General journals

Lecanemab (Leqembi), the first drug to show an ability to slow cognitive decline in Alzheimer’s disease, will be available for home use in the US from 6 October, following the approval of a weekly subcutaneous injectable version by the Food and Drug Administration (FDA).The new treatment, Leqembi Iqlik, will be covered by Medicare, which extends to all US citizens aged 65 and over. Its market price will be $19 500 (£14 400; €16 600) for a year’s treatment. This compares with around $13 300 for lecanemab outpatient intravenous (IV) maintenance therapy, which the FDA approved in January. The savings in hospital and clinic visits are expected to make the home use version a cheaper option, despite its higher price tag.Patients are only eligible for weekly injectable or monthly IV maintenance treatments following an 18 month outpatient course of biweekly IV therapy. This was the first lecanemab treatment to be approved... [...]

Thousands of striking resident doctors began to return to hospitals in South Korea on 1 September, ending an 18 month standoff that endured through police raids, a martial law declaration, and five changes of president.The return was agreed on 7 August at the third meeting of a consultative body that brought together health officials, resident doctors, and medical students.1The Korean Medical Association (KMA) cautiously welcomed the decision and the engagement from the new minister for health and welfare, Jeong Eun-kyeong, while calling for “policies that accurately reflect the reality of the medical field, not empty talk.”2 After meeting the minister this week, KMA president Kim Taek-woo urged her to “drastically improve” conditions for trainees.A spokesperson for the health minister did not answer questions by press time, and the KMA did not respond to enquiries.The end to the strikes came after positive signals from the new health minister, who has spoken... [...]

The BMJ’s former editor in chief, Fiona Godlee, was arrested this weekend alongside over a dozen other healthcare workers at a demonstration outside the Houses of Parliament in London while holding a sign reading, “I oppose genocide. I support Palestine Action.”The protest in Parliament Square on 6 September attracted an estimated crowd of 1500 to demonstrate against the genocide in Gaza,1 the UK’s continuing supply of arms to Israel, and the government’s proscription of the group Palestine Action as a terrorist organisation.In a video clip obtained by The BMJ Godlee is seen sitting at the protest holding a sign as six police officers approach. One then speaks to Godlee, telling her she is under arrest, before she is then taken away by two officers, with one confiscating her sign and a white flower she was also holding.At this point Godlee, who did not resist, turns to her fellow protesters and... [...]

bmj;390/sep05_10/r1847/FAF1faJulian was born in Horsham and brought up in Crawley, West Sussex. His father (who was blind) was an organist, piano teacher, and choirmaster, and his mother a magistrate. He attended Worthing High School for Boys and won a scholarship to Edinburgh University, starting medical school in 1950. He completed an intercalated honours degree in neuroanatomy and qualified in 1957.During his academic career he was much involved with politics and became president of the university Labour Club. He completed his preregistration year at East Fortune Hospital, Lothian, and St Bartholomew’s Hospital in Rochester, Kent.He then worked in East Africa for several years, arriving in 1958 with his wife Dörte and their young daughter. He was deputy to Ian Gordon at the tuberculosis hospital in Kibong’oto, Tanganyika (now Tanzania), in the foothills of Mount Kilimanjaro. Because of an acute shortage of medical staff in neighbouring Masailand, he moved to the hospital... [...]

Doctors have reported outbreaks of respiratory infections such as covid-19 and flu, as conditions worsen further for the population in Gaza.The UN Office for the Coordination of Humanitarian Affairs said that more than half (58%) of all recorded illnesses in Gaza in the week 3-9 August were acute respiratory infections. Particularly affected were children and people with chronic conditions, with crowded shelters driving transmission.Gaza’s health ministry has said that a total of 64 231 people have been killed and more than 161 000 injured since October 2023, though true numbers are likely to be higher, with many still trapped under rubble.Famine was declared on 22 August,1 and at least 370 people, including 131 children, have died from acute hunger, nearly 100 in the past two weeks alone.Healthcare workers remain frequent targets. On 25 August Israeli airstrikes on Nasser Hospital, a major facility in southern Gaza, killed at least 20 people,... [...]

Majno-Hurst and colleagues describe how asking patients scheduled for major surgery to share a short biography with the healthcare team has changed their working culture and improved care.1As a general practitioner, I have put together genograms and taken biographical details from patients for the past 30 years. A genogram is a schematic model of the structure and processes of a family, which includes the family structure, life cycle, and family relational patterns; “complex” genograms present families with psychosocial problems.2 Genograms should not include excessive information that paralyses understanding and intervention.3Genograms can provide recognition, clarification, and expanded information on risks and health problems (biological, psychological, and social) in the individual and the family. This has benefits for the doctor-patient relationship, for diagnosis, treatment, long term follow-up, prognosis, screening, preventive care, and epidemiological studies. The genogram connects individual care with community care.23Genograms can evolve over time. In addition to basic aspects of... [...]

At least 15 people including four healthcare workers have died from Ebola in the Democratic Republic of the Congo (DRC), the World Health Organization said on 4 September 2025 as it officially declared an outbreak of the disease.1At least 28 people have been infected in the remote province of Kasai, marking the DRC’s first outbreak in three years and the first in Kasai since 2008.WHO said it was dispatching healthcare specialists to the Bulape and Mweka regions in Kasai to help local teams contain the outbreaks. The deployment includes epidemiologists, infection control specialists, laboratory scientists, and case management experts.“We’re acting rapidly to halt the spread of the virus and protect communities,” said Mohamed Janabi, WHO’s regional director for Africa. “We’re working closely with the health authorities to quickly scale up key response measures to end the outbreak as soon as possible.”The DRC has seen 15 outbreaks of Ebola since the... [...]

The state of Florida intends to end all mandates requiring vaccines for children and adults, Governor Ron DeSantis and Surgeon General Joseph Ladapo said on 3 September. It is the first US state to make such a move.DeSantis also announced he was creating a state Make America Healthy Again commission, like that proposed by US Health Secretary Robert F Kennedy Jr.12Ladapo said at a news conference, “The Florida Department of Health, in partnership with the governor, is going to be working to end all vaccine mandates in Florida law.”All 50 US states and the District of Columbia have vaccine requirements for children in school but allow exemptions on medical grounds. Most allow exemptions on religious grounds, and some on personal grounds.Florida has banned mandates for covid-19 vaccines but they remain available in the state. At the time of writing, Florida still requires several vaccines for children.3 Ladapo, as head of... [...]

A former NHS consultant vascular surgeon who inflicted injuries on himself—causing his legs to be amputated—has been jailed for two years and eight months for making fraudulent insurance claims and possessing extreme pornography.Neil Hopper, 49, submerged his feet in dry ice for eight hours, causing them to become “unviable,” and he underwent below-the-knee amputations in 2019, Truro Crown Court heard.He pleaded guilty to two counts of fraud by false misrepresentation over claims that his injuries were caused by illness.1 Hopper obtained more than £466 000 from two insurance policies after telling insurers he had had septicaemia.The court was told that Hopper had a sexual interest in amputation. He admitted three charges of possessing extreme pornographic images from a website dedicated to body modifications. He was identified after investigations into Marius Gustavson, who ran the EunuchMaker website.Judge James Adkin said the videos showed people suffering from “shocking and irreversible life-changing injuries.”In... [...]

Martha’s rule—a scheme allowing patients and families to get an urgent second opinion if they are concerned about their own or a loved one’s care—will be expanded to every acute care hospital in England.The programme is named after 13 year old Martha Mills, who died in an NHS hospital in 2021 from sepsis after being admitted with a pancreatic injury sustained when she fell off her bike. During her care, her family’s concerns about her deteriorating condition were not responded to.1 An inquest later concluded that Martha would probably have survived had she been moved to intensive care earlier.2Last year NHS England launched a pilot of the scheme in 143 hospitals, after a campaign by Martha’s parents, Merope Mills and Paul Laity.Early data showed that as a result of the scheme dozens of patients received critical interventions such as urgent transfers to intensive care, being given oxygen, or receiving antibiotics.3New... [...]

Do we need experts? You might think that we don’t, that experts are troublesome or even dangerous. You probably hold these views if you spend too much time listening to people who do not possess the expertise of their opponents. When politicians condemn experts and their expert utterances it tends to happen when politicians are in danger of losing an argument that matters to them. We saw this in the UK during the ill informed national “debate” that inflicted the mass harm of Brexit. The theme emerged again at the height of the covid-19 pandemic when a generation of self-confessed social media experts believed their newfound opinions to be superior to the pontification of old fashioned experts with relevant degrees, professorships, and experience. What do they know, eh?The value of experts and expertise is in question again after a recent diatribe by Robert F Kennedy Jr, US secretary for health... [...]

Almost 1.1 billion people have mental health conditions, and global efforts to treat them are “insufficient and inadequate,” the World Health Organization (WHO) has said.The agency published a new report on 2 September looking at data from 144 countries between 2021 and 2024.1 The results estimate that 13.6% of people had mental disorders in 2021—more than one in every seven people and 0.9% higher than a decade earlier.Prevalence of mental health conditions was highest in those aged 40-44 (17%), and adults aged 20-29 saw the largest rise in mental health issues since 2011.Despite mental health problems being the second largest cause of long term disability, they remain neglected, particularly in poorer countries, WHO said. More than half of patients with serious mental illness in high income countries are receiving treatment, but in low income nations less than 1 in 10 are receiving support.“Transforming mental health services is one of the... [...]

This randomized clinical trial examines the safety and efficacy of intravenous alteplase administered 4.5 to 24 hours after stroke onset in patients with salvageable brain tissue. [...]

