General journals

ABSTRACT Background Colorectal cancer liver metastasis (CRCLM) profoundly impacts the overall survival rates of affected individuals. Although chemotherapy remains a cornerstone of treatment, the variability in tumour response presents a considerable challenge to effective clinical management. Radiomics-based artificial intelligence (AI) modelling, utilising pre-treatment imaging, has been proposed as a tool to predict treatment response and inform therapeutic decision-making. Methods A systematic search using Clarivate (Web of Science) and Ovid (Embase and MEDLINE) from inception to April 8, 2025, was performed in accordance with Preferred Reporting Items for Reviews and Meta-Analysis (PRISMA) guidelines. Studies evaluating the use of AI radiomics models to predict CRCLM response to chemotherapy treatment, alone or in combination with targeted therapies were identified. Full-text review and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Checklist for Diagnostic Test Accuracy Studies. Results Thirteen studies met inclusion criteria. All studies described the development and validation of AI models with no implementation studies. The AI models developed demonstrated a varied ability to predict CRCLM response to chemotherapy. Predictive performance was classified as good in six studies and excellent in three. Model development used differing combinations of imaging modalities (CT or MRI), lesion inclusion criteria, dimensionality (2D vs. 3D), and use of clinical features. Most studies did not validate model performance in an external dataset. Conclusion Radiomics-based AI models show potential in predicting chemotherapy response in CRCLM. However, limited external validation and methodological variability currently restrict clinical applicability. Standardisation and prospective validation are required for clinical translation. [...]

ABSTRACT Background Colorectal cancer liver metastasis (CRCLM) profoundly impacts the overall survival rates of affected individuals. Although chemotherapy remains a cornerstone of treatment, the variability in tumour response presents a considerable challenge to effective clinical management. Radiomics-based artificial intelligence (AI) modelling, utilising pre-treatment imaging, has been proposed as a tool to predict treatment response and inform therapeutic decision-making. Methods A systematic search using Clarivate (Web of Science) and Ovid (Embase and MEDLINE) from inception to April 8, 2025, was performed in accordance with Preferred Reporting Items for Reviews and Meta-Analysis (PRISMA) guidelines. Studies evaluating the use of AI radiomics models to predict CRCLM response to chemotherapy treatment, alone or in combination with targeted therapies were identified. Full-text review and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Checklist for Diagnostic Test Accuracy Studies. Results Thirteen studies met inclusion criteria. All studies described the development and validation of AI models with no implementation studies. The AI models developed demonstrated a varied ability to predict CRCLM response to chemotherapy. Predictive performance was classified as good in six studies and excellent in three. Model development used differing combinations of imaging modalities (CT or MRI), lesion inclusion criteria, dimensionality (2D vs. 3D), and use of clinical features. Most studies did not validate model performance in an external dataset. Conclusion Radiomics-based AI models show potential in predicting chemotherapy response in CRCLM. However, limited external validation and methodological variability currently restrict clinical applicability. Standardisation and prospective validation are required for clinical translation. [...]

ABSTRACT Background While studies have explored the gender gap in scientific literature, there is a scarcity of information on the impact within surgical publications. We examine the gender gap in Plastic and Reconstructive Surgery papers across two prominent Australasian journals. Methods All original clinical science articles published in AJOPS and ANZ Journal of Surgery were reviewed from 2018 to 2024. The gender of the first and last authors, as well as the subspecialty category, type of paper, journal volume, year and issue were entered in a database for further analysis. In addition, we examined whether first author gender was correlated to the gender of the senior faculty with whom they were co-authored. Results A total of 344 papers met the inclusion criteria for the study. Male authorship was more prevalent accounting for 65% in comparison to female authorship at 35%. When selecting for editorials only, male first authors accounted for 83% (43) versus female first authors at 17% (10). Excluding editorials, male first authorship reached 62% (183) while females made up the remaining 38% (108). In terms of senior authorship, males accounted for 80% (234) versus 20% (59). Conclusion Despite some fluctuation, our findings demonstrate a persistent disequilibrium in gender representation in the chosen journals which likely reflects the current disparity in the profession. Whether the increased recruitment and retention of female trainees and surgeons, is gradually translating to publication output, is not entirely understood. Further research is needed to identify and address the barriers to publication experienced by women in plastic surgery. [...]

ABSTRACT Background While studies have explored the gender gap in scientific literature, there is a scarcity of information on the impact within surgical publications. We examine the gender gap in Plastic and Reconstructive Surgery papers across two prominent Australasian journals. Methods All original clinical science articles published in AJOPS and ANZ Journal of Surgery were reviewed from 2018 to 2024. The gender of the first and last authors, as well as the subspecialty category, type of paper, journal volume, year and issue were entered in a database for further analysis. In addition, we examined whether first author gender was correlated to the gender of the senior faculty with whom they were co-authored. Results A total of 344 papers met the inclusion criteria for the study. Male authorship was more prevalent accounting for 65% in comparison to female authorship at 35%. When selecting for editorials only, male first authors accounted for 83% (43) versus female first authors at 17% (10). Excluding editorials, male first authorship reached 62% (183) while females made up the remaining 38% (108). In terms of senior authorship, males accounted for 80% (234) versus 20% (59). Conclusion Despite some fluctuation, our findings demonstrate a persistent disequilibrium in gender representation in the chosen journals which likely reflects the current disparity in the profession. Whether the increased recruitment and retention of female trainees and surgeons, is gradually translating to publication output, is not entirely understood. Further research is needed to identify and address the barriers to publication experienced by women in plastic surgery. [...]

ABSTRACT Background Renal vein and caval tumour extension occurs in 10%–25% of patients with renal cell carcinoma. This study aims to examine perioperative morbidity and survival outcomes after radical nephrectomy with inferior vena cava tumour thrombectomy at a quaternary institution in Australia. Methods This was a retrospective review of nephrectomy with tumour thrombectomy cases between June 2012 and 2022 at a single centre, followed up until September 2024. Overall survival (OS) was visualised by Kaplan–Meier plots and comparisons between survival by presence of metastases, margin status, and thrombus level (I-III vs. IV) were explored with the log-rank test. Recurrence-free survival (RFS) in patients without initial metastases was also examined. Results We identified 39 patients, 25 (64%) were male and the median (IQR) age was 64 years (55–69). Metastatic disease was present in 14 patients (36%). Nineteen (49%) had level IV (supradiaphragmatic) tumour thrombus involvement. Six patients (15%) died in hospital, including two intraoperative deaths. A further 14 (36%) experienced Clavien-Dindo grade III or IV complications during their hospital stay. The median OS was 57 months (95% CI: 17–not reached). Excluding those who died in hospital, the median OS was 60 months (95% CI: 33–not reached). There was a significant difference in OS observed by the presence of metastatic disease (p = 0.003), but not with margin status (p = 0.35) or thrombus level (p = 0.22). The median RFS for M0 patients was 60 months (95% CI: 8–not reached). Conclusion While associated with high morbidity and mortality, nephrectomy and caval thrombectomy remain an effective treatment option for otherwise fatal advanced RCC. [...]

