Internal Medicine Journal最新文献

{"title":"ASCIA 2025 Conference Poster Abstracts","authors":"","doi":"10.1111/imj.70240","DOIUrl":"https://doi.org/10.1111/imj.70240","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 S6","pages":"4-53"},"PeriodicalIF":1.5,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626741","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":"Who will review the reviewers? Anonymity and selection processes for peer-reviewers require evaluation","authors":"Mason Crossman, Brandon Stretton, Benjamin Cook, Joshua Kovoor, Aashray Gupta, Weng Onn Chan, Stephen Bacchi","doi":"10.1111/imj.70264","DOIUrl":"10.1111/imj.70264","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 1","pages":"144-145"},"PeriodicalIF":1.5,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632707","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":"Enhancing nationwide awareness of cholesterol treatment in type 1 diabetes (ENACT-T1D): an Australian multi-centre survey of patients and clinicians","authors":"Nick S. R. Lan,&nbsp;Christopher Ryan,&nbsp;Alfrida Rudén,&nbsp;James R. K. Glasby,&nbsp;Natalie Nanayakkara,&nbsp;Yasser Elghattis,&nbsp;Laima Brazionis,&nbsp;Michael L. H. Huang,&nbsp;Sarah Lum,&nbsp;Andrzej S. Januszewski,&nbsp;Richard J. MacIsaac,&nbsp;Regina S. Y. Hong,&nbsp;Johnny Ludvigsson,&nbsp;David N. O'Neal,&nbsp;Neale Cohen,&nbsp;P. Gerry Fegan,&nbsp;Alicia J. Jenkins","doi":"10.1111/imj.70276","DOIUrl":"10.1111/imj.70276","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Type 1 diabetes (T1D) is associated with an increased risk of cardiovascular disease (CVD), yet many patients do not attain recommended lipid targets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aimed to identify patient and clinician factors affecting lipid management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The identified patient- and clinician-related factors should be addressed in future studies and in clinics to optimise lipid management in T1D.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 1","pages":"51-62"},"PeriodicalIF":1.5,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632488","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}

{"title":"Stroke predictors for atrial fibrillation - outside the CHA₂DS₂-VA.","authors":"Billy Quirk, Nicholas D'Elia, Peter M Kistler, Alex Voskoboinik","doi":"10.1111/imj.70269","DOIUrl":"https://doi.org/10.1111/imj.70269","url":null,"abstract":"<p><p>The use of oral anticoagulation to mitigate atrial fibrillation-related stroke is a core component of atrial fibrillation management. Current Australian guidelines use the CHA₂DS₂-VA clinical risk score to risk-stratify patients appropriate for oral anticoagulation. However, the efficacy of the CHA₂DS₂-VA is modest and has numerous limitations in clinical practice. The addition of novel risk factors to these scores may improve their predictive ability. This review article aims to identify clinical risk factors, biochemical markers, electrocardiogram features and cardiac imaging findings outside of the CHA₂DS₂-VA that have been found to increase the risk of stroke for patients with atrial fibrillation. The article proposes future directions using these novel risk factors to help further risk-stratify patients who may have initially been deemed low risk by the CHA₂DS₂-VA score and guide clinicians in prescribing anticoagulation.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632787","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":"Magnetic resonance imaging eligibility for anti-amyloid monoclonal antibody treatment for Alzheimer disease: a single-centre retrospective review for service planning","authors":"Madeleine Healy,&nbsp;Sarah Thomas,&nbsp;Amy Brodtmann","doi":"10.1111/imj.70254","DOIUrl":"10.1111/imj.70254","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 1","pages":"138-139"},"PeriodicalIF":1.5,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632739","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":"Iron deficiency and anaemia in people with inflammatory bowel disease: do we have an ongoing issue of care quality? Crohns Colitis Cure data insights programme","authors":"Brigid Pinnuck,&nbsp;Wai Kin Su,&nbsp;William Wilson,&nbsp;Susan J. Connor,&nbsp;Jane M. Andrews","doi":"10.1111/imj.70282","DOIUrl":"10.1111/imj.70282","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Inflammatory bowel disease (IBD) increases the risk of nutritional deficiencies, particularly iron deficiency (ID). ID and anaemia are not routinely tracked in IBD care, with reported rates of ID in IBD cohorts varying from 23% to 90% worldwide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To examine current rates of iron deficiency and subsequent anaemia in a large national cohort of people under routine IBD care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Rates of ID and/or anaemia were explored in a multisite Australasian IBD point-of-care documentation system – Crohns Colitis Care (CCCare). Patients with a clinical encounter within 14 months were included. ID was defined as serum ferritin &lt;30 μg/L or transferrin saturation &lt;16% (if ferritin &gt;30 μg/L). Anaemia was defined as haemoglobin &lt;130 g/L in men and &lt;115 g/L in women. CCCare was interrogated in September 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 7493 eligible people, 35.2% (<i>n</i> = 2615) had iron studies and haemoglobin recorded. ID was found in 25.4% (<i>n</i> = 663), with a comparable rate among IBD subtypes: 26.1% in Crohns disease, 23.7% in ulcerative colitis and 30.3% in IBD-unclassified. Of those with ID, 22.8% (<i>n</i> = 151) had concurrent anaemia. The most common form of iron replacement was ferric carboxymaltose (<i>n</i> = 67, 69.8%); yet overall, only 96 of 673 (14.5%) with ID were documented to have been given iron replacement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite being a well-known issue in IBD, easily diagnosed and treated, ID remains highly prevalent in routine care in this large real-world cohort. ID is more common than ID with anaemia, yet both likely impair quality of life. Protocolised screening and repletion may be needed to ensure consistency, and approaches such as benchmarking or open data reporting on key performance indicators may need to be implemented to drive change at scale.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 1","pages":"38-42"},"PeriodicalIF":1.5,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632784","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}

