Carolynn L. Smith, Christina Rojas, Yvonne Zurynski, Andrew Partington, Jeffrey Braithwaite
COP-28, the United Nations' Climate Change Conference, hosted by the United Arab Emirates, ended on 12 December 2023. At the convention, Australia released its National Health and Climate Strategy, committing to low-carbon, climate-responsive care. The Strategy will need new policies, projects and investments and a fit-for-purpose health workforce. This is a tall order considering healthcare's challenges. Everyone has a role, including clinicians, healthcare agencies, policymakers, politicians, patients and the providers and manufacturers in the supply chain. Clinicians' groups, policymakers and federal and state departments of health have an opportunity to lead climate change reform by considering climate change impacts across clinical practice and health policy.
{"title":"What Australia must do to create a climate-responsive health system","authors":"Carolynn L. Smith, Christina Rojas, Yvonne Zurynski, Andrew Partington, Jeffrey Braithwaite","doi":"10.1111/imj.16528","DOIUrl":"10.1111/imj.16528","url":null,"abstract":"<p>COP-28, the United Nations' Climate Change Conference, hosted by the United Arab Emirates, ended on 12 December 2023. At the convention, Australia released its National Health and Climate Strategy, committing to low-carbon, climate-responsive care. The Strategy will need new policies, projects and investments and a fit-for-purpose health workforce. This is a tall order considering healthcare's challenges. Everyone has a role, including clinicians, healthcare agencies, policymakers, politicians, patients and the providers and manufacturers in the supply chain. Clinicians' groups, policymakers and federal and state departments of health have an opportunity to lead climate change reform by considering climate change impacts across clinical practice and health policy.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 11","pages":"1913-1918"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16528","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286268","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}
Joshua G. Kovoor, Harry Smallbone, Alexander Jenkins, Brandon Stretton, Sanjana Santhosh, Jonathan H. W. Jacobsen, Aashray K. Gupta, Ammar Zaka, Silas D. Nann, Melinda Jiang, Yuchen Luo, Caitlyn Withers, Sara Ataie, Nasim Nematzadeh, Leigh R. Warren, Matthew Marshall-Webb, WengOnn Chan, Keith McNeil, Samuel Gluck, Richard Turner, Melanie Tan, Tobin South, Toby Gilbert, Ashley M. Hopkins, Andrew S. Vanlint, Gregory M. Sweetman, Timothy R. Bates, Amandeep Hansra, Stephen Bacchi
Given their frontline role in Australia and Aotearoa New Zealand (ANZ) healthcare, trainee medical officers (TMOs) will play a crucial role in the development and use of artificial intelligence (AI) for clinical care, ongoing medical education and research. As ‘digital natives’, particularly those with technical expertise in AI, TMOs should also be leaders in informing the safe uptake and governance of AI within ANZ healthcare as they have a practical understanding of its associated risks and benefits. However, this is only possible if a culture of broad collaboration is instilled while the use of AI in ANZ is still in its initial phase.
