General journals

A consultant in emergency medicine has been cleared of the sexual harassment of three female students and of “harassment related to sex” regarding a fourth.1However, Adam Chesters was given a formal warning about his future conduct.Chesters, who works at Cambridge University Hospitals NHS Trust, was acting as an examiner or supervisor during demonstration sessions involving three of the students, referred to as A, B, and C.The fourth, D, was taking part in university lecture forums. All incidents occurred between 2022 and 2024.The tribunal found that he had abused his senior position in “manhandling” D, placing his hands on her waist or shoulders to move her to different positions in the room and instructing her to “pout” for the camera or words to that effect.Counsel for the General Medical Council told the tribunal that Chesters was a highly respected and eminent doctor while D was at the start of her journey,... [...]

A consultation to clarify how physician assistants (PAs) work, which patients they can see, and how they are supervised has been launched.More than a year ago an independent review set out how PAs and anaesthesia assistants (AAs) should work in healthcare alongside clinicians.1There has been criticism of a lack of progress towards implementing the review’s 18 recommendations, all of which were accepted by the government at the time.2Now, a draft clinical protocol for PAs, their supervisors, team members, and employers, designed to advance some of the review’s recommendations, has been shared with a range of bodies.3Seen by The BMJ, the draft protocol has been produced by Gillian Leng, president of the Royal Society of Medicine and former chief executive of the National Institute for Health and Care Excellence.Leng carried out the government commissioned review into the safety and scope of the roles published in July 2025.4Her review said that PAs... [...]

There are many models for neighbourhood health, including different approaches taken in Fleetwood, Lancashire, and international models in Singapore, Brazil, and New Zealand.12 Brazil’s Family Health Strategy and Healthy Families New Zealand were shaped by distinct histories and system structures and operate in different ways. What stands out is that their relative success depends not on the model itself, but on the conditions that allowed their approaches to take root and endure. We can learn from them about whether England’s approach to implementing neighbourhood health has the potential to create the necessary conditions for transformation.New Zealand and Brazil had clearly defined, long term ambitions and purpose. Brazil’s aim was to make proactive, neighbourhood based care the default model for the whole population. New Zealand focused on driving community led change to reduce health inequalities. Their goals differed, but in each case those goals were explicit—and that clarity mattered.I worry that... [...]

Pay for resident doctors remains significantly behind where it should be despite this year’s settlement, and the pay review body should be “on notice” ahead of its next recommendation, the departing chair of the BMA’s Resident Doctors Committee (RDC) says.Speaking to The BMJ, Jack Fletcher warned that the agreement accepted by members in June would not end the union’s efforts to improve pay, training opportunities, and working conditions.The government’s June 2026 deal, now accepted by the BMA, gave resident doctors in England an average pay rise of 6.5% and 4500 extra specialty training posts over the next three years, alongside more secure employment and nationally aligned contracts for locally employed doctors.1But Fletcher, an acute medicine doctor in North East England who became RDC chair in September 2025, said this was only progress on pay, not a conclusion.“This is not an endpoint,” he said. “Residents are still behind on their pay... [...]

On 23 September 2026, the Australian prime minister, Anthony Albanese, disclosed that on 18 June 2026 an OpenAI agent gained unauthorised access to the Medicare Statistics Reporting Service, a public facing portal hosted by Services Australia that publishes aggregate data on Medicare billing, vaccination uptake, use of the Pharmaceutical Benefits scheme, and organ donor registrations.12 This has been widely reported as the first known “AI hack of a government website.”Both Albanese and OpenAI have stressed that no personal data were accessed. However, the agent did run commands; retrieve internal files, credentials, and aggregate statistics; and write files. It also accessed the websites of the Victorian Department of Health, the Australian Institute of Health and Welfare, and the NSW Bureau of Crime Statistics and Research.3The Australian government has launched a taskforce to investigate the incident and chastised OpenAI for taking too long to notify it of the agent’s actions; and for... [...]

A botched execution attempt of a woman on death row in Tennessee has reignited the debate over use of the lethal drug phenobarbital.Christa Pike, 50, was taken to hospital after two syringes of pentobarbital were administered at a prison in Nashville. According to her legal team, these failed to stop her heartbeat and she could be heard snoring.Pike’s lawyers filed an emergency motion seeking to immediately halt the execution, saying she was in unnecessary agony and it was violating her right to be executed free of cruel and unusual punishment.Pentobarbital is a short acting barbiturate that slows down the central nervous system. In the UK it is used almost exclusively for veterinary euthanasia (box). David Nicholl, a UK doctor who submitted a petition to the Florida Supreme Court to stop an execution using pentobarbital in 2011, said the Pike case highlighted why it should not be used in lethal injections.“The... [...]

kabbasi@bmj.comSocial care has had its NHS moment. Andy Burnham’s announcement of a national care service may become historic if he is able to deliver it. His vision will be met with resistance, just as Aneurin Bevan’s announcement of the NHS was received in 1945. The importance of national reconstruction, agreed during the second world war, led to the Beveridge report, which identified “five giants” that needed to be tackled for Britain to succeed economically and socially: “want, disease, ignorance, squalor, and idleness.”1 The five giants have been forced back at various times but they seem to be back on the march.Some commentators observe that the covid-19 pandemic was the other great national emergency of the past 100 years, alongside the second world war.2 The need to build back better and fairer remains (doi:10.1136/bmj.n1677).3 Economist John Maynard Keynes, subject of a new West End play,4 deemed the plans in Beveridge’s report... [...]

AI “has the capacity to dominate us to free us from medical tyranny” US health secretary Robert F Kennedy Jr has claimed.1“It can give you a second opinion that is much better informed than any doctor in the country,” Kennedy told a Make America Healthy Again summit earlier this week.2Kennedy quoted Sam Altman, OpenAI’s chief executive, who reportedly told him in a private meeting days before that it would be “malpractice for a doctor to make a diagnosis or to make a prescription without at least checking AI.”“One of the things that is going to change is that we’re never ever again gonna be dominated by public officials who tell us ‘trust the experts,’” Kennedy said.“If somebody tells you, ‘Masks work, trust the experts,’ AI may tell you otherwise. If somebody tells you, ‘Social distancing works, trust the experts,’ AI may correct that. And if somebody tells you that a... [...]

Holdsworth and colleagues emphasise that “clear and sensitive communication of dying with patients and relatives can improve quality of care and build trust.”1As a general practice trainee working in UK primary care, I frequently see how terminology influences patients’ willingness to engage with discussions about their future care. Terms such as palliative care and end-of-life care are well established in clinical practice, yet many patients interpret them as signalling imminent death or withdrawal of active treatment. This creates fear, avoidance, and missed opportunities for earlier supportive conversations.We should consider alternative terminology such as integrated care planning or future care planning. They reduce the stigma associated with “palliative,” which remains poorly understood outside clinical settings.Reframing the language may help clinicians initiate earlier conversations, reduce emotional barriers, and support patients to articulate their values, priorities, and preferences for care. It may also encourage a more holistic view of support that includes symptom... [...]

England’s integrated care boards (ICBs) will receive almost £50m funding to help general practices refer victims of domestic abuse.Funding for the previously announced “Steps to Safety” scheme was outlined by the health and social care secretary, Yvette Cooper, who described the problem as a “public health epidemic.”Steps to Safety was first announced last year and updated in May this year as part of a cross government strategy to build a safer society for women and girls.1The scheme seeks to connect patients to specialist domestic abuse and sexual violence services in their local area through their GP, with practice staff also offered training to better identify and support victims.It is estimated that one in four people in England and Wales have experienced domestic abuse.2Speaking at the Labour Party annual conference in Liverpool, Cooper said, “One of the biggest causes of ill health and harm for women, including in pregnancy, isn’t really... [...]

This week at the Labour Party Conference, Andy Burnham proposed, among other reforms, a social care service for “people, not profit.”1 This promise to end profit motivated care holds much bigger potential for change in the social care system than his other proposal to pay for people’s care upfront. The current social care system is made up almost entirely of for-profit providers so almost all their organisational structures will need to change.Burnham’s promise is radical for two reasons: firstly, because of the scale of for-profit involvement in social care, and secondly, because of the many ways profit motives currently influence experiences of care. In England, 85% of care homes registered with the Care Quality Commission are run for profit. The proportion of home based care providers run for profit is likely higher.23Currently, 1.3 million people are employed in the private social care sector—a figure comparable to the number of NHS... [...]

“Down a few pounds already without obsessing over food,” a Reddit user wrote. “It feels like a ‘lighter’ way to try GLP-1s without the full intensity people always talk about.”“I’m obsessed,” another Reddit user added, claiming to have lost 6 lbs (2.7 kg) in three weeks, “It was so easy. I’d recommend [it] to anyone.”The users are part of a popular Reddit thread dedicated to people experimenting with GLP-1 receptor agonist drugs, such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro), for weight loss.“Microdosing” is the colloquial term, referring to the administration of any amount below the recommended therapeutic doses of drugs.1 Such off-label use is not recommended by medical professionals, says Caroline Apovian, a professor at Harvard Medical School and codirector at the Centre for Weight Management and Wellness at Brigham and Women’s Hospital in Boston.Kath McCullough, Royal College of Physicians obesity special adviser, told The BMJ that microdosing “is... [...]

The ADVOCATE initiative and how autonomous AI agents could help patients with heart failure are discussed by JAMA+ AI Editor in Chief Roy Perlis, MD, MSc, and Haider Warraich, MD, a cardiologist and the program manager at ARPA-H, for the JAMA+ AI Conversations podcast. [...]