{"title":"We still need to think critically about positive thinking in health care","authors":"Lucas J. Dixon,&nbsp;Daniel R. Schweitzer,&nbsp;Joseph Ting","doi":"10.1111/imj.70274","DOIUrl":"10.1111/imj.70274","url":null,"abstract":"&lt;p&gt;We often hear people talk about ‘fighting’, ‘not giving up’ and ‘keeping a positive attitude’ in the face of illness. These expressions are so familiar we rarely stop to think about what they really mean and, importantly, whether they are universally helpful. Almost 20 years ago in the &lt;i&gt;Internal Medicine Journal&lt;/i&gt; article ‘Right’ way to ‘do’ illness? Thinking critically about positive thinking, McGrath &lt;i&gt;et al&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; cautioned against taking this for granted. They noted how people hold different views about what positive thinking means. Perhaps influenced by the word ‘positive’ in the phrase itself, varied interpretations tend to share one assumption – that the thinking &lt;i&gt;they&lt;/i&gt; are referring to is inherently helpful. A closer look reveals important caveats to this assumption. For example, focussing on ‘good’ thoughts or emotions while avoiding ‘bad’ ones may bring short-term comfort, but, if habitually used long term, it may delay evidence-based treatment or hinder end-of-life discussions. Further, a strong social imperative to stay positive could lead to blame and guilt for patients who struggle to maintain it.&lt;/p&gt;&lt;p&gt;Nearly two decades later these assumptions remain, and not just for patients. A recent global survey showed positive thinking was the most popular coping strategy used by healthcare practitioners during COVID-19, ahead of peer support and exercise.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; However, they did not capture what ‘positive’ meant to study participants. Assuming ubiquity of meaning in the face of so many possible interpretations suggests we &lt;i&gt;still&lt;/i&gt; need to think critically about positive thinking. The adaptiveness of any psychological or behavioural strategy likely depends on its sensitivity to context, including personality, illness prognosis and the social environment. Without such nuance, we risk promoting anything with the word ‘positive’ in it as an assumed universal good.&lt;/p&gt;&lt;p&gt;It is imperative that healthcare practitioners, patients and their loved ones have effective ways of coping with the emotional burden of diagnosis and treatment. Therefore, this editorial attempts to clarify the conceptual ambiguity around positive thinking, so that we can develop research programmes and best practices that show how and when to apply it effectively.&lt;/p&gt;&lt;p&gt;People define positive thinking in diverse ways, representing a range of strategies aimed at achieving subjectively favourable outcomes. For example, qualitative research described how patients with cancer had multiple meanings of ‘being positive’ at different stages of their illness and patients’ definitions of positive thinking differed from those of health professionals.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; So, to understand why someone regards thinking as ‘positive’, we must first understand what outcome they are trying to achieve. In the literature, these aims vary. First, positive thinking may represent focussing on good, rather than bad, outcomes.&lt;span&gt;&lt;sup&gt;","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 12","pages":"1979-1982"},"PeriodicalIF":1.5,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632758","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}