ABSTRACT Background Renal vein and caval tumour extension occurs in 10%–25% of patients with renal cell carcinoma. This study aims to examine perioperative morbidity and survival outcomes after radical nephrectomy with inferior vena cava tumour thrombectomy at a quaternary institution in Australia. Methods This was a retrospective review of nephrectomy with tumour thrombectomy cases between June 2012 and 2022 at a single centre, followed up until September 2024. Overall survival (OS) was visualised by Kaplan–Meier plots and comparisons between survival by presence of metastases, margin status, and thrombus level (I-III vs. IV) were explored with the log-rank test. Recurrence-free survival (RFS) in patients without initial metastases was also examined. Results We identified 39 patients, 25 (64%) were male and the median (IQR) age was 64 years (55–69). Metastatic disease was present in 14 patients (36%). Nineteen (49%) had level IV (supradiaphragmatic) tumour thrombus involvement. Six patients (15%) died in hospital, including two intraoperative deaths. A further 14 (36%) experienced Clavien-Dindo grade III or IV complications during their hospital stay. The median OS was 57 months (95% CI: 17–not reached). Excluding those who died in hospital, the median OS was 60 months (95% CI: 33–not reached). There was a significant difference in OS observed by the presence of metastatic disease (p = 0.003), but not with margin status (p = 0.35) or thrombus level (p = 0.22). The median RFS for M0 patients was 60 months (95% CI: 8–not reached). Conclusion While associated with high morbidity and mortality, nephrectomy and caval thrombectomy remain an effective treatment option for otherwise fatal advanced RCC. [...]

Hundreds of thousands of children are set to be lifted out of poverty, as the UK government has announced that it will end the limit restricting universal credit support to two children per family.The announcement—part of the autumn budget that was leaked by the Office for Budget Responsibility (OBR) ahead of a speech by the chancellor of the exchequer, Rachel Reeves—said that the two child benefit cap would be lifted from April 2026. Its removal would cost £2.3bn in 2026-27 and £3bn in 2029-30, said the OBR.This comes after a year and a half of political infighting within the Labour Party over the cap and other welfare decisions, such as previously proposed disability cuts.1 Some 4.5 million children—nearly one in three (31%)—are estimated to be living in poverty in the UK.In a speech at the King’s Fund yesterday the health secretary, Wes Streeting, called the two child limit “a terrible... [...]

As a final year medical student who is transitioning to a career in medicine after a 25 year career in professional services, I’m pleased that NHS England has mandated a 10 point plan to improve the working conditions of resident doctors, and particularly the senior level oversight and transparent reporting to ensure the changes are delivered.1I do, however, have three main concerns. Firstly, that doctors will view this as too little too late. There has been a real breakdown in trust between the Department of Health and Social Care and NHS England and the resident doctor community. This is not helped by recent non-pay changes agreed in the 2024-25 pay negotiations not being delivered—for example, exception reporting changes. The government really needs to focus on rebuilding trust with resident doctors so that we can move beyond the current stalemate.Secondly, the changes being requested are welcome but don’t cover many of... [...]

The case for a greater focus on medical “expert generalists” in the NHS has been in the health policy news recently. The NHS England diagnostic review of postgraduate medical training, which I discussed in my last BMJ column,1 was clear on the need for more doctors with good generalist skills, to reflect the reality that our ageing population has a growing number of people with multiple long term conditions. Chris Whitty, lead coauthor of that report and chief medical officer for England, made a similar case in his 2023 report Health in an Ageing Society,2 calling for doctors with the training, skills, and mindset to support a population with those changing needs.Doctors will increasingly be caring for patients with undifferentiated symptoms or several simultaneous conditions, often compounded by frailty or by age related cognitive or functional impairment. These patients need multiple medicines and have competing management priorities and trade-offs, use... [...]

Adding fluoride to drinking water has no negative effect on cognitive ability and may even confer a small cognitive benefit, research has found.1The finding comes as the public health practice of adding fluoride to drinking water faces increasing scrutiny in the US and the UK. Robert F Kennedy Jr, the US health secretary, has repeatedly criticised the adding of fluoride to water supplies, calling it “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”Kennedy said this month that “the Trump White House will advise all US water systems to remove fluoride from public water.”2 In March this year Utah became the first US state to ban fluoride in public drinking water, despite opposition from the American Dental Association and the American Academy of Pediatrics.3Around 63% of the US population have fluoridated water. Most of western Europe does not add fluoride to its... [...]

Groping out of my sedation, halfway conscious, halfway not, hallucinatory and maybe not, [...]

Groping out of my sedation, halfway conscious, halfway not, hallucinatory and maybe not, [...]

This Viewpoint discusses the effect of changes in vaccine policies on public health and strategies for reversing the policies’ direction. [...]

This Viewpoint discusses the effect of changes in vaccine policies on public health and strategies for reversing the policies’ direction. [...]

Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA. [...]

Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA. [...]

This meta-analysis evaluates the prevalence and characteristics of discordance between creatinine- and cystatin C–based estimated glomerular filtration rate as well as the association of discordance with adverse outcomes. [...]

This meta-analysis evaluates the prevalence and characteristics of discordance between creatinine- and cystatin C–based estimated glomerular filtration rate as well as the association of discordance with adverse outcomes. [...]

Chronic kidney disease (CKD) affects more than 800 million people worldwide, significantly increasing the risk for kidney failure, cardiovascular disease, and all-cause mortality. Accurate assessment of glomerular filtration rate (GFR) is essential for identifying and managing CKD. Although GFR is most accurately measured by analyzing the rate of kidney excretion of infused exogenous substances, such as inulin or iohexol, this is not practical in most cases. Therefore, estimated glomerular filtration rates (eGFRs) have become important for CKD diagnosis and management. [...]

Chronic kidney disease (CKD) affects more than 800 million people worldwide, significantly increasing the risk for kidney failure, cardiovascular disease, and all-cause mortality. Accurate assessment of glomerular filtration rate (GFR) is essential for identifying and managing CKD. Although GFR is most accurately measured by analyzing the rate of kidney excretion of infused exogenous substances, such as inulin or iohexol, this is not practical in most cases. Therefore, estimated glomerular filtration rates (eGFRs) have become important for CKD diagnosis and management. [...]

The JAMA Insights titled “Microplastics and Human Health,” published on October 15, 2025, was corrected to fix the spelling of a coauthor’s surname. This article was corrected online. [...]

The JAMA Insights titled “Microplastics and Human Health,” published on October 15, 2025, was corrected to fix the spelling of a coauthor’s surname. This article was corrected online. [...]

When scientists gather, it is not uncommon for them to lament a decline in the public's trust of science. The examples are well described: anti-vaccination movements, climate scepticism, COVID-19 conspiracy theories. But are we talking ourselves into premature failure? In October, 2024, the Pew Research Center surveyed 9593 US adults “to understand how Americans view scientists and their role in making public policy”. The survey was carefully designed to represent the US adult population in terms of gender, race, ethnicity, education, and political affiliation. [...]

We read the Article by Graham S Cooke and colleagues1 exploring strategies to optimise treatment for hepatitis C virus (HCV) infection. Their investigation into response-guided therapy (RGT) is particularly pertinent as clinicians seek to personalise treatment duration while maintaining high cure rates. [...]

We thank Lei Xu and Wenzhe Zhao for their interesting observations focused on response-guided therapy in the era of direct-acting antivirals. We support their view that strategies proposed to date to select those patients with hepatitis C infection who could be cured with 4 weeks (ultra-short) treatment are still not able to offer high enough cure rates to be recommended routinely. However, it is worth noting that, in our trial,1 the 80% sustained virological response at week 12 rates in patients selected for 4 weeks of treatment, based on day 7 viral load under the lower limit of quantification, is the highest of studies to date. [...]

Following the formation of the Lancet Commission on disability and health,1 it is essential that young people with disabilities in humanitarian settings are not overlooked. In 2019, the UN Security Council adopted an urgent call to respect the rights of people with disabilities in conflict under the Convention on the Rights of Persons with Disabilities (2006).2 According to UNICEF, 13% of children worldwide aged 5–17 years have a disability, with higher levels in regions impacted by armed conflict. [...]

The recent announcement of the Lancet Commission on disability and health offers a vital platform for advancing disability-inclusive health systems.1 However, it falls short by not explicitly naming how interlocking systems of discrimination, such as racism (eg, anti-Indigenous and anti-Black racism), homophobia, and transphobia, intersect with ableism to compound and worsen health outcomes for people with disabilities. [...]

