General journals

Further escalation by GPs in collective action against changes to doctors’ contracts has been postponed.Instead, the BMA’s General Practitioners Committee in England (GPCE) said it will re-enter “bilateral” contract talks with the Department of Health and Social Care and NHS England as part of a reset of relations with officials.GPCE has been engaged in collective action since March, after GPs in England voted by 99% to reject the government’s changes to their contract for 2026-27.1This action has included asking practices to stop signing up to voluntary data sharing agreements,2 switching off non-contractual medicines optimisation software,3 and rejecting what the GPCE labelled new “unsafe” and “underfunded” shared care agreements.4But, in its latest update the committee has paused any new action. The GPCE said that this would allow its new negotiating team time to meet the new ministerial team of the Burnham government to try to make progress in ending the dispute.5However,... [...]

Thirteen year olds across the EU could be banned from freely accessing tech platforms like Instagram and YouTube, while those under 13 would be barred from creating their own accounts, the European Commission (EC) has announced.1Called the “‘EU Kids ’Act,” the proposed legislation will also set 15 as the EU-wide minimum age for children to have their own social media account.Commission president Ursula von der Leyen said that social media companies in the EU will also be banned from using addictive, attention grabbing algorithms and reward mechanisms designed to encourage infinite scrolling for users under 18.2 She said that children are now engaging with the “most sophisticated technology ever created,” which was “not designed with their wellbeing in mind.”Under the legislation, minors’ profiles on social media must be private by default, with geolocation, camera, and microphone access turned off.It also outlines that more effective screentime management tools that allow children... [...]

For many years the regulatory process for doctors has been perceived as discriminating against international medical graduates (IMGs), doctors whose primary medical qualification was obtained abroad.In the early 2010s IMGs were more likely to be referred to the General Medical Council (GMC) and more likely to face a full investigation than UK trained colleagues. Subsequently, when their case was heard by the Medical Practitioners Tribunal Service (MPTS), IMGs were more likely to be struck off or suspended than colleagues who qualified in the UK.The evidence indicates that this disproportionality continues, although there are some signs it has reduced.A recent report in the Telegraph once again brought the issue into focus, reporting that foreign trained doctors were responsible for the “majority of misconduct cases.”1But what do the data show?The latest figures, shared with The BMJ, show that there were 111 new MPTS hearings between the start of 2026 and the end... [...]

Might artificial intelligence indeed kill us all? The chances are greater than 10%, according to one expert. Another researcher has publicly quit the AI company Anthropic over safety fears.1 This news arrives around the same time that Anthropic warns us that people are attempting to use AI to create biological weapons (doi:10.1136/bmj-2026-100871).2 The threat from such weapons is real and is a major concern for ministries of defence around the world. A BMJ analysis paper earlier this year outlined how a surveillance system for biological threats might be constructed (doi:10.1136/bmj-2025-086457).3The warnings are being served. Is it wise to ignore them? One view is that safety concerns about AI are being exaggerated to allow the leading AI companies to maintain their competitive advantage and maintain their influence over regulation. That may be true to some degree, but is it sensible to park an existential threat when the evidence suggests that our... [...]

Edwards and colleagues rightly ask why UK maternity units keep producing the same failures despite 895 recommendations made since 2014.1 In fact, the diagnosis of failure is older still.In her pioneering maternal mortality report of 1924, Janet Campbell showed not just that most maternal deaths were avoidable but that they reflected systemic rather than individual failure.2 She then did what the current reviews stop short of: she took action to fix it. Antenatal clinics, midwife training, and the salaried midwifery service established by the 1936 Midwives Act. Maternal mortality fell more than 40-fold in the 50 years that followed. That success cannot be repeated today, but we can mark her forgotten centenary by learning again from her direct, pragmatic approach: to make changes to (re)build maternal health systems, not merely to recommend them. [...]

Thousands of women in England with an incurable form of breast cancer will gain access a life extending drug on the NHS after successful negotiations over its cost.NHS England will make trastuzumab deruxtecan (Enhertu, made by Daiichi Sankyo and Astra Zeneca) available to around 1000 women with HER2 low advanced or metastatic breast cancer whose disease has progressed after treatment.This came after an updated recommendation from the National Institute for Health and Care Excellence (NICE) that has been hailed as “momentous” by campaigners, who previously criticised the decision not to recommend the treatment.1The deal follows changes to NHS rules determining which drugs provide value for money that were made as part of the UK-US drug pricing deal.2HER2 low is a subgroup of breast cancer previously considered HER2 negative. People with HER2 low metastatic or unresectable breast cancer have cancer cells with low amounts of HER2 protein.Clinical trial evidence shows that... [...]

Doctors who provide cosmetic treatments should screen patients for body dysmorphic disorder (BDD), new clinical guidance advises.If a person is suspected of having BDD, clinicians should refer them for specialist assessment rather than proceeding with the cosmetic procedure, recommends the new draft guideline from the UK National Institute for Health and Care Excellence (NICE) recommend.The draft guideline for assessing and managing BDD and obsessive compulsive disorder (OCD) aims to improve the identification of two conditions that can go unnoticed for years because people often hide symptoms out of shame and embarrassment.NICE said earlier identification could help more people get the support they need before their symptoms become severe or reach a crisis point.The watchdog’s guidelines on treating these conditions were last updated in 2005.The new draft guidance advises doctors to consider assessing for OCD or BDD in higher risk patients, such as those with depression, anxiety, autism, or attention deficit/hyperactivity... [...]