The Original Investigation titled “Global Burden of Elevated LDL-C: Findings From the Global Burden of Disease Study 2023,” published July 29, 2026, was corrected to update the author affiliations list. This article was corrected online. [...]

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

Alzheimer disease is defined by the accumulation of extracellular amyloid-β plaques and intraneuronal neurofibrillary tangles composed of hyperphosphorylated tau. For many years, drug development efforts have focused on amyloid-β plaques, culminating in the recent approval of the amyloid-targeting monoclonal antibodies lecanemab and donanemab for the treatment of early-stage Alzheimer disease. In parallel, there has been considerable interest in developing treatments directed at tau tangles, the second pathognomonic lesion of Alzheimer disease. [...]

This randomized clinical trial examines the efficacy and safety of the potent oral O-linked N-acetylglucosaminidase inhibitor ceperognastat in early symptomatic Alzheimer disease. [...]

This study evaluated whether the oral O-linked N-acetylglucosaminidase inhibitor ceperognastat, at doses of 0.75 and 3 mg, compared with placebo, slows clinical progression in patients with early symptomatic Alzheimer disease with low to medium tau levels. [...]

In the JAMA Clinical Guidelines Synopsis titled “Antiviral Therapies for Adults With Mild to Moderate COVID-19 Infection,” published online June 30, 2026, several points were rewritten for clarification. In the third paragraph of the Evidence Base section, the second sentence was revised to “Coadministration of nirmatrelvir-ritonavir is contraindicated with certain medications due to risk of serious or fatal toxicity (eg, amiodarone, statins [especially simvastatin and lovastatin], phosphodiesterase 5 inhibitors [eg, sildenafil], α-blockers [eg, tamsulosin], or benzodiazepines [eg, triazolam, midazolam]) or strong CYP3A inducers (eg, rifampin, carbamazepine, St John’s wort).” In the fifth paragraph of the Evidence Base section, the last sentence was revised to “Patients who can become pregnant should use contraception during molnupiravir use and for 4 days following the last dose if their partner did not also use molnupiravir. Individuals with a male partner who used molnupiravir should use effective contraception for 3 months after the last dose. Patients who are breastfeeding should consider interrupting breastfeeding and instead pump and discard breast milk during treatment with molnupiravir and for 4 days after the last dose.” In the second paragraph of the Discussion section, an additional sentence was added regarding molnupiravir: “It is currently available in the US only through Emergency Use Authorization, although the authorization will be terminated effective June 29, 2027.” This article was corrected online. [...]

This Perspective discusses the ethical, scientific, clinical, and manufacturing implications of excluding patients living with HIV from gene therapies for sickle cell disease. [...]

This Medical News article discusses a new scientific statement from the American College of Cardiology about caring for older adults with cardiovascular disease. [...]

This Viewpoint discusses how consolidation in frontline care delivery has shaped health care markets across the US and how changes in ownership of hospitals and practices affect clinicians and patient outcomes. [...]

This Medical News article discusses the estimated population-level effects of the 2025 blood pressure guideline, which expanded antihypertensive treatment eligibility. [...]

Radiotherapy and immunotherapy combination has been a field of intense investigation globally over the past decade. The phase 3 randomised clinical trial (SWOG/NRG S1914) in The Lancet by Megan E Daly and colleagues,1 conducted in the USA, evaluated whether adding perioperative atezolizumab (neoadjuvant, concurrent, and adjuvant) to stereotactic body radiation therapy (SBRT) improved outcomes in high-risk, medically inoperable early-stage non-small-cell lung cancer (NSCLC). Its primary objective was to compare overall survival between patients assigned to atezolizumab plus SBRT (n=210) or SBRT alone (n=207). [...]

When Evan Hubinger, a safety scientist at Anthropic, posted on X last month that there is a greater than 10% chance that artificial intelligence (AI) could kill all humans within the next decade, he was making a prophecy of eye-catching proportions. Medicine is the discipline among all disciplines that knows something about prophecies. Doctors learn the natural history of disease to guide patients through the likely course of their illness. Clinical researchers do randomised trials to make judgements about the safety and efficacy of the treatments they prescribe. [...]

We welcome the correction to the Seminar by Erik von Seth and colleagues,1 which clarifies that no vancomycin-resistant enterococci were found in published studies of patients with primary sclerosing cholangitis treated with oral vancomycin. The incidence reported initially in the Seminar (8·7%) has been corrected to 0%.1 [...]

We commend Erik von Seth and colleagues for their comprehensive Seminar on primary sclerosing cholangitis.1 However, we wish to discuss two key points regarding liver transplantation that might benefit from an updated perspective. [...]

We thank Kevin M Johnson and colleagues for their Correspondence regarding oral vancomycin in primary sclerosing cholangitis. We acknowledge that current evidence has not identified a clear signal of increased incidence of vancomycin-resistant enterococci among individuals with primary sclerosing cholangitis receiving oral vancomycin, although vancomycin-resistant enterococci have not been systematically assessed in all studies. We, however, believe that the central issue extends beyond vancomycin-resistant enterococci. [...]

The Lancet's Editorial on cardiometabolic disease describes a growing challenge in clinical practice: patients with obesity, type 2 diabetes, chronic kidney disease, metabolic dysfunction-associated steatotic liver disease, and cardiovascular disease often attend multiple specialist clinics and receive recommendations from different guidelines despite shared biological pathways and therapies.1 [...]

We welcome The Lancet's Editorial for highlighting the rising cancer burden among younger people.1 However, it would benefit from distinguishing adolescent and young adult (AYA) oncology from early-onset cancer: overlapping but non-synonymous concepts. [...]

Chan WY, Pires da Silva I, Long GV, Rizos H. Targeting MEK in cancer and beyond: mechanistic insights and therapeutic opportunities. Lancet 2026; 407: 1639–56—In this Therapeutics paper, in table 2, the objective response rate (95% CI) should have been 15% (11–20) for the binimetinib group in the NEMO trial and 64% (59–69) for the trametinib + dabrafenib group in the Combi-v trial. The median progression-free survival (95% CI) in the NEMO trial should have been 2·8 months (2·8–3·6) in the binimetinib group and 1·5 (1·5–1·7) in the dacarbazine group. [...]

Gaythorpe KAM, Li X, Shankar M, et al. Quantifying relative health impact across Gavi, the Vaccine Alliance's portfolio in 117 countries at the subregional level: a modelling study. Lancet 2026; 407: 1941–52—The appendix of this Article has been corrected as of Oct 1, 2026. [...]

Peripheral arterial disease, caused by atherosclerotic narrowing of the arteries supplying the limbs, is widely regarded as a local disease of the legs and, particularly when asymptomatic, as relatively benign. Both impressions are inaccurate. Peripheral arterial disease is a manifestation of systemic atherosclerosis, and when symptoms do appear, they are often attributed to ageing or musculoskeletal disease, and only a minority of patients report the classical intermittent claudication—exertional leg pain relieved by rest—that clinicians are taught to search for. [...]

On its 129th rescue mission, the humanitarian vessel of the non-governmental organisation Open Arms did two operations in Italy's search and rescue zone in 15 days, bringing 101 people to safety. On both occasions, the port designated by the Italian authorities for the disembarkation of the rescued individuals required the ship to sail for several days to ports in northern Italy. After the first operation, a voyage of more than 700 nautical miles to the port of Savona transformed the deck of the Open Arms from an emergency scene into a place of waiting. [...]

Volatile and prohibitive immigration rules are raising concerns about staffing health and social care across the USA. Roxanne Nelson reports. [...]

Abstract Vascular Ehlers–Danlos syndrome (vEDS), caused by likely pathogenic COL3A1 variants, carries a high risk of arterial dissection or rupture, intestinal perforation and uterine rupture, and a median survival near 51 years. It is often recognized only at a catastrophe, and its acute management is deliberately counter-intuitive. The therapeutic landscape changed in 2025 with the first randomized evidence for an angiotensin-receptor blocker. We provide a clinical, practice-oriented review for internists and the multidisciplinary team. As is appropriate for a rare disease, case-level evidence was considered alongside cohorts and trials. Suspicion is the rate-limiting step, and we set out speciality-specific red flags. Diagnosis requires molecular confirmation, with differentiation from other heritable arteriopathies. Genotype is a probabilistic predisposition, not a deterministic predictor: there is ascertainment bias, reduced penetrance and intrafamilial variability temper inference. Emergency care is harm-avoidant—catheter angiography, elective endoscopy and unnecessary surgery should be avoided, and endovascular and tissue-sparing techniques preferred. Pharmacological prevention rests on celiprolol, with randomized evidence now supporting irbesartan added to background celiprolol, and expert-centred consideration of angiotensin-receptor blockade when celiprolol is not tolerated. Surveillance should be individualized along the European Reference Network on Rare Multisystemic Vascular Diseases logic. Pregnancy, psychosocial care and cascade testing complete lifelong management. In vEDS, earlier recognition and the avoidance of iatrogenic harm—not new molecules—offer the largest near-term gains in survival and quality of life. [...]