Chairing a Lancet Commission is a daunting challenge.1 Our task is particularly great as we are leading the first Commission focused on disability, and it should encompass the experience of 1·3 billion people with disabilities globally.2 We will need to present the overall health inequalities experienced by people with disabilities, the solutions required to reduce those gaps, the economic case for addressing this inequity, and consider why the topic is not yet a global priority. At the same time, we must recognise that people with disabilities are an enormously diverse group, including people with different impairment types, ages, sexes, geographies, etc. [...]

The destruction of Gaza's health system represents one of the worst humanitarian crises of our time and demands a response from professional health organisations. European public health associations have objected to the “scale and intensity of the destruction being wrought by the Israel Defense Forces, creating a virtually complete collapse of the health and social systems in Gaza”,1,2 but other professional health associations have remained largely silent—or worse, have actively silenced members advocating for Palestinian health. [...]

Guerrero ME, Daniels DV, Makkar RR, et al. Percutaneous transcatheter valve replacement in individuals with mitral regurgitation unsuitable for surgery or transcatheter edge-to-edge repair: a prospective, multicountry, single-arm trial. Lancet 2025; 406: 2541–50—In figure 2A of this Article, the p value should have read “p [...]

There was a strange sense of relief at the eighth replenishment conference for The Global Fund to Fight AIDS, Tuberculosis and Malaria, which took place on Nov 21, in South Africa. The USA is by far the Global Fund's largest donor and its pledge of US$4·6 billion, while much less than the $6 billion it gave in 2022, surprised many, given the Trump administration's scorched earth policy in global health. Still, the total of $11·34 billion pledged, far short of the $18 billion target, was disappointing, if not surprising. [...]

Advocate for survivors of sexual and domestic violence and legal campaigner. She was born in Englewood, NJ, USA, on Aug 8, 1946, and died from cancer in New York City, NY, USA, on Sept 6, 2025, aged 79 years. [...]

Science and scientists are under assault. From denial of vaccines to climate change, political leaders are increasingly sacrificing democracy as well as science on the altar of populism and authoritarianism. While scientists often see the result of such attacks on science and scientific institutions through loss of funding or jobs, they are sometimes naive about the underlying forces behind such attacks, weakening their ability to fight back. [...]

“One thing about South Asian populations is that we do have a very different presentation of diabetes, partly due to our genetics, partly due to migration pressures”, says Rohini Mathur, Professor and Chair of Health Data Science at Queen Mary University of London (QMUL), UK. Factors such as these affect care pathways and quality of life not only in the subcontinent, but also across diaspora populations. As an example, Mathur, whose work spans projects in India, Thailand, and the UK, explains how “in the standard NHS guidelines, type 2 diabetes diagnosis criteria usually look at high BMI and older age. [...]

Journal of Internal Medicine, Volume 299, Issue 1, Page 1-1, January 2026. [...]

Abstract Background Studies suggest an increase in autoimmune diseases following SARS-CoV-2 infection and/or COVID-19-vaccination. We aimed to describe possible associations in Norway. Methods We used information from the emergency preparedness register for COVID-19, BeredtC19, for all residents aged 18–64 (N = 3,450,080). BeredtC19 includes data from mandatory nationwide registers on demographics, SARS-CoV-2 tests, deaths, vaccinations, and hospitalizations. Cox regression was used to estimate adjusted hazard ratios (aHRs) for 30-day and 30–180 day risk windows. Findings SARS-CoV-2 infection was associated with an increased risk of purpura, thrombocytopenia, and agranulocytosis within 30 days and 30–180 days. In the first 30 days, Bell's palsy and inflammatory arthritis were associated with infection, whereas 30–180 days postinfection showed an association with polyneuropathy. Vaccination was associated with an increased risk of inflammatory bowel disease (IBD) and celiac disease, both in the first 30 days and 30–180 days postvaccination. Additionally, in the first 30 days postvaccination, we found associations with inflammatory arthritis and erythema nodosum, and between 30 and 180 days with arthralgia, agranulocytosis, and acute disseminated encephalomyelitis (ADEM). There was also a reduced risk of dermatopolymyositis 30–180 days postvaccination. Interpretation Most autoimmune disorders showed no significant association with SARS-CoV-2 infection or COVID-19 vaccination. Associations between vaccination and IBD and ADEM warrant further investigations, as these observations reflect associations and do not establish causality. [...]

Abstract Background Studies suggest an increase in autoimmune diseases following SARS-CoV-2 infection and/or COVID-19-vaccination. We aimed to describe possible associations in Norway. Methods We used information from the emergency preparedness register for COVID-19, BeredtC19, for all residents aged 18–64 (N = 3,450,080). BeredtC19 includes data from mandatory nationwide registers on demographics, SARS-CoV-2 tests, deaths, vaccinations, and hospitalizations. Cox regression was used to estimate adjusted hazard ratios (aHRs) for 30-day and 30–180 day risk windows. Findings SARS-CoV-2 infection was associated with an increased risk of purpura, thrombocytopenia, and agranulocytosis within 30 days and 30–180 days. In the first 30 days, Bell's palsy and inflammatory arthritis were associated with infection, whereas 30–180 days postinfection showed an association with polyneuropathy. Vaccination was associated with an increased risk of inflammatory bowel disease (IBD) and celiac disease, both in the first 30 days and 30–180 days postvaccination. Additionally, in the first 30 days postvaccination, we found associations with inflammatory arthritis and erythema nodosum, and between 30 and 180 days with arthralgia, agranulocytosis, and acute disseminated encephalomyelitis (ADEM). There was also a reduced risk of dermatopolymyositis 30–180 days postvaccination. Interpretation Most autoimmune disorders showed no significant association with SARS-CoV-2 infection or COVID-19 vaccination. Associations between vaccination and IBD and ADEM warrant further investigations, as these observations reflect associations and do not establish causality. [...]

Abstract Background Individuals with psoriasis have a high prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD), yet the association between MASLD as a cardiometabolic risk factor and cardiac manifestations in this population remains unclear. Objectives We aimed to evaluate associations between MASLD, cardiometabolic risk factors, and cardiac structure and function in adults with psoriasis. Methods We performed a cross-sectional analysis of 255 adults with psoriasis prospectively enrolled. Participants underwent transthoracic echocardiography and transient elastography. MASLD was defined by hepatic steatosis with a controlled attenuation parameter of ≥250 dB/m and the presence of ≥1 cardiometabolic risk factor(s), excluding other liver disease causes. Cardiac structure and function were compared between individuals with psoriasis and MASLD and those without MASLD. Associations between MASLD and myocardial dysfunction were assessed in uni- and multivariable regression models. Results MASLD was present in 92 participants (36.1%), of whom 5 (5.4%) had evidence of increased liver stiffness. Those with MASLD exhibited higher blood pressure, body mass index (BMI), and more adverse cardiometabolic profiles. MASLD was associated with cardiac structural changes and worse diastolic and systolic function. After adjusting for age, sex, and BMI, most associations were attenuated. In fully adjusted models, higher BMI and diabetes, but not MASLD, were independently associated with myocardial dysfunction. Conclusions In adults with psoriasis, the association between MASLD and cardiac structural and functional changes was attenuated after adjusting for BMI and cardiometabolic risk factors, underscoring the importance of cardiometabolic risk factor control, in particular of obesity and diabetes, in psoriasis with concomitant MASLD. [...]