Over 100 days since the start of the current Ebola outbreak, the response in the Democratic Republic of Congo (DRC) is at an impasse, with fears the situation will worsen. The World Health Organization declared the outbreak, caused by the Bundibugyo species of Ebola virus, a public health emergency of international concern in May. On 6 September 2026, the DRC reported a total of 6686 confirmed and probable cases and 3226 deaths, with 586 new confirmed cases and 276 deaths in the past seven days.1 The outbreak looks set be worse than the 2014-16 crisis, which caused 11 325 deaths.23Global health leaders have called for additional support for frontline health workers and effective coordination of the response, and for donors to speed up the dispersal of pledged aid. Some $264m has been disbursed, but an estimated $518m is needed for the immediate response and another $882m for the humanitarian crisis.45... [...]

AI is already being introduced into workflows in the NHS, and in the coming years it will undoubtedly become part of the day-to-day practice of most doctors. But what happens when AI contributes to patient harm? Unlike doctors, an AI system cannot be sued under English law. Legal responsibility may instead fall on the clinician, healthcare provider, developer, or manufacturer, depending on what exactly went wrong and why.NHS Resolution, which handles clinical negligence claims involving NHS trusts and general practices, has already received its first cases in which “the use of AI in delivering patient care is a potential factor.”1 The General Medical Council (GMC) has also revealed that it has received referrals about doctors misusing AI systems. These claims and complaints are likely to increase in number.1Doctors could face criticism for their AI use for several reasons, including:Using an AI system when it should not have been usedUsing an... [...]

Jersey will not provide a “Dignitas-style model” for British citizens seeking an assisted death after the bill for England and Wales was rejected,1 the head of the island’s implementation committee has told The BMJ.But Sarah Wollaston, the doctor and former British MP now overseeing the rollout of the Channel Island’s assisted dying service, said that Jersey could provide a template for UK nations if they decide to revisit the debate again.In February, Jersey passed a law to introduce an assisted dying service—becoming the first UK and Channel Island jurisdiction to do so.2Wollaston, a former GP and MP who served as chair of the commons health and care select committee, is now charged with ensuring that the service is introduced safely and effectively as chair of Jersey’s assisted dying assurance and delivery committee.She emphasised that she is not a campaigner either for or against assisted dying, and that her role is... [...]

Singh calls for removal of the General Medical Council’s (GMC’s) power to appeal decisions made by the Medical Practitioners Tribunal Service.1 The current consultation on the draft General Medical Council Order 2026 follows the Mann review, which recommended retaining the GMC’s right of appeal. This reversed the previous policy position, following the Williams review of 2018, that the appeal power should be removed (albeit after considerable delay). The draft order would preserve that appeal right while also introducing a financial framework under which the regulator would gain the power to set its own registration fees, without external oversight, alongside powers to borrow and receive government grants or loans.For doctors, regulatory action and subsequent appeals carry substantial financial consequences. Registrants generally rely on medical defence organisations, personal funds, or, increasingly, public crowdfunding. Medical defence organisations provide assistance on a discretionary basis and operate with finite resources, ultimately funded through doctors’ subscriptions.... [...]

Hazel Thornton returned from a holiday in France in 1991 to find an invitation to attend Essex County Hospital in Colchester for a routine breast scan. Like many, she found the prospect slightly unnerving. Yet she had more reason than most to worry: surgery for a malignant melanoma some years earlier had left a hole in her leg the size of an apple.The results of her mammogram brought greater uncertainty, revealing a breast abnormality but no telltale lump. Her consultants said that she had ductal carcinoma in situ (DCIS), which was hard to diagnose and harder to treat. They asked her to take part in a clinical trial involving 1000 patients randomly administered one of four “treatments”—tamoxifen, radiotherapy, a combination of the two, or a placebo. “The very fact that my doctor was offering the trial to me meant he was saying, ‘I don’t know how to treat this condition,’”... [...]

To the Editor In a recent Review of endometrial cancer, the major hormonal risk factors associated with this malignancy were discussed. However, polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), the most common endocrine disorder affecting reproductive-aged women, was not addressed. This omission is noteworthy given the substantial evidence linking PMOS to an increased risk of endometrial cancer, particularly among premenopausal women. This association primarily concerns low-grade endometrioid carcinomas, which typically arise through estrogen-dependent pathways. [...]

To the Editor A recent Review offered a comprehensive overview of endometrial cancer, highlighting the emerging significance of molecular classification in informing prognosis and treatment, which reflects the growing role of molecular classification in clinical care. Nevertheless, the practical implementation of molecular classification was inadequately explored. Access to comprehensive molecular testing is inconsistent across health care systems. Even in high-resource settings, the availability of assays such as polymerase epsilon (POLE) sequencing is variable and result interpretation lacks standardization. These challenges are more pronounced in low-resource settings, resulting in a disparity between theoretical optimal care and real-world clinical practice. [...]

In Reply We appreciate the letters about our Review on endometrial cancer. [...]

The American Academy of Pediatrics (AAP) and the American College of Obstetricians & Gynecologists (ACOG) released statements criticizing a recent executive order on childhood vaccine recommendations. [...]