Abstract Background Recommendations for blood pressure (BP) measurement are poorly followed in clinical practice, possibly leading to inaccurate BP estimates. Objectives To assess the agreement between routine and standardized BPs, and the association between BP level and cardiovascular disease (CVD) for each measurement type. Methods Standardized BPs were recorded in a screening program for middle-aged people during 1992–2012 in Sweden. Intraindividual differences between standardized BP and routine BP from primary care were calculated. Association between BP level and composite CVD, and population-attributable fraction (PAF) explained by BP, were determined through adjusted Cox regression for each measurement type. Results In 9567 participants, routine BPs were on average 4.0/1.7 mmHg higher than standardized BPs. Routine measurements frequently misclassified people into higher BP categories; 16% more had hypertension (≥130/80 mmHg), and 50% less had normal BP ( [...]

Abstract Background Evidence from randomized controlled trials (RCTs) testing medication reviews in geriatric oncology is sparse. Methods We conducted a single-blinded RCT in ten rehabilitation clinics across Germany. Patients with common cancers, aged ≥ 65 years, and polypharmacy (regularly ≥ five drugs) were randomly allocated in equal proportions to usual care or a comprehensive pharmacist-led medication review conducted with the validated Fit fOR The Aged (FORTA) list. The FORTA score is the sum of drugs classified as potentially inappropriate medication (PIM) (each two points), drug underuse (each one point), and drug overuse (each one point). Changes in the FORTA score and its subcomponents from rehabilitation admission to discharge were tested using the chi-square test or the Wilcoxon's rank-sum test. Findings At admission, 66.1%, 94.6%, and 58.9% of 443 trial participants included in the intention-to-treat analysis were exposed to PIM, medication underuse, or overuse, respectively, and the median FORTA score was six. At discharge, participants of the intervention group (n = 234) had a statistically significant greater reduction in the mean FORTA score than the control group (n = 209): mean difference [95% confidence interval]: −3.7 [−4.2; −3.3] score points. Furthermore, the proportions of subjects with PIM, underuse, and overuse were statistically significantly reduced by the intervention by 41.3, 35.5, and 30.7 percentage points (all p  [...]

Journal of Internal Medicine, EarlyView. [...]

Abstract Population ageing is portrayed as a threat to the sustainability of health and welfare systems. This narrative—grounded in static chronological definitions of old age—risks overstating the burden of increasing longevity while overlooking changes in survival, health and population composition. In this article, we adopt a demographic perspective to rethink longevity and healthspan through the lens of positive demography, which reframes ageing as a structural transformation that can generate opportunities if institutions, health systems and policies adapt accordingly. Using prospective measures that define old age by remaining life expectancy (LE), we show that population ageing appears less burdensome than conventional indicators suggest (e.g., dynamic dependency ratios fluctuate around 20% compared with 40% under fixed thresholds). Nonetheless, challenges persist, including growing heterogeneity and inequalities in late-life health and care needs (with healthcare workforce demand by 2071 ranging from a 33% increase to a 16% decrease depending on morbidity trends) and a widening gap between lifespan and healthspan (LE at age 60 has risen at double the rate of healthy LE), resulting in more prolonged dependency and complex end-of-life trajectories. Prevention (primordial, primary, secondary and tertiary) and palliative care emerge as crucial but insufficiently integrated components of ageing societies’ health systems. We conclude that a forward-looking demographic framework—integrating dynamic age thresholds, cohort-specific health profiles, and equitable access to care across the full continuum—is essential to align societies with realities of longer lives. Population ageing is not a problem to be solved but a context within which health systems and policies must evolve. [...]

Journal of Internal Medicine, Volume 300, Issue 4, Page 389-389, October 2026. [...]

Abstract Conventional Swedish snus is used by millions in Scandinavia and increasingly worldwide, yet its cardiovascular effects remain poorly characterized. The emergence of nicotine pouches—commonly referred to as ‘white snus’ in Sweden—that deliver comparable nicotine without tobacco constituents adds complexity to a heterogeneous landscape and raises questions about whether cardiovascular risk follows nicotine exposure regardless of product type. We explore epidemiological and mechanistic evidence on snus and cardiovascular disease, the contributions of nicotine versus tobacco-specific nitrosamines (TSNAs) to risks, and identify knowledge gaps, with focus on novel nicotine products and the research opportunity offered by the Swedish Tobacco Cohort (SWETOC). Epidemiological evidence suggests elevated cardiovascular disease (CVD) mortality among snus users, with the most consistent signals for fatal myocardial infarction and heart failure. Associations with incident atherosclerotic events are more heterogeneous. Mechanistic evidence points to nicotine-mediated pathways, including sympathetic activation, endothelial dysfunction and increased arterial stiffness, whereas evidence for TSNA-driven CVD risk remains sparse, and declining TSNA levels in modern Swedish snus make that path less likely and harder to study. Nicotine pouches deliver comparable or higher systemic nicotine than conventional snus but lack long-term cardiovascular outcome data. Real-world cessation data from Denmark suggest structured programmes can achieve 6-month abstinence rates of approximately 53% among non-smoking nicotine users. The evidence supports nicotine as the primary driver of snus-associated CVD risk, with important implications for the cardiovascular safety of novel nicotine products. Evidence is needed to inform public health guidance, clinical advice and regulatory decisions. SWETOC represents a unique infrastructure to generate this evidence. [...]

Abstract Objective To systematically evaluate the association between current statin use and global cognitive impairment in US older adults and examine potential variations across treatment intensity, duration, and specific cognitive domains to guide clinical cardiometabolic management. Methods This survey-weighted cross-sectional study included 3137 National Health and Nutrition Examination Survey 2011–2014 participants aged ≥60 years. Cognitive performance across Consortium to Establish a Registry for Alzheimer's Disease, animal fluency, and digit symbol substitution test (DSST) was composite-summarized to define impairment (Z-score ← 1.5 standard deviation). Survey-weighted multivariable models adjusted for sociodemographic, lifestyle, cardiometabolic, psychotropic medication, polypharmacy, and substance-use proxies, supplemented by inverse probability of treatment weighting (IPTW) and multiple imputation. Results In the primary fully adjusted model, current statin use was not associated with global cognitive impairment (odds ratio [OR] = 0.90, 95% confidence interval: 0.48–1.67, p = 0.736). Results remained consistent across psychotropic-adjusted (OR = 0.91), IPTW (OR = 1.03), and multiply imputed models (OR = 0.86). Domain-specific analyses showed statin use was associated with lower odds of DSST impairment (OR = 0.51, p = 0.009), with no clear trend across statin intensity or duration categories. Conclusion Current statin use was not significantly associated with global cognitive impairment in older adults. Although cross-sectional observational neutrality precludes inferring long-term safety, indicated statin therapy should not be routinely withheld over cognitive concerns, with prescribing remaining firmly guided by established atherosclerotic cardiovascular disease risk guidelines. [...]

Abstract Background AA amyloidosis (AAA) remains a life-threatening yet largely preventable complication of monogenic autoinflammatory diseases (AIDs). Methods We retrospectively described patients with AAA secondary to one of the four historical monogenic AIDs (familial Mediterranean fever [FMF], cryopyrin-associated periodic syndrome [CAPS], mevalonate kinase deficiency [MKD] and tumour necrosis factor receptor–associated periodic syndrome [TRAPS]) followed at the French National Referral Centre for Monogenic AIDs and Inflammatory Amyloidosis (2012–2025). Results Among 181 patients followed for AAA, 50 (28%) had one of the four monogenic AIDs (FMF n = 41, CAPS n = 4, MKD n = 3, TRAPS n = 2), corresponding to an overall prevalence of 5% among all patients with monogenic AIDs. AAA preceded the diagnosis of the underlying AID in 40% of patients, particularly those with non-FMF diseases. Disease burden remained high, with 46% of patients requiring kidney transplantation, whereas mortality reached 26% during follow-up. Conclusion AAA continues to reflect delayed diagnosis, highlighting the need for increased awareness among adult healthcare providers, systematic genetic evaluation of unexplained AAA and early inflammatory control. [...]

Journal of Internal Medicine, EarlyView. [...]

Abstract Lipodystrophy comprises a heterogeneous group of disorders characterized by reduced adipose tissue often associated with severe metabolic complications. Lipodystrophy may be genetic, acquired, or secondary to medical therapies initiated for other conditions. Despite major advances in understanding adipose tissue biology and in human genetic technologies, diagnosis of lipodystrophy is still commonly delayed or missed. Conversely, increasing use of next-generation sequencing has led to proliferation of proposed new genetic causes of lipodystrophy with variable supporting evidence. To address these challenges, an international expert working group from the European Consortium for Lipodystrophies first developed a consensus definition of lipodystrophy as deficient development and/or inadequate maintenance of adipose tissue not attributable to nutritional deprivation or a systemic catabolic state. Anatomical adipose deficiency alone is generally insufficient for diagnosis, with evidence of adipose tissue dysfunction or pathology also usually required. Building on this definition, a framework for evaluating candidate monogenic lipodystrophy syndromes is suggested, based on the strength of human phenotypic, genetic, and biological evidence. Primacy was assigned to direct evidence from affected individuals, with genetic and biological evidence considered supportive but not determinative. This approach accommodates both the variable penetrance and expressivity characteristic of many lipodystrophy syndromes and potential discrepancies between human observations and experimental models. Although the proposed definition is applicable across all forms of lipodystrophy, the classification system described here is restricted to monogenic disorders. Together, these tools aim to improve clinical recognition, promote diagnostic consistency, and provide a robust and adaptable framework for evaluating emerging gene–disease associations in lipodystrophy. [...]