Abstract Background Individuals with psoriasis have a high prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD), yet the association between MASLD as a cardiometabolic risk factor and cardiac manifestations in this population remains unclear. Objectives We aimed to evaluate associations between MASLD, cardiometabolic risk factors, and cardiac structure and function in adults with psoriasis. Methods We performed a cross-sectional analysis of 255 adults with psoriasis prospectively enrolled. Participants underwent transthoracic echocardiography and transient elastography. MASLD was defined by hepatic steatosis with a controlled attenuation parameter of ≥250 dB/m and the presence of ≥1 cardiometabolic risk factor(s), excluding other liver disease causes. Cardiac structure and function were compared between individuals with psoriasis and MASLD and those without MASLD. Associations between MASLD and myocardial dysfunction were assessed in uni- and multivariable regression models. Results MASLD was present in 92 participants (36.1%), of whom 5 (5.4%) had evidence of increased liver stiffness. Those with MASLD exhibited higher blood pressure, body mass index (BMI), and more adverse cardiometabolic profiles. MASLD was associated with cardiac structural changes and worse diastolic and systolic function. After adjusting for age, sex, and BMI, most associations were attenuated. In fully adjusted models, higher BMI and diabetes, but not MASLD, were independently associated with myocardial dysfunction. Conclusions In adults with psoriasis, the association between MASLD and cardiac structural and functional changes was attenuated after adjusting for BMI and cardiometabolic risk factors, underscoring the importance of cardiometabolic risk factor control, in particular of obesity and diabetes, in psoriasis with concomitant MASLD. [...]

Abstract Background The long-term risk across severity strata of people infected with SARS-CoV-2 has not yet been comprehensively described. Methods Using nationwide registries, all COVID-19 cases in Sweden with [...]

Abstract Background The long-term risk across severity strata of people infected with SARS-CoV-2 has not yet been comprehensively described. Methods Using nationwide registries, all COVID-19 cases in Sweden with [...]

Abstract Background and objective Post-infectious sequelae can increase burden on healthcare systems. We aimed to assess the long-term effect of COVID-19 on healthcare utilization across all levels of care. Methods In this register-based cohort study, we included all adult (≥18 years) residents in Sweden's two largest counties with a registered COVID-19 index date between 31 January 2020 and 9 February 2022. Each exposed individual was matched 1:1 to a control without registered COVID-19 on index date based on gender, birth year, vaccination status and the change in number of healthcare contacts between 2018 and 2019. We counted the number of healthcare contacts across all levels of care during the pre-index (13–1 months) and post-index (4–15 months) full-year periods. A difference-in-difference (DID) analysis was used to assess changes in the number of healthcare contacts and specific diagnoses, between each individual's pre- and post-periods, as well as comparing individuals with and without COVID-19. Results The study included 753,905 matched pairs, comprising 1,415,432 unique individuals. Trends in healthcare contacts were parallel between the matched groups prior to the index date. The DID analysis revealed a mean increase of 0.33 (95%CI 0.30–0.36) healthcare contacts following COVID-19, mainly observed from a smaller proportion of the population (5%) and by contacts with primary healthcare. The largest diagnosis-specific difference was observed for reactions to severe stress (0.02, 0.01–0.03). The estimate varied across gender, acute COVID-19 severity, virus variant period and vaccination status. Conclusion This study demonstrates increased healthcare utilization after COVID-19 in a smaller proportion of the population. [...]

Abstract Background and objective Post-infectious sequelae can increase burden on healthcare systems. We aimed to assess the long-term effect of COVID-19 on healthcare utilization across all levels of care. Methods In this register-based cohort study, we included all adult (≥18 years) residents in Sweden's two largest counties with a registered COVID-19 index date between 31 January 2020 and 9 February 2022. Each exposed individual was matched 1:1 to a control without registered COVID-19 on index date based on gender, birth year, vaccination status and the change in number of healthcare contacts between 2018 and 2019. We counted the number of healthcare contacts across all levels of care during the pre-index (13–1 months) and post-index (4–15 months) full-year periods. A difference-in-difference (DID) analysis was used to assess changes in the number of healthcare contacts and specific diagnoses, between each individual's pre- and post-periods, as well as comparing individuals with and without COVID-19. Results The study included 753,905 matched pairs, comprising 1,415,432 unique individuals. Trends in healthcare contacts were parallel between the matched groups prior to the index date. The DID analysis revealed a mean increase of 0.33 (95%CI 0.30–0.36) healthcare contacts following COVID-19, mainly observed from a smaller proportion of the population (5%) and by contacts with primary healthcare. The largest diagnosis-specific difference was observed for reactions to severe stress (0.02, 0.01–0.03). The estimate varied across gender, acute COVID-19 severity, virus variant period and vaccination status. Conclusion This study demonstrates increased healthcare utilization after COVID-19 in a smaller proportion of the population. [...]

Abstract Cryoglobulinemia (CG) is defined by the presence of serum immunoglobulins that precipitate below 37°C and redissolve upon rewarming. It is classified into three types based on immunoglobulin composition. Type I, a rare form, involves monoclonal IgM or IgG and is linked to lymphoproliferative disorders. Types II and III are known as mixed CG (MC): Type II consists of polyclonal IgG and monoclonal IgM with rheumatoid factor (RF) activity, whereas Type III includes polyclonal IgG and polyclonal IgM with RF activity. MC is predominantly associated with hepatitis C virus (HCV) infection and involves B-cell lymphoproliferation and autoantibody production. CG may lead to systemic vasculopathy, ranging from mild symptoms (purpura, asthenia, and arthralgia) to severe complications such as skin ulcers, peripheral neuropathy, renal involvement, and non-Hodgkin lymphoma. Compared to MC, Type I is more often marked by severe cutaneous involvement (ulcers, gangrene), hyperviscosity, and a higher risk of morbidity due to the underlying hematologic malignancy. Management of Type I requires control of vasculopathy and treatment of the hematologic neoplasm, whereas MC demands antiviral therapy in all HCV-associated or hepatitis B virus–associated cases. Severe vasculopathy in both types may benefit from corticosteroids, immunomodulators, anti-CD20 monoclonal antibodies, and plasma exchange. A multidisciplinary approach is essential for addressing both etiology and complications, thereby improving outcomes. This review summarizes the pathophysiology, clinical features, recent etiopathogenetic insights, and therapeutic advances related to the various forms of CG. [...]

Abstract Cryoglobulinemia (CG) is defined by the presence of serum immunoglobulins that precipitate below 37°C and redissolve upon rewarming. It is classified into three types based on immunoglobulin composition. Type I, a rare form, involves monoclonal IgM or IgG and is linked to lymphoproliferative disorders. Types II and III are known as mixed CG (MC): Type II consists of polyclonal IgG and monoclonal IgM with rheumatoid factor (RF) activity, whereas Type III includes polyclonal IgG and polyclonal IgM with RF activity. MC is predominantly associated with hepatitis C virus (HCV) infection and involves B-cell lymphoproliferation and autoantibody production. CG may lead to systemic vasculopathy, ranging from mild symptoms (purpura, asthenia, and arthralgia) to severe complications such as skin ulcers, peripheral neuropathy, renal involvement, and non-Hodgkin lymphoma. Compared to MC, Type I is more often marked by severe cutaneous involvement (ulcers, gangrene), hyperviscosity, and a higher risk of morbidity due to the underlying hematologic malignancy. Management of Type I requires control of vasculopathy and treatment of the hematologic neoplasm, whereas MC demands antiviral therapy in all HCV-associated or hepatitis B virus–associated cases. Severe vasculopathy in both types may benefit from corticosteroids, immunomodulators, anti-CD20 monoclonal antibodies, and plasma exchange. A multidisciplinary approach is essential for addressing both etiology and complications, thereby improving outcomes. This review summarizes the pathophysiology, clinical features, recent etiopathogenetic insights, and therapeutic advances related to the various forms of CG. [...]

