Internal Medicine Journal

BACKGROUND: Pleural procedures are essential for the investigation and management of pleural disease and can be associated with significant morbidity and mortality. There is a lack of pleural procedure complication data in the Australia and New Zealand region. AIMS: To review pleural procedure practices at Wollongong Hospital with an emphasis to assess complications, use of thoracic ultrasound, pathology results and compare findings with international data. METHODS: Retrospective analysis of medical records was performed on pleural procedures identified through respiratory specialist trainee logbooks at Wollongong Hospital from January 2018 to December 2021...

BACKGROUND: Pharmaceutical industry exposure is widespread during medical training and may affect education and clinical decision-making. Medical faculties' conflict of interest (COI) policies help to limit this exposure and protect students against commercial influence. AIMS: Our aim was to investigate the prevalence, content, and strength of COI policies at Australian medical schools, and changes since a previous assessment conducted in 2009. METHODS: We identified policies by searching medical school and host university websites in January 2021, and contacted Deans to identify any missed policies...

BACKGROUND: The self-perceived preparedness of medical students to transition into practising junior doctors has implications for patient safety, graduate wellbeing and development of professional identity. AIMS: To examine the impact of changes to final year education and placements and determine key elements that contribute to self-perceived preparedness for transition to work. METHODS: An online survey among final year medical students at one Australian medical school in 2020 (the cohort most affected by the COVID-19 pandemic), exploring overall self-perceived preparedness and specific competencies, including questions in previous Australian Medical Council/Medical Board of Australia annual national surveys...

Novel medicines are entering the market rapidly and are increasingly being used alone or in combination to treat illnesses of every sort. While transforming the lives of many patients, these new therapies have also forced us to reconsider the way we evaluate, use and fund medicines. This article offers a primer to help practitioners understand how the therapeutic landscape is changing and how this might impact on evidence generation, access to interventions, patient experience and quality of care. This article is protected by copyright...

BACKGROUND: Patients with IBD patients are at increased risk of malignancy and infection compared to the general population. AIMS: We aim to identify the risk factors for malignancy or serious infection in our IBD cohort. METHODS: IBD patients at an adult tertiary referral centre were included. Demographic and clinical details including immunosuppressant exposure were collected and medical records were retrospectively screened for adverse events including malignancy or infection requiring hospitalisation...

INTRODUCTION: Substance use disorders cause significant harm to regional Australians, who are more likely to misuse alcohol and other drugs and encounter difficulty accessing treatment services. The primary aims of this study were to describe the demographics of patients aeromedically retrieved from regional locations and compare hospital outcomes with a metropolitan-based cohort. METHODS: Retrospective case-controlled cohort study. Participants were aeromedically retrieved within Western Australia for substance use disorders between 1st July 2014 and 30th June 2019...

BACKGROUND: We aimed to observe, up to 2 years, the effectiveness of initiating first-generation automated insulin delivery for type 1 diabetes management. METHOD: Retrospective, real-world, observational study using medical records, conducted across five sites in Australia. Adults with type 1 diabetes, who had automated insulin delivery initiated between February 2019 and December 2021, were observed for 6-24 months post-initiation (until June 2022). Outcomes examined included glucose metrics assessed by HbA1c and continuous glucose monitoring (CGM), safety, and therapy continuation...

BACKGROUND: There is limited literature on the prevalence of rheumatologic conditions in Australian First Nations people. Existing evidence suggests a high disease burden with poorer outcomes. In 2016 a rheumatology clinic was established at The Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (CoE). AIMS: To improve knowledge of rheumatic diseases presentations in an urban First Nations cohort and to assess the effectiveness of the CoE clinic...

No abstract text is available yet for this article.

INTRODUCTION: GLP-1 receptor agonists (GLP-1 RAreduce elevated blood glucose levels and induce weight loss. Multiple GLP-1 RAs and one combined GLP-1/GIP agonist currently available. This review was conducted with the aim of summarising direct comparisons between subcutaneous semaglutide and other GLP-1 RAs in individuals with type 2 diabetes(T2DM), particularly with respect to efficacy for inducing weight loss and improving other markers of metabolic health. METHODS: This systematic review of PubMed and Embase from inception to early 2022 was registered on PROSPERO, and was conducted in accordance with the PRISMA and MOOSE guidelines...