Abstract Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and a leading cause of cirrhosis, hepatocellular carcinoma, and cardiometabolic morbidity. Often clinically silent until advanced fibrosis develops, management has largely relied on lifestyle interventions, with limited pharmacological options and inconsistent risk stratification. Recent advances in noninvasive diagnostics and targeted therapies are beginning to transform this approach. This review examines the evolving management paradigm of MASLD and metabolic dysfunction-associated steatohepatitis (MASH), focusing on practical implementation of fibrosis-based risk stratification, structured care pathways, and newly approved or late-stage pharmacological therapies. Recent clinical trials demonstrate that therapies targeting metabolic dysfunction and hepatic fibrogenesis can improve steatohepatitis and fibrosis, particularly in patients with advanced disease. Incretin-based therapies have shown MASH resolution in approximately 40%–60% of patients, accompanied by weight loss of 10%–20%, whereas thyroid hormone receptor-β agonists have demonstrated substantial reductions in liver fat and improvements in fibrosis-related endpoints. Emerging fibroblast growth factor analogs and combination therapeutic approaches suggest additive benefit through complementary metabolic and anti-fibrotic mechanisms. Together, these advances support treatment strategies guided by fibrosis risk rather than steatosis alone. MASLD care is therefore moving from reactive disease management toward structured pathways that integrate scalable diagnostics with disease-modifying therapy, offering the potential to alter disease progression and reduce the burden of advanced liver disease. [...]

ABSTRACT Background Pelvic exenteration (PE) has emerged as a viable resection strategy for locally advanced and recurrent pelvic cancers; however, it carries the burden of significant morbidity. The vertical rectus abdominis myocutaneous (VRAM) flap is a reconstructive method designed to minimise postoperative wound complications, and this study highlights its potential for minimising morbidity following PE. Method We present results from a retrospective cohort study of patients undergoing PE at the sole tertiary referral service in Western Australia from 2017 to 2025. Patients were identified from the departmental database and data extracted from electronic records. Data was collected including demographics, operative outcomes, postoperative complications and survival. We analysed complications in those undergoing VRAM flap vs. primary closure and discuss our results. Results Forty-five patients underwent PE of which 35 patients had colorectal adenocarcinoma, 20 patients received VRAM flaps and 25 underwent primary closure, 11 of whom received mesh reconstruction. Postoperative complications were less frequent in the VRAM group compared with primary closure and we identified 24 patients who developed postoperative pelvic collections (RR = 0.75), 15 who developed deep pelvic infections (RR = 0.31) and 13 who developed superficial perineal wound infections (RR = 0.78). Twenty-three patients experienced major (Clavien–Dindo ≥ 3) postoperative morbidity, 90-day overall survival was 97.8%, and 1-year overall survival was 89.9%. Conclusion VRAM flaps were associated with a reduced incidence of postoperative collections, deep infections and wound infections. Our results are consistent with existing literature and support VRAM flaps as a safe reconstruction technique to minimise postoperative morbidity following PE. [...]

In this retrospective single-centre cohort of 52 patients with pancreatic body or tail pancreatic ductal adenocarcinoma who underwent neoadjuvant therapy followed by distal pancreatectomy, the PANAMA score significantly stratifies patients by overall survival (p = 0.009) and disease-free survival (p = 0.029). These findings support the prognostic utility of the PANAMA score in pancreatic body and tail PDAC following neoadjuvant therapy and resection. ABSTRACT Background The PANAMA score was developed as a post-NAT prognostic tool for PDAC. Prior validations have been dominated by pancreatic head cancers. Pancreatic body and tail tumours represent a biologically distinct subgroup and remain underrepresented in NAT cohorts. Whether the score reliably predicts outcomes in distal PDAC remains unknown. Methods A retrospective study was conducted at a single centre including patients with PDAC who received NAT followed by distal pancreatectomy between January 2015 and December 2024. Patients were stratified into low-, intermediate- and high-risk groups based on the original PANAMA score. Overall survival (OS) and disease-free survival (DFS) were assessed. Prognostic performance of the PANAMA score and AJCC staging was compared. Results Fifty-two patients were included. Median OS and DFS were 40.8 months (95% CI: 28.7–55.0) and 11.6 months (95% CI: 9.7–14.5), respectively. High-risk patients showed worse OS compared to intermediate- and low-risk groups (21.8, 31.1 and 55.0 months, respectively, p = 0.009). A similar pattern was observed for DFS (10.3, 11.2 and 29.2 months, respectively, p = 0.029). The AJCC stage outperformed the PANAMA score in OS prediction (C-index 0.70 vs. 0.64). Conclusion The PANAMA score effectively stratifies patients with pancreatic body and tail PDACs undergoing neoadjuvant therapy and resection into prognostic groups. [...]

Among 573 patients undergoing long-course neoadjuvant chemoradiotherapy and total mesorectal excision between 2006 and 2020, five-year overall survival was 85.7%. Local recurrence was 3.4% and metastatic recurrence was 16.5%. Pathological stage and tumour regression grade stratified long-term outcomes, providing regional benchmarks for evaluating organ-preservation programmes. ABSTRACT Background Watch and wait strategies offer organ preservation for selected patients with rectal cancer following neoadjuvant chemoradiotherapy (nCRT). Long-term outcomes following nCRT and total mesorectal excision (TME) provide important context for evaluating these approaches. We report regional surgical, pathological, and long-term oncological outcomes following nCRT and TME, with oncological outcomes stratified by treatment response. Methods A multicentre retrospective cohort study included patients with rectal cancer treated with curative-intent nCRT followed by TME across four Western Australian centres between 2006 and 2020. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were estimated using Kaplan–Meier methods. Local and metastatic recurrence were estimated using cumulative incidence functions, with death without the recurrence of interest treated as a competing event. Outcomes were stratified by baseline clinical stage, pathological stage, and American Joint Committee on Cancer (AJCC) tumour regression grade (TRG). Results Among 573 patients, anastomotic leak occurred in 10.8% of patients with an anastomosis and an intended permanent stoma was formed in 31.9%. A pathological complete response occurred in 21.8%, and 3.1% had a positive circumferential resection margin. Five-year OS was 85.7%, CSS was 89.3% and DFS was 76.7%. The five-year cumulative incidences of local and metastatic recurrence were 3.4% and 16.5%, respectively. Baseline clinical stage was not associated with oncological outcomes, whereas pathological stage and AJCC TRG provided significant prognostic stratification. Five-year DFS was 92.2% for TRG 0% and 62.9% for TRG 3, with corresponding metastatic recurrence of 3.9% and 24.9%. Conclusion Long-course nCRT followed by TME achieved favourable long-term oncological outcomes. Pathological stage and AJCC TRG provided greater prognostic stratification than baseline clinical stage. These response-stratified estimates provide regional context for evaluating contemporary organ-preservation programmes. [...]

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

Using Motion Tracking to Assess Skill in Surgery. ABSTRACT Background Surgical assessment often relies on subjective expert observation, which may introduce bias. We aimed to objectively differentiate skill levels in a complex simulated operative procedure using hand-tracking metrics through a wearable mixed reality headset. Methods A validated paediatric open inguinal herniotomy simulator was used to simulate a surgical task composed of multiple sequential operative steps. Novices (medical students) and experts (paediatric surgeons) were recruited. After completing a pre-task questionnaire, participants performed the task while wearing the mixed reality headset (Microsoft HoloLens 2). A post-task questionnaire was completed. Metrics collected included total path length, average path length, average movement velocity and total time. Data are reported as mean (± SD) and analysis included descriptive statistics, frequency counts and comparative testing using t-tests. A p-value of [...]

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

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

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

ABSTRACT Background Anastomotic leak (AL) is the anathema of colorectal surgery. Early diagnosis is important to enable early intervention. Temporary diverting ileostomy (TDI) does not prevent AL and presents inherent complications. Numerous drain fluid biomarkers have been studied in colorectal surgery and extravasated intraluminal substances such as lipase have shown promise. The aim of this study was to assess drain fluid lipase (DFL) as a biomarker of AL after rectal resection with low colorectal anastomosis and no TDI. Methods This prospective observational cohort study collected samples of DFL in consecutive patients undergoing rectal resection with low colorectal anastomosis and without TDI. Data were collected and analysed relating to patient demographics, operation, indication, and daily DFL measurements from pelvic drains. Results Between August 2018 and March 2021, there were 62 patients recruited who met eligibility criteria. Overall, the anastomotic leak rate was 9.7% (6/62). These six patients were assigned to the AL group. The DFL on postoperative day 3 was found to be higher in the AL group compared to the NAL group (p = 0.034). A DFL cutoff threshold of less than 64 U/L was found to have a negative predictive value of 97.6% and a negative likelihood ratio of 0.32 in excluding AL. Conclusion This is the first study to assess the utility of DFL as a biomarker for AL following colorectal anastomosis without TDI. The measurement of DFL has value as a strong negative predictor of AL and moderate impact on post-test probability. The results are comparable to the use of systemic biomarkers. [...]