Abstract Background The microbiota–gut–brain axis has been implicated in dementia. Yet whether dementia is associated with microscopic colitis (MC), an age-related inflammatory colonic disease involving gut dysbiosis, remains unknown. Methods Using the nationwide ESPRESSO cohort in Sweden, we compared MC patients histologically diagnosed 1990–2017 and aged ≥30 years to their population-based comparators and siblings, separately. MC association with incident and prevalent dementia diagnosis, respectively, was investigated in a matched cohort and a matched case-control design. Findings Following 13,037 MC patients and 61,710 population comparators for a median of ∼10 years, we observed 4674 incident dementia cases (46% were Alzheimer's disease [AD]). During the first 5 years since biopsy, MC was associated with a 19% higher dementia risk (adjusted hazard ratio [aHR]: 1.19; 95% confidence interval [CI]: 1.07–1.32). This short-term association applied to both AD and vascular dementia and appeared stronger as compared to siblings (aHR: 1.55; 95% CI: 1.22–1.97). After 5 years, it attenuated to null in both comparisons, regardless of dementia subtype. Prior dementia was less prevalent in MC (adjusted odds ratio [aOR]: 0.73; 95% CI: 0.65–0.82). This inverse association was independent from medications commonly prescribed in MC but was not supported by sibling findings (aOR: 1.11; 95% CI: 0.81–1.51). Conclusions MC patients may be more vulnerable to dementia diagnosis in early disease course. The intriguing inverse association between MC and preexisting dementia implies a possible underdiagnosis of MC in demented population and warrants further investigation. [...]

ABSTRACT Minimally invasive oesphagectomy has been found to reduce complications, length of stay and have improved post-operative quality of life compared to open oesophagectomy. Multiple techniques of the oesophagogastric anastomosis have been described in Australia including a three-stage approach with a neck anastomosis and a two-stage approach utilising the trans-orally placed anvil. We describe a two-stage approach with an intra-thoracic hand-sewn anastomosis for a junctional oesophageal cancer. [...]

ANZ Journal of Surgery, EarlyView. [...]

ANZ Journal of Surgery, EarlyView. [...]

ANZ Journal of Surgery, EarlyView. [...]

ANZ Journal of Surgery, EarlyView. [...]

ABSTRACT Background Colorectal cancer liver metastasis (CRCLM) profoundly impacts the overall survival rates of affected individuals. Although chemotherapy remains a cornerstone of treatment, the variability in tumour response presents a considerable challenge to effective clinical management. Radiomics-based artificial intelligence (AI) modelling, utilising pre-treatment imaging, has been proposed as a tool to predict treatment response and inform therapeutic decision-making. Methods A systematic search using Clarivate (Web of Science) and Ovid (Embase and MEDLINE) from inception to April 8, 2025, was performed in accordance with Preferred Reporting Items for Reviews and Meta-Analysis (PRISMA) guidelines. Studies evaluating the use of AI radiomics models to predict CRCLM response to chemotherapy treatment, alone or in combination with targeted therapies were identified. Full-text review and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Checklist for Diagnostic Test Accuracy Studies. Results Thirteen studies met inclusion criteria. All studies described the development and validation of AI models with no implementation studies. The AI models developed demonstrated a varied ability to predict CRCLM response to chemotherapy. Predictive performance was classified as good in six studies and excellent in three. Model development used differing combinations of imaging modalities (CT or MRI), lesion inclusion criteria, dimensionality (2D vs. 3D), and use of clinical features. Most studies did not validate model performance in an external dataset. Conclusion Radiomics-based AI models show potential in predicting chemotherapy response in CRCLM. However, limited external validation and methodological variability currently restrict clinical applicability. Standardisation and prospective validation are required for clinical translation. [...]

ABSTRACT Background Colorectal cancer liver metastasis (CRCLM) profoundly impacts the overall survival rates of affected individuals. Although chemotherapy remains a cornerstone of treatment, the variability in tumour response presents a considerable challenge to effective clinical management. Radiomics-based artificial intelligence (AI) modelling, utilising pre-treatment imaging, has been proposed as a tool to predict treatment response and inform therapeutic decision-making. Methods A systematic search using Clarivate (Web of Science) and Ovid (Embase and MEDLINE) from inception to April 8, 2025, was performed in accordance with Preferred Reporting Items for Reviews and Meta-Analysis (PRISMA) guidelines. Studies evaluating the use of AI radiomics models to predict CRCLM response to chemotherapy treatment, alone or in combination with targeted therapies were identified. Full-text review and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Checklist for Diagnostic Test Accuracy Studies. Results Thirteen studies met inclusion criteria. All studies described the development and validation of AI models with no implementation studies. The AI models developed demonstrated a varied ability to predict CRCLM response to chemotherapy. Predictive performance was classified as good in six studies and excellent in three. Model development used differing combinations of imaging modalities (CT or MRI), lesion inclusion criteria, dimensionality (2D vs. 3D), and use of clinical features. Most studies did not validate model performance in an external dataset. Conclusion Radiomics-based AI models show potential in predicting chemotherapy response in CRCLM. However, limited external validation and methodological variability currently restrict clinical applicability. Standardisation and prospective validation are required for clinical translation. [...]

ABSTRACT Background While studies have explored the gender gap in scientific literature, there is a scarcity of information on the impact within surgical publications. We examine the gender gap in Plastic and Reconstructive Surgery papers across two prominent Australasian journals. Methods All original clinical science articles published in AJOPS and ANZ Journal of Surgery were reviewed from 2018 to 2024. The gender of the first and last authors, as well as the subspecialty category, type of paper, journal volume, year and issue were entered in a database for further analysis. In addition, we examined whether first author gender was correlated to the gender of the senior faculty with whom they were co-authored. Results A total of 344 papers met the inclusion criteria for the study. Male authorship was more prevalent accounting for 65% in comparison to female authorship at 35%. When selecting for editorials only, male first authors accounted for 83% (43) versus female first authors at 17% (10). Excluding editorials, male first authorship reached 62% (183) while females made up the remaining 38% (108). In terms of senior authorship, males accounted for 80% (234) versus 20% (59). Conclusion Despite some fluctuation, our findings demonstrate a persistent disequilibrium in gender representation in the chosen journals which likely reflects the current disparity in the profession. Whether the increased recruitment and retention of female trainees and surgeons, is gradually translating to publication output, is not entirely understood. Further research is needed to identify and address the barriers to publication experienced by women in plastic surgery. [...]

ABSTRACT Background While studies have explored the gender gap in scientific literature, there is a scarcity of information on the impact within surgical publications. We examine the gender gap in Plastic and Reconstructive Surgery papers across two prominent Australasian journals. Methods All original clinical science articles published in AJOPS and ANZ Journal of Surgery were reviewed from 2018 to 2024. The gender of the first and last authors, as well as the subspecialty category, type of paper, journal volume, year and issue were entered in a database for further analysis. In addition, we examined whether first author gender was correlated to the gender of the senior faculty with whom they were co-authored. Results A total of 344 papers met the inclusion criteria for the study. Male authorship was more prevalent accounting for 65% in comparison to female authorship at 35%. When selecting for editorials only, male first authors accounted for 83% (43) versus female first authors at 17% (10). Excluding editorials, male first authorship reached 62% (183) while females made up the remaining 38% (108). In terms of senior authorship, males accounted for 80% (234) versus 20% (59). Conclusion Despite some fluctuation, our findings demonstrate a persistent disequilibrium in gender representation in the chosen journals which likely reflects the current disparity in the profession. Whether the increased recruitment and retention of female trainees and surgeons, is gradually translating to publication output, is not entirely understood. Further research is needed to identify and address the barriers to publication experienced by women in plastic surgery. [...]