{"title":"The future is bright: artificial intelligence for trainee medical officers in Australia and New Zealand","authors":"Joshua G. Kovoor, Harry Smallbone, Alexander Jenkins, Brandon Stretton, Sanjana Santhosh, Jonathan H. W. Jacobsen, Aashray K. Gupta, Ammar Zaka, Silas D. Nann, Melinda Jiang, Yuchen Luo, Caitlyn Withers, Sara Ataie, Nasim Nematzadeh, Leigh R. Warren, Matthew Marshall-Webb, WengOnn Chan, Keith McNeil, Samuel Gluck, Richard Turner, Melanie Tan, Tobin South, Toby Gilbert, Ashley M. Hopkins, Andrew S. Vanlint, Gregory M. Sweetman, Timothy R. Bates, Amandeep Hansra, Stephen Bacchi","doi":"10.1111/imj.16518","DOIUrl":"10.1111/imj.16518","url":null,"abstract":"<p>Given their frontline role in Australia and Aotearoa New Zealand (ANZ) healthcare, trainee medical officers (TMOs) will play a crucial role in the development and use of artificial intelligence (AI) for clinical care, ongoing medical education and research. As ‘digital natives’, particularly those with technical expertise in AI, TMOs should also be leaders in informing the safe uptake and governance of AI within ANZ healthcare as they have a practical understanding of its associated risks and benefits. However, this is only possible if a culture of broad collaboration is instilled while the use of AI in ANZ is still in its initial phase.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 11","pages":"1909-1912"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286267","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}
Luke J. Vlismas, Michael Potter, Mark R. Loewenthal, Katie Wilson, Kelleigh Allport, Donna Gillies, Dane Cook, Stephen Philcox, Steven Bollipo, Nicholas J. Talley
Background and Aim
Barrett's oesophagus predisposes individuals to oesophageal adenocarcinoma (OAC), with the risk of progression to malignancy increasing with the degree of dysplasia, categorized as either low-grade dysplasia (LGD) or high-grade dysplasia (HGD). The reported incidence of progression to OAC in LGD ranges from 0.02% to 11.43% per annum. In patients with LGD, Australian guidelines recommend 6-monthly endoscopic surveillance. We aimed to describe the surveillance practices within a tertiary centre, and to determine the predictive value of surveillance as well as other risk factors for progression.
Methods
Endoscopy and pathology databases were searched over a 10-year period to collate all cases of Barrett's oesophagus with LGD. Medical records were reviewed to document patient factors and endoscopic and histologic details. Because follow-up times varied greatly, survival analysis techniques were employed.
Results
Fifty-nine patients were found to have LGD. Thirteen patients (22.0%) progressed to either HGD or OAC (10 (16.9%) and three (5.1%) respectively); the annual incidence rates of progression to HGD/OAC and OAC were 5.5% and 1.1% respectively. All patients who developed OAC had non-guideline-adherent surveillance. A Cox model found only two predictors of progression: (i) guideline-adherent surveillance, performed in 16 (27.1%), detected progression to HGD/OAC four times earlier than non-guideline-adherent surveillance (95% confidence interval (CI) = 1.3–12.3; P = 0.016). (ii) The detection of visible lesions at exit endoscopy independently predicted progression (hazard ratio = 6.5; 95% CI = 1.9–22.8; P = 0.003).
Conclusion
Barrett's oesophagus with LGD poses a significant risk of progression to HGD/OAC. Guideline-recommended surveillance is effective, but is difficult to adhere to. Clinical predictors for those who are more likely to progress are yet to be defined.
{"title":"Outcomes of patients with Barrett's oesophagus with low-grade dysplasia undergoing endoscopic surveillance in a tertiary centre: a retrospective cohort study","authors":"Luke J. Vlismas, Michael Potter, Mark R. Loewenthal, Katie Wilson, Kelleigh Allport, Donna Gillies, Dane Cook, Stephen Philcox, Steven Bollipo, Nicholas J. Talley","doi":"10.1111/imj.16532","DOIUrl":"10.1111/imj.16532","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Barrett's oesophagus predisposes individuals to oesophageal adenocarcinoma (OAC), with the risk of progression to malignancy increasing with the degree of dysplasia, categorized as either low-grade dysplasia (LGD) or high-grade dysplasia (HGD). The reported incidence of progression to OAC in LGD ranges from 0.02% to 11.43% per annum. In patients with LGD, Australian guidelines recommend 6-monthly endoscopic surveillance. We aimed to describe the surveillance practices within a tertiary centre, and to determine the predictive value of surveillance as well as other risk factors for progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Endoscopy and pathology databases were searched over a 10-year period to collate all cases of Barrett's oesophagus with LGD. Medical records were reviewed to document patient factors and endoscopic and histologic details. Because follow-up times varied greatly, survival analysis