{"title":"Clinical decision-making in the care of older adults: practical insights for non-geriatricians","authors":"Isaac K. S. Ng,&nbsp;Grace Rui Si Lim,&nbsp;Yanling Xu,&nbsp;Elaine Ah Gi Lo,&nbsp;Desmond B. Teo,&nbsp;Li Feng Tan","doi":"10.1111/imj.70260","DOIUrl":"10.1111/imj.70260","url":null,"abstract":"<p>Clinical reasoning forms the cornerstone of medical practice and decision-making and directly determines the quality of healthcare services provided to patients. However, in recent years, increasing attention has been directed at strengthening clinical decision-making processes through educational pedagogy in recognition of a diagnostic and medical error epidemic. Amidst a rapidly ageing global population, there will undoubtedly be increasing challenges and complexities in the medical care of older adults with varying degrees of medical comorbidities, functional statuses, as well as differing care goals and needs. Although geriatric medicine as a specialty has developed over the years, with inter-disciplinary collaborations for optimal care of older adult patients, there remains a large proportion of these patients who will be cared for by non-geriatrician generalists and specialists. Therefore, in this article, we hope to provide practical insights in clinical decision-making when caring for older adult patients, specifically looking at common proclivities for cognitive errors in the form of bias and 'noisy' clinical judgements in real-world practice, and discuss multi-levelled strategies that could mitigate these challenges and strengthen the quality of care.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 1","pages":"122-127"},"PeriodicalIF":1.5,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632450","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":"D. James B. St. John, AO, gastroenterologist, mentor and visionary","authors":"Graeme P. Young,&nbsp;Finlay A. Macrae,&nbsp;Geoffrey Hebbard,&nbsp;Alex Boussioutas","doi":"10.1111/imj.70239","DOIUrl":"https://doi.org/10.1111/imj.70239","url":null,"abstract":"&lt;p&gt;Professor D. James B. St. John, AO (‘Jim’) passed away peacefully on August 25, 2025, at age 89, leaving a profound legacy in gastroenterology and colorectal cancer prevention. A Melbourne University graduate, Jim trained at leading hospitals in Melbourne and London before returning to Australia in 1967, first to the Monash University Department of Medicine at Alfred Hospital, after which he became the first full-time Director of Gastroenterology at the Royal Melbourne Hospital and Professor at the University of Melbourne in 1977. There, he led clinical and academic efforts for nearly three decades until ‘retirement’. Although he retired from patient care in 2001, he became Senior Clinical Consultant in the National Cancer Control Initiative (2001–2006), Honorary Senior Associate at Cancer Council Victoria and Honorary Clinical Professorial Fellow at the University of Melbourne. His family commented that full retirement never seemed to eventuate.&lt;/p&gt;&lt;p&gt;Jim's career commenced with pioneering research into gastrointestinal bleeding and colorectal cancer screening. His early studies with Finlay Macrae and Graeme Young on aspirin-induced bleeding and haemoglobin degradation in the gut laid the groundwork for innovations in faecal occult blood testing. Some years later, after coming across the faecal immunochemical test (FIT), he recognised the rationale for using the more sensitive and specific FIT test for human haemoglobin in stool rather than the older guaiac test. Indeed, he participated in the research in which he and colleagues swallowed their own blood to test the specificity of this approach for the selective detection of bleeding from the large bowel, rather than the stomach. This exemplified his scientific rigour and curiosity.&lt;/p&gt;&lt;p&gt;Jim's passionate advocacy for population-based organised colorectal cancer screening began in the late 1970s, leading to the 1991 publication of Australia's screening guidelines through the Australian Gastroenterology Institute, even before the definitive value of the guaiac occult blood tests was proven by randomised controlled trials. He subsequently updated this as an National Health and Medical Research Council Act Guideline for the management of colorectal cancer. His passion was shared globally by early pioneers, including Sidney Winawer, Jack Hardcastle, Jean Faivre, Jack Mandel and Ole Kronborg, who worked together effectively to raise awareness and build the randomised controlled trial-based evidence necessary to ensure that colorectal cancer screening entered mainstream practice and public health policy.&lt;/p&gt;&lt;p&gt;Nationally, Jim's and and his colleagues’ clinical research into the application of FIT technology plus persuasive advocacy was instrumental in establishing Australia's National Bowel Cancer Screening Programme, one of the first countries to use FIT in organised screening. That programme has already saved many lives and is projected to save tens of thousands more. As a result, his honours inc","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 12","pages":"1983-1984"},"PeriodicalIF":1.5,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70239","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145761270","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}

{"title":"Embedding healthy workplace culture into wellbeing curricula","authors":"Jennifer H. Martin,&nbsp;Susannah Bond,&nbsp;Sabe Sabesan","doi":"10.1111/imj.70280","DOIUrl":"10.1111/imj.70280","url":null,"abstract":"<p>Workforce wellbeing – including that of medical students and trainees – has become a global priority in response to increasing challenges such as burnout, workforce shortages and declining productivity. While workplace culture is widely recognised as a key determinant of wellbeing, most existing frameworks and curricula continue to place the burden on individuals, rather than addressing systemic factors. Current wellbeing programmes typically focus on personal behaviours and professionalism, overlooking the crucial influence of organisational culture. To address this gap, a contemporary, holistic approach is needed – one that embeds cultural literacy and systems thinking into wellbeing curricula through lectures, tutorials and case studies. A healthy workplace culture is strongly linked to an empowered workforce, as well as broader improvements in societal mental health and social cohesion. By incorporating these elements, we can better prepare future professionals to lead and sustain human-centred, psychologically safe workplaces. Training providers and accreditation bodies play a pivotal role in driving this shift by setting standards for training environments, curriculum design and accreditation processes as part of fostering a culture of training. The Royal Australasian College of Physicians has commenced this journey, with a statement of intent – ‘Civility Statement’ – and an examination of structures in the College that affect member and staff wellbeing. This work is the commencement of a long journey to improve wellbeing among our trainees and our colleagues.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 1","pages":"93-97"},"PeriodicalIF":1.5,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145603567","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}