Internal Medicine Journal最新文献

Background: International research indicates that patients with spontaneous intracerebral haemorrhage (ICH) have worse clinical outcomes than those with ischaemic stroke.

Aims: This study analyses a national cohort to compare the baseline characteristics, in-hospital interventions, complications and outcomes of patients admitted with ICH and ischaemic stroke in New Zealand.

Methods: We conducted a post-hoc analysis of a prospective, nationwide cohort study. Adult patients with a confirmed diagnosis of spontaneous ICH or ischaemic stroke were recruited from 28 hospitals between 1 May and 31 October 2018. The primary outcome was modified Rankin Scale (mRS) at 3 months, dichotomised into favourable (mRS 0-2) and unfavourable (mRS 3-6). Secondary outcomes included dichotomised mRS at 12 months, mortality at 3 and 12 months, and living situation at 3 months. Results were adjusted for age, pre-stroke independence, living alone, stroke severity, sex, ethnicity and presenting hospital.

Results: The study included 291 patients with ICH and 1937 patients with ischaemic stroke. Baseline characteristics were largely similar, but patients with ICH scored higher on clinical measures of stroke severity. At 3 months after stroke, patients with ICH had lower odds of a favourable functional outcome than those with ischaemic stroke (adjusted odds ratio (aOR) = 0.36, 95% confidence interval (CI) 0.24-0.53, P < 0.001), higher mortality (aOR = 2.41, 95% CI 1.68-3.46, P < 0.001), and were over twice as likely to be living in residential care (aOR = 2.55, 95% CI 1.39-4.71, P = 0.003). Patients with ICH also had more in-hospital complications, lower rates of admission to an acute stroke unit and higher rates of early palliative care initiation.

Conclusion: This New Zealand-based study confirms that patients with ICH have poorer outcomes than those with ischaemic stroke. Further research is needed into effective therapies for ICH and to assess adherence to best practice ICH management across New Zealand.

Objective: The ability to conduct and use research is an integral physician skill, and subsequently specialist training colleges mandate trainee research projects. Limited research has explored barriers faced by Australian physician trainees. This study aimed to investigate barriers to research and potential solutions among Queensland general medicine and geriatric trainees.

Methods: A 27-question survey was electronically distributed to 210 current and recent trainees in Queensland Geriatric or General Medicine Training Networks. The survey gathered quantitative and qualitative data on trainee research experience, including perceived support, barriers and potential improvements.

Results: Sixty trainees (28.5%) responded, with the majority being female and metropolitan-based. Only 16.9% of trainees reported feeling encouraged and supported to undertake research 'all of the time', and 23.7% were allocated non-clinical time for research. Trainees who felt supported were more likely to indicate an intention to pursue future research. Twenty-two percentage of respondents felt that their fellowship was (or was likely to be) delayed due to the research project. The research project was reported by the majority (59%) to add value to their training. Preferred solutions to address barriers included increased access to non-clinical time and structured project topic support.

Conclusions: This study highlights significant barriers to research engagement among Queensland geriatric and general medicine trainees. Enhanced local and statewide support, through increased non-clinical time and access to research resources, is needed to reduce barriers and foster research engagement.

The predictive value of PromarkerD tests for incident diabetic kidney disease or rapid decline in estimated glomerular filtration rate was evaluated in 1010 non-Aboriginal and 71 Aboriginal adults with diabetes. Areas under the receiver operating characteristic curves were not significantly different (P ≥ 0.081) for first- (non-Aboriginals 0.890 (95% confidence interval 0.864 to 0.915) and Aboriginals 0.769 (0.624 to 0.915)) and second-generation (0.890 (0.862 to 0.917) and 0.711 (0.543 to 0.878)) tests. PromarkerD has potential renal prognostic value in Aboriginals with diabetes.

Background: Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes (T2D). Early treatment can prevent kidney damage, reduce mortality and hospitalisations and delay progression to end-stage kidney disease. While albuminuria screening identifies some at-risk individuals, additional tools are needed to stratify risk in those with normal or moderately increased albuminuria and enable timely use of renoprotective therapies.

Aims: This study evaluated the potential impact of PromarkerD, a biomarker-based blood test that predicts CKD risk, on T2D management by Australian clinicians.

Methods: A web-based survey was conducted among general practitioners, endocrinologists, nephrologists and diabetologists to understand current management of patients with T2D and early-stage CKD (estimated glomerular fitration rate ≥60 mL/min per 1.73 m² and normal or moderately increased albuminuria). Clinicians assessed the utility of a validated predictive CKD test and its influence on treatment decisions. The survey introduced the clinical evidence supporting PromarkerD but blinded respondents to the test's commercial name to reduce bias.