techniques were employed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-nine patients were found to have LGD. Thirteen patients (22.0%) progressed to either HGD or OAC (10 (16.9%) and three (5.1%) respectively); the annual incidence rates of progression to HGD/OAC and OAC were 5.5% and 1.1% respectively. All patients who developed OAC had non-guideline-adherent surveillance. A Cox model found only two predictors of progression: (i) guideline-adherent surveillance, performed in 16 (27.1%), detected progression to HGD/OAC four times earlier than non-guideline-adherent surveillance (95% confidence interval (CI) = 1.3–12.3; <i>P</i> = 0.016). (ii) The detection of visible lesions at exit endoscopy independently predicted progression (hazard ratio = 6.5; 95% CI = 1.9–22.8; <i>P</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Barrett's oesophagus with LGD poses a significant risk of progression to HGD/OAC. Guideline-recommended surveillance is effective, but is difficult to adhere to. Clinical predictors for those who are more likely to progress are yet to be defined.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 11","pages":"1867-1875"},"PeriodicalIF":1.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16532","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286266","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}
Philip Crispin, Robert Henderson, James Yun, Christina Crosbie, David Tognarini, Sherif Youssef, Giulio Barrese, Simone Fleischmann
Background
Subcutaneous immunoglobulin (SCIg) therapy is important in the treatment of primary (PID) and secondary immunodeficiencies (SID) and chronic inflammatory demyelinating polyneuropathy (CIDP). Patient support programmes (PSPs) help patients self-administer medication regimens and play a more active role in the self-management of their medical conditions.
Aim
To describe the effectiveness of the CSL Behring CARES PSP in optimising the quality use of SCIg in a hospital-free environment.
Design
This retrospective, observational study analysed records of patients enroled in the CSL Behring CARES PSP. Key outcomes were accessibility and effectiveness. Data were extracted from the patient database and analysed using descriptive methods.
Results
Seven hundred eighty-nine patients with PID (30.8%), SID (53.4%) and CIDP (15.8%) were enroled in the CARES PSP, 92.8% of whom were referred from public hospitals and the remaining from private hospitals. Of the total patient population, 697 (88.3%) received the nurse-led SCIg self-administration training and education (COACH), out of which 656 (94.1%) completed training and achieved competency after an average of 2.3 training sessions. The proportions of patients who achieved competency were similar across age groups and prior SCIg hospital education status.
Conclusion
This is the largest real-world evidence study that describes the effectiveness of SCIg PSPs across three therapeutic disease states. These PSPs can optimise hospital resources such as infusion nurse time and allocation of infusion chairs that were once used for intravenous immunoglobulin infusions, improve patient access to SCIg therapy and enable patients self-administer SCIg outside a hospital environment.
{"title":"Outcomes of a patient support programme for subcutaneous immunoglobulin therapy in patients with primary or secondary immunodeficiencies or chronic inflammatory demyelinating polyneuropathy","authors":"Philip Crispin, Robert Henderson, James Yun, Christina Crosbie, David Tognarini, Sherif Youssef, Giulio Barrese, Simone Fleischmann","doi":"10.1111/imj.16520","DOIUrl":"10.1111/imj.16520","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Subcutaneous immunoglobulin (SCIg) therapy is important in the treatment of primary (PID) and secondary immunodeficiencies (SID) and chronic inflammatory demyelinating polyneuropathy (CIDP). Patient support programmes (PSPs) help patients self-administer medication regimens and play a more active role in the self-management of their medical conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe the effectiveness of the CSL Behring CARES PSP in optimising the quality use of SCIg in a hospital-free environment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This retrospective, observational study analysed records of patients enroled in the CSL Behring CARES PSP. Key outcomes were accessibility and effectiveness. Data were extracted from the patient database and analysed using descriptive methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven hundred eighty-nine patients with PID (30.8%), SID (53.4%) and CIDP (15.8%) were enroled in the CARES PSP, 92.8% of whom were referred from public hospitals and the remaining from private hospitals. Of the total patient population, 697 (88.3%) received the nurse-led SCIg self-administration training and education (COACH), out of which 656 (94.1%) completed training and achieved competency after an average of 2.3 training sessions. The proportions of patients who achieved competency were similar across age groups and prior SCIg hospital education status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the largest real-world evidence study that describes the effectiveness of SCIg PSPs across three therapeutic disease states. These PSPs can optimise hospital resources such as infusion nurse time and allocation of infusion chairs that were once used for intravenous immunoglobulin infusions, improve patient access to SCIg therapy and enable patients self-administer SCIg outside a hospital environment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 11","pages":"1827-1837"},"PeriodicalIF":1.