This Medical News article discusses the latest SARS-CoV-2 variants and how well COVID-19 vaccines planned for 2025-2026 will protect against them. [...]

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

To the Editor We read with interest the recent article on the incidence and outcomes of cardiac arrest during long-distance running events in the US. However, we would like to highlight a methodological concern regarding the use of race finishers as a surrogate for race participants. While the authors acknowledged that this approach may have included some runners more than once—potentially underestimating the per-person incidence—it also introduced a second bias not addressed in the limitations section: exclusion of nonfinishers from the denominator, despite the inclusion of all cardiac arrests (including those occurring mid-race) in the numerator. [...]

In Reply We appreciate the thoughtful commentary provided by Dr Schober and colleagues in response to our recent article that documented sudden cardiac arrest and death during US-based long-distance running races from 2010 to 2023. The authors question the accuracy of our cardiac arrest and death incidence rates with a focus on the methodology used to generate the denominator component of these statistics. As described, the denominator used for our incidence estimates relied on the total number of race finishers, a metric carefully tabulated on an annual basis by our research partner Running USA. However, the total number of race finishers during the study period may have included repeat race finishers. As transparently acknowledged in the article, we concur with Schober and colleagues that this introduced the possibility that our incidence data may have underestimated the true “per-person” risk of cardiac arrest and death. [...]

This Viewpoint discusses the challenges of implementing “most-favored-nation,” or international reference, pricing for prescription drugs in the US. [...]

As AI tools like large language models move rapidly toward real-world application in health care, key questions remain about how best to evaluate them. A JAMA+ AI podcast features David Rhew, MD, Microsoft’s Global Chief Medical Officer, discussing the opportunities and challenges. Reflecting on the rapid evolution of the technology, Rhew notes that even opinions about the technology from 6 months ago “may need to be reassessed—because it’s definitely gotten a lot better.” He also addresses the importance of ensuring AI literacy for clinicians. [...]

This study examines trends in colorectal cancer incidence among adults younger than 55 years after recommendations for earlier screening. [...]

Worldwide, obesity affects approximately 19% of women and 14% of men. In the US, obesity affects approximately 42% of adults and has been projected to affect 1 in 2 adults by the year 2030. New medications with incretin-based effects, such as semaglutide and tirzepatide, can help individuals achieve weight loss of 15% and 21%, respectively, providing new and highly effective therapeutic options for obesity. These incretin-based therapies also have cardiometabolic effects that can improve human health. For example, semaglutide prevented new cardiovascular events in patients with established cardiovascular disease and slowed progression of chronic kidney disease. Tirzepatide was effective for treating patients with moderate to severe obstructive sleep apnea. New and even more potent medications for obesity treatment are undergoing testing in randomized clinical trials and are likely to be available to clinicians in the relatively near future. [...]

All day I am crammed into this room. Gawking at the wires, prodding snakes tracing my arms. My joints plough into the sheets & the machines above waver & whimper, like shadows in the wind. Years before, I was always by the porch. I’d stare past the lawn, past the streets, where the valleys seemed to swell upwards breath by breath. Now, here, time moves a little faster. This is a life where each day trudges along with apology— clamor out in the hallway, a crowd of trolleys hiccuping across the linoleum. & I am still here, waiting for the nights to quiet & cradle me to sleep. [...]

This Perspective discusses the use of artificial intelligence (AI) tools in health care and offers a framework for deciding what patients should be told about AI tools. [...]

For patients with type 2 diabetes (T2D) and obesity, glucagon-like peptide-1 (GLP-1) drugs may offer neuroprotective and cerebrovascular benefits in addition to glycemic control, a recent study found. [...]

The treatment landscape for first-line oncogene driver-negative metastatic non-small-cell lung cancer (NSCLC) has remained largely unchanged in recent years. Since the 2016 approval of the anti-PD-1 immune checkpoint inhibitor (ICI) pembrolizumab for front-line treatment of patients with metastatic NSCLC with PD-L1 expression of 50% or greater,1 numerous ICI monotherapies and combination regimens have followed. With an abundance of treatment options already available in the first-line setting, the HARMONi-2 trial—the results of which are presented by Anwen Xiong and colleagues in The Lancet2—raises critical questions: does ivonescimab, a novel bispecific antibody targeting VEGF and PD-L1, offer meaningful clinical advantages over existing PD-1 or PD-L1 inhibitors? And is there a compelling need for another therapeutic option in this space? [...]

In the Chief Medical Officer for England's 2018 independent annual report, we called for the creation of a Composite Health Index (CHI)1,2 to track and inform efforts to improve the nation's health. The UK Office for National Statistics (ONS) responded by developing a beta Health Index3 followed by three updates, the latest covering 2015–21, which was published in June, 2023.4 We commend the ONS for their work, although funding constraints have since halted updates. With the new Secretary of State prioritising health-driven economic growth, we believe a renewed CHI should play a key part in tracking and informing these efforts over the coming years. [...]

Tuberculosis is a leading cause of death globally. Given the airborne transmission of tuberculosis, anybody can be infected, but people in high-incidence settings are more exposed. Risk of progression to disease is higher in the first years after infection, and in people with undernourishment, immunosuppression, or who smoke, drink alcohol, or have diabetes. Although cough, fever, and weight loss are hallmark symptoms, people with tuberculosis can be asymptomatic, so a high index of suspicion is required. [...]

Our findings indicate that young children with AIPL1-related retinal dystrophy benefited substantially from subretinal administration of rAAV8.hRKp.AIPL1, with improved visual acuity and functional vision and evidence of some protection against progressive retinal degeneration, without serious adverse effects. [...]

Inherited retinal dystrophies are a genetically heterogeneous group of disorders that cause vision loss through degeneration or dysfunction of retinal photoreceptors. Gene-based therapies aim to correct the underlying molecular defect to arrest further degeneration or to ameliorate the dysfunction. Large improvements in vision have been reported in early phase clinical trials of gene-based therapies for some inherited retinal dystrophies characterised by functional defects with preservation of cellular architecture,1–4 and one gene therapy, voretigene neparvovec, has received regulatory approval. [...]

We are writing to respond to comments from Joshua W Miller and colleagues1 regarding our 2024 report of the Lancet standing Commission on dementia prevention, intervention, and care.2 Miller and colleagues propose adding homocysteine to the list of potentially modifiable dementia risk factors, citing a 2013 post hoc analysis of data from the VITACOG trial.3 This analysis suggested that lowering homocysteine concentrations through vitamin B supplementation reduced atrophy in a subgroup of people with mild cognitive impairment. [...]

Street vendors, who make up a substantial portion of the informal workforce in many low-income and middle-income countries, remain largely excluded from formal health insurance coverage, which poses a major risk to their health and financial wellbeing. Despite their key economic role, street vendors often do not have the legal recognition, stable income, and collective bargaining power required to access public or private health insurance schemes.1 [...]

Gill Livingston and colleagues report an updated combined population attributable fraction (PAF) of 45% for modifiable dementia risk.1 This statistic provides important direction for risk reduction and will receive much attention. [...]

I read with interest the Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission by Gill Livingston and colleagues.1 The authors present an updated meta-analysis on the association between hearing loss and dementia, reporting a pooled hazard ratio (HR) of 1·37 (95% CI 1·00–1·87), which is lower than previous estimates (1·9; 1·4–2·7).2 [...]

In the Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, Gill Livingston and colleagues identify a final set of 14 modifiable risk factors for delaying or preventing dementia.1 However, although sleep was discussed, it was not included in this final set. [...]

We read with great interest the Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission.1 Although the report offers valuable insights, we believe it overlooks the substantial role of oral health in dementia risk. [...]

We are pleased that our 2024 Lancet Commission's1 discussion of dementia risk has prompted international interest. Within it, we have been transparent about the assumptions behind our new population attributable fraction (PAF) calculations and present the best current estimates. These estimates will continue to change with new research and adjustments in the way people live. We discuss other risk factors that might be included in the future as stronger evidence emerges, but which have not yet reached the consistent, high-quality evidence threshold for inclusion. [...]

Abstract Objectives To assess the association between infections, assessed by antibiotic reimbursement, and the occurrence of giant cell arteritis (GCA) and/or polymyalgia rheumatica (PMR). Methods We conducted a nested case–control study from the French cohort E3N-European Prospective Investigation into Cancer and Nutrition, which has followed 98,995 women since 1990. Cases, defined as patients who developed GCA and/or PMR during follow-up, were matched with 20 controls on age and vital status. Infections prior to index date, defined by ≥1 antibiotic reimbursement on the medication claims reimbursement database, were compared between groups using conditional logistic regression models, adjusted for potential confounders. Different time periods before the index date and different antibiotic classes were compared. Results A total of 428 GCA/PMR cases (113 GCA, 232 PMR, 83 undefined) were compared to 8560 matched controls. Compared to controls, GCA/PMR cases had higher odds to have any infection in the [0–24] months prior to index date (aOR [95% CI] 1.22 [1.00–1.51]). Considering the 6-month periods prior to index date, the association was stronger when close to index date (1.18 [0.94–1.47]; 0.95 [0.75–1.19] for [0–6] and [18–24] months, respectively). This association was only found among GCA cases (1.63 [1.08–2.48] for [0–24] months), but not among PMR cases. Quinolone reimbursements were the most associated with subsequent GCA (2.07 [1.23–3.49] for [0–12] months). Conclusion Compared to controls, GCA patients were at higher risk of having used antibiotics in the 24 months prior to the diagnosis. Infections or a disbalanced microbiome could act as a trigger of the disease, although a reverse causation bias cannot be excluded. [...]