To the Editor A recent Perspective framed clinician burnout as a systems-level issue, describing lessons from parallels to the patient safety and quality movement. [...]

In Reply We appreciate the thoughtful letter by Drs Nadkarni and Fromson regarding our Perspective on accelerating workforce well-being. We agree that intersectionality is essential to understanding and addressing burnout. [...]

E-scooter riders may face higher risk of certain injuries than motorcyclists and bicyclists, according to a recent study. [...]

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

To the Editor With regard to colorectal cancer surveillance in older adults, a recent study presented compelling data highlighting that the risk of noncolorectal cancer death far exceeds the risk of colorectal cancer in adults aged 75 years or older, even among those with a prior adenoma. This finding is important for shared decision-making and supports the deescalation of surveillance in this population. However, we wish to raise 2 points regarding the interpretation of these results that are highly relevant to current clinical practice. [...]

To the Editor A recent study provided valuable competing risk data for surveillance decisions in adults aged 75 years or older with prior colonoscopy. In their cohort, 10-year colorectal cancer incidence was higher among individuals with prior adenoma than among those without adenoma, but the absolute difference was small (1.1% vs 0.7%). Colorectal cancer mortality was similarly low, whereas noncolorectal cancer death was approximately 48%, and increased to 82% among those with severe frailty. The accompanying Editorial appropriately framed these findings as a challenge to reflexive surveillance in late life. [...]

To the Editor A recent study reported that among adults aged 75 years or older, the 10-year cumulative incidence of colorectal cancer after a prior adenoma was only 1.1% and colorectal cancer–specific death was 0.5%, whereas noncolorectal cancer mortality approached half of the cohort. The absolute excess associated with prior adenoma was therefore modest, making these data clinically important for decisions about surveillance intensity. However, 2 issues deserve attention before these findings are translated into broad deimplementation. [...]

In Reply In their letters about our article, Dr Mei and colleagues and Dr Zhang and colleagues raise the possibility of using noninvasive screening tests as an option for deimplementing routine, colonoscopy-based surveillance. We welcome this suggestion and, in the Discussion section of our article, highlighted the importance of an ongoing trial in the US comparing fecal immunochemical testing vs colonoscopy-based surveillance for older adults with prior polypectomy. [...]

Byung-Chul Han's short book, Psychopolitics: Neoliberalism and New Technologies of Power (2025, first published in German in 2014), opens with a line that should make us all pause: “Freedom will prove to have been merely an interlude.” End-of arguments have not fared well in recent years. The end of history? We can only wish. But Han's case deserves a hearing because his critique attacks some of health science's most cherished principles. He claims that the era of ever-larger quantities of data is reducing human freedoms. [...]

Global efforts to strengthen rehabilitation systems are urgently needed. The WHO Rehabilitation 2030 initiative and its work to develop standardised rehabilitation indicators1 are therefore important steps towards improving rehabilitation services and advancing the aims of the UN Convention on the Rights of Persons with Disabilities. However, Wouter de Groote and colleagues’2 expectation that these indicators can ensure “a measurable path to independence and participation” risks overlooking structural and social inequalities in access to rehabilitation. [...]

As President of the Mario Robles Ossio Foundation, a Mexican patient organisation, I strongly support the focus on implementation in the Health Policy by Tonelli and colleagues.1 Mexico has one of the highest burdens of kidney disease worldwide. In March, 2025, chronic kidney disease was included within the National Medical Care Protocols.2 However, as the paper highlights, the real challenge begins after policy adoption: translating those commitments into actions that reach people in their daily lives. [...]

We read with great interest the Seminar by Antonio Cannata and colleagues1 on novel diagnosis and management approaches to heart failure with reduced ejection fraction (HFrEF). We were surprised by the omission of recent guideline-recommended regular physical activity counselling and supervised exercise training;2,3 therefore, we highlight here its benefits combined with pharmacotherapy. [...]

We thank Tim Kambič and colleagues for their Correspondence regarding the importance of exercise and physical activity for patients with heart failure with reduced ejection fraction (HFrEF). [...]

We congratulate Nicoletta Colombo and colleagues for the practice changing results of the ENGOT-ov65/KEYNOTE-B96 trial in platinum-resistant ovarian cancer.1 Their study reports clinically significant improvement in progression-free survival and clinically meaningful improvement in overall survival with pembrolizumab plus weekly paclitaxel, with or without bevacizumab, in patients who had received no more than two previous lines of systemic therapies (for platinum-resistant ovarian cancer).1 These findings are notable in a setting of historically poor prognosis. [...]

We thank Stanislas Quesada and colleagues for their thoughtful comments and for recognising the clinically meaningful benefit of pembrolizumab plus weekly paclitaxel, with or without bevacizumab, in platinum-resistant ovarian cancer.1 Because ENGOT-ov65/KEYNOTE-B96 was not designed to support unplanned subgroup analyses, we have limited our response to prespecified analyses and results that can be interpreted within the trial design. [...]

Tonelli and colleagues should be commended for their recently published Health Policy.1 This advocacy paper will indeed profoundly change the vision of nephrology practice on chronic kidney disease (CKD). The paper itemises the major steps towards a major paradigm shift, that is, the transition from replacing kidney function by means of dialysis and transplantation to preserving kidney function through conservative kidney management, which reflects the original mission of the specialty. [...]