ABSTRACT Background Renal vein and caval tumour extension occurs in 10%–25% of patients with renal cell carcinoma. This study aims to examine perioperative morbidity and survival outcomes after radical nephrectomy with inferior vena cava tumour thrombectomy at a quaternary institution in Australia. Methods This was a retrospective review of nephrectomy with tumour thrombectomy cases between June 2012 and 2022 at a single centre, followed up until September 2024. Overall survival (OS) was visualised by Kaplan–Meier plots and comparisons between survival by presence of metastases, margin status, and thrombus level (I-III vs. IV) were explored with the log-rank test. Recurrence-free survival (RFS) in patients without initial metastases was also examined. Results We identified 39 patients, 25 (64%) were male and the median (IQR) age was 64 years (55–69). Metastatic disease was present in 14 patients (36%). Nineteen (49%) had level IV (supradiaphragmatic) tumour thrombus involvement. Six patients (15%) died in hospital, including two intraoperative deaths. A further 14 (36%) experienced Clavien-Dindo grade III or IV complications during their hospital stay. The median OS was 57 months (95% CI: 17–not reached). Excluding those who died in hospital, the median OS was 60 months (95% CI: 33–not reached). There was a significant difference in OS observed by the presence of metastatic disease (p = 0.003), but not with margin status (p = 0.35) or thrombus level (p = 0.22). The median RFS for M0 patients was 60 months (95% CI: 8–not reached). Conclusion While associated with high morbidity and mortality, nephrectomy and caval thrombectomy remain an effective treatment option for otherwise fatal advanced RCC. [...]

ABSTRACT Background Renal vein and caval tumour extension occurs in 10%–25% of patients with renal cell carcinoma. This study aims to examine perioperative morbidity and survival outcomes after radical nephrectomy with inferior vena cava tumour thrombectomy at a quaternary institution in Australia. Methods This was a retrospective review of nephrectomy with tumour thrombectomy cases between June 2012 and 2022 at a single centre, followed up until September 2024. Overall survival (OS) was visualised by Kaplan–Meier plots and comparisons between survival by presence of metastases, margin status, and thrombus level (I-III vs. IV) were explored with the log-rank test. Recurrence-free survival (RFS) in patients without initial metastases was also examined. Results We identified 39 patients, 25 (64%) were male and the median (IQR) age was 64 years (55–69). Metastatic disease was present in 14 patients (36%). Nineteen (49%) had level IV (supradiaphragmatic) tumour thrombus involvement. Six patients (15%) died in hospital, including two intraoperative deaths. A further 14 (36%) experienced Clavien-Dindo grade III or IV complications during their hospital stay. The median OS was 57 months (95% CI: 17–not reached). Excluding those who died in hospital, the median OS was 60 months (95% CI: 33–not reached). There was a significant difference in OS observed by the presence of metastatic disease (p = 0.003), but not with margin status (p = 0.35) or thrombus level (p = 0.22). The median RFS for M0 patients was 60 months (95% CI: 8–not reached). Conclusion While associated with high morbidity and mortality, nephrectomy and caval thrombectomy remain an effective treatment option for otherwise fatal advanced RCC. [...]

ABSTRACT Background Large defects of the posterior trunk after soft tissue sarcoma resection represent a challenge in reconstructive surgery. Coverage with musculocutaneous flaps or free flaps is often associated with donor site morbidity and functional deficits. With increasing popularity, the clinical indications of locoregional perforator flaps have been expanded to defects of the back. In the present study, the use of various perforator propeller flaps for oncologic reconstruction of large soft tissue defects of the posterior trunk is evaluated. Methods Between 2014 and 2023, perforator propeller flaps were performed in 23 patients for reconstruction of large soft tissue defects after sarcoma resection in different regions of the posterior trunk. Results Soft tissue defects after wide resection of soft tissue sarcoma of the back comprised the cervical, thoracic, lumbar, and sacral regions. Donor sites included perforator propeller flaps of the posterior intercostal artery, lumbar artery, and superior gluteal artery vascular territories. The dimensions of the soft tissue defects of the flaps were 166.6 ± 17.3 cm2. All perforator propeller flaps survived. Revision surgery was required in two patients (partial necrosis of flap tip due to hematoma, n = 1; infected seroma with impaired wound healing, n = 1). During the follow-up (range 6 months–8 8 years) no donor site morbidities or functional deficits were noted. Furthermore, aesthetic results showed excellent contour reconstruction and all patients were satisfied with the surgical outcome. Conclusion In our experience, perforator flaps represent a safe, versatile and reliable option to resurface large posterior trunk defects following oncological resection. [...]

ABSTRACT Background Scabies is a common health issue in the Pacific and may contribute to rheumatic heart disease (RHD). This study assessed the prevalence of scabies and other skin conditions among Tongan schoolchildren and examined the association between these conditions and RHD. Methods Children from four primary schools on Tongatapu were screened for scabies, other skin conditions and RHD. Health workers were trained to recognise scabies and related skin conditions accurately. All children also underwent echocardiographic screening to detect heart valve abnormalities consistent with RHD. Statistical analysis included prevalence ratio calculations, and Fisher's exact tests to evaluate associations between skin and heart findings. Results Four hundred children were screened (mean age: 8 years 6 months), with 18 (4.5%) having echocardiographic features of RHD. The prevalence of scabies was 29.8% (119/400), while the prevalence of impetigo was 20% and more severe bacterial skin infection was 15.5%. Children with both scabies and skin infection were 4.65 times more likely than children without any such lesions to have RHD (95% confidence interval: 1.60–13.6). Children with scabies, impetigo and bacterial infection were associated with progressively higher prevalence of RHD (p for trend = 0.008). The population attributable fraction for scabies and infection as a potential cause of RHD was 26.5%. Conclusions The results indicate a very high prevalence of scabies, bacterial skin infection, and RHD among Tongan school children. Enhanced treatment and control of scabies are likely to reduce the incidence of both bacterial infection and RHD. Mass drug administration is recommended. [...]

ABSTRACT Background Scabies is a common health issue in the Pacific and may contribute to rheumatic heart disease (RHD). This study assessed the prevalence of scabies and other skin conditions among Tongan schoolchildren and examined the association between these conditions and RHD. Methods Children from four primary schools on Tongatapu were screened for scabies, other skin conditions and RHD. Health workers were trained to recognise scabies and related skin conditions accurately. All children also underwent echocardiographic screening to detect heart valve abnormalities consistent with RHD. Statistical analysis included prevalence ratio calculations, and Fisher's exact tests to evaluate associations between skin and heart findings. Results Four hundred children were screened (mean age: 8 years 6 months), with 18 (4.5%) having echocardiographic features of RHD. The prevalence of scabies was 29.8% (119/400), while the prevalence of impetigo was 20% and more severe bacterial skin infection was 15.5%. Children with both scabies and skin infection were 4.65 times more likely than children without any such lesions to have RHD (95% confidence interval: 1.60–13.6). Children with scabies, impetigo and bacterial infection were associated with progressively higher prevalence of RHD (p for trend = 0.008). The population attributable fraction for scabies and infection as a potential cause of RHD was 26.5%. Conclusions The results indicate a very high prevalence of scabies, bacterial skin infection, and RHD among Tongan school children. Enhanced treatment and control of scabies are likely to reduce the incidence of both bacterial infection and RHD. Mass drug administration is recommended. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue 8, Page 852-853, December 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue 8, Page 852-853, December 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue 8, Page 852-853, December 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue 8, Page 852-853, December 2025. [...]