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268113","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}
Paul Komesaroff, Elizabeth Potter, Emma R. Felman, Jeff Szer
<p>The advent of artificial intelligence (AI) models has already produced wide-ranging effects on all aspects of social life,<span><sup>1</sup></span> and these continue to evolve rapidly. What the impact on medicine and science will be remains uncertain, but it is also likely to be profound. In the current fluid context, there is a need for clinicians and researchers to inform themselves of both the beneficial possibilities of AI and the ways in which it might undermine or compromise practices and values they have been taking for granted.</p><p>While the present pace of change may seem particularly intense, there is, of course, nothing remarkable about change itself. Indeed, we are familiar with a constant flux of new treatments, investigative techniques and tools of various other kinds. Occasionally, concerns have been expressed about a possible loss of skills<span><sup>2</sup></span> or a potential impact on relationships with patients,<span><sup>3</sup></span> but for the most part, innovations are welcomed and comfortably accommodated.<span><sup>4</sup></span></p><p>Despite this familiarity with change, it has been argued that the impact of AI will be different from that of previous epochs of technological innovation.<span><sup>5</sup></span> This is supposedly because AI is not just another tool that allows everyday tasks to be completed more quickly and efficiently but, in many cases, can actually replace human inputs altogether or even, more fundamentally, actually challenge the nature of what it is to be human. While it is too early to tell whether this will indeed turn out to be the case, it is clear that, for the present, we need to scrutinise carefully what is claimed and delivered.</p><p>Under these circumstances of uncertainty and ferment, journals and professional societies are hurriedly preparing policies to respond to perceived challenges emerging in the field of scientific publishing.<span><sup>6</sup></span> Particular emphasis is being placed on issues relating to authorship and originality of manuscripts,<span><sup>7</sup></span> reviewing practices,<span><sup>8</sup></span> intellectual property<span><sup>9</sup></span> and accountability.<span><sup>10</sup></span> For the most part, the policies remain provisional and precautionary<span><sup>6</sup></span> and reflect a recognition of the likely need for revision as further information becomes available.</p><p>The <i>Internal Medicine Journal</i> (IMJ) welcomes this reflective process and invites comments and suggestions from readers about their experiences with AI and what they consider to be its potential benefits and risks. We also recognise that a reflection on the impact of AI on journal publishing requires an examination of the multiple tasks that journals themselves serve and provides an opportunity for these tasks to be clarified and refined.</p><p>Medical journals like the IMJ are not mere manuscript-publishing machines, and their functions are not purely technical
{"title":"How should journals respond to the emerging challenges of artificial intelligence?","authors":"Paul Komesaroff, Elizabeth Potter, Emma R. Felman, Jeff Szer","doi":"10.1111/imj.16519","DOIUrl":"10.1111/imj.16519","url":null,"abstract":"<p>The advent of artificial intelligence (AI) models has already produced wide-ranging effects on all aspects of social life,<span><sup>1</sup></span> and these continue to evolve rapidly. What the impact on medicine and science will be remains uncertain, but it is also likely to be profound. In the current fluid context, there is a need for clinicians and researchers to inform themselves of both the beneficial possibilities of AI and the ways in which it might undermine or compromise practices and values they have been taking for granted.</p><p>While the present pace of change may seem particularly intense, there is, of course, nothing remarkable about change itself. Indeed, we are familiar with a constant flux of new treatments, investigative techniques and tools of various other kinds. Occasionally, concerns have been expressed about a possible loss of skills<span><sup>2</sup></span> or a potential impact on relationships with patients,<span><sup>3</sup></span> but for the most part, innovations are welcomed and comfortably accommodated.