We highly commend Isabelle Ray-Coquard and colleagues for their Comment announcing the Lancet Commission on Ovarian Cancer,1 emphasising equity-driven reform. However, we believe they overlook a crucial barrier to improving population-level survival: emergency presentations. [...]

We thank Rui Wu and colleagues for their thoughtful commentary on the outlined objectives for the Lancet Commission on Ovarian Cancer.1 The authors have provided intriguing data regarding the percentage of women who are first diagnosed in emergency room settings (up to 50% in some jurisdictions) and the associated prognostic implications of this presentation. Wu and colleagues raise important findings: these patients are far more likely to be older, frailer, and to have inequities in access to stable health care (for a variety of complex reasons that vary by country) and thus might be excluded from optimised diagnostic pathways (inclusive of genetics and molecular profiling), surgical intervention, access to novel therapeutics, and optimised survivorship plans. [...]

Hatter L, Holliday M, Oldfield K, et al. Budesonide–formoterol versus salbutamol as reliever therapy in children with mild asthma (CARE): a 52-week, open-label, multicentre, superiority, randomised controlled trial. Lancet 2025; 406: 1473–83—In this Article, the percentage of participants in the salbutamol group with at least one serious adverse event has been corrected in table 3. A clarification has also been added to table 3 that the data included within are unadjusted raw count results. These changes have been made to the online version as of Sept 17, 2026. [...]

More than 260 million people worldwide live with asthma, and more than 400 000 die of the disease each year. 5–10% of people with asthma live with severe asthma, but it has an outsized effect—frequent disease exacerbations, poor lung function, and a widespread dependence on corticosteroids. Despite serious symptoms, asthma is often underdiagnosed and mismanaged, which—in the worst-case scenarios—can be fatal. [...]

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

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

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

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

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

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

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

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

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

Abstract Polyendocrine metabolic ovarian syndrome (PMOS), previously known as polycystic ovary syndrome, affects 10%–13% of women of reproductive age and remains underdiagnosed despite its substantial health burden. The introduction of the new PMOS nomenclature in 2026 reflects a fundamental shift in understanding the condition as a lifelong endocrine and metabolic disorder with prominent reproductive, psychological, dermatological, and cardiometabolic consequences. Once considered primarily a reproductive disorder, PMOS is now recognized as a multisystem condition. Insulin resistance and compensatory hyperinsulinemia are central pathophysiological mechanisms linking endocrine and metabolic features to reproductive dysfunction. In PMOS, insulin resistance affects 75% of lean and 95% of overweight women. Here we focus on the metabolic features. Recent advances in epidemiology include the first systematic review and meta-analysis examining regional variations in PMOS prevalence. In parallel, contemporary population-based studies of unselected women have confirmed that increased risks of metabolic complications observed in selected clinical cohorts also apply at the population level and have demonstrated increased risk of major adverse cardiovascular events (MACE). These studies report an almost 3-fold increased risk of Type 2 diabetes (OR 2.9) and MACE (HR 1.2–2.5), with cardiovascular risk diverging from approximately 35 years of age. In this review, we summarize recent advances in epidemiology, pathophysiology, metabolic dysfunction, and cardiovascular risk of PMOS, together with their implications for diagnosis and clinical management. Recognizing PMOS as an early-life marker of cardiometabolic disease highlights opportunities for earlier diagnosis, prevention, and individualized risk stratification, supporting integrated, patient-centered care across the life course. [...]

Abstract Hypocholesterolemia is perceived as benign given its association with lower cardiovascular risk. However, genetic and epidemiological evidence indicates that persistently low levels of low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (ApoB) arise from distinct biological mechanisms with different hepatic implications. Hypocholesterolemia may reflect either impaired hepatic assembly and secretion of ApoB-containing lipoproteins or enhanced peripheral clearance of circulating lipoproteins, with divergent outcomes. Genetic defects disrupting ApoB-dependent lipoprotein secretion, notably variants in apolipoprotein B gene (APOB) and microsomal triglyceride transfer protein gene (MTTP), limit hepatic lipid export and promote intrahepatic triglyceride retention, predisposing to steatosis and progressive liver disease without metabolic risk factors. Hypocholesterolemia driven by increased lipoprotein clearance, as observed with loss-of-function variants in proprotein convertase subtilisin/kexin type 9 (PCSK9) or angiopoietin-like protein 3 (ANGPTL3), produces lifelong LDL-C reduction that is cardioprotective without consistent evidence of adverse hepatic outcomes. Cohort and sequencing studies demonstrate an increased burden of liver disease in secretion-driven hypocholesterolemia but not in clearance-driven phenotypes. These findings indicate that clinical consequences are determined by the underlying biological mechanism rather than the degree of cholesterol lowering. After exclusion of secondary causes, genetic testing may be considered in people with metabolic dysfunction-associated steatotic liver disease (MASLD) and hypocholesterolemia to clarify the mechanism, guide follow-up, and enable family cascade screening. In impaired secretion phenotype forms, lifelong MASLD monitoring may be warranted, with timely consideration of therapy if liver disease progresses. In clearance-mediated phenotypes, management should follow standard MASLD risk stratification and care, without additional surveillance related to the genetic defect. [...]