This graphical abstract summarizes a three-arm randomized controlled trial including 180 patients who underwent lobectomy. Patients were allocated to Benson relaxation (n = 60), progressive muscle relaxation (PMR; n = 60), or routine care/control (n = 60). The Benson and PMR groups received two 20-min sessions on postoperative Days 1 and 2. Pain intensity was assessed using the Visual Analogue Scale (VAS), and sleep quality was assessed using the Richards–Campbell Sleep Questionnaire (RCSQ) at baseline on postoperative Day 1 and again on postoperative Days 2 and 3. Both relaxation interventions were associated with lower postoperative pain and better sleep quality than routine care, while PMR produced the most favorable overall results. ABSTRACT Background/Objective Pain is one of the most common complications in patients undergoing lobectomy and can negatively affect sleep quality. This study aims to compare the effects of Benson relaxation technique and progressive muscle relaxation exercises on pain and sleep quality in patients who have undergone lobectomy. Methods This study was conducted as a three-arm, randomized controlled trial involving 180 patients who underwent lobectomy at a hospital in Turkey's Marmara region. The patients were randomly assigned to three groups (60 patients in each group): the Benson relaxation group, the progressive relaxation group, and the control group. Patients in the Benson relaxation and progressive relaxation groups were instructed to perform the exercises twice: once on the first day after surgery and once on the second day after surgery. The control group did not perform any exercises. Pain intensity and sleep quality were assessed at baseline (on the first day after surgery, before the exercise) and re-assessed on the second and third days after surgery. Results Significant differences were observed between the groups in pain scores on postoperative Days 1, 2, and 3 (p  [...]

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

ABSTRACT Background Rural communities in Aotearoa New Zealand experience inequitable access to surgical care. Rural surgical outreach clinics aim to reduce geographic and financial barriers by delivering specialist care closer to patients. Healthcare professionals' perspectives on the functioning, value and sustainability of these services remain underexplored. Methods A qualitative descriptive study was conducted using semi-structured interviews with nine staff members (consultant surgeons, nurses, junior doctors and administrative staff) purposively sampled from general surgical outreach clinics in Waipukurau and Wairoa, Hawke's Bay, Aotearoa New Zealand. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results Five interconnected themes were identified: (1) bringing care to the people—outreach as equity in action; (2) reducing the hidden costs of care; (3) relationships, cultural safety and trust; (4) staff as agents of change and rural outreach champions; and (5) the fragility and sustainability of outreach services. Participants perceived outreach clinics as improving access to specialist care, reducing the practical and financial burden of travel for patients, strengthening relationships with rural and Māori patients and enhancing team cohesion and professional fulfilment. However, outreach services were seen as vulnerable to resource constraints, centralised booking processes, reliance on committed individuals and policy pressures favouring centralisation. Conclusion Rural surgical outreach clinics form part of a rural and regional model of healthcare that mitigates barriers for patients and the wider health system. Sustaining and scaling these services will require deliberate institutional support and appropriate resourcing. [...]

ABSTRACT Introduction Assessment of the safety of Superior Hypogastric Nerve Block (SHNB) in uterine artery embolisation (UAE) for symptomatic fibroids. Method Retrospective single tertiary centre analysis of patients who underwent UAE with SHNB (n = 40). Outcomes include assessment of pain scores, overnight stays and complications. A follow-up phone survey was conducted to assess the women's willingness to undergo the procedure again (n = 18). Results Our cohort achieved a mean post-procedural pain score of 2.83 using SHNB and our analgesic regimen, with no complications attributed to the block. Most procedures were ambulatory, yielding a 67.5% same-day discharge rate. Although the low response rate to the follow-up survey limits generalisability of findings, 88.9% (16/18) of respondents were willing to undergo the procedure again, suggesting patient satisfaction. Conclusion This study provides reassuring evidence that superior hypogastric nerve block (SHNB) during uterine artery embolisation (UAE) yields favourable analgesic outcomes and short hospital stays. Notably, no SHNB-related complications were observed. [...]

Journal of Medical Imaging and Radiation Oncology, EarlyView. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S1, Page S4-S7, September 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S1, Page S1-S3, September 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S1, Page S13-S19, September 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S1, Page S20-S22, September 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S1, Page S8-S12, September 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue 6, Page 489-493, September 2026. [...]

ABSTRACT Objective This guideline defines recommendations for the provision of quality care for prostate artery embolisation (PAE) treatment for symptomatic benign prostatic hyperplasia (BPH). It has been developed using the AGREE-II framework and aligns with current evidence, sourced from Randomised Controlled Trials, meta-analyses and expert consensus. Recommendations are graded according to the level of evidence supporting them. Target Audience Men with symptomatic BPH considering their treatment options and referring clinicians including general practitioners, urologists and interventional radiologists. Formulation of Recommendations This guideline was developed using a modified Delphi approach among a panel of expert interventional radiologists, with a structured review of current literature including randomised controlled trials, meta-analyses and high-quality cohort studies. Target Users This guideline is intended for use by medical practitioners involved in the assessment and management of men with symptomatic BPH, including general practitioners, urologists and interventional radiologists. It may also inform policy-makers, hospital administrators and quality assurance bodies regarding the standard of care for PAE. Updating Procedure This guideline will be reviewed 5 years after publication, or earlier if significant new evidence emerges. Updates will follow the AGREE CheckUp process and will be published in relevant peer-reviewed outlets and society guidelines. [...]

ABSTRACT Introduction Stroke is a leading cause of morbidity and mortality in New Zealand, with ethnic disparities known to exist. Endovascular thrombectomy (EVT) has proven efficacy in reducing or preventing disability for stroke patients, but little is known about ethnic differences in functional outcomes following EVT in New Zealand. Methods A retrospective nationwide registry-based study was conducted, including all patients who underwent EVT between 1st January 2011 through to 31st December 2023 in New Zealand. Demographic, clinical and procedural data were obtained from the National Stroke Register. Primary outcomes were mortality at 7 days and dichotomised modified Rankin Scale (mRS) at 90 days. Subgroup analysis compared patients presenting directly to EVT-capable centres with those requiring transfer. Results 2852 EVT patients were included (68.7% European, 14.6% Māori, 7.4% Pacific, 8.4% Asian and 1.0% Other). Non-Europeans presented at younger ages and with greater vascular risk factors. Functional outcomes and 7-day mortality rates did not differ significantly by ethnicity. Odds of symptomatic intracranial haemorrhage (sICH) were greater in Māori (aOR 3.01, 1.42–6.38, p = 0.004), Pacific peoples (3.40, 1.22–9.53, p = 0.02) and Asian (aOR 3.57, 1.57–8.15, p = 0.002) patients compared to Europeans. Nearly half of patients (46.5%) initially presented to non-EVT capable centres; although EVT was delayed, functional and mortality outcomes remained similar. Conclusion This nationwide study found no significant ethnic disparities in functional outcomes or 7-day mortality following EVT, though sICH was more likely in non-Europeans. Despite treatment delays, patients initially presenting to non-EVT capable centres achieved comparable functional outcomes to those presenting directly to EVT centres. [...]

ABSTRACT Objectives We aimed to evaluate the adoption of hypofractionated radiotherapy (HFRT) for localised prostate cancer (PCa) and the quality of life (QOL) outcomes at a population-based level in Victoria. Methods This is a population-based cohort of individuals with PCa registered in the Victorian Prostate Cancer Outcomes Registry (PCOR-Vic) who had radiotherapy between 2016 and 2023. The primary outcomes were the proportion of individuals who had HFRT, and QOL 12 months post-treatment assessed using the EPIC26 questionnaire. Multivariable logistic regressions were used to evaluate factors associated with HFRT use, and linear regressions were used to estimate differences in EPIC26 domain scores between HFRT and conventional fractionated radiotherapy (CFRT). Results There were 3647 individuals included in the study—213 (6%) low-risk PCa, 1799 (49%) intermediate-risk PCa, and 1635 (45%) high-risk PCa. There were 1729 (47%) individuals who had HFRT. The use of HFRT increased from 2% for the whole cohort in 2016 to 87% for low-intermediate risk PCa and 52% for high-risk PCa in 2023. In multivariable analyses, increased age, low-intermediate risk PCa, and more recent years of treatment were independently associated with treatment with HFRT. Among individuals who completed the 12-month post-treatment EPIC26 questionnaire, no statistically or clinically significant differences in urinary and bowel QOL outcomes were observed between HFRT and CFRT. Conclusion There was a significant increase in the adoption of HFRT in this contemporaneous population-based cohort of individuals who had radiotherapy for localised PCa in Victoria. At a population-based level, there was no evidence of differences in QOL outcomes at 12 months after HFRT and CFRT. [...]

ABSTRACT Objectives We aimed to evaluate the adoption of hypofractionated radiotherapy (HFRT) for localised prostate cancer (PCa) and the quality of life (QOL) outcomes at a population-based level in Victoria. Methods This is a population-based cohort of individuals with PCa registered in the Victorian Prostate Cancer Outcomes Registry (PCOR-Vic) who had radiotherapy between 2016 and 2023. The primary outcomes were the proportion of individuals who had HFRT, and QOL 12 months post-treatment assessed using the EPIC26 questionnaire. Multivariable logistic regressions were used to evaluate factors associated with HFRT use, and linear regressions were used to estimate differences in EPIC26 domain scores between HFRT and conventional fractionated radiotherapy (CFRT). Results There were 3647 individuals included in the study—213 (6%) low-risk PCa, 1799 (49%) intermediate-risk PCa, and 1635 (45%) high-risk PCa. There were 1729 (47%) individuals who had HFRT. The use of HFRT increased from 2% for the whole cohort in 2016 to 87% for low-intermediate risk PCa and 52% for high-risk PCa in 2023. In multivariable analyses, increased age, low-intermediate risk PCa, and more recent years of treatment were independently associated with treatment with HFRT. Among individuals who completed the 12-month post-treatment EPIC26 questionnaire, no statistically or clinically significant differences in urinary and bowel QOL outcomes were observed between HFRT and CFRT. Conclusion There was a significant increase in the adoption of HFRT in this contemporaneous population-based cohort of individuals who had radiotherapy for localised PCa in Victoria. At a population-based level, there was no evidence of differences in QOL outcomes at 12 months after HFRT and CFRT. [...]