Abstract Objectives In retroperitoneal fibrosis (RPF), glucocorticoids (GC), alone or in combination with immunosuppressive agents, induce remission in 80%–90% of patients but up to two thirds of them relapse. There is limited knowledge on outcome predictors in RPF. We aimed to identify clinical, laboratory and imaging predictors of remission and relapse in RPF. Methods We included consecutive RPF patients treated with 6–9-month courses of GC with/without immunosuppressive agents. Baseline and post-treatment computed tomography, magnetic resonance imaging and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) were assessed. The potential predictive value of the examined parameters as predictors of remission and time-to-relapse was analysed using logistic and Cox regression models. Results Of 152 patients screened, 115 were included. Of them, 101 (87.8%) achieved remission a median of 4 months (interquartile range 3–5) after starting treatment. At multivariable analysis, smoking (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.11–0.99) and atypical RPF localization (e.g., pelvic) (OR 0.11, 95% CI 0.02–0.52) were negatively associated with remission, whereas pre-treatment 18F-FDG-PET activity was positively associated (OR 11.51, 95% CI 1.35–98.20). A median of 33 months (17–57) after treatment initiation, 42% patients relapsed (median time from remission to relapse, 14 months [8–26]). Thoracic vessel involvement and positive 18F-FDG-PET at the end of treatment independently predicted relapse (hazard ratio [HR] 2.61, 95% CI 1.19–5.68 and HR 3.47, 95% CI 1.54–7.82, respectively). Conclusions Metabolic activity of RPF at 18F-FDG-PET is an important predictor of remission and relapse. Smoking and atypical localization are negatively associated with remission, whereas thoracic aorta involvement is associated with relapse risk. [...]

Abstract Objective To investigate the natural history of diabetes mellitus (DM) based on metabolic phenotypes of prediabetes in a community-based prospective study. Methods Individuals aged 40–69 years without DM were followed for 20 years. Glycemic parameters, including the 75 g oral glucose tolerance test, were assessed at baseline and biennially thereafter. Markov models were used to estimate each glycemic state's annual transition probabilities and average total length of residence. Results Among the 7,676 participants without DM, 205 had isolated impaired fasting glucose (iIFG), and 1,753 had impaired glucose tolerance (IGT) at baseline. During the 17.5 years of follow-up, 2,313 (30.1%) cases of DM occurred. The annual transition to DM for those with iIFG was 7.7% (95% confidence interval [CI] 6.9, 8.5) and 6.9% (95% CI 6.6, 7.3) for those with IGT. In the normoglycemia ↔ iIFG → DM model, the total length in normoglycemia was 49.4 years (95% CI 47.0, 52.1), and the length in iIFG was 6.3 years (95% CI 5.9, 6.8). In the normoglycemia ↔ IGT → DM model, the total length in normoglycemia was 34.0 years (95% CI 32.4, 35.4), and the length in IGT was 11.9 years (95% CI 11.1, 12.5). Conclusions Individuals remained normoglycemic for long periods. However, the progression to DM occurs rapidly once prediabetes develops, regardless of the metabolic phenotype. [...]

Journal of Internal Medicine, Volume 298, Issue 3, Page 145-145, September 2025. [...]

Abstract Background Type 2 diabetes mellitus (T2DM) and gout are associated with an increased risk of cardiovascular events. Despite the approval for the secondary prevention of cardiovascular diseases by the United States Food and Drug Administration in 2023, evidence regarding the effectiveness of colchicine among T2DM population remains limited. Objectives We aimed to evaluate the association between the use of colchicine and the risk of major adverse cardiovascular events (MACE) among patients with gout and T2DM. Methods We conducted a nationwide, population-based cohort study with active comparator, new-user design using nationwide claims data of South Korea (2010–2022). Patients with T2DM and gout who initiated colchicine or non-steroidal anti-inflammatory drugs (NSAIDs) from 2011 to 2022 were included. The primary outcome was MACE (myocardial infarction, ischemic stroke, and cardiovascular death). Secondary outcomes were each individual components of primary outcome and hospitalization due to heart failure. As-treated approach with 30-day grace period was applied. Results Before propensity score (PS) matching, 13,019 colchicine users and 111,594 NSAIDs users were included in the study cohort (mean age, 65.5 vs. 62.9; 35.0% vs. 29.8% female). After 1:2 PS matching, 12,908 colchicine users and 25,816 NSAIDs users remained (mean age, 65.7 vs. 65.7 years; 35.2% vs. 35.1% female). The PS-matched hazard ratio for MACE was 0.94 (95% confidence interval 0.65–1.36), and all secondary outcomes also resulted in null findings. Conclusions Use of colchicine does not significantly reduce the risk of MACE compared with NSAIDs in a real-world population with T2DM and gout in South Korea between 2011 and 2022. [...]

Abstract This review elucidates the critical role of inter-organ crosstalk in systemic health, focusing on the kidney's interactions with the heart, bone marrow, lung, liver, intestine, bone-vascular, and nervous system. These interactions are vital for maintaining physiological homeostasis and are mediated by hormones, cytokines, and metabolites. The kidney's role in these networks is pivotal, as dysfunction can exacerbate systemic diseases, highlighting the need for integrated therapeutic strategies. Chronic kidney disease and acute kidney injury serve as key examples of how kidney dysfunction impacts other organs, leading to complex disease states. The central idea is that the kidney functions within a network of physiological processes, influencing and being influenced by other organs. This review provides an overview of the mechanisms underlying kidney-related inter-organ communication, emphasizing the significance of these interactions in disease progression. We explore how advanced computational models and multi-omics approaches can enhance our understanding of these complex networks, paving the way for precision medicine. The insights derived from this work underscore the potential for future research in developing innovative treatments that target these intricate pathways. By fostering interdisciplinary collaboration and leveraging emerging technologies, we aim to address the multifaceted nature of systemic diseases, offering new avenues for therapeutic intervention. This review represents a paradigm shift from reductionist to integrative approaches, emphasizing the importance of systemic balance and adaptation in human health, and sets the stage for future exploration into the interconnectedness of body systems. [...]

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

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

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

Abstract Although outcomes for newly diagnosed acute myeloid leukaemia (AML) have been incrementally improved over the last decades, management of relapsed and refractory (R/R) AML remains a medical challenge. A curative intent for R/R AML usually involves chemotherapy (with or without targeted therapy) with subsequent consolidation, including allogeneic haematopoietic stem cell transplantation. Despite this, long-term survival rates of R/R AML only reach approximately 10% in adults and 40% in children. Given this great unmet clinical need, this review outlines the current and emerging paradigms for preventing and treating R/R AML. Somatic mutations, gene expression, and functional drug testing are important for the selection of small molecule inhibitors of oncogenic signalling pathways (e.g., FLT3), menin inhibitors that disrupt leukemogenic programmes, inhibitors of isocitrate dehydrogenases to restore oncometabolic homoeostasis, and proapoptotic Bcl-2 homology 3 (BH3) mimetics, such as venetoclax. Targeting the recently identified resistance factor SAMHD1 promises to overcome resistance to cytarabine and fludarabine. Given the growing number of potential combinatorial drug regimens and the genetic heterogeneity of AML, real-time ex vivo drug response profiling to guide individualized treatment decisions will become an important complement. We argue that better outcomes for R/R AML critically depend on being guided by precision oncology to define the best combination of chemotherapy, targeted therapy, and immunological therapy informed by phenotypic and genotypic patient- and disease-specific parameters. [...]

Abstract Background Infection has been suspected as a risk factor for amyotrophic lateral sclerosis (ALS). However, previous research has focused on specific pathogens and rarely examined the influence of infection on disease progression. Objectives To assess whether hospital-treated infections correlate with the risk and prognosis of ALS. Methods Using data from the Swedish Motor Neuron Disease Quality Registry, we conducted three nested case-control studies, including 1159 individuals diagnosed with ALS during 2015–2023 and 5795 age- and sex-matched population controls, 1558 full-sibling controls, and 680 spouse controls, respectively. We used conditional logistic regression to estimate the association of hospital-treated infections with subsequent risk of ALS and Cox model to assess the association of pre- or post-diagnostic infections with mortality after an ALS diagnosis. Results Hospital-treated infections before diagnosis were associated with an increased risk of ALS in the population comparison (odds ratio [OR] 1.31; 95% confidence interval [CI] 1.15–1.49). A similar association was noted after excluding infections within 3-, 5-, or 10-years preceding ALS diagnosis and was confirmed in sibling and spouse comparisons, although results were not always statistically significant. Patients with a hospital-treated infection before diagnosis were more likely to present with bulbar symptoms, poorer functional status, and higher prevalence of anxiety and depressive symptoms at diagnosis than others. Pre-diagnostic infections were not associated with mortality, whereas post-diagnostic infections were associated with increased mortality (hazard ratio [HR] 1.89; 95%CI 1.59–2.24) among ALS patients. Conclusion Hospital-treated infections are associated with an increased risk of ALS and may modify its clinical presentation at diagnosis. Post-diagnostic infections are associated with poor survival in ALS. [...]

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

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

ANZ Journal of Surgery, Volume 95, Issue 7-8, Page 1287-1290, July/August 2025. [...]

ANZ Journal of Surgery, Volume 95, Issue 7-8, Page 1625-1626, July/August 2025. [...]