Abstract Sudden cardiac death (SCD) is a leading cause of mortality across the chronic kidney disease (CKD) continuum and becomes particularly prominent in dialysis-dependent kidney failure. In hemodialysis, SCD accounts for roughly one quarter to one third of all deaths and up to 60%–75% of cardiovascular mortality, with marked temporal clustering around the long interdialytic interval and the first post-interval session. Traditional views have emphasized descriptive epidemiology and presumed ventricular tachyarrhythmias. More recent device-based studies challenge this paradigm, revealing a heterogeneous arrhythmic spectrum in which bradyarrhythmias, pauses, and conduction system disease are often at least as frequent as sustained ventricular tachycardia or fibrillation. This narrative, non-systematic review synthesizes epidemiologic, mechanistic, and interventional data on SCD in CKD and dialysis, with particular emphasis on insights from implantable loop recorder and implantable cardioverter–defibrillator cohorts and on modifiable dialytic and pharmacologic factors. A framework for prevention is proposed around three interacting domains: the structural myocardial substrate, the electrophysiologic milieu, and dialysis-related triggers. Within this framework, contemporary heart failure and CKD therapies (including sodium–glucose cotransporter 2 inhibitors, angiotensin receptor–neprilysin inhibitors, mineralocorticoid receptor antagonists, and beta-blockers), individualized dialysis prescriptions (targeting potassium, calcium, bicarbonate, ultrafiltration, and scheduling), and selective use of device therapy are considered complementary components of mechanism-driven SCD prevention. Methodological challenges in defining and adjudicating SCD in CKD are discussed, and priorities are outlined for improved phenotyping, continuous rhythm monitoring, and CKD-specific risk stratification, with the overarching aim of moving from descriptive statistics to effective risk modification. [...]

ABSTRACT Aim The Australian National Bowel Cancer Screening Program began in 2006, offering free faecal occult blood testing every 2 years to Australians aged 50–75 years. We hypothesised a difference in overall survival between screen-detected and non-screen-detected colorectal cancer in an Australian cohort, for each stage I–III. Methodology A retrospective cohort study of patients with stage I–III colorectal cancer from 2010 to 2024 was conducted using a prospectively maintained institutional database. Overall survival (OS) was calculated from the date of diagnosis. Kaplan–Meier analysis and log-rank testing were used to compare survival between screen-detected and non-screen-detected cancers, stratified by stage. Results A total of 881 colorectal cancer episodes were included, of which 254 (28.8%) were screen-detected. The proportion of screen-detected cancers increased significantly over time (Cochran–Armitage trend test, p  [...]

ABSTRACT This article commemorates the life and works of Marius Fahrer MD (Bucharest), MB, BS(Qld), FRACS, FAFRM, possibly one of the last few Australian ‘surgeon-anatomists’ whose career brought together anatomical scholarship, hand surgery and surgical education. Born in Bucharest in 1927, Fahrer emigrated to Australia via Paris in 1963 as a political refugee. Despite challenges with medical registration and limited English, he secured a position at the University of Queensland after an unusual interview with Professor Max Hickey, conducted largely in Latin. Fahrer subsequently requalified medically in Australia whilst maintaining surgical expertise through sabbaticals in Queensland, France and Germany. His collaboration with Raoul Tubiana at the Institute of Hand Surgery in Paris proved substantial, contributing to the seminal English translation of Tubiana's five-volume treatise on hand surgery. Throughout his distinguished career, Fahrer championed cadaveric dissection in surgical education, mentored countless trainees and served as Honorary Curator of the Cowlishaw Collection, receiving both the ESR Hughes Award and the Kenneth Russell Medal for his outstanding contributions. Widely respected in Australia and internationally, Fahrer's career exemplified the integration of anatomical scholarship with surgical innovation at a time when surgical subspecialisation was rapidly developing. His influence as a teacher, mentor, and an advocate for anatomy-based surgical education left a lasting legacy for subsequent generations of hand surgeons and anatomists. [...]

Study evaluated the effectiveness and safety of topical tranexamic acid in breast surgery. Topical TXA reduced postoperative haematoma risk by 75% and significantly decreased postoperative drain output compared with controls, while seroma rates were unchanged. Topical TXA appears to be a safe and effective adjunct in reducing postoperative bleeding complications. ABSTRACT Background Haematoma and seroma formation are recognised postoperative complications following breast surgery. Tranexamic acid (TXA), an antifibrinolytic agent widely used in other surgical specialties, has not yet been routinely adopted in breast surgery. This systematic review and meta-analysis evaluated the effect of topical TXA on postoperative outcomes in breast surgery. Methods A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase and Cochrane CENTRAL were searched from inception to February 2026 using the terms (tranexamic OR TXA) AND breast AND topical. Outcomes included postoperative haematoma, seroma and drain output. Random-effects meta-analysis was performed to calculate mean differences and risk ratios (RRs). Results Seven studies (five randomised controlled trials and two cohort studies) involving 1258 breasts (629 topical TXA and 629 controls) were included. Meta-analysis demonstrated a significant reduction in postoperative drain output with topical TXA (mean difference −16.22 mL; 95% CI: −26.54 to −5.91; p = 0.002). Topical TXA was associated with a 75% reduction in haematoma risk (RR 0.25; 95% CI: 0.08–0.72; p = 0.01). Seroma rates did not differ significantly between groups (p = 0.26). Subgroup analysis by procedure type showed numerically greater effects in mastectomy cohorts, with no significant subgroup differences for drain output (p = 0.31) or haematoma (p = 0.19). No TXA-related adverse events were reported. Conclusion Topical tranexamic acid appears to be a safe adjunct in breast surgery, reducing postoperative drain output and haematoma formation. Larger, high-quality randomised controlled trials are needed to validate these findings and establish standardised protocols. [...]