<span><sup>4</sup></span></p><p>Despite this familiarity with change, it has been argued that the impact of AI will be different from that of previous epochs of technological innovation.<span><sup>5</sup></span> This is supposedly because AI is not just another tool that allows everyday tasks to be completed more quickly and efficiently but, in many cases, can actually replace human inputs altogether or even, more fundamentally, actually challenge the nature of what it is to be human. While it is too early to tell whether this will indeed turn out to be the case, it is clear that, for the present, we need to scrutinise carefully what is claimed and delivered.</p><p>Under these circumstances of uncertainty and ferment, journals and professional societies are hurriedly preparing policies to respond to perceived challenges emerging in the field of scientific publishing.<span><sup>6</sup></span> Particular emphasis is being placed on issues relating to authorship and originality of manuscripts,<span><sup>7</sup></span> reviewing practices,<span><sup>8</sup></span> intellectual property<span><sup>9</sup></span> and accountability.<span><sup>10</sup></span> For the most part, the policies remain provisional and precautionary<span><sup>6</sup></span> and reflect a recognition of the likely need for revision as further information becomes available.</p><p>The <i>Internal Medicine Journal</i> (IMJ) welcomes this reflective process and invites comments and suggestions from readers about their experiences with AI and what they consider to be its potential benefits and risks. We also recognise that a reflection on the impact of AI on journal publishing requires an examination of the multiple tasks that journals themselves serve and provides an opportunity for these tasks to be clarified and refined.</p><p>Medical journals like the IMJ are not mere manuscript-publishing machines, and their functions are not purely technical","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 10","pages":"1601-1602"},"PeriodicalIF":1.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16519","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249983","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}
Gary Xu, Ramon Yuson, Martina Rafferty, Thuy L. Thai, Sandhya Limaye
Hypersensitivity to exogenous or endogenous progesterone presents with a variety of clinical, usually cutaneous, manifestations. The condition can occur at any age during the reproductive years, causes debilitating symptoms and can impact the use of exogenous hormones. Management strategies include symptom control or hormonal manipulation via desensitisation. Strategic testing confirms the diagnosis, while targeted intervention can significantly and positively impact quality of life and further childbearing.
{"title":"Progestogen hypersensitivity: successful use of progesterone desensitisation and omalizumab to facilitate in vitro fertilisation","authors":"Gary Xu, Ramon Yuson, Martina Rafferty, Thuy L. Thai, Sandhya Limaye","doi":"10.1111/imj.16517","DOIUrl":"10.1111/imj.16517","url":null,"abstract":"<p>Hypersensitivity to exogenous or endogenous progesterone presents with a variety of clinical, usually cutaneous, manifestations. The condition can occur at any age during the reproductive years, causes debilitating symptoms and can impact the use of exogenous hormones. Management strategies include symptom control or hormonal manipulation via desensitisation. Strategic testing confirms the diagnosis, while targeted intervention can significantly and positively impact quality of life and further childbearing.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 10","pages":"1749-1752"},"PeriodicalIF":1.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16517","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249984","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}
Sakiko Isojima, Ning Li, Saskia Rowson, Rangi Kandane-Rahtnayake, Rachel Koelmeyer, Eric F. Morand, Alberta Hoi
Background
Systemic lupus erythematosus (SLE) affects women, with the onset of disease typically around the childbearing years.
Aims
This study examines the frequency and risk factors for adverse pregnancy outcomes (APOs) in an Australian cohort, and any disease flares during pregnancy and post partum.
Methods
Female patients with SLE enrolled in the Australian Lupus Registry and Biobank (ALRB) between January 2007 and June 2019 were studied. Self-reported pregnancy history, including adverse foetal or maternal outcomes, was collected at the time of enrolment and updated as appropriate. Baseline demographics, clinical parameters, medication exposure and disease activity were collected. Factors associated with APO were examined using univariate and multivariate logistic regression analyses.