ABSTRACT Objective To examine the trend of locational equity in utilising Medicare-reimbursed psychiatric consultations (face-to-face and telepsychiatry) across states/territories. Design Time series analysis of administrative data. Setting Medicare-reimbursed private psychiatric consultations. Main Outcome Measures Greater coefficients of variation (CVs) represented higher state/territory variations in per capita consultations (2005 Q3–2023 Q4). We ran an autoregressive integrated moving average model for telepsychiatry-related CV change, with restricted rural-remote telepsychiatry items (2005–2022) and unrestricted telepsychiatry items (2020 Q1–2023 Q4) as the predictors. We examined the association between distance from mean per capita consultations and the fraction of per capita telepsychiatry consultations using state/territory-level data in another regression analysis, with telehealth legislative policy changes as another independent variable. Results Including telepsychiatry items since their introduction resulted in lower all-item CVs (i.e., reduced state/territory variation) than the corresponding CVs for face-to-face items only. The rural-remote-restricted telepsychiatry items had a larger effect than the unrestricted ones. Every 1000 restricted consultations were associated with 0.287 units of CV improvement (i.e., reduction in regional variation), in contrast to 0.007 units per 1000 consultations for unrestricted items. Telehealth-enabling policy changes significantly modified the association between distance from mean per capita face-to-face consultations and the fraction of telepsychiatry consultations. Lower per capita face-to-face consultations were associated with higher telepsychiatry fractions. Conclusion Telepsychiatry may help improve mental health equity. Bulk-billed, incentivised telepsychiatry for rural and remote areas may enhance regional health access. [...]

ABSTRACT Objective This study examines barriers and enablers to implementing Clinical Yarning into health care from the perspective of health care staff. Setting The Midwest Region (> 60,000 km2), Western Australia (WA). Design Semi-structured interviews with health care practitioners across four regional, rural and remote centers. Interview schedule was drawn from the Theoretical Domains Framework (TDF). Interviews were transcribed verbatim and analysed using inductive and framework analysis, informed by the TDF and Mechanisms of Action. Results Interviews with 53 health care practitioners (17% Aboriginal, 83% non-Aboriginal) ranged from 14 to 60 min in length. Barriers and enablers coalesced around three main themes: knowledge/perceptions of Clinical Yarning, training practices in general and Clinical Yarning specifically, and environmental conditions including general cultural safety and executive support. The barriers and enablers found in each of the domains lead to implementation strategies which use program champions and executive support, build on the positivity towards Clinical Yarning, pay attention to training delivery modes like including local cultural experts where able and acknowledge the larger cultural safety/security barriers within the health service. The barriers presented by workforce challenges are important key variables in any success of the Clinical Yarning intervention. Conclusion The documented enablers and barriers to implementing Clinical Yarning in the Midwest when viewed through a TDF/MoA framework provide a way to create a systematic implementation strategy to address the identified barriers and enablers. The findings have implications for other health services wishing to implement Clinical Yarning as well as culturally secure health care more broadly. [...]

ABSTRACT Objective Despite sustained investment in research capacity building, embedding research within clinical practice remains challenging, particularly within regional, rural and remote healthcare settings where workforce shortages, geographic dispersion and limited research infrastructure constrain research engagement. This paper presents the Integrated Research Enablement Framework (IREF), explaining how clinician-led research is activated, supported and embedded within healthcare settings. Methods A theory-informed framework development approach integrated cumulative empirical evidence generated through 9 years of implementation and evaluation of a regional research capacity building program with an interpretive synthesis of relevant research capacity building and implementation science literature. Framework development iteratively integrated empirical observations and theoretical models to identify mechanisms underpinning research enablement. Results The IREF comprises three interdependent domains: capability development, relational expertise and enabling infrastructure. These operate through integrated mechanisms including facilitation, mentorship, organisational alignment and resourcing, to support the activation, sustainment and embedding of clinician-led research. The framework conceptualises research capability development as a relational, practice-integrated process responsive to the contextual realities of regional and rural healthcare delivery. Conclusion The IREF complements existing research capacity building and implementation science frameworks by explicitly articulating the mechanisms through which clinician-led research becomes embedded within routine clinical practice. It provides an operational framework for developing research capability while strengthening the organisational conditions required to sustain research within healthcare systems. [...]

ABSTRACT Aim This commentary explores the growing financial challenges associated with rural and remote clinical placements for nursing and allied health students and considers their implications for workforce development in regional Australia. Drawing on routinely collected survey data provided by the Western Australian Centre for Rural Health (WACRH) between 2017 and 2024, we use student-reported experiences as evidence of persistent concerns about financial burdens during rural clinical placements and discuss potential policy and practice responses. Context Rural workforce shortages remain a persistent national challenge for University Departments of Rural Health which facilitate rural training experiences for health science students. Rising costs of living, housing shortages across Australia, and a policy shift towards longer rural placements have increased concerns about placement poverty, a term used to describe the financial burden students experience because of completing mandatory professional placements. WACRH includes support for students undertaking clinical placements in our regions through accommodation at no personal cost to the student, vehicle access for placement activities and limited travel subsidies to remote sites. Approach Data from pre- and post-placement surveys (2017–2024) was analysed. Quantitative data from Likert-style questions on financial concerns were analysed in Stata, while qualitative open-ended responses describing financial challenges were manually coded. Analyses examined variation by year and location. Conclusion Financial concerns have increased over time, with a notable rise in students reporting being “Concerned” or “Very concerned” since 2022. Many students reported significant cost-of-living pressures, dual accommodation expenses, additional food and travel costs, and limited financial support. Achieving national rural workforce policy outcomes requires greater support for rural placements, including funding that reflects the true costs of rural training. [...]

Australian Journal of Rural Health, Volume 34, Issue 5, October 2026. [...]

Australian Journal of Rural Health, Volume 34, Issue 5, October 2026. [...]

ABSTRACT Introduction Health professionals in rural and remote settings face distinct challenges including geographical isolation, workforce shortages, limited continuing professional development and reduced exposure to high-acuity, low-occurrence (HALO) clinical scenarios. Simulation-based education (SBE) has been proposed as a strategy to address these challenges; however, its design, implementation and evaluation in rural and remote contexts has not been comprehensively synthesized. Objective To map and characterize existing literature on SBE designed and delivered to rural and remote health professionals in high-income countries. Design A scoping review was conducted in accordance with JBI guidelines using the participant, concept, context (PCC) framework. Screening and data extraction were conducted using Covidence and results reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Findings Thirty-seven articles met the inclusion criteria, predominantly from the United States of America (USA), Australia and Canada. Most used quantitative or mixed methods designs. SBE was characterized across six areas: Simulation activity, modality, facilitators, support structures, research methods and learning objectives. Emergency care training, particularly for the management of deteriorating patients and HALO scenarios, was most prevalent. Modalities included simulated patients, in situ simulation, virtual simulation and procedural simulation. Technology-enabling approaches, including telemedicine and mobile simulation units, were increasingly reported. Discussion Reporting quality was variable. Most studies focused on learner-level outcomes, with limited evidence on system-level, workforce or patient outcomes. Rural-metropolitan collaboration through telemedicine and virtual facilitation was a recurring theme. Conclusion SBE sustains clinical capability in rural and remote settings, particularly for deteriorating patient management, HALO scenarios and for introducing emerging technologies. Further research on implementation, outcomes and workforce impact is warranted. [...]

ABSTRACT Objective To examine whether a VR rural health experience, co-created using an established process and research protocol, could achieve similar impacts on rural practice intent and reflective engagement in a different geographic and organisational context. Setting Metropolitan Sydney and Central Tablelands of New South Wales, Australia. Participants Forty-one health science students and professionals recruited at careers-related events or while on placement. Most participants (81.1%) were from metropolitan areas, and 39% had no prior rural work exposure. Design A parallel convergent mixed-methods study. Participants completed pre- and post-viewing surveys assessing intended practice location and presence in the VR environment. A subset (n = 38) participated in semi-structured interviews exploring their experiences. Quantitative data were analysed descriptively and using Wilcoxon Signed Rank tests; interviews underwent reflexive thematic analysis. Results Post-VR, there was a significant shift in intended practice location (p = 0.035, r = 0.233), with increased interest in inner regional and small rural communities. Participants reported high levels of presence and engagement. Three themes and four subthemes were developed, summarised as: (1) VR as immersive and convenient, though limited in interactivity; (2) a rural education and awareness tool that contextualised the rural environment and challenged assumptions; and (3) a career decision-making aid that reduced uncertainty, supported exploration and helped assess person–environment fit. Conclusion A locally tailored VR rural health experience reproduced, and built on the key outcomes of an earlier study in a different context, supporting its adaptability and potential as a scalable tool for rural workforce development through critical reflection and informed career exploration. [...]