ABSTRACT Backgrounds Pancreatic intraductal papillary mucinous neoplasm (IPMN) with multiple risk features, including worrisome features (WFs) and high-risk stigmata (HRS), may have a higher probability of malignant transformation. This study aimed to evaluate the risk of progressing to invasive carcinoma (IC) in IPMN patients. Methods This study collected data from IPMN patients who received regular monitoring at our hospital between June 2017 and January 2025, with a monitoring duration of more than 6 months. The changes in risk features and progression to IC during monitoring were recorded. Results IPMN patients with > 2 WFs or HRS had a higher probability of presenting with IC. Univariate and multivariate Cox regression analyses revealed that > 2 WFs (HR = 22.65, 95% CI: 4.28–119.83, p  [...]

A randomised, controlled, double-blind clinical trial comparing tissue reinforcement using the remnant hernial sac versus polypropylene mesh repair in 132 patients with indirect inguinal hernia. At 1-year follow-up, both techniques demonstrated comparable safety, recurrence rates, postoperative complications, and recovery times, supporting flexible and patient-tailored surgical decision-making. ABSTRACT Background Indirect inguinal hernia is a common condition that often requires surgical intervention. This study compares two surgical approaches for hernia repair: tissue reinforcement using the remaining sac and polypropylene mesh repair. Methods A randomised, controlled, double-blind clinical trial was conducted on 132 patients aged 18–82 diagnosed with indirect inguinal hernia. Participants were randomly assigned to two intervention groups: one undergoing polypropylene mesh repair and the other using tissue reinforcement with the remaining sac. Key outcomes, including recurrence rates, postoperative complications, pain intensity, recovery time and hospital stay, were assessed at multiple intervals. Results Both techniques demonstrated comparable safety and efficacy. Recurrence rates were low in both groups (1.5% in the mesh group vs. 3% in the tissue reinforcement group, at one-year follow-up, p = 0.56). Postoperative complications, including seroma and haematoma, were identical (3% in both groups). Pain intensity (mean VAS score: 5.7 vs. 5.6, p = 0.847) and recovery time (6.7 days vs. 6.6 days, p = 0.960) were similar between the two approaches. Conclusion Both polypropylene mesh and tissue reinforcement techniques are effective and safe for indirect inguinal hernia repair, with minimal differences in outcomes. Surgical decisions should be tailored to individual patient needs and clinical scenarios. These findings provide evidence supporting the flexibility of surgical approaches in managing indirect inguinal hernias. Trial Registration: IRCT20230410057871N3 [...]

Temporary mesocaval shunting, in highly specialized centers, facilitates resection of pancreatic cancer with complex vascular involvement with acceptable morbidity, mortality, and survival outcomes. ABSTRACT Background Extensive vascular involvement remains a major challenge in the surgical management of borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC). Temporary mesocaval shunting (tMCS) may facilitate resection in cases of mesenteric venous occlusion or collateralisation and improve exposure of the superior mesenteric artery; however, its use in pancreatic surgery is rarely reported. Methods We performed a retrospective case series of patients with borderline or locally advanced PDAC who underwent curative-intent resection with intra-operative tMCS between 2017 and 2022. Demographics, perioperative outcomes, post-operative complications and survival were analysed using the Kaplan–Meier method. Results Six patients underwent pancreatectomy with tMCS (three pancreaticoduodenectomies, three total pancreatectomies). Median age was 58.5 years. All shunts used cryopreserved cadaveric iliac vein grafts. Median length of stay was 13 days. Two patients (33%) developed Clavien–Dindo grade ≥III complications, including one post-operative death. R0 resection was achieved in two patients (33%). Median overall survival was 24.8 months (33.2 months excluding post-operative mortality), and median disease-free survival was 8 months. Conclusion Selective tMCS may enable resection in PDAC with extensive vascular involvement. This complex approach should be reserved for carefully selected patients at high-volume centres with vascular expertise. [...]