Results
Pregnancy history was available in 278 patients; 30% were nulliparous. Most pregnancies occurred before the diagnosis of SLE. Patients who had pregnancies after SLE diagnosis had an earlier age of diagnosis, and had fewer pregnancies. The APO rate was 44.3% in the overall cohort, with most presenting as prematurity with or without foetal growth restriction. Women with APO were also diagnosed with SLE at a younger age and had a higher prevalence of anti-cardiolipin antibodies and hypocomplementemia. Early age of SLE diagnosis was a significant independent risk factor for APO. No increase in disease flare was observed in those who experienced APO during the observation period of ALRB.
Conclusion
This study shows a considerable incidence of APO in patients with SLE, emphasising the need for pre-pregnancy counselling and collaboration between maternal-foetal medicine specialists and rheumatologists, especially for women diagnosed with SLE at a younger age.
背景系统性红斑狼疮（SLE）对女性的影响很大，通常在育龄期发病。目的本研究调查了澳大利亚队列中不良妊娠结局（APO）的发生频率和风险因素，以及妊娠期和产后疾病复发的情况。在入组时收集了自我报告的妊娠史，包括不良胎儿或产妇结局，并酌情进行了更新。还收集了基线人口统计学、临床参数、药物接触和疾病活动。通过单变量和多变量逻辑回归分析研究了与 APO 相关的因素。大多数患者是在确诊系统性红斑狼疮之前怀孕的。在确诊系统性红斑狼疮后怀孕的患者确诊年龄较早，怀孕次数较少。在整个群组中，APO的发生率为44.3%，大多数表现为早产，伴有或不伴有胎儿生长受限。患有 APO 的妇女被诊断为系统性红斑狼疮的年龄也较小，抗心磷脂抗体和低补体血症的发病率也较高。早诊断出系统性红斑狼疮是导致 APO 的一个重要独立风险因素。结论：这项研究表明，系统性红斑狼疮患者的 APO 发生率相当高，强调了孕前咨询以及母胎医学专家和风湿病专家之间合作的必要性，尤其是对那些确诊系统性红斑狼疮的年龄较小的女性。
{"title":"Pregnancy outcomes in Australian patients with systemic lupus erythematosus","authors":"Sakiko Isojima, Ning Li, Saskia Rowson, Rangi Kandane-Rahtnayake, Rachel Koelmeyer, Eric F. Morand, Alberta Hoi","doi":"10.1111/imj.16524","DOIUrl":"10.1111/imj.16524","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Systemic lupus erythematosus (SLE) affects women, with the onset of disease typically around the childbearing years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study examines the frequency and risk factors for adverse pregnancy outcomes (APOs) in an Australian cohort, and any disease flares during pregnancy and post partum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Female patients with SLE enrolled in the Australian Lupus Registry and Biobank (ALRB) between January 2007 and June 2019 were studied. Self-reported pregnancy history, including adverse foetal or maternal outcomes, was collected at the time of enrolment and updated as appropriate. Baseline demographics, clinical parameters, medication exposure and disease activity were collected. Factors associated with APO were examined using univariate and multivariate logistic regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pregnancy history was available in 278 patients; 30% were nulliparous. Most pregnancies occurred before the diagnosis of SLE. Patients who had pregnancies after SLE diagnosis had an earlier age of diagnosis, and had fewer pregnancies. The APO rate was 44.3% in the overall cohort, with most presenting as prematurity with or without foetal growth restriction. Women with APO were also diagnosed with SLE at a younger age and had a higher prevalence of anti-cardiolipin antibodies and hypocomplementemia. Early age of SLE diagnosis was a significant independent risk factor for APO. No increase in disease flare was observed in those who experienced APO during the observation period of ALRB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study shows a considerable incidence of APO in patients with SLE, emphasising the need for pre-pregnancy counselling and collaboration between maternal-foetal medicine specialists and rheumatologists, especially for women diagnosed with SLE at a younger age.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 11","pages":"1876-1882"},"PeriodicalIF":1.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16524","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142208706","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}
Alexander Sweetman, Chelsea Reynolds, Cele Richardson
Background
Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT-i) is the recommended ‘first line’ treatment but is accessed by a minority of people with insomnia.
Aims
To improve CBT-i access in Australia, we aimed to develop and test a self-guided interactive digital CBT-i program.