ABSTRACT Introduction Biliary stent placement is a critical palliative treatment for obstructive jaundice due to malignancies. The site, either supra-ampullary (above the ampulla of Vater) or trans-ampullary (below the ampulla of Vater), may influence complication rates which significantly impact patient outcomes. This study evaluates the infection and obstruction rates associated with these two distinct stent placement strategies. Methods Data from 66 patients who underwent biliary stent placements between 2017 and 2022 at our institution were analysed. Patients were categorised into two groups based on stent placement: supra-ampullary (12 patients) and trans-ampullary (54 patients). We assessed the incidence of infection within 30 and 90 days post-procedure and in these patients evidence of radiological stent obstruction. Results In the supra-ampullary group, infection rates were 41.67% within 30 days and 58.33% within 90 days post-procedure. The trans-ampullary group exhibited infection rates of 12.96% within 30 days and 20.37% within 90 days. Higher infection rates were observed in the supra-ampullary group at 30 days, and this difference was statistically significant (p = 0.020). The difference in infection rates at 90 days was also statistically significant (p = 0.008). In cases of infection where stent patency was investigated, radiologically confirmed stent obstructions (either stenosis or occlusion) within 90 days were not statistically significant (p = 0.296). Conclusion Supra-ampullary stent placements are associated with higher rates of post-procedural infections compared to trans-ampullary placements at both timepoints, highlighting the importance of selecting optimal stent placement strategies to reduce infection rates and improve patient outcomes. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue 8, Page 771-775, December 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue 8, Page 771-775, December 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue 8, Page 771-775, December 2025. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 69, Issue 8, Page 771-775, December 2025. [...]

ABSTRACT Background Dual-energy X-ray absorptiometry (DEXA) remains the gold standard test for the assessment of bone density. In a previous Magnetic Resonance Imaging (MRI) study of the lumbar spine it has been noted that when the T1 vertebral body/CSF (cerebrospinal fluid) ratio is high it is suggestive of osteoporosis. Purpose The aim of this study is to investigate whether the relative signal intensity of the imaged bone marrow in the knee compared to the other structures can also be used to detect osteoporosis. Patients and Methods A total of 103 patients who had undergone both a knee MRI and a DEXA scan within the same 12-month period were identified. The T1/PD (Proton Density) and FS (Fat Suppression) signal intensity of marrow (of the femur, tibia and patella), vastus medialis muscle, joint fluid and subcutaneous fat were measured within a region of interest, and the signal intensity ratios were calculated. The ratios were stratified as normal, osteopenic, or osteoporotic based on DEXA T-scores. The correlation between the signal intensity ratios and the DEXA T-score was evaluated using Pearson's linear coefficient and ROC analysis. Intraclass correlation coefficients (ICC) were also calculated. Results The bone marrow (FS)/joint fluid (FS) ratio was significantly higher in the osteoporotic group than in the normal and osteopenic groups (femoral p = 0.0018, patellar bone marrow (tibia) p = 0.0003 and pooled p = 0.0022). The intraobserver (ICC = 0.923–0.974) and interobserver reliability (ICC = 0.803–0.945) were excellent. Conclusion The bone marrow/joint fluid (FS) ratios of the knee MRI have some predictive value for the presence of osteoporosis. [...]

Australian Journal of Rural Health, Volume 33, Issue 6, December 2025. [...]

ABSTRACT Objective To explore how mobile interviewing can be utilised to better inform rural health promotion efforts, as well as the type and breadth of data generated. Mobile methods are defined by the researcher and participant being in motion in a specific setting, collaborating in the data collection process. Setting A rural health service catchment in Victoria, Australia. Participants Members of local Progress Associations, Town Advisory Committee and service clubs within the catchment. Design The study employed an exploratory qualitative design. Mobile interviewing was used in the form of unstructured guided tours, led by participants. The theme provided was ‘What in your town helps or hinders community health?’. Content and thematic qualitative analysis were applied, and a socioecological model was adopted to structure the findings. Results Six guided tours involving seven participants were conducted. Local drivers of health were identified across all five levels of the applied model (intrapersonal, interpersonal, institutional, community, public policy). Institutional-level factors figured most prominently during the guided tour discussions (e.g., relating to the agricultural sector or not-for-profit community organisations). Community factors (e.g., intentional support between local organisations) were also highlighted. Public policy factors were the least discussed out of the five levels of the socioecological model. The study found that perceptions of community health drivers varied substantially, even among geographically close and demographically similar towns. Conclusion The study highlights how mobile interviewing can generate rich, contextual data. The findings suggest that guided tours can serve as a valuable tool for rural health promotion practitioners, providing a holistic understanding of local drivers of health and informing more tailored interventions. [...]

ABSTRACT Objective This pilot study evaluated the feasibility and acceptability of a student-led group falls prevention exercise program delivered to a fixed hub via telehealth to older adults in a remote community. Design A convergent parallel mixed-methods design involving pre- and post-participation outcome measures, semi-structured focus groups and interviews explored the experiences and perspectives of participants completing the program and health professional students conducting the sessions. Setting Telehealth delivery to a very remote town (Modified Monash Model 7) in southwestern Queensland from a regional city in southeast Queensland. Participants Over 2022 and 2023, 17 community participants completed the program. Seven final year students, six studying exercise physiology and one studying physiotherapy, completed a clinical placement in a regional health and wellness clinic and implemented the telehealth program during their placement. Results Community participants demonstrated significant improvements in mobility and function following program participation, with higher BOOMER scores (M = 13.12, 95% CI 11.94–14.29) and faster 10-m walk times (M = 8.56 s, 95% CI 7.31–9.81) compared to baseline (M = 10.94, 95% CI 9.04–12.84; and M = 10.31 s, 95% CI 8.32–12.31, respectively). Clinically meaningful gains on the 10-m walk test were achieved by 64.7% of participants. Beyond physical outcomes, the program fostered valuable social connections. Health professional students reported increased awareness of effective telehealth strategies and growth in clinical skills as additional benefits. Conclusions Telehealth delivery of a group-based exercise program to a fixed hub appears to be a feasible and well-accepted model of rural health service delivery for both older adults and health students. Wider implementation of this approach to a broader range of health services could improve access to high-value care for rural and remote communities. [...]

ABSTRACT Objective To explore the place of origin and placement locations as predictors of non-metropolitan practice among domestic pharmacy graduates from the University of Tasmania (UTAS). Methods The 2023 principal place of practice (PPP) for all domestic UTAS pharmacy graduates between 2011 and 2022 was identified using the Australian Health Practitioners Regulation Agency (Ahpra) online registration database. The graduates' place of origin (home address at the time of course application), locations where they undertook placements, and their 2023 PPP were described using the Modified Monash Model (MM) classification system of remoteness. A multivariable logistic regression model was used to identify independent predictors of regional (MM2), or rural or remote (MM3–7) PPP. Results 329 domestic UTAS pharmacy graduates were practicing in Australia in 2023; 58.7% were working regionally and 13.1% in a rural or remote area. Predictors of a regional PPP included regional (aRR 36.32, 95% CI 7.88, 167.33, p  [...]

ABSTRACT Objective To explore the perceptions of rural Australian clinicians towards antenatal point-of-care ultrasound (APoCUS) training and accreditation, investigating barriers and enablers to continuing professional development (CPD). Methods A prospective cross-sectional online survey of rural Australian clinicians (doctors, nurses, midwives) was undertaken in 2023, using non-probability sampling with self-selection/voluntary response. The survey targeted rural clinicians caring for pregnant patients. Thematic and descriptive analyses were performed with response frequencies grouped by role, work sector, APoCUS use and previous training experience. Fisher's exact test was used for association. Results Fifty-seven responses were analysed (41 midwives/nurses, 16 physicians/doctors). Two-thirds were performing APoCUS, half reported formal or on-the-job training, and none were accredited. Midwives/nurses had a poorer understanding of their scope of practice (eligibility to learn/perform APoCUS) and accreditation requirements. Interest in accreditation was high, particularly for the midwife/nurse cohort. The perceived benefits of accreditation surrounded improved patient care and services, scanning capability and professional satisfaction. The main barriers to pursuing accreditation were supervision for scanning and assessments, cost, time commitment and workforce shortages. Half of the respondents had access to employer-provided CPD funds, and most reported having to self-fund to meet professional registration requirements. Conclusion Australian rural clinicians are driven to upskill and provide high-quality care to patients but face significant barriers to CPD and attaining accreditation, evidenced by low accreditation rates. Future efforts should focus on simplifying accreditation processes, improving access to qualified supervisors/mentors and raising awareness of training and accreditation opportunities while providing support and incentives for rural clinicians to facilitate access. [...]