In this systematic review and meta-analysis of eleven studies comprising 16 252 patients undergoing lobectomy for NSCLC, there was no significant difference in the incidence of PAL between RATS and VATS approaches. ABSTRACT Introduction Minimally invasive approaches are widely adopted for anatomical lung resection in early-stage non-small cell lung cancer, with video-assisted thoracoscopic surgery (VATS) representing the established standard. Robotic-assisted thoracoscopic surgery (RATS) has emerged as an alternative platform, although its clinical advantages remain uncertain. Persistent air leak (PAL) is a common complication following lobectomy, occurring in up to 8%–19% of patients and contributing to prolonged hospitalization and morbidity. Prior comparative studies of RATS and VATS have been limited by heterogeneity in operative procedures and inclusion of sublobar resections. This study aimed to compare PAL following RATS versus VATS lobectomy, restricting inclusion to lobectomy-only cohorts to reduce procedural heterogeneity. Methods A systematic review and meta-analysis of studies comparing RATS and VATS lobectomy was performed. Exclusively lobectomy-only cohorts were included to reduce procedural heterogeneity. The primary outcome was PAL (> 5 days). Random-effects models were used to calculate pooled risk ratios (RR). Results Thirteen studies comprising 16 252 patients (RATS, n = 2427; VATS, n = 13 825) were included. There was no significant difference in PAL between RATS and VATS (RR, 1.01; 95% CI, 0.75–1.37; p = 0.93). Moderate heterogeneity was observed (I 2 = 44%). No evidence of publication bias was identified (Egger's test; intercept −0.54; 95% CI, −1.74 to 0.67; p = 0.41). Secondary outcomes were largely comparable, although length of stay was modestly shorter following RATS. Discussion In this lobectomy-restricted analysis, surgical platform was not associated with differences in persistent air leak. These findings suggest that PAL is primarily driven by patient- and technique-related factors rather than operative platform. Restriction to lobectomy improves comparability relative to prior studies. However, incomplete baseline reporting and observational design limit causal inference. Conclusions In lobectomy-only cohorts, RATS and VATS are associated with comparable rates of persistent air leak. Surgical platform alone does not appear to independently influence this outcome. [...]

ABSTRACT Arthrography is a vital tool in paediatric elbow surgery to accurately visualise the articular surface and assess joint stability. This is particularly relevant following open arthrotomies for procedures correcting joint alignment. We describe a reproducible, simple technique for performing elbow arthrography after open arthrotomy of the paediatric elbow, accompanied by illustrative images and a video demonstration. [...]

In 28 patients undergoing jaw reconstruction with implant-retained dental rehabilitation, patient-reported quality of life generally declined during the first postoperative year, with favourable trends towards baseline over longer-term follow-up among available respondents. Appearance-related outcomes showed particularly favourable recovery, whereas some functional domains, including oral competence and eating, remained impaired. ABSTRACT Background Data on health-related quality-of-life (HRQoL) is indispensable in understanding patient outcomes following jaw reconstruction. This study aims to evaluate long-term HRQoL using validated patient-reported outcome measures (PROMs) following jaw reconstruction using buried skin grafts to facilitate implant-retained dental prosthetic rehabilitation. Methods A cohort study of all patients that underwent prelamination as described by Rohner or the Sydney Modified–Alberta Reconstruction Technique (SM-ART) from October 2012 to June 2023 at Chris O'Brien Lifehouse, Sydney, Australia with HRQoL data was conducted. HRQoL was assessed using the FACE-Q Head and Neck Cancer Module, MD Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) at one-year intervals from baseline to 5 years post-operatively. Results Twenty-eight cases (Rohner technique; n = 19 or SM-ART; n = 9) were included (median age, 52 years). Six dental implant losses were recorded across five patients (median time to implant loss, 21.5 months). Three patients required denture removal; however, all had an implant-retained prosthesis at end of follow-up. While cross-sectional HRQoL scores were lower across most subscales at 12 months post-operatively as compared with baseline, mean scores among available respondents showed favourable trends towards baseline by 60 months. Appearance distress notably improved beyond baseline (mean difference [MD] +19.9, 95% confidence interval [CI] −4.1 to 43.9), while oral competence (MD −16.6, 95% CI −53.4 to 20.2) and eating distress (MD −8.5, 95% CI −50.3 to 33.3) suggested a more persistent deficit. Conclusions Favourable trends in long-term HRQoL were observed following these reconstructive techniques to optimise dental rehabilitation, although long-term estimates should be interpreted cautiously. These data may help inform patient counselling regarding the anticipated trajectory of recovery. [...]

Ultrasound frequently detects ‘imaging-only’ groin hernias that do not cause symptoms. Many patients will have musculoskeletal groin pain that is driven by the adductor muscles. This study found high long-term satisfaction among patients treated conservatively for adductor-related groin pain, identified on physical examination alone. ABSTRACT Background Groin pain is a common and diagnostically challenging presentation. Imaging often detects hernias that are not clinically evident (‘imaging-only hernias’) which can lead to unnecessary surgical intervention and under-diagnosis of musculoskeletal conditions like adductor-related groin pain (ARGP). This study evaluates long-term outcomes of patients diagnosed with ARGP in a variety of settings. Methods This was a retrospective study of patients diagnosed with ARGP (between January 2021 and June 2024) using the Groin-MAP. Patients were categorised into groups: (1) ARGP with imaging-only hernia, (2) ARGP with clinical inguinal hernia and (3) ARGP following inguinal hernia repair. Long-term patient-reported outcome measures were assessed. Results Follow-up was completed for 110 of 133 eligible patients at a median of 29 months (range 10–66). Group 1 (n = 47) reported 90% satisfaction after management of their adductor pain alone; only 1/47 had a hernia repair elsewhere. Group 2 (n = 29) reported 90% satisfaction with equivalent management of ARGP, but varied management for inguinal hernia. Up-front hernia repair was opted for by 14/29 and 15/29 opted for watchful waiting, of which 2 progressed to surgery. Group 3 (n = 34) had a higher symptom burden; yet 70% maintained mild or no activity limitation and 1/34 had revision hernia surgery. Conclusion ARGP is under-recognised as a cause of groin pain in surgical practice, and is best diagnosed on physical examination. Patients with ARGP have good long-term outcomes without intervention for incidental imaging-only inguinal hernias. Those with clinical inguinal hernias might delay or avoid surgical repair by addressing concomitant ARGP. [...]