ABSTRACT Background While education and training managers are key personnel within surgical training programs regarding management of trainee performance including remediation, there is a lack of research concerning their perspectives. For improvements in remediation at a systems level, insight to their perspectives and experiences is essential. Methods This qualitative study explored the perspectives of 12 education and training managers of surgical societies/associations/colleges in Australia and Aotearoa New Zealand. Purposive and snowball sampling was utilized for data collection in semi-structured interviews. Following an interpretivist approach, transcribed interviews were analyzed using reflexive thematic analysis. Results Four themes and 10 subthemes were identified: “a guiding role”; remediation is a “well-oiled machine”; remediation is “not punitive”; and room for improvement. Conclusion Educational managers hold a pivotal role in guiding trainees and supervisors throughout the remediation process. From their perspective, remediation is considered well managed, with nearly all trainees successfully completing remediation. Although they recommend further resources and additional support for supervisors, their focus on improvement centers on tightening governance and reducing the risk of trainee litigation. Including the perspectives of managers in the remediation process will aid in its successful implementation. [...]

Among White patients, the adjuvant chemotherapy group showed significantly better OS than the non-adjuvant chemotherapy group, while no OS difference was observed between the two groups in non-White populations. Only non-White patients with poorly differentiated tumors benefited from adjuvant chemotherapy. ABSTRACT Background The survival benefits of adjuvant chemotherapy for stage IB non-small cell lung cancer (NSCLC) remain controversial. The existing evidence is mostly based on the Caucasian population, especially the differences in efficacy among different races are not yet clear. Method Based on the data of patients with stage T2N0M0 NSCLC in the SEER database from 2010 to 2018 (n = 7458), they were divided into white people (6076 cases) and non-white people (1382 cases). The baseline characteristics of the adjuvant chemotherapy group and the non-adjuvant chemotherapy group were balanced by propensity score matching (PSM). The overall survival (OS) was assessed using Kaplan–Meier methodology with log-rank testing, while multivariable Cox regression analysis was employed to identify independent prognostic factors. Result Among white people, the OS of the adjuvant chemotherapy group was significantly better than that of the observation group (p  4 cm), VPI, or grade of differentiation. There was no statistically significant difference in OS among non-white people (p > 0.05 before and after PSM), and only the poorly differentiated subgroup showed limited benefits (p = 0.008). Multivariate Cox analysis confirmed that adjuvant chemotherapy was an independent predictor of OS in white people (p  [...]

By combining Total Neoadjuvant Therapy with a watch-and-wait strategy, patients can achieve organ preservation and improved quality of life, while experiencing lower, though not absent, rates of LARS. ABSTRACT Aim Total neoadjuvant therapy (TNT) for locally advanced rectal cancer improves oncological outcomes and organ preservation rates, but the impact on patient quality of life (QoL) is not known. This cohort study compares the quality of life (QoL) of post-TNT watch-and-wait (W&W) patients to a historical cohort of patients that underwent standard care. Method Patients managed with a W&W approach following a personalised TNT (pTNT W&W group) were compared with historical group patients who had undergone standard treatment but who would have been eligible for pTNT under our current protocol (STD group). Patients were sent three questionnaires to complete: Survey of International Delphi consensus definition for lower anterior resection syndrome (LARS) symptoms, EORTC-QLQ-CR29, and the LARS score. Results Questionnaires were completed for 29 of 41 patients in the pTNT W&W group, and 33 of 63 patients in the STD group (a response rate of 70.7% and 52.4%, respectively). Patients were well matched at baseline. The pTNT W&W group had significantly lower LARS rates (55.6% vs. 87.5%, p = 0.012) with fewer cases of major LARS (29.6% vs. 58.3%, p = 0.039). The pTNT W&W also had significantly improved QoL scores across several parameters of EORTC–QLQ–CR29 including stool frequency (20.7 vs. 30.8, p = 0.009), embarrassment regarding bowel symptoms (16.1 vs. 31.3, p = 0.018), and abdominal pain (5.8 vs. 14.1, p = 0.005). Conclusions Despite retaining the irradiated rectum, patients managed with organ preservation after TNT experience a higher QoL with much lower, but not absent, rates of bowel and bladder dysfunction. [...]

In 226 patients discharged after open abdominal aortic aneurysm repair, near-lifelong follow-up showed a 19% incisional hernia rate. Obesity and prior laparotomy increased the risk. Our findings support personalised counselling, risk optimisation, and long-term planning in an era of expanding AAA treatment options. ABSTRACT Background Incisional hernia (IH) is a known complication of open abdominal aortic aneurysm repair (OAAAR), with reported rates ranging from 5.6% to 69%. Few studies have examined the long-term risk of IH. As OAAAR is often performed in younger patients requiring durable outcomes, understanding lifetime IH risk is important for preoperative counselling. This study aimed to determine the lifetime risk of IH following OAAAR. Methods A retrospective review of patients who underwent OAAAR at Auckland City Hospital between January 2004 and December 2008 was conducted. Patients who died within 30 days of surgery, who resided outside New Zealand, or who had incomplete medical records were excluded. Multivariable Cox regression analysis was performed to assess the influence of demographic, anthropometric, disease, and treatment factors on IH development. Results Two hundred and twenty-six patients were identified, of whom 75.7% were male and 85.0% of European ethnicity. 90.7% of the cohort were deceased at the time of analysis. The median follow-up amongst survivors was 18.2 years. In total, 19% of patients developed an incisional hernia after OAAAR. IH was significantly more likely in patients with BMI ≥ 30 kg/m2 (aHR 3.49, 95% CI 1.82–6.69, p  [...]

Contemporary surgical management of colorectal cancer in lynch syndrome: considering the implications of known genotype. ABSTRACT Background Lynch syndrome (LS) is an autosomal dominant disorder caused by germline mutations in mismatch repair (MMR) genes, accounting for 1%–3% of all colorectal cancer (CRC) diagnoses. It is associated with an elevated lifetime CRC risk of 30%–80% and predisposes individuals to various extra-colonic malignancies. Advances in genetic profiling have refined our understanding of LS, offering opportunities to tailor surgical and surveillance strategies. Summary The surgical management of LS is shifting from a uniform, aggressive approach to more nuanced strategies guided by patient-specific factors, including age, tumor characteristics, and genetic variants. While extended resections reduce metachronous CRC risk, they may not significantly improve survival compared to segmental resections and can negatively affect quality of life. Enhanced surveillance and emerging therapies, such as chemoprophylaxis and immunotherapy, are further reshaping treatment paradigms. Key Message Surgical management of LS must remain patient-centered, integrating functional outcomes, genetic risk, and individual circumstances. Genetic-variant-specific recommendations, coupled with personalized surveillance strategies, are essential to optimizing care without compromising survival or quality of life. [...]

ABSTRACT Background Approximately one-quarter of patients undergoing resection for intrahepatic cholangiocarcinoma (ICC) experience very early recurrence (within 6 months after liver resection), which is associated with a poor prognosis. Identifying factors associated with very early recurrence may help optimize patient selection for surgery and avoid futile, high-risk hepatectomies. The aim of this study was to assess whether preoperative clinical factors alone can reliably predict very early recurrence following curative liver resection for ICC. Methods A retrospective analysis was conducted on 83 patients who underwent liver resection between 2010 and 2020. Results The 5-year overall survival (OS) rate for the entire cohort was 51.4%. Recurrence occurred in 54 patients (65.1%), with 17 (20.5%) experiencing very early recurrence. The 5-year OS for patients with very early recurrence was significantly lower than for those without it (0% vs. 48.7%, respectively; p = 0.013). Preoperative clinical prognostic factors failed to identify patients at high risk of very early recurrence, which occurred in 21% of patients classified as low risk. Conclusions Preoperative clinical factors alone are insufficient for accurate risk stratification. Integrating clinicopathological data with molecular classifications of ICC is urgently needed to enable a more personalized oncological approach for these patients. [...]

ABSTRACT Background Research productivity is a key indicator of academic and clinical advancement in surgery. While previous studies have identified key drivers of productivity, comprehensive analyses examining the key determinants of research output across multiple Australian surgical departments remain limited. Methods A cross-sectional study was conducted analysing publicly available data from 16 surgical departments at Royal Prince Alfred (RPA) Hospital in December 2024. Data on researcher characteristics, including number of publications, citations, h-index, higher degree by research (HDR) training, academic appointments, and international collaboration, were collated and aggregated for each department. Departmental research productivity was assessed through three primary outcomes: total publication count, aggregate citation count, and median h-index. Univariate and multivariable logistic regression analyses were performed in RStudio to examine associations between these factors and departmental research productivity, measured by publication count, citation count, and median h-index. Results A total of 216 research members (148 consultants) were included. For publication count, univariate analyses showed significant associations with HDR training (p = 0.016) and academic appointment level (p = 0.048). In the multivariable model, only HDR training remained independently associated with publication count (β = 8.31, 95% CI: 1.77–14.85, p = 0.016, R 2 = 0.347). For h-index, HDR training (p = 0.027), academic appointment level (p = 0.138), international qualification (p = 0.039), and international collaboration (p = 0.044) showed associations in univariate testing. In the multivariable model, both HDR training (β = 0.29, 95% CI: 0.03–0.55, p = 0.030, R 2 = 0.491) and international collaboration (β = 0.47, 95% CI: 0.00–0.93, p = 0.048, R 2 = 0.491) remained significant. No multivariable models constructed for citations met statistical significance. Conclusions This study highlights HDR training as the most consistent predictor of surgical research productivity across multiple metrics across surgical departments in a tertiary Australian hospital. International collaboration emerges as an additional significant driver of research impact, as measured by h-index. These findings provide evidence to support institutional investments in HDR training pathways and international collaborative networks as strategic approaches to enhance research culture and productivity in Australian surgical departments. [...]