Methods
An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT-i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ-9), anxiety (GAD-7), fatigue, sleepiness and maladaptive beliefs about sleep at 8-week follow-up. The control group accessed the intervention after the 8-week follow-up. Questionnaires were additionally administered at 16 and 24 weeks. Intent-to-treat mixed models and complete-case chi-squared analyses were used.
Results
Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between-group differences in baseline characteristics or missing 8-week data (14.5%). After adjusting for baseline scores, CBT-i was associated with lower insomnia (Diffadj (95% CI) = 7.32 (5.0–9.6), P < 0.001, d = 1.64), depression (3.36 (1.3–5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5–7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1–18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (−0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT-i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT-i group.
Conclusions
This interactive digital CBT-i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT-i access and uptake.
{"title":"Digital cognitive behavioural therapy for insomnia versus digital sleep education control in an Australian community-based sample: a randomised controlled trial","authors":"Alexander Sweetman, Chelsea Reynolds, Cele Richardson","doi":"10.1111/imj.16521","DOIUrl":"10.1111/imj.16521","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT-i) is the recommended ‘first line’ treatment but is accessed by a minority of people with insomnia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To improve CBT-i access in Australia, we aimed to develop and test a self-guided interactive digital CBT-i program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT-i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ-9), anxiety (GAD-7), fatigue, sleepiness and maladaptive beliefs about sleep at 8-week follow-up. The control group accessed the intervention after the 8-week follow-up. Questionnaires were additionally administered at 16 and 24 weeks. Intent-to-treat mixed models and complete-case chi-squared analyses were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between-group differences in baseline characteristics or missing 8-week data (14.5%). After adjusting for baseline scores, CBT-i was associated with lower insomnia (Diff<sub>adj</sub> (95% CI) = 7.32 (5.0–9.6), <i>P</i> < 0.001, <i>d</i> = 1.64), depression (3.36 (1.3–5.4), <i>p</i> = 0.002, <i>d</i> = 0.84), fatigue (5.2 (2.5–7.9), <i>P</i> < 0.001, <i>d</i> = 1.00) and maladaptive beliefs about sleep (11.0 (4.1–18.0), <i>P</i> = 0.002, <i>d</i> = 0.82), but not anxiety symptoms at 8 weeks (1.84 (−0.1 to 3.8), <i>p</i> = 0.060, <i>d</i> = 0.50). Compared to control, CBT-i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, <i>P</i> < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, <i>P</i> < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT-i group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This interactive digital CBT-i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT-i access and uptake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 11","pages":"1838-1848"},"PeriodicalIF":1.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142208704","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}
Stephanie J. Snedden, Paul Thein, Wee J. Chee, Julia Ong, Ralph Junckerstorff
Background
Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more ‘complex’.
Aims
The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9-year period.
Methods
Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty. We selected 100 consecutive patients discharged from General Medicine at Monash Medical Centre (a tertiary hospital in Melbourne, Australia) in the month of April of each year from 2011 to 2019. For each patient, we retrospectively calculated their burden of comorbidity and their degree of dependency/frailty. Comorbidity was measured using the Charlson Comorbidity Index (CCI), and dependence/frailty was assessed using the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Braden Scale (BS). The BS is a pressure injury risk assessment tool. Additional demographic data were collected, including length of stay, admission and discharge residence, 30-day readmission rate and inpatient mortality.
Results
There was no statistically significant change in the CCI or the Katz ADL. The median BS did however significantly decrease from 19 in 2011 to 16 in 2019 (P = 0.006), reflecting an increased risk of pressure injuries.
Conclusions
Despite a stable level of comorbidity, our finding of a decreasing BS score may suggest that patients are becoming more dependent. This increase in dependency rather than a change in chronic disease burden may be the cause of apparent increasing patient complexity.
