile serrated lesions (SSLs) in three (0.32%) but no cancer was identified.

Conclusions: Adherence to NHMRC surveillance colonoscopy guidelines after polypectomy is inadequate, with almost half of colonoscopies being performed outside of the recommended surveillance interval. The diagnostic yield for advanced adenomas, SSLs or colorectal cancer from repeat colonoscopies within 3 years of the previous one for all indications was low. Therefore, we recommend increased scrutiny of the appropriateness of repeat colonoscopy referrals within 3 years of the previous one.

Chronic respiratory diseases, including chronic obstructive pulmonary disease and asthma, pose substantial challenges to healthcare systems worldwide, which are projected to grow in coming years. Variations in care represent a threat to health equity and must be identified and remedied. Robust auditing systems can improve healthcare effectiveness and efficiency by identifying strengths and weaknesses in existing service models. The Australia New Zealand Respiratory Audit Programme (ANZRAP) is a new funded research and quality improvement programme commencing in 2025 aiming to improve quality of care, clinical outcomes and health service provision for people with respiratory illness across Australia and New Zealand. This paper describes the development, plans for implementation and likely outcomes of the ANZRAP.

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.

This review of omalizumab use in chronic spontaneous urticaria (CSU) over a 9-year period in a rural setting identified that a 'complete response' to 3 months of omalizumab treatment was associated with an elevated IgE level, absence of other autoimmune diseases and older age, compared with a 'partial response'. Median CSU duration was 36 months prior to omalizumab. There is insufficient evidence to recommend routine IgE testing to predict omalizumab response as it is unlikely to change management.

Background: The prison population is a uniquely disadvantaged group with complex healthcare needs. Australian prisons are currently facing overcrowding, and the number of older prisoners is growing. Humanitarian guidelines mandate equivalence of healthcare for prisoners, but evidence shows that prisoners face barriers at every stage of cancer care.

Objective: To explore the perceived challenges healthcare professionals (HCPs) face when treating prisoners with cancer.

Methods: This study used a qualitative, cross-sectional, exploratory design. Transcripts from seven focus groups with 24 HCPs from St Vincent's Hospital Melbourne were thematically analysed using a three-step coding process. HCPs were recruited based on their experience treating prisoners with cancer and included oncologists, oncology psychiatrists, radiation oncologists, surgeons, tumour stream and prison ward nurses, and prison medical staff.

Results: Though participants were motivated to provide optimal cancer care to prisoners, they faced several challenges, summarised by three key themes, which emerged from the data:, (1) Prisoner health is an informal specialty (learned on the job) (2) and the medical care of prisoners is difficult (3) communication with prisoners is different.

Conclusion: This study reports on the unique challenges that HCPs face when treating prisoners with cancer.

Significance: HCPs would benefit from formal guidelines for treating prisoners with and improved communication between hospital and prison systems. There is a need for further research from the viewpoint of prisoners.

Background: Malnutrition in hospitalised patients is common and increases morbidity, mortality and health care costs.

Aim: This study aimed to determine the risk of malnutrition at hospital admission and its associated risk factors among patients admitted to the internal medicine ward.

Methods: In this prospective observational study, 1052 patients hospitalised in the internal medicine ward of a tertiary care hospital were evaluated. Malnutrition risk was assessed using the Nutritional Risk Screening 2002 (NRS-2002), and demographic characteristics, history of hospitalisation, comorbidity burden, anthropometric measurements and biochemical parameters (haemoglobin, C-reactive protein (CRP), albumin, urea, creatinine, uric acid) were recorded. Binary logistic regression analysis was performed to identify independent predictors of malnutrition risk.

Results: Of all participants, 61.4% were at high risk of malnutrition. In-hospital mortality rate (5.3%), comorbidity burden (5.70 ± 3.70) and length of hospital stay (11.0 (13.0)) were higher in the high malnutrition risk group (P < 0.05). Age, duration of hospitalisation, body mass index (BMI), CRP and albumin levels were significantly associated with malnutrition risk (P < 0.05). In binary logistic regression analysis, older age (odds ratio (OR) = 1.019; 95% confidence interval (CI): 1.006-1.032), low BMI (OR = 0.969; 95% CI: 0.948-0.990), high CRP (OR = 0.997; 95% CI: 0.995-0.999) and low albumin (OR = 0.911; 95% CI: 0.882-0.942) were independent predictors of high risk of malnutrition after adjustment for potential confounders.

Conclusion: Advanced age, prolonged hospitalisation, inflammation and hypoalbuminemia are associated with an increased risk of malnutrition. Routine screening using the NRS-2002 is likely to be more effective than subjective clinical assessment in identifying patients at risk of malnutrition and guiding appropriate nutritional interventions.