ABSTRACT Introduction Following evidence that participation in rural clinical training during medical school is associated with later rural work, there is a growing literature comparing the effectiveness of different approaches to training. Objective To map literature examining the effectiveness of rural clinical training for graduates of Australian medical schools, accounting for differences in training design. Design A scoping review was conducted using literature searches performed across five academic databases from January 1, 2000 to January 12, 2026, selecting literature reporting on outcomes related to rural practice intent, internship preferencing or acceptance, and practice location at any point following participation in rural training during medical school. Findings A total of 413 unique records were screened, with 43 satisfying the inclusion criteria. Most studies examined outcomes of practice location spanning postgraduate years 1–17 (n = 33), with a smaller number examining internship preferencing and/or location (n = 10), rural practice intent (n = 6) and choice of rural vocational training (n = 1). Studies examined the effects of training duration, remoteness of placements, timing and use of longitudinal integrated clerkships (LICs) or other pedagogical approaches. Discussion Existing literature has focused on duration-related effects, consistently identifying that rural training of ≥ 1 year duration is associated with positive rural workforce outcomes in a dose-dependent manner, and established evidence for the effectiveness of rural LICs, particularly when combined with additional rural training. Conclusion There are opportunities to extend from existing literature to establish the effectiveness of core design elements within longer-duration rural training and LICs within more remote contexts, accounting for interaction with contextual variables. [...]

ABSTRACT THE CHALLENGE Rural and remote clinicians frequently make treatment decisions under conditions of uncertainty, exacerbated by limited access to specialist services, fewer locally available treatment options, and evidence that may not fully inform care for an individual patient. THE OPPORTUNITY N-of-1 trials and related single-case experimental designs (SCEDs) offer a structured method for generating individual-level evidence to support treatment decisions yet remain rarely used in routine clinical practice. Beyond informing care for individual patients, aggregated N-of-1 trials can also generate evidence that is directly relevant to rural populations and models of care. IMPLICATIONS This editorial outlines the potential of N-of-1 trials and SCEDs in rural and remote health and argues that increasing awareness, training, and practical support could enable their wider adoption. [...]

ABSTRACT Objective There is a paucity of evidence exploring the experiences and care needs for First Nations Australians with head and neck cancer (HNC). The aim of the study was to explore the journey of HNC diagnosis, treatment, and early recovery for patients and carers to inform service improvement. Setting, Participants and Design First Nations HNC patient and carer (n = 19) experiences were explored qualitatively through Yarning. Data was analysed using reflexive thematic analysis, with First Nations researcher involvement embedded in all stages of data collection and analysis. Results Key themes identified included: Strengths and protective factors; Coordination of care; Quality and continuity of care; Cultural safety; Communication and information; Cultural connectedness in hospital; and Gaps in health system support. The Strengths and protective factors theme was noted to be interwoven throughout the other themes and supported participants as a safety net during their care. Practical recommendations to the HNC care pathway were also offered under each theme. Conclusions The seven themes identified provided insights into the HNC care experiences for First Nations Australians. These findings and participant recommendations will inform a co-design process to create an optimised care pathway. [...]

ABSTRACT Aims This commentary examines how guardianship legislation interacts with the practical realities of providing care to older adults with cognitive decline in rural New South Wales. It aims to highlight systemic inequities arising from geographic isolation, workforce limitations and medico-legal uncertainty, and proposes reforms that align guardianship practice with the principles of autonomy, dignity and supported decision-making. Context In Australia, substitute decision-making for adults lacking capacity is governed by state guardianship law and Commonwealth-aged care regulation. Although these frameworks are designed to protect vulnerable individuals, their implementation in rural hospitals is often constrained by access to Consultation-Liaison (CL) Psychiatry, restricted administrative support, and delayed access to tribunal processes. These pressures contribute to inconsistent interpretation of guardianship powers, prolonged hospitalisation, and uncertainty around restrictive practice. The Royal Commission into Aged Care Quality and Safety called for nationally consistent rights-based decision-making but did not fully address the unique barriers faced in rural settings. Approach Drawing on three illustrative clinical vignettes from a rural CL Psychiatry service, this commentary explores how legislative ambiguity and resource scarcity shape substitute decision-making in everyday clinical practice. The discussion integrates medico-legal analysis, CL Psychiatry perspectives and rural health literature to identify critical gaps in knowledge, access and coordination. Conclusion Improving guardianship practice in rural hospitals requires investments in clinical education, streamlined medico-legal and psychiatric support, and coherent legislative alignment between state and Commonwealth frameworks. Addressing these inequities is essential to ensuring that the protections embedded in guardianship law translate into timely, person-centred care for older adults living in rural Australia. [...]

BACKGROUND AND OBJECTIVEUrinary tract infection (UTI) is a common bacterial infection during childhood. This article reports on a technical review investigating the management of UTI to inform the development of an updated clinical practice guideline (CPG) by the American Academy of Pediatrics (AAP).METHODSThe authors performed 5 systematic reviews comparing different options for: 1) antibiotic duration in children without known anatomic anomalies; 2) antibiotic route in children without known anatomic anomalies; 3) use of continuous antibiotic prophylaxis (CAP) for children with vesicoureteral reflux (VUR); 4) use of CAP for children with bowel and bladder dysfunction (BBD); and 5) timing of evaluation of children with suspected UTI. We performed database searches of Medline via PubMed, Embase, and Cochrane library from January 1, 2008, through August 5, 2023. Eligible studies were published in English and compared management strategies in a population of children with UTI, suspected UTI, acute pyelonephritis, VUR, and/or BBD. Data on study characteristics and patient-important outcomes were extracted from studies and pooled using meta-analysis when appropriate. Risk of bias was assessed using the Prediction model of Risk Of Bias ASsessment Tool, the Risk of Bias in Nonrandomized Studies of Interventions, and version 2 of the Cochrane risk-of-bias tool for randomized trials. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.RESULTSOut of 6154 identified records, a total of 60 studies were included. Overall, there was low to very low certainty regarding the effects of any intervention on patient outcomes. These results suggest that a relatively shorter course of antibiotic therapy (7 days or fewer) may not increase the risk of recurrent UTI, although it is likely to reduce the adverse events associated with antibiotic therapy. Additionally, oral antibiotic therapy may be similarly effective to parenteral (or parenteral-to-oral) therapy while avoiding potential harms associated with hospitalization. Rates of breakthrough UTI and renal scarring may be similar among children who receive CAP compared with those who do not, but rates of antibiotic-resistant UTI may increase with administration of CAP. Prompt medical evaluation within 72 hours of symptom onset may be associated with less renal scarring compared with later evaluation and treatment.CONCLUSIONThese results informed the development of the updated AAP CPG on the management of pediatric UTI, including recommendations on the duration of antibiotic therapy, route of antibiotic administration, use of prophylaxis in children with VUR and BBD, and timing of medical evaluation when UTI is suspected. Specific areas of uncertainty identified through this review may be addressed with future research. [...]

BACKGROUNDVesicoureteral reflux (VUR) may be present in as many as 40% of children without known underlying neurogenic bladder or anatomic abnormalities in whom a first urinary tract infection (UTI) is diagnosed. This article reports on a technical review investigating the diagnosis of VUR using renal and bladder ultrasonography (RBUS) to inform the development of an updated clinical practice guideline (CPG) by the American Academy of Pediatrics.METHODSThe authors performed a systematic review to evaluate the diagnostic test accuracy (DTA) of RBUS for the detection of VUR in pediatric patients following either their first UTI or recurrent UTI. We performed database searches of Medline via PubMed, Embase, and Cochrane Central Register of Controlled Trials from January 1, 2008, through August 5, 2023. Eligible studies were published in English and reported on DTA for RBUS performed in pediatric patients with an acceptable reference standard. Data on study characteristics and DTA parameters were extracted from studies and pooled using meta-analysis, when appropriate. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.RESULTSOut of 857 identified records, a total of 90 studies were included. Overall, there is low-to-moderate certainty that RBUS lacks accuracy in detecting VUR in children with their first UTI and low certainty that RBUS lacks accuracy in detecting VUR in children with recurrent UTI. The pooled sensitivity and specificity for children with their first UTI are 50% (95% confidence interval [CI], 42% to 58%) and 71% (95% CI, 62% to 78%), respectively. Accuracy does not substantially improve when restricted to the detection of high-grade (III-V) VUR (sensitivity: 66% [95% CI, 60% to 72%], specificity: 77% [95% CI, 71% to 82%]) or to children with recurrent UTI (sensitivity: 26% [95% CI, 23% to 28%], specificity: 79% [95% CI 76% to 81%]).CONCLUSIONThis systematic review illustrates the unreliability of RBUS as a stand-alone test in detecting VUR in a variety of scenarios. These results informed the development of an updated AAP CPG on the management of pediatric UTI. Specific areas of uncertainty identified through this review may be addressed with future research. [...]

10.1542/6403651574112Video AbstractPEDS-VA_2026-0785656403651574112Urinary tract infection (UTI) is one of the most common bacterial infections in infants and young children, with a prevalence of 7% in infants with fever. This clinical practice guideline (CPG) provides an update of the literature and clinical recommendations of the 2011 American Academy of Pediatrics (AAP) CPG on diagnosing and managing UTI in infants and children. It is designed to provide guidance for pediatricians and other pediatric clinicians on the diagnosis and management of UTIs in infants and children 8 days to 5 years of age and is intended for use in children with low medical complexity across a variety of settings. The CPG is accompanied by 3 technical reports to further elucidate the data that guided the development of recommendations and to establish criteria for the diagnosis of UTI. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of the evidence and formulate recommendations and good practice statements, including GRADE evidence-to-decision frameworks, which were reviewed by internal and external contributors. The CPG provides 8 Key Action Statements (2 strong and 6 conditional clinical recommendations, ranging from low to very low certainty of evidence) and 4 Good Practice Statements regarding medical evaluation of suspected UTI, management of UTI specific to antibiotic treatment, and imaging modalities and prevention strategies for structural abnormalities, including vesicoureteral reflux, and bowel and bladder dysfunction evaluation and treatment. [...]