背景从轶事来看，患者似乎并不比 10 年前更加不适，但他们似乎仍然更加 "复杂"。研究目的本研究旨在使用客观测量方法评估 9 年间普通内科患者复杂性的变化趋势。我们选取了莫纳什医疗中心（澳大利亚墨尔本的一家三级医院）2011 年至 2019 年每年 4 月份连续出院的 100 名普通内科患者。我们对每位患者的合并症负担和依赖性/虚弱程度进行了回顾性计算。合并症使用夏尔森合并症指数（Charlson Comorbidity Index，CCI）进行测量，依赖性/虚弱程度使用卡茨日常生活活动独立性指数（Katz Index of Independence in Activities of Daily Living，Katz ADL）和布莱登量表（Braden Scale，BS）进行评估。BS 是一种压力损伤风险评估工具。此外，还收集了其他人口统计学数据，包括住院时间、入院和出院居住地、30 天再入院率和住院病人死亡率。但是，BS 中位数从 2011 年的 19 显著下降到 2019 年的 16（P = 0.006），反映出压伤风险增加。结论尽管合并症水平稳定，但我们发现 BS 分数在下降，这可能表明患者的依赖性在增加。依赖性的增加而非慢性疾病负担的变化可能是患者复杂性明显增加的原因。
{"title":"Are our patients becoming more complex? Trends in comorbidity and functional dependence in General Medicine 2011–2019","authors":"Stephanie J. Snedden, Paul Thein, Wee J. Chee, Julia Ong, Ralph Junckerstorff","doi":"10.1111/imj.16505","DOIUrl":"10.1111/imj.16505","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more ‘complex’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty. We selected 100 consecutive patients discharged from General Medicine at Monash Medical Centre (a tertiary hospital in Melbourne, Australia) in the month of April of each year from 2011 to 2019. For each patient, we retrospectively calculated their burden of comorbidity and their degree of dependency/frailty. Comorbidity was measured using the Charlson Comorbidity Index (CCI), and dependence/frailty was assessed using the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Braden Scale (BS). The BS is a pressure injury risk assessment tool. Additional demographic data were collected, including length of stay, admission and discharge residence, 30-day readmission rate and inpatient mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no statistically significant change in the CCI or the Katz ADL. The median BS did however significantly decrease from 19 in 2011 to 16 in 2019 (<i>P</i> = 0.006), reflecting an increased risk of pressure injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite a stable level of comorbidity, our finding of a decreasing BS score may suggest that patients are becoming more dependent. This increase in dependency rather than a change in chronic disease burden may be the cause of apparent increasing patient complexity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 11","pages":"1849-1855"},"PeriodicalIF":1.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142208707","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}
Takotsubo syndrome is a condition characterised by temporary acute left ventricular dysfunction with regional wall abnormalities extending beyond a single coronary artery territory. Initially thought to be benign, this condition, which is challenging to distinguish from acute coronary syndrome, has substantial morbidity and mortality. The mechanism behind this condition remains elusive, but multiple theories have been proposed. Although beta blockers and angiotensin-converting enzyme inhibitors are used as treatments for left ventricular dysfunction, currently, there are no randomised controlled trials to support their use. In this paper, we review the latest evidence regarding aetiologies, pathophysiology, diagnostic criteria, prognosis, complications and management of Takotsubo syndrome.
{"title":"Clinical perspectives: Takotsubo cardiomyopathy","authors":"Jayant Ravindran, David Brieger","doi":"10.1111/imj.16493","DOIUrl":"10.1111/imj.16493","url":null,"abstract":"<p>Takotsubo syndrome is a condition characterised by temporary acute left ventricular dysfunction with regional wall abnormalities extending beyond a single coronary artery territory. Initially thought to be benign, this condition, which is challenging to distinguish from acute coronary syndrome, has substantial morbidity and mortality. The mechanism behind this condition remains elusive, but multiple theories have been proposed. Although beta blockers and angiotensin-converting enzyme inhibitors are used as treatments for left ventricular dysfunction, currently, there are no randomised controlled trials to support their use. In this paper, we review the latest evidence regarding aetiologies, pathophysiology, diagnostic criteria, prognosis, complications and management of Takotsubo syndrome.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"54 11","pages":"1785-1795"},"PeriodicalIF":1.8,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16493","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153898","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}
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