BACKGROUND: The epidemiology of anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) varies worldwide. Previous Australian studies have described a higher incidence of AAV in rural areas, however this has not yet been investigated in Victoria. AIMS: To calculate the incidence of AAV in rural and regional Victoria and characterise the demographics and clinical outcomes of this cohort. METHODS: We performed a retrospective review of patients with newly diagnosed AAV confirmed on renal biopsy at Bendigo Health between 2013 - 2021...

BACKGROUND: COVID-19 is an infectious disease caused by SARS-CoV-2 with a heterogenous presenting ranging from severe pneumonitis to asymptomatic infection. International studies have demonstrated the utility of Respiratory Care Units (RCUs) to facilitate the delivery of non-invasive ventilation techniques to patients with COVID-19 pneumonitis. AIMS: This study aims to describe the patient characteristics, flow and outcomes of admissions to the Royal Melbourne Hospital (RMH) COVID-19 Respiratory Care Unit (CRCU) during its initial period of operation...

OBJECTIVES: Given treatment-related hypoglycaemia in hospital can lead to adverse outcomes, the Australian Commission on Safety and Quality in Health Care has included hypoglycaemia as reportable hospital-acquired complications (HAC) with financial disincentives. However, designation of hypoglycaemia HACs rely on clinical coding without a defined glucose threshold or clinical context. We assessed the biochemical validity and clinical relevance of hypoglycaemia HACs. METHODS: We performed a retrospective review on patients discharged from the Northern Health hospitals between March-August 2021 that were designated as experiencing a hypoglycaemia HAC...

Findings of prior studies about the efficacy and safety of non-vitamin K antagonist oral anticoagulants in patients(≥80 Years of Age) with atrial fibrillation are controversial. So we perform the meta-analysis to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants versus vitamin-K antagonists (VKAs) in patients(≥80 Years of Age) with atrial fibrillation. A systematic review of PubMed, Cochrane, EmBase, Web of Science, and Chinese BioMedical databases was conducted up to October 1st 2022...

In 2021, the rapid rise in COVID-19 infections put overwhelming demand on health care services. It was recognised that patients could be managed in the community if an appropriate monitoring service existed. Medical students were recruited for roles that combined technology, teamwork and clinical skills. This is an example of how novel roles can provide solutions in times of health care crises.

BACKGROUND: Women with a history of gestational diabetes (GDM) have a high risk of developing diabetes and subsequent cardiovascular disease (CVD). AIM: Assess whether diabetes screening and CVD risk screening occurred in general practice amongst post-partum women with GDM. METHODS: This is a retrospective study of clinical record data of women with GDM, under active GP management, from the MedicineInsight programme, run by Australia's National Prescribing Service (NPS) MedicineWise, with general practice (GP) sites located in Australian throughout January 2015 to March 2021...

BACKGROUND: Inflammatory bowel disease (IBD) therapies now utilise higher doses of immunomodulatory and biologic therapies, predisposing patients to an increased risk of infections. AIMS: We aimed to determine whether infections were associated with high anti-TNF drug levels in IBD and to quantify the risk and consequences of infections. METHODS: Two retrospective studies were performed, a descriptive cohort study and a matched case control study...

Veterans with posttraumatic stress disorder (PTSD) commonly exhibit associated gastrointestinal (GI) symptoms. We compared upper GI endoscopy and abdominal ultrasound rates in veterans with and without PTSD. Veterans with PTSD were 77-81% more likely to undergo these procedures than those without PTSD. PTSD symptomatology influences GI investigation rate and more emphasis on clinician and patient education is recommended regarding stress-related gut symptoms.

Organ donation after voluntary assisted dying (VAD) in Australia may potentially increase organ transplant rates. Despite significant international experience with donation after VAD, there has been little discussion of this in Australia. We review potential ethical and practical concerns relating to donation after VAD and advocate action to establish programmes in Australia that ensure safe, ethical and effective donation after VAD.

Good communication with the patient is the cornerstone of effective and efficient consultation. The absence of a common language between the patient and physician negatively impacts the consultation outcome. Australia is a multicultural and multilingual country, with immigrants from all over the world. In the absence of a common language, it will be a challenging conversation affecting the patient's engagement with the healthcare system and poor treatment adherence. While involving an interpreter may help, it has its downsides and may not be ideal in all situations...