ABSTRACT Objective Evaluate the impact on spirometry quality of a culturally responsive Indigenous Health Worker Spirometry Training and Mentoring programme (IHWS). Methods Participation in two-day face-to-face IHWS including post-training telehealth mentoring Design Submission of spirometry reports before training (T1), after training (T2) and after telehealth mentoring (T3). Setting Urban, rural and remote primary healthcare services in Queensland Australia. Participants Primarily Australian First-Nations Health Workers. Main Outcome Measures Two raters used nine-point quality criteria to score spirometry at T1, T2 and T3. Inter-rater reliability was assessed using Cohen's original kappa. Reports submitted at a minimum of two time-points were included in the analysis. A linear mixed model analysis and post hoc analysis assessed differences in total scores across different timepoints. Results Between 2011 and 2018, 360 participants (75.5% Indigenous) attended 43 workshops. Of the 284 participants attending workshops #1–#34, 56.7% (161/284) hadn't performed spirometry before IHWS and were excluded from comparative analysis because spirometry reports could be submitted at only one timepoint (T2). Introduction of telehealth mentoring sessions from workshop #35, increased spirometry submission for assessment at T2 from 9.9% (28/284) to 68.4% (52/76). Thirty-six participants submitted reports at two timepoints or more. Spirometry quality improved across all timepoints (p  [...]

ABSTRACT Objective Quality indicators (QIs) specific to older adults receiving health care in rural and remote settings can be used to monitor healthcare quality, inform service improvements, and outcomes for these populations. This scoping review aimed to identify population-based QIs used to evaluate healthcare quality received by older people in rural and remote settings. Methods Two academic databases and grey literature sources were searched to identify population-based rural QI monitoring programs or rural QIs, routinely used and reported since 2012. QI program and specific characteristics, including country of origin, dimension of care quality captured, domain represented, QI type, data sources used, reporting strategies, and care settings were summarised. Findings Nine QI programs from seven countries with 52 QIs were identified. The QIs measured quality-of-service delivery (n = 28, 54%), accessibility (n = 11, 21%), resources (n = 9, 17%), and hospital readmissions (n = 4, 8%). Most QIs were outcome (n = 25, 48%) or process (n = 19, 37%) indicators, considering the dimension of safe healthcare. Three QIs (6%) measured rural hospital readmission in older people residing in rural areas. Conclusions Three QIs measuring the proportion of older adults with unplanned rural hospital readmission were identified that could facilitate consistent reporting and benchmarking of care provided to older adults residing in rural and remote communities. Given the known disparities in equitable access and quality of healthcare for older people residing in rural and remote areas, these findings highlight the need for QIs across all quality dimensions to monitor healthcare quality and drive improvements in access and quality of healthcare. [...]

ABSTRACT Objective Primary: To evaluate adherence to statewide guidelines for managing fever in infants [...]

Australian Journal of Rural Health, Volume 33, Issue 6, December 2025. [...]

ABSTRACT Objective To analyse the changes in psychiatric inpatient admissions following the 2022 Lismore floods, focusing on admission frequency, length and reason. Methods We separated our dataset into two groups of equal time frame, representing the 12 months directly preceding (N = 407) and directly following (N = 500) the floods, and analysed the differences between them. Design A retrospective cohort study. Setting The adult inpatient mental health service of Lismore Base Hospital. Participants 907 patients admitted to the Lismore Base Hospital adult inpatient mental health unit between 1 March 2021 and 28 February 2023. Main Outcome Measures Patient characteristics, number of admissions, admission length and admission reason were compared between the pre-flood and post-flood groups. Results We found a 22.9% (p = 0.002) increase in the number of admissions and an 18.2% (p = 0.001) reduction in the median admission length following the floods, culminating in no change in the total time spent in hospital when summed across all admissions. Additionally, there was a reduction in the length of Suicidality, Homicidality or Deliberate Self-Harm (DSH) admissions (p  [...]

Australian Journal of Rural Health, Volume 33, Issue 6, December 2025. [...]

Australian Journal of Rural Health, Volume 33, Issue 6, December 2025. [...]

I read with great interest the case report by Klokman et al. that described the application of an interfascial plane block for pain relief of shoulder injuries in the emergency department (1). I appreciate the authors for presenting this wonderful case report. I would like to present my clarifications on the regional anesthesia techniques of the shoulder. [...]

We read the recent article by Murk et al., recently published in JEM, with great interest. We appreciate the author's effort in exploring the opioid-sparing strategies in the emergency department (ED) [1]. However, several methodological and reporting concerns warrant clarification before the findings can be confidently interpreted or generalized. [...]

We commend Lee et al. for their multi-center evaluation of adenosine versus fixed-dose intravenous bolus diltiazem for supraventricular tachycardia (SVT) in the emergency department (ED) (1). The work contributes valuable real-world data on a common clinical scenario. However, several important considerations merit further discussion to contextualize and expand upon their findings. [...]

We read with interest the article published by Dr. Cowan and colleagues describing a pilot randomized clinical trial of HIV pre-exposure prophylaxis (PrEP) initiation among emergency department (ED) patients and we congratulate the authors for taking on such an important, but challenging, topic. (1) Their study randomized 26 patients to immediate PrEP initiation (n = 13) versus outpatient referral for PrEP initiation (n = 13) using dedicated clinical research staff to screen for and enroll into the trial. [...]

Upper gastrointestinal bleeding (UGIB) is a common and life-threatening emergency with a mortality rate of 2–8%. Although prognostic assessment often relies on the Glasgow-Blatchford Score (GBS) and Rockall Score (RS), their inclusion of multiple parameters limits use in acute settings. The shock index (SI), derived from heart rate and systolic blood pressure, provides a simple and rapid alternative. This study investigates the relationship between the SI and established risk scores (GBS and RS) in patients with UGIB. [...]

The authors appreciate the interest of Mohanty et al. in our recently published article, “Pericapsular Nerve Group (PENG) Block-Augmented Analgesia vs. Conventional Opioid Analgesia for Hip Fracture Patients in the Emergency Department,” and thank them for their thoughtful comments. [...]

We thank Dr. Sethuraman for his thoughtful Letter to the Editor, “Clarity on: Regional Anesthesia Techniques for the Shoulder,” (1) which addresses terminology and technical considerations related to our recent case report describing the Interfascial Plane Block (IPB) for proximal humerus fracture and fracture-dislocation management in the emergency department (ED) (2). We welcome the opportunity to clarify points of nomenclature, technique, and comparative scope. [...]

The place of extracorporeal membrane oxygenation (ECMO) in resuscitational guidelines has become unquestionable, but the exact time to start the treatment and appropriate patient selection remains unclear. The aim of this study is to find correlations between pre-ECMO parameters and subsequent survival indicators of patients requiring ECMO treatment, which could help intra-/prehospital providers to more easily identify potential ECMO candidates among their patients. [...]

Abstract Introduction Type 1 diabetes (T1D) is associated with an increased risk of cardiovascular disease (CVD), yet many patients do not attain recommended lipid targets. Aims We aimed to identify patient and clinician factors affecting lipid management. Methods 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. Results 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. Conclusion The identified patient- and clinician-related factors should be addressed in future studies and in clinics to optimise lipid management in T1D. [...]

Abstract 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. [...]

Internal Medicine Journal, EarlyView. [...]