ABSTRACT Background The use of robotic surgery in minimally invasive spleen and splenic vessel preserving distal pancreatectomy, known as Kimura technique (MI-KT), is on the rise. This study aims to compare the surgical outcomes of robotic and laparoscopic approaches. Methods We performed a retrospective analysis of patients who underwent MI-KT at the National Cheng Kung University Hospital, comparing outcomes such as spleen preservation rate, operation time, blood loss, complications, and length of hospital stay, using propensity score matching. Results Among 136 patients (111 laparoscopic, 25 robotic), proficiency milestones differed significantly. Although no statistically significant differences were observed in postoperative outcomes between the robotic and laparoscopic groups post-matching, the robotic approach exhibited a shorter learning curve (p  [...]

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

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

ABSTRACT Introduction Glioblastoma management in elderly patients is challenging. The aim of this study was to review oncological treatment strategies at a single institution from 2011 to 2020. Methods Patients aged ≥ 70 years who received radiotherapy and/or chemotherapy for radiological or histological glioblastoma were identified from a centralised database. Patients receiving supportive care only were excluded, whether or not they had surgery at diagnosis. Clinicopathologic data and treatment modalities were collected. Median survival from diagnosis was calculated by the Kaplan–Meier method. Results Seventy-eight people were identified during the study period, median age 74.5 years (range 70–88). Seventy-five people had surgery (24 biopsy only, and 51 resection) and three people had radiological diagnosis only. The most common first-line treatment was concurrent chemoradiation (33/78, 42%). Only 18/33 (55%) went on to receive adjuvant temozolomide, median of five cycles (interquartile range [IQR] 2–6). The most common radiotherapy dose was 40 Gy in 15 fractions (52/73, 71%) and 60 Gy in 30 fractions was less frequently prescribed over time. Second-line therapy for recurrent or progressive disease was received in 23% overall, and varied in modality. Median survival was 7.0 months (IQR 4.4–12.5), and 6.4% (CI 4.3%–9.1%) at 2 years. Conclusion Survival is poor for elderly patients with glioblastoma despite treatment. Concurrent chemoradiation was the most common treatment strategy, and 40 Gy in 15 fractions was the most common radiotherapy schedule. A small proportion of people received treatment for recurrent disease, and modality varied greatly. [...]

ABSTRACT Introduction MRI-guided adaptive radiation therapy (ART) is the resource-intensive process of daily treatment plan modification. This study aims to demonstrate the feasibility of radiation therapist (RT)-led MRI-guided ART for oligometastatic disease (OMD) by comparing geometric accuracy and dosimetric differences between RT and radiation oncologist (RO) re-contouring. Methods Five RTs and five ROs retrospectively re-contoured gross target volumes (GTVs) and organs-at-risk (OARs) for eight OMD cases. RT and RO contours were compared against consensus RO Simultaneous Truth and Performance Level Estimation (RO-STAPLE) contours using the Dice similarity coefficient (DICE), mean distance to agreement (MDA), planning target volume (PTV) D95 and OAR D0.5cc using the Wilcoxon signed-rank test. Moreover, an RO qualitatively scored all contours using a 5-point Likert scale. Results We found very good geometric accuracy with average (±standard deviation) GTV DICE of 0.82 ± 0.06 for RTs and 0.85 ± 0.09 for ROs and MDA of 0.88 ± 0.03 mm for RT and 0.75 ± 0.05 mm for ROs relative to the RO-STAPLE. Qualitative GTV Likert scores were excellent, 4.8/5 for RTs and 4.7/5 for ROs. Mean percent difference in PTV D95 compared to RO-STAPLE was small but significantly higher for RTs (0.5% ± 1.5%) compared with ROs (−0.7% ± 1.9%, p  [...]

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

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

ABSTRACT Introduction Rib fractures following falls are common among patients over 70 years of age. While nonoperative management is standard, surgical stabilisation of rib fractures (SSRF) is increasingly performed in selected elderly patients despite concerns about frailty and comorbidities. Although osteoporosis significantly increases fracture risk, rib fractures have not traditionally been categorised as fragility fractures. Methods This study retrospectively evaluated bone mineral density (BMD), represented by L1 vertebral Hounsfield units (HU) and correlated clinical outcomes in patients with rib fractures from trauma. A control group of 100 age- and sex-matched nontrauma patients was included for comparison. Results Overall, trauma patients exhibited higher mean L1 HU values, 125.0, compared to controls, 105.5 (p = 3 × 10−5). Within the patients sustaining rib fractures, the low-energy trauma group had lower mean L1 HU values (112.6) than those from high-energy trauma (133, p = 0.002), suggesting a link between lower BMD and susceptibility to rib fractures. Low BMD (L1 HU ≤ 110) was not associated with worse clinical outcomes such as hospital length of stay, analgesia requirements or fracture healing, whether managed operatively or nonoperatively. Low BMD did not affect rib union post-SSRF, with no hardware failures. These results suggest that low BMD alone should not contraindicate SSRF. Conclusion The authors recommend routine osteoporosis screening using opportunistic L1 HU measurement on trauma CT scans, particularly in elderly patients sustaining low-energy trauma, to facilitate early osteoporosis management and reduce future fracture risk. [...]

ABSTRACT Introduction Long term survival for adenoid cystic carcinoma (ACC) arising from the head and neck declines for many decades after initial treatment due to late disease relapse. Follow up and surveillance imaging practices vary due to limited evidence as well as a lack of international guidelines (until 2021). Methods A retrospective cohort study was conducted for patients treated curatively for ACC between 2007 and 2024 at a single institution. Clinicopathologic information, treatment details, patterns of follow-up (including radiologic investigations) and oncological outcomes are reported. Results 51 patients comprised the study cohort. Median age was 50 years; 96% of patients underwent surgery and adjuvant radiation therapy. Median follow-up was 7.65 years. 5-year overall survival (OS) and disease-free survival (DFS) were 88% and 73% respectively. 18% and 61% of patients underwent surveillance imaging within 3- and 12-months of treatment completion respectively. 80% of first recurrences were detected on surveillance imaging. Half the episodes of first disease recurrence occurred within 5 years of initial treatment, a further 25% within 10 years and the remaining 25% occurred > 10 years post treatment. Conclusion This cohort of patients curatively treated for ACC at a single institution highlights the propensity for late distant relapse as well as heterogeneity of surveillance imaging. A local institutional protocol is proposed based upon the 2021 ASCO guidelines to standardise clinical and radiologic follow-up for this group. [...]

ABSTRACT Background Hypothalamic hamartoma (HH) is a rare congenital malformation that can significantly disrupt patient quality of life and typically presents with either central precocious puberty or gelastic seizures. Objective We seek to add to the current literature through a retrospective review of all cases of HH seen at our paediatric tertiary centre over the previous two decades. We also sought to test the novel hypothesis that lesions located closer to or contacting the infundibulum were more likely to present with central precocious puberty (CPP). Materials and Methods Retrospective review of the public PACS system was performed, yielding a total of sixteen patients with HH identified on MRI between January 2000 and February 2022. Imaging and patient records were retrospectively evaluated. Results Six patients presented with central precocious puberty (CPP), six with gelastic or other seizure disorders, and four had alternate presenting issues. Our study demonstrates a statistically significant relationship between pedunculated lesions and CPP and between sessile/intrahypothalamic lesions and gelastic seizure/neuropsychiatric symptoms. We did not demonstrate a relationship between tumour location relative to the infundibulum or mammillary bodies and clinical manifestations. Conclusion Hypothalamic hamartomas are rare congenital malformations which typically present with one of two classical phenotypes: CPP or gelastic seizure. The study demonstrates a statistically significant relationship between pedunculated lesions and CPP and between lesions with third ventricular involvement and gelastic seizure/neuropsychiatric symptoms. We did not demonstrate a clear relationship between specific tumour location within the hypothalamus and phenotype; larger cohort studies are recommended to further investigate this hypothesis. [...]

ABSTRACT On July 1, 2025, Australia commenced screening eligible participants in a ground-breaking health initiative with the launch of a national lung cancer screening program (NLCSP). Designed for individuals at high risk, this program aims to promote early detection and improve both survival rates and treatment outcomes. Radiology will serve as a cornerstone of the program's success. This article provides a comprehensive overview from the radiologist's perspective. [...]

ABSTRACT Introduction Radiation Oncology Nurses (RONs) are key members of the radiation oncology team; however, the role of the RON is not always clear. The aims of this study were to provide an overview of the RON workforce in Australia, to describe the roles and responsibilities of RONs, and to identify challenges and job satisfaction of RONs. Methods This was a two-part multi-methods survey study. Two self-reported questionnaires were distributed online using purposive and snowball sampling: Radiation Oncology Facility Survey (ROFS) and RON Workforce Survey (RONWS). The surveys used tick boxes, Likert scale and open and closed-ended questions. Frequencies and percentages were calculated for categorical variables; mean/standard deviation for continuous variables. Results A total of 42 responses were received for the ROFS and 139 for the RONWS, representing all States and Territories in Australia except the Australian Capital Territory (ACT): 52% were metropolitan and 50% were public facilities. Only 17% reported radiation oncology specific training, but 58% had plans to further their education. 80% reported being satisfied with their career and position, believing their role was recognised and generally respected among colleagues and patients. Areas of dissatisfaction included salary, staffing resources and opportunities for advancement. Conclusion This is the largest study of RONs in Australia, revealing that RON is a satisfying oncology specialty. Data from this study can be used to identify opportunities for improvement in staffing, engagement and retention of RONs, possibly leading to the development of national guidelines for radiation oncology nursing in Australia. [...]