Results: Responses from 178 clinicians revealed an unmet need for predictive CKD testing in T2D management. PromarkerD testing was associated with earlier treatment initiation in moderate- and high-risk individuals. Among high-risk patients, clinicians reported increased prescribing of sodium-glucose co-transporter 2 inhibitors (62% vs. 40%), angiotensin-converting enzyme inhibitors (73% vs. 49%), angiotensin receptor blockers (66% vs. 42%) and statins (57% vs. 32%), compared with standard care (all P < 0.0001). Moderate-risk individuals also saw smaller but significant increases (all P ≤ 0.007).

Conclusions: Predictive PromarkerD risk scores could improve CKD prevention in T2D by enabling early intervention and guided treatment strategies, with the potential to improve patient outcomes.

Antimicrobial resistance in Campylobacter is a global concern. We conducted a single-centre retrospective observational study to investigate antimicrobial resistance in adult patients with Campylobacter gastroenteritis (2020-2023). From our cohort of 331 patients over 3 years, there was 22% ciprofloxacin resistance and 100% susceptibility to erythromycin. Compared to prior literature in Australia, ciprofloxacin resistance has increased over time. Ongoing antimicrobial surveillance, stewardship and review of treatment guidelines are recommended.

Prehabilitation, a multidisciplinary approach to optimise patients pre-surgery, aims to reduce frailty and enhance surgical outcomes. However, limited evidence exists on the effectiveness of improving clinical outcomes in patients with frailty undergoing cancer-related surgery. This systematic review assessed whether prehabilitation enhanced clinically relevant outcomes for patients with frailty undergoing cancer-related surgery. We conducted a systematic review and meta-analysis, reviewing four databases from January 2000 through April 2024 for studies examining the association between prehabilitation before elective cancer surgery and clinical outcomes. The primary outcome was hospital length of stay (LOS). Secondary outcomes included functional status, complication rates and readmission rates. We performed a random-effects meta-analysis, estimating associations for binary outcomes using relative risks (RRs) and continuous outcomes using mean differences (MDs). Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool for randomised clinical trials and Joanna Briggs Institute for observational cohort studies. We included 15 studies (1955 patients); 67.7% (657 of 970) were frail. The hospital LOS was comparable between the prehabilitation and control groups (MD = -0.29 (95% confidence interval (CI): -0.89 to 0.30); P = 0.34). No significant improvements were noted in post-operative functional status (MD = 29.95 (95% CI: -11.24 to 71.14); P = 0.15), complication rates (RR = 0.76 (95% CI: 0.56-1.04); P = 0.085) or readmission (RR = 1.23 (95% CI: 0.84-1.81); P = 0.29). Prehabilitation approaches and frailty assessments were notably heterogeneous and inconsistently reported. Prehabilitation did not reduce hospital LOS or major postoperative complications in patients with frailty undergoing cancer-related surgery. Heterogeneity in prehabilitation protocols and reporting limited the interpretation of results and highlights a critical gap in research methodologies.

Background: The HINTS (head impulse, nystagmus, and test of skew) examination can surpass early magnetic resonance imaging (MRI) in detecting central causes of acute vestibular syndrome (AVS) when performed by neurologists, but its accuracy in routine hospital practice by non-neurologists is uncertain.

Aims: To evaluate the utilisation, documentation, diagnostic accuracy and clinical influence of HINTS in AVS cases at a tertiary Australian hospital and whether combining HINTS with the ABCD² (age, blood pressure, clinical features, duration, diabetes (clinical risk score)) score improves diagnosis.

Methods: We retrospectively reviewed adult AVS presentations to the Gold Coast University Hospital's emergency department from January 2021 to July 2024. Data included HINTS performance rates, documentation completeness, clinician specialty/seniority and impact on neuroimaging decisions. Diagnostic metrics were compared with MRI, and we assessed whether combining 'central' HINTS with an ABCD² score ≥4 improved test characteristics.

Results: Of 322 patients, fully performed HINTS examinations were completed in 42% of emergency department, 40% of neurology, 18% of general medicine and 93% of physiotherapy encounters. Documentation completeness ranged from 30% (general medicine) to 89% (physiotherapy). Sensitivity for central causes was low (21.4% in emergency, 58.8% in physiotherapy), and inter-rater agreement was poor (κ = 0.10). HINTS rarely altered MRI ordering, except in physiotherapy. Combining a central HINTS with an ABCD² score ≥4 improved specificity but reduced sensitivity.

Conclusions: HINTS was under-utilised and inconsistently interpreted and demonstrated lower accuracy in this study compared with previous studies involving neurology specialists. Improved training and standardisation of documentation are needed to optimise AVS diagnosis and care.