Accurate diagnosis is essential to appropriate care. Although urinary tract infection (UTI) is one of the most common bacterial infections in children, there is no gold standard for its diagnosis. During the American Academy of Pediatrics’ revision of its Clinical Practice Guideline for the Diagnosis and Treatment of Urinary Tract Infection in Children from Eight Days to Five Years of Age, the Guideline panel established a revised UTI definition through an iterative discussion process. This article details the rationale behind those revisions. The definition of UTI is based in three domains: symptoms, signs of inflammation, and culture results. The panel focused the revision of the definition in the domains of inflammation and culture results. Although there is controversy in the literature regarding the inclusion of pyuria in the definition of UTI, current literature also supports that, in most clinical scenarios, pyuria is present in a UTI and should be included as a diagnostic criterion. Thus, the panel agreed that the UTI definition should include pyuria as a diagnostic criterion, and identified separate thresholds based on age and whether urine cultures results are available or pending. The other major domain where the panel closely examined the evidence was culture results. In accordance with the updated literature base, the panel modified the definition for positive culture on the basis of age and method of urine collection. The panel’s goal in developing the new UTI definition was to use currently available evidence to optimize management of children with UTI by avoiding overdiagnosis and overtreatment, while minimizing the number of missed diagnoses and delaying treatment. [...]

We thank Prof. Weizman for the thoughtful and careful reading of our study. [...]

In this issue of Pediatrics, Glantz analyzes data from the 2025 National Youth Tobacco Survey (NYTS) and reports on the most common products used by youth, including the disturbing trend of increasing intensity of e-cigarettes use over the past 12 years and a doubling of nicotine pouch use since 2021.1 Although overall tobacco use prevalence continues to decline in this school-age demographic with 7.2% using any tobacco product, this study demonstrates that hundreds of thousands of adolescents are getting addicted to nicotine each year in the United States, with 2.01 million students currently using tobacco products. [...]

I read with great interest the study by Omar et al,1 which examines sociodemographic variability in pediatric emergency recommendations generated by an ensemble of large language models (LLMs). The study’s scale, with over 3.7 million model outputs across 10 LLMs and 52 sociodemographic variants, is a meaningful contribution to the growing literature on equity and artificial intelligence in pediatric care. I wish, however, to raise several methodological concerns that bear on the interpretation of its conclusions. [...]

BACKGROUND AND OBJECTIVESThis paper summarizes 2025 findings of the National Youth Tobacco Survey (NYTS) regarding middle and high school students’ use of tobacco and compares these findings with historical information on the 2 most common products used by youth, e-cigarettes and nicotine pouches.METHODSPrevalence estimates from the NYTS public use dataset, accounting for complex survey design, are presented.RESULTSTobacco use continued declining through 2025, when 7.2% of youth used tobacco. Only nicotine pouches increased, doubling from 0.8% in 2021 to 1.7% in 2025. Pouches were the second-most-used tobacco product, after e-cigarettes (5.2%). Most youth used flavored tobacco products. E-cigarette use intensity increased over time, with daily use growing from 9.4% in 2014 to 35.4% in 2025. Dual and poly use is common among e-cigarette and pouch users.CONCLUSIONAlthough progress continued in reducing overall youth tobacco use, nicotine pouch use doubled. The changing market, elimination of the Centers for Disease Control and Prevention Office on Smoking and Health, and protobacco Food and Drug Administration regulatory decisions threaten progress in youth tobacco control, increasing the importance of state and local tobacco control policies, including comprehensive flavor bans, smokefree laws, and consistently higher taxes across all tobacco products. [...]

10.1542/6402013712112Video AbstractPEDS-VA_2025-0753336402013712112CONTEXTThe last meta-analysis of behavioral interventions regarding pediatric type 1 diabetes (T1D) management was conducted over a decade ago.OBJECTIVEThis meta-analysis aimed to (1) provide an updated review of adherence-promoting behavioral interventions and their effect on youths’ hemoglobin A1C (HbA1C) and (2) evaluate whether multicomponent interventions targeting both direct and indirect processes of T1D management continue to yield greater HbA1C improvements.DATA SOURCESWe conducted a systematic search in PubMed and Scopus for articles published between April 2009 and February 2025.STUDY SELECTIONIncluded studies were randomized controlled trials (RCTs) evaluating behavioral interventions targeting T1D self-management in youth and young adults up to age 25 years.DATA EXTRACTIONExtracted data included study characteristics, intervention content and duration, and glycemic outcomes for intervention and comparison groups.RESULTSOf the 62 RCTs identified, 46 reported sufficient data for quantitative analysis. The pooled effect size demonstrated a small benefit of adherence-promoting interventions on HbA1C (g = 0.12). Pilot RCTs showed larger effects (g = 0.36) than full RCTs (g = 0.07). Multicomponent interventions yielded greater improvements (g = 0.19) than direct (g = 0.08) or indirect (g = 0.15) interventions. Family-focused interventions demonstrated stronger effects (g = 0.29) than youth- (g = 0.05) or parent-focused (g = 0.04) interventions.LIMITATIONSFindings are limited to published RCTs.CONCLUSIONSDespite significant advancements in diabetes technology over the last decade, behavioral interventions continue to modestly improve HbA1C in youth with T1D. Multicomponent, family-focused strategies appear to be most effective. Findings highlight the need for rigorous trial designs to advance care for youth living with T1D.ARTICLE SUMMARYUpdated meta-analysis shows behavioral interventions modestly improve HbA1C in youth with T1D, with multicomponent, family-focused approaches outperforming single-component, youth- or parent-focused strategies overall. [...]

10.1542/6402012658112Video AbstractPEDS-VA_2025-0753466402012658112OBJECTIVETo test 2 strategies designed to enhance primary care–based literacy promotion (LP): (1) text message reminders (texts), and (2) texts plus referral to community resources.METHODSWe recruited 630 Latino caregiver-infant (aged 6 to 12 months) dyads for an effectiveness-implementation hybrid type 1 randomized trial. Dyads were randomly assigned into (1) LP-only (Reach Out and Read), (2) LP plus text messages (LP+texts), or (3) LP+texts plus referral to Connecting New Jersey (CNJ) (LP+texts+CNJ), which streamlines access to community resources based on the national Help Me Grow model. Participants completed online surveys and assessments at enrollment, and 9 and 18 months after enrollment. Primary outcomes focused on 3 domains: child language and social-emotional development, and parenting behaviors, including reading and verbal responsiveness. We followed the intent-to-treat principle and used step-down minimum P value method to adjust for multiple comparisons.RESULTSAmong caregivers, 74% had less than or equal to a high school diploma and 88% reported speaking English less than very well. At 18 months after enrollment, the LP+text arm [effect size (ES) = 0.391; adjusted (adj.) P = .001] but not LP+text+CNJ had higher language scores compared with LP-only. At 9 and 18 months after enrollment, the LP plus texts plus CNJ arm had higher scores on social-emotional development than LP-only (ES = 0.267; adj. P = .04 and ES = 0.300; adj. P = .03, respectively), whereas the LP+text arm did not. At 9 months after enrollment, scores were higher for the LP+text+CNJ arm on verbal responsiveness (ES = 0.400; adj. P < .001) and the LP+text arm on reading (ES = 0.415; adj. P = .002) compared with LP-only.CONCLUSIONTwo strategies with high potential for scale enhanced LP’s ability to promote relational and developmental health. Clinicians and policymakers can use this knowledge to optimize LP’s impact. [...]

10.1542/6400729864112Video AbstractPEDS-VA_2026-0763916400729864112OBJECTIVEOur objective was to descriptively examine national patterns of head computed tomography (CT) use for pediatric patients with mild traumatic brain injury (mTBI) across adult, pediatric, and mixed hospitals.METHODSWe conducted a retrospective study of children aged older than 18 years with isolated mTBI treated at National Trauma Data Bank-participating hospitals from 2017 to 2023. Hospitals were categorized as adult, pediatric, or mixed based on American College of Surgeons verification levels and state-level designations. We computed annual CT scan rates and 95% bootstrap CI overall and stratified by patient demographics, clinical features, and hospital characteristics. Subgroup analyses described CT use among scanned patients.RESULTSAmong 12 030 children with isolated mTBI during the study period, 32.1% were treated at adult hospitals, 31.6% at pediatric hospitals, and 36.2% at mixed hospitals. Overall, head CT use remained high with minimal variation over the study period, ranging from 43.5% to 51.5%. Adult hospitals consistently demonstrated the highest CT use (59.5%), followed by mixed hospitals (44.0%) and pediatric hospitals (38.8%). Increased imaging rates were observed among patients with lower Glasgow coma scale scores, impaired consciousness, and those treated in nonteaching or smaller hospitals. Most scanned patients were male, white, privately insured, and treated at level I or II trauma centers.CONCLUSIONDespite national guidelines, head CT use in pediatric mTBI remains high across all hospital types. These findings reveal persistent gaps in guidelines adoption and call for targeted interventions to reduce unnecessary imaging. Future research should identify barriers to adherence and institutional factors driving variability. [...]

The following essay, by Ms Tiffany Jackson, is the winner of this year’s annual Section on Pediatric Trainees (SOPT) essay competition in Pediatrics. The competition focused on the 2025–2026 SOPT advocacy campaign “Myth Busters: Kids First, Facts Always” by inviting essays on injury prevention. The runner-up essay will appear in a future issue of Pediatrics. [...]