ABSTRACT Introduction Prostate cancer is a prevalent malignancy with rising incidence rates globally. High-intensity focused ultrasound (HIFU) is a promising, minimally invasive treatment for localised prostate cancer. However, recurrence following HIFU, indicated by rising PSA levels or imaging-confirmed local recurrence, remains a concern. Salvage radiotherapy is a potential treatment for recurrent prostate cancer post-HIFU, but evidence on its efficacy and safety is limited. Method This retrospective study evaluated eight patients with localised prostate cancer who underwent salvage radiotherapy following HIFU failure. Salvage treatment consisted of external beam radiation therapy (EBRT), delivered either as conventional fractionation (76 Gy in 38 daily fractions) or stereotactic ablative radiotherapy (36.25–40 Gy in five alternate-day fractions). Outcomes assessed included prostate-specific antigen (PSA) response, biochemical progression-free survival (bPFS), overall survival (OS) and treatment-related toxicity profiles. Results All eight patients experienced a significant decline in PSA levels, with no biochemical failures observed during a median follow-up of 72.4 months. The 5-year biochemical failure-free survival and overall survival rates were 100%. Among the eight patients, 6 (75%) had Grade 2 or lower genitourinary toxicity, and 5 (62.5%) had Grade 2 or lower gastrointestinal toxicity, with no Grade 3 or higher adverse events. Discussion Salvage EBRT after HIFU failure provides durable disease control with manageable side effects. Further research with larger cohorts is needed to refine treatment strategies for recurrent prostate cancer. [...]

ABSTRACT Introduction The emergence of search engines powered by artificial intelligence and large language models (LLMs), such as ChatGPT, provides easy access to seemingly accurate health information. However, the accuracy of the information produced is uncertain. The purpose of this research is to assess the quality of information produced by ChatGPT about the treatment of health conditions commonly managed by Interventional Radiologists (IRs). Methods ChatGPT was asked “what is the best treatment” in relation to six conditions commonly managed by IRs. The output statements were assessed using the DISCERN instrument and compared against the current evidence base for the management of those conditions. Results Six conditions were assessed. The mean overall score for the ChatGPT output statements was 1.3 compared to 3.8 for the reference articles. This poor performance by ChatGPT is largely attributable to the lack of transparency regarding sources. Although ChatGPT performed well in some areas such as presenting information in an unbiased manner, it showed significant weaknesses regarding source materials, the risks and benefits of each treatment, and the treatment's mechanism of action. Conclusion LLMs signify a considerable shift in how patients obtain and consume medical information. Understanding the strengths and weaknesses of ChatGPT's outputs regarding conditions commonly treated by IRs will enable tailored messaging and constructive discussions with patients in consultation with their IR. [...]

ABSTRACT Aims Workforce maldistribution is a challenge to the equitable provision of healthcare in Australia. This Commentary details how a multi-university, large-scale, and growing data asset is positioned to contribute strategically and operationally to addressing national workforce priorities. Context The Nursing and Allied Health Graduate Outcome Tracking (NAHGOT) study is a prospective longitudinal research project with a commitment to nationwide geographical coverage. NAHGOT links practice location data (the outcome) from the Australian Health Practitioner Regulation Agency (Ahpra) with university administrative records, such as admission and placement data (explanatory variables). NAHGOT also links external surveys and publicly available spatial data describing socio-economic conditions and access to services. There are seven universities formally part of the collaboration, with five others in the process of joining. NAHGOT has established a framework including project governance, data linkage and management protocols, and a central repository for de-identified data. Approach The background of NAHGOT, the benefits to the Rural Health Multidisciplinary Training program, current limitations and challenges, and the case for scale-up and future direction are described. Conclusion Universities are uniquely positioned to lead graduate tracking as they have access to a suite of key explanatory variables not available elsewhere. Increasing the number of participating universities within NAHGOT is a priority, as is broadening the pool of disciplines beyond those covered by Ahpra. The geo-enrichment of placement and practice data is also a priority. This will allow a more granular understanding of local workforce dynamics that can be overlooked if analysis is limited to existing geographical classifications. [...]

ABSTRACT Objective To evaluate the effectiveness of the Griffith Ophthalmology Project in improving visual acuity and quality of life (QoL) among cataract surgery patients in regional New South Wales (NSW), Australia. Design Retrospective observational study. Setting Griffith Base Hospital's Department of Ophthalmology in the Western Murrumbidgee Local Health District (MLHD). Participants The 135 patients (168 eyes) undergoing cataract surgery between March 2022 and July 2023 completed QoL surveys. Main Outcome Measures Changes in vision-related QoL (assessed by National Eye Institute Visual Function Questionnaire; NEI-VFQ), health-related QoL (assessed by EuroQol 5-Dimensional 5-Level survey; EQ-5D-5L), visual acuity, and surgical waiting times. Methods Patients completed the NEI-VFQ and EQ-5D-5L surveys before and/or after surgery. Pre- and post-operative visual acuity and waiting list data were collected and analysed. Results EI-VFQ data showed significant enhancements in 11 of 12 QoL subscales (including social functioning and mental health) as well as the composite QoL score. EQ-5D-5L results indicated improvements in all five dimensions, with overall health-related QoL significantly increased. Visual acuity improved significantly, the surgical waitlist was reduced from 123 to 10 patients, and waiting times decreased from 15 to 2 months. Conclusions The Griffith Ophthalmology Project significantly improved visual and QoL outcomes for cataract surgery patients in regional NSW and reduced surgical waiting times. This model of utilising visiting specialists and collaborative local support may serve as a template for sustainable regional healthcare services in Australia. [...]

Australian Journal of Rural Health, Volume 33, Issue 5, October 2025. [...]

ABSTRACT Introduction Soft tissue knee injuries (STKIs) pose a significant healthcare challenge, particularly in rural settings with limited access to imaging and specialist consultation. This study aimed to evaluate current practices and challenges in diagnosing acute knee injuries in a rural setting and presented a pathway tailored for rural healthcare settings to improve diagnostic confidence, optimise imaging use, and streamline patient management. Methods A survey-based study was conducted among seventeen medical officers in six rural medical centres across New South Wales and Queensland. The survey involved a structured questionnaire on current practices and challenges. A structured rural pathway for acute knee injury was presented, and feedback was reported. Results Most clinicians assessed knee injuries weekly, showing variable confidence in their assessments and special tests. Key barriers identified included limited access to imaging, lack of specialist consultation, and diagnostic uncertainty, which led to increased referrals. The proposed pathway was rated highly intuitive, aligned with clinical guidelines, and was expected to streamline management. Conclusion The proposed pathway has clinical support and the potential to enhance knee injury management in rural settings by improving diagnostic accuracy, offering pathways aligned with the risk of injury, and promoting timely specialist care. Further research is necessary to assess long-term clinical outcomes and pathway integration across allied health services and rural healthcare facilities. [...]

ABSTRACT Objectives Rural communities in Australia face significant barriers to health. Grounded in phenomenology as a research methodology, this study aimed to explore health literacy and shared decision-making in rural areas from the perspective of community members. Design Semi-structured interview study, with data analysed using Framework Analysis. Participants Twenty-five adults living in rural communities. Setting Interviews were conducted remotely, spanning seven Australian states and territories. Results Three main themes were generated from the data (comprising 10 sub-themes): (a) service access, (b) healthcare engagement, trust and decision making, (c) ‘a different approach for us’: leveraging community strengths. Demands on health literacy in rural settings were amplified, with additional health literacy requirements related to accessing and using healthcare services, navigating the healthcare system and understanding how to take appropriate health action in a rural setting. Participants reflected on the transient nature of the healthcare workforce in rural areas and experiences of pressurised health systems as barriers to service access and shared decision-making. Our analysis also identified a complex interplay between the social determinants of health and health literacy in rural contexts; challenges in healthcare access and navigation were discussed in the context of socioeconomic status, education, literacy and language. However, we also identified rural community strengths which could be leveraged to support health literacy action and responsiveness. Conclusion By addressing unique health literacy challenges and leveraging the strengths of rural communities, healthcare policies and interventions can better meet the needs of these populations. [...]

ABSTRACT Objective This paper aims to identify ways in which University Departments of Rural Health (UDRHs) contribute intellectual capital to their rural and remote regions. Background UDRHs contribute to their regions through various means, including student placements, workforce development, First Nations support and training, community engagement, economic impacts and research. UDRHs also contribute to various forms of community capital, although there remains a lack of detailed understanding of how UDRHs contribute to the intellectual capital of their regions. Methods Senior staff from six UDRHs worked from a constructivist research paradigm as ‘insider’ researchers to identify four key avenues through which UDRHs contribute and enhance intellectual capital in their regions. For each avenue, a case study was developed to examine these contributions in detail. Results The four case studies illustrate how different UDRHs contribute intellectual capital through students and health professional education and training, community partnerships to address local issues, research and research capacity building and through UDRHs networks that cross regions and rural–urban boundaries. UDRHs were found to contribute to health practice, local evidence, partnerships and advocacy, all benefiting their regions. Conclusion The co-production of locally tailored knowledge by UDRHs offers a valuable contribution to rural and remote communities. The knowledge and evidence contributed by universities is often not provided by other sectors in rural areas, but is valued by communities, contributes to intellectual capital in these regions, and bridges the urban–rural knowledge divide. [...]

ABSTRACT Introduction The global nursing shortage significantly impacts healthcare sustainability, particularly in rural Australia, where geographic isolation, professional remoteness and resource constraints amplify challenges. Objective To map and synthesise evidence on factors influencing rural nursing workforce sustainability across individual, organisational and systemic levels. Design A scoping review following PRISMA-ScR guidelines was conducted. Five databases and grey literature were searched for English-language publications (1995–2024) on rural nursing workforce sustainability. A micro-meso-macro conceptual framework guided the analysis of 33 publications, focusing on baccalaureate-prepared Registered Nurses. Findings Key determinants were identified across three levels. Micro-level factors included personal characteristics, professional identity and safety considerations. Meso-level factors, addressed in 32 studies, encompassed health services programmes, organisational culture, management approaches and professional development opportunities. Macro-level factors included community engagement, educational pathways, scope of practice policies and government initiatives. Significant interconnections existed between factors across all levels. Discussion While targeted interventions show promise, programmes need systematic evaluation using standardised frameworks. Research priorities include longitudinal effectiveness studies, economic impact analyses and the development of practical implementation tools. Conclusion A sustainable rural nursing workforce requires integrated approaches that simultaneously address individual, organisational and systemic factors. Success depends on evidence-based collaboration between healthcare organisations, educational institutions and government bodies to strengthen rural healthcare delivery through coordinated multilevel strategies. [...]

ABSTRACT Objective Aboriginal and Torres Strait Islander children, particularly those in remote Australia, face disproportionately higher rates of preventable health conditions and disability. Early intervention is considered particularly important for this demographic, but previous attempts have had limited success. Design In response to a need identified by the Cherbourg Health Service, Starlight Children's Foundation Australia (Starlight) partnered with them to host a unique “third birthday party” event in Cherbourg, Queensland. Setting and Participants The event aimed to provide health checks and a culturally sensitive, positive healthcare experience for three-year-old children and the Cherbourg community, incorporating key health service providers and Starlight “Captains” to facilitate the health checks and activities/games. Main outcome measure(s): To evaluate the third birthday party health initiative, the main outcome measures were the strengths and future considerations and improvements of the event. Result The quantitative and qualitative data highlighted the event's success in promoting an effective and positive community-led healthcare experience by employing a unique, prevention-focused methodology, with benefits extending from the community to health staff and students. Conclusion Overall, the Cherbourg third birthday party serves as a model for culturally appropriate early health interventions in Australia, offering valuable insights to enhance healthcare promotion, access, and engagement for Indigenous children and communities. [...]

ABSTRACT Objective The objective of this study was to determine the effect of rural clinical placements on allied health students' perceived self-efficacy in service delivery, as part of a larger evaluation of facilitated student placements in Northern New South Wales residential aged-care homes. Methods A mixed-methods design was employed. Allied health students from a variety of universities undertook at least five-week clinical placements in two rural residential aged-care homes via a programme designed and coordinated by the University Centre for Rural Health in partnership with the Aged Care Residential facility. Quantitative data were collected using a modified Self-Efficacy in Clinical Performance Scale, pre and post-placement. Semi-structured interviews were conducted post-placement. Self-efficacy scores were compared using the Wilcoxon Signed-Rank test, and the effect size was calculated. Reflexive thematic analysis was conducted to identify themes from interview transcripts. Results Twenty-five students completed the surveys, and 12 interviews were included in this study. There was a statistically significant increase, post-placement compared to pre-placement, in total self-efficacy in clinical performance scores, as well as in subscale scores. The subscales related to assessment, diagnosis, and planning and implementation. Two themes were identified from the qualitative interviews: (1) heightened confidence, independence, and work readiness; and (2) confidence and enthusiasm for interprofessional work. Conclusions Our findings provide beginning evidence that a well-resourced and focused programme of clinical placements can improve allied health student self-efficacy and may stimulate greater enthusiasm for working in the rural aged-care sector. [...]

ABSTRACT Objective To assess the comparative importance of dimensions of access when accessing primary care across different levels of rurality in Australia. Design A quantitative survey using the paired comparison method. Setting Regional, rural, and remote communities in Queensland, Australia, are defined by the Modified Monash Model classification. Participants 3204 households were surveyed, with 192 responses received (6% response rate). After data cleaning, 163 usable surveys were included in the final analysis. Main Outcome Measure(s) Level of importance for seven dimensions of access: availability, geography, affordability, accommodation, timeliness, acceptability, and awareness. Results Awareness was the most important dimension, consistent across all ruralities. Timeliness and availability also ranked highly, though their relative importance varied slightly with the level of rurality. Residents of the regional centre and small rural town ranked timeliness second, while remote and very remote community residents ranked availability second. Geography increased in importance as rurality increased, rising from least important for regional centre residents to mid-level importance for remote and very remote residents. Affordability consistently ranked low in importance across all ruralities. Conclusion This study reveals differences in the importance of dimensions of access when accessing primary care for residents of regional, rural, and remote Australian communities. These findings suggest that strategies to improve primary care access should be tailored to address the most critical factors across different levels of rurality, focusing on improving awareness, availability, and timeliness of primary care services. The increased importance of geography in the remote and very remote community highlights the need for innovative solutions to overcome geographical barriers for these residents. [...]

ABSTRACT Introduction Rural populations were particularly vulnerable to COVID-19. However, willingness to comply with health advice varied across population groups and was influenced by perceptions of risk. Objective This study aimed to identify the characteristics of the population (e.g., age, gender, First Nations status, perceived vulnerability, efficacy and levels of fear) associated with variations in compliance with health advice in rural Australia to inform health communication strategies for future pandemics. Methods—Design, Setting and Participants The study used a cross-sectional online survey of Australian residents aged 18 years and over (n = 701) residing in western NSW, Australia. Both bivariate and multivariable analyses were conducted, including multinomial logistic regression modelling. Results The characteristics that predicted both intention to comply with health advice and actual behaviour were gender (being female), First Nations status (Aboriginal) and age (older). The lower the perceived risk to the individual, the more likely they were to have limited or no intention to comply with preventative measures. A bivariate correlation analysis determined that there was a small (r = 0.265) significant (p  [...]

ABSTRACT Objective To examine the impact of an individualised registrar training programme on final year General Practitioner (GP) trainees' experiences and decisions to remain in a rural setting. Methods This pilot study utilised a concurrent three-phase mixed methods triangulation design to collect quantitative and qualitative data derived from surveys and interviews. Setting A healthcare service in a priority GP area of regional Australia. Participants Overseas-born GP trainees and supervisors. Main Outcome Measures Demographic factors and aspects of rural retention pertaining to Whole-of-Person Retention Improvement Framework, such as remuneration, opportunities for training, connectedness to the community, and job satisfaction. Results Seven individuals (five registrars and two supervisors) participated in this study. All trainees agreed that final year remuneration impacts their decision to stay in a location on completion of their training. Intention to remain in the same location was also influenced by a range of other factors, including stage of life, social isolation, limited opportunities for partners and children, feelings of being treated differently, and access to additional training. Conclusions To enhance recruitment and retention in rural settings, future research should utilise the three interrelated components of the Whole-of-Person Retention Improvement Framework: community/place, role/career, and workplace/organisational environment. [...]

10.1542/6374766509112Video AbstractPEDS-VA_2024-0701436374766509112OBJECTIVEInfants with chronic critical illness (CCI) are increasingly surviving to neonatal intensive care unit (NICU) discharge. Following discharge, parents of infants with CCI must navigate complex decision-making, provide direct intensive care, “including managing supportive technologies”, and coordinate complex medical care, yielding high rates of distress. However, this vulnerable population’s specific support needs remain poorly understood.METHODSIn this longitudinal qualitative study, we conducted semi-structured interviews with parents of infants with CCI in 2 care settings: (1) NICU toward the end of the infant’s admission, and (2) home within 3 months of discharge. Rapid qualitative analysis identified emergent themes. Matrix analysis enabled comparison of content across individuals, care settings, and domains.RESULTSA total of 17 parents of 15 infants with CCI completed an interview while in the NICU, and 13 completed a second interview after discharge. Most parents were mothers (88%) and married (53%), and over one-quarter were Black (29%) or Latinx (24%). The most common infant diagnosis was prematurity (40%), and all infants were supported by medical technologies at discharge. Parents reported supports, gaps in support, and recommendations for improving supports across care settings. Their narratives depicted the contrast between feeling highly supported during the NICU stay and strikingly under-supported after discharge, illuminating the need for additional hospital- and community-based supports to bridge this transition.CONCLUSIONSParents of infants with CCI report a steep decline in supports on NICU discharge. Further studies must partner with parents to identify and test interventions to accompany them through the critical transition from NICU to home. [...]

Gastrointestinal stromal tumors (GISTs) account for approximately 3% of gastrointestinal tumors and are the most prevalent mesenchymal tumors, primarily affecting the stomach and small intestine. In pediatrics, they are considered rare tumors and differ from GISTs that are found in adults because they often lack mutations in the KIT or platelet-derived growth factor α (PDGFRA) genes and are thereby classified as “wild-type.” Currently, there are few specific guidelines for treating this type of tumor in the pediatric population. More data are needed to better understand GISTs and develop more effective targeted therapies. The present report describes the case of a patient, now an adult, who was diagnosed with a GIST during childhood and experienced several relapses. A therapeutic regimen was devised and implemented, resulting in a favorable outcome. [...]

10.1542/6373950435112Video AbstractPEDS-VA_2025-0716666373950435112OBJECTIVETo derive and internally validate a clinical prediction rule to identify febrile infants aged 61–90 days at low risk of invasive bacterial infections (IBIs).METHODSUsing data from 17 Pediatric Emergency Care Applied Research Network Registry (PECARN) emergency departments, we included noncritically ill, previously healthy infants aged 61–90 days with temperatures greater than or equal to 38°C and urinalyses and blood cultures obtained between January 1, 2012, and April 30, 2024. Our outcome was IBI, defined as growth of pathogenic bacteria from blood or cerebrospinal fluid culture. Using recursive partitioning with 10-fold cross-validation, we derived and internally validated a prediction rule using age, temperature, urinalysis (negative/positive), and absolute neutrophil count (ANC) as candidate predictors. Limiting the analysis to infants with procalcitonin (PCT) and ANC results, we evaluated PCT as an additional predictor.RESULTSOf 4952 infants included, 100 (2.0%) had IBIs, including 95 (1.9%) with bacteremia without meningitis and 5 (0.1%) with bacterial meningitis. The optimal prediction rule identified low-risk infants as those with negative urinalyses and highest temperatures less than or equal to 38.9°C, yielding a sensitivity of 86.0% (95% CI, 77.6–92.1) and specificity of 58.9% (95% CI, 57.5–60.3). In the subset of 1207 infants with PCT and ANC measurements, including 27 (2.2%) with IBIs (2 [0.2%] with bacterial meningitis), we identified PCT of 0.24 ng/mL or less and ANC of 10 710 cells/mm3 or less as low-risk predictors. This PCT-based rule demonstrated sensitivity of 100.0% (95% CI, 87.2–100.0) and specificity of 65.8% (95% CI, 63.0–68.5).CONCLUSIONSWe derived 2 accurate clinical prediction rules to identify febrile infants aged 61–90 days at low risk of IBIs when urine and blood testing are obtained. Prospective validation is needed. [...]

The participation of advanced practice registered nurses (APRNs) in neonatal care continues to be supported by the American Academy of Pediatrics. Traditionally, neonatal nurse practitioners and neonatal clinical nurse specialists were the two roles well established within the Neonatal Intensive Care Unit (NICU). With ongoing shortages of these roles, some institutions have turned toward pediatric nurse practitioners (acute and primary care) and family nurse practitioners to meet patient care needs. This clinical report aims to review the roles, scope of practice, collaboration, and credentialling of these categories of APRNs with recommendations for the safe and effective utilization of these providers in neonatal care. This clinical report will not address other roles in the NICU, including hospitalists or physician assistants in the NICU, nor speak to the potential shortages and solutions these professions are experiencing, as those topics are well covered in the Standards for Levels of Neonatal Care: II, III, IV and Neonatal Provider Workforce Technical Report. [...]

The majority of children, adolescents, and young adults with complex medical needs, especially those who use life-sustaining equipment, are cared for at home by their families and community. Home health care is an essential service that supports families to be able to safely care for their children outside of the hospital, and the medical home serves as the hub to help coordinate and communicate between providers and families. It is essential that pediatric health care providers develop and implement an interdisciplinary and coordinated plan of care that addresses the child’s ongoing health care needs. The goal is to ensure that each child remains healthy, thrives, and obtains optimal medical home and developmental supports that promote ongoing care at home. Discharge planning from long-term hospitalizations and rehabilitation for this population can be a complicated process that requires a deliberate, multistep approach. This clinical report presents an approach to addressing the needs of children with complex medical needs and their families in the home environment and supporting the transitions between hospital and home. [...]

10.1542/6373916301112Video AbstractPEDS-VA_2024-0663666373916301112BACKROUND AND OBJECTIVESWhether variables specific to children’s neighborhood-level social determinants of health are associated with neighborhood incidence of pediatric firearm-related injury hospital encounters has not been assessed in any entire state. This study sought to determine the relationship between home zip code Childhood Opportunity Index (COI) and zip code incidence of pediatric firearm-related injury hospital encounters in 4 geographically representative states.METHODSThis retrospective observational cohort study combined 2016–2021 discharge data from Florida, Maryland, New York, and Wisconsin with COI 3.0 zip code data. The primary exposure was zip code COI quintile. The primary outcome was zip code incidence of pediatric (ages 0–17 years) firearm-related injury hospital encounters. Hot spots of pediatric firearm-related injury hospital encounters were identified. Incidence rate ratios of pediatric firearm-related injury hospital encounters were compared by child home zip code COI quintile.RESULTSThere were 6896 pediatric firearm-related injury hospital encounters. A larger proportion of hot spots were among very low compared with very high COI zip codes (28.4% vs 5.5%, P  [...]

Rates of mental health, emotional, and behavioral (MEB) problems in the United States continue to rise, with current estimates of 13% to 20% of children having an MEB disorder and an additional 19% with problems causing impairment or distress that do not meet diagnostic criteria for a specific disorder. This clinical report incorporates and expands on recommendations from the 2019 American Academy of Pediatrics policy statement “Mental Health Competencies for Pediatric Practice” as well as “Recommendations for Preventive Pediatric Health Care.” It addresses the rising MEB needs of youth since the previous clinical report, “Promoting Optimal Development: Screening for Behavioral and Emotional Problems,” was published in 2015. This report outlines specific guidance for MEB screening, identification, and care of children in pediatric primary care. Screening, as part of regular health supervision visits and surveillance, begins within the first month of life to identify postpartum depression in caregivers. Child-focused screening for MEB problems begins at 6 months of age and continues at 12-, 24-, and 36-month health supervision visits, alternating with recommended developmental and autism spectrum disorder screenings at every visit in the Bright Futures Periodicity schedule and additionally when clinically indicated. After age 3, MEB screening continues annually. This report also 1) reviews updated information on prevalence of MEB problems; 2) articulates the current state of detection of these problems in pediatric primary care; 3) addresses how to manage a positive screen; 4) describes barriers to screening, including special population needs, and potential models to address those barriers; and 5) discusses potential changes at a practice and systems level that facilitate successful MEB screening. [...]

10.1542/6374900136112Video AbstractPEDS-VA_2025-0716706374900136112OBJECTIVEIntentional self-poisoning is the most common method by which youth attempt suicide, is increasing in frequency, and carries a high risk of morbidity. The objective of this study was to describe pediatric emergency department (ED) encounters for intentional self-poisoning and to identify factors associated with self-poisoning recurrence.METHODSWe conducted a retrospective cross-sectional study of patients aged 6 to 17 who presented to a pediatric ED with intentional self-poisoning between March 2020 and March 2023. Encounters with a reason-for-visit or billing code related to an ingestion, overdose, or suicide attempt were included. We extracted demographic data, clinical features of the ingestion, and medical and psychiatric history from the electronic medical record. We calculated descriptive statistics and constructed a multivariable logistic regression model to identify factors associated with self-poisoning recurrence.RESULTSFive hundred and thirty-five encounters representing unique patients were included. 70.3% ingested a single toxicant, 58.3% presented within 4 hours of poisoning, 46% required medical intervention in the ED, and 23.7% required admission to an inpatient medical or critical care unit. 68 patients (12.7%) had prior visit(s) for self-poisoning. Existing psychiatric diagnosis (aOR 17.03, 3.92–74.04), history of sexual abuse (aOR 1.96, 1.12–3.42), and history of self-injurious behavior (aOR 3.00, 1.22–7.38) were associated with self-poisoning recurrence.CONCLUSIONIntentional self-poisoning was associated with morbidity, with nearly half of the patients requiring medical intervention and nearly one-quarter requiring medical admission. Recurrent visits for intentional self-poisoning were not uncommon, occurring in 1 in 8 patients. We identified risk factors for recurrent intentional self-poisoning. Further study is required to devise targeted approaches for prevention. [...]

OBJECTIVESTo characterize temperature percentiles for infants at least 35 weeks’ gestation through the first 48 hours of their birth hospitalization in the newborn nursery.METHODSThis retrospective cross-sectional study used electronic health record data from mothers and newborns admitted to a university-affiliated newborn nursery between May 2015 and August 2021. Axillary temperature values measured during the nursery stay were analyzed in prespecified time intervals to generate first, fifth, 50th, 95th, and 99th temperature percentiles from birth through 48 hours after birth. Descriptive, stratified subanalyses by infant sex, gestational age, birth weight, mode of delivery, and exposure to maternal peripartum fever were also conducted.RESULTSWe analyzed 227 813 axillary temperature values from 23 352 infants. The median temperature ranged from 36.9 °C at birth to 37.0 °C at 48 hours following birth. The temperature range between the first and 99th percentile was widest at birth (36.1–38.4 °C, δ 2.3 °C) and narrowed thereafter to a range of 36.5 °C to 37.8 °C (δ 1.3 °C) at 48 hours following birth. Temperature percentiles did not differ by sex but did increase minimally with increases in gestational age and birth weight; however, 95% CIs often overlapped. Infants delivered via cesarean had lower temperatures at birth than infants born vaginally, and infants exposed to peripartum maternal fever had higher temperatures following birth than nonexposed infants.CONCLUSIONSThese hour-specific temperature percentiles in late preterm and term infants in the newborn nursery strengthen the foundation for interpreting newborn temperatures in clinical context and highlight the need for more nuanced, evidence-based approaches to hypothermia evaluation and management. [...]

The following is an address given by the 2025 recipient of the Joseph W. St Geme, Jr Leadership Award, presented by the Federation of Pediatric Organizations at the Pediatric Academic Societies meeting on April 25, 2025: [...]

BACKGROUND AND OBJECTIVESPrevious studies have reported early undernutrition and growth delay in children born with esophageal atresia (EA). Our goal was to assess their long-term nutritional status.METHODSWe longitudinally studied 204 children born with EA (91% with tracheoesophageal fistula) from birth to 16 years. Undernutrition (Z-score for body mass index [BMI]  [...]