This retrospective cohort study of patients undergoing either surgery (hemithyroidectomy) or I131 radioactive iodine for the management of solitary toxic nodules at a single institution compares the hypothyroidism rates between these two options. While hyperthyroidism cure rates are high with both surgery and radioactive iodine, hemithyroidectomy has much lower rates of post-treatment hypothyroidism (6.7% vs. 27%, p = 0.009). ABSTRACT Background For solitary toxic adenoma (STA) hemithyroidectomy and radioactive iodine (RAI) both cure hyperthyroidism, but their hypothyroidism risks differ. Aim To review the thyroid status of patients who had received definitive therapy for a STA to determine differences in the hypothyroidism rates between those who underwent surgery as compared with RAI. Methods Retrospectively collected cohort study (2010–2020) from a single centre in New Zealand. STA was defined by a low TSH and solitary hot nodule on 99ᵐTc imaging. Primary outcome was hypothyroidism at 12 months. Results Among 98 patients (RAI 48; surgery 50), cure of hyperthyroidism was 98% (RAI) versus 100% (surgery). After excluding those with missing data, hypothyroidism at 12 months occurred in 12/44 (27%) after RAI versus 3/45 (6.7%) after surgery (absolute risk difference ~20%; NNT≈5). Of those with biochemical hypothyroidism, 9/12 RAI patients were treated with levothyroxine and 2/3 in the surgical group. In multivariable analysis, RAI was associated with higher odds of hypothyroidism versus surgery. Conclusion Both treatments are effective, but when using a fixed dose 555 MBq RAI protocol, hemithyroidectomy is associated with substantially lower hypothyroidism risk. Findings support shared decision-making that weighs patient preference to avoid lifelong levothyroxine against operative risks and local expertise. [...]

Intelligent case analysis. ABSTRACT Objective To investigate the feasibility and effectiveness of combining AI-enhanced teaching with traditional instruction for clinical skills training of resident physicians undergoing standardized training in cardiac and great vessel surgery. Methods Forty resident physicians were randomly divided into two groups. The AI-combined teaching group (n = 20) received an 8-week AI-enhanced teaching program (including intelligent learning planning, an intelligent surgical video library, and an intelligent case analysis library) combined with traditional instruction; the traditional teaching group (n = 20) received only conventional teaching. Before and after the training, Objective Structured Clinical Examinations (OSCE) and porcine heart model assessments for mitral valve replacement and coronary artery bypass grafting were conducted, and satisfaction was surveyed. Results After training, the total OSCE score of the AI-combined teaching group was significantly higher than that of the traditional teaching group (85.6 ± 4.2 vs. 78.3 ± 5.1, p  [...]

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

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

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

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

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

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

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

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

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

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

ABSTRACT Purpose Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal breast lesion with a broad spectrum of clinical and radiologic presentations. We aimed to evaluate the demographic, radiologic and histopathologic features of PASH-containing breast lesions. Methods This retrospective single-centre study included patients with histopathologically confirmed PASH identified between January 2019 and January 2026. Clinical records, mammography, ultrasonography, MRI findings and pathology reports were reviewed. Imaging findings were analysed descriptively together with demographic and histopathologic characteristics. Results Thirty-one female patients with a mean age of 34.1 ± 11.7 years (range, 11–51 years) were included. Most patients were premenopausal (29/31, 94%). PASH was most commonly identified as an incidental or associated stromal finding, particularly in fibroadenoma-spectrum lesions (18/31, 58%). On ultrasonography, the predominant appearance was an oval, parallel-oriented, hypoechoic lesion with circumscribed margins, although suspicious findings such as indistinct margins and non-parallel orientation were also observed. Mammographic findings ranged from negative examinations to mass-like densities and calcifications. MRI appearances were heterogeneous and included both mass and non-mass enhancement patterns. Two young patients demonstrated rapidly enlarging dominant diffuse/nodular PASH lesions with diffusion restriction on MRI, raising preoperative suspicion for angiosarcoma and ultimately requiring surgical management. Conclusion Breast PASH demonstrates substantial biologic and radiologic heterogeneity, ranging from incidental stromal findings within benign proliferative lesions to rapidly enlarging diffuse/nodular masses with aggressive imaging features mimicking angiosarcoma. Because imaging findings may reflect both the PASH component and associated breast pathology, radiologic–pathologic correlation is essential for accurate diagnosis and appropriate management. [...]

ABSTRACT Purpose Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal breast lesion with a broad spectrum of clinical and radiologic presentations. We aimed to evaluate the demographic, radiologic and histopathologic features of PASH-containing breast lesions. Methods This retrospective single-centre study included patients with histopathologically confirmed PASH identified between January 2019 and January 2026. Clinical records, mammography, ultrasonography, MRI findings and pathology reports were reviewed. Imaging findings were analysed descriptively together with demographic and histopathologic characteristics. Results Thirty-one female patients with a mean age of 34.1 ± 11.7 years (range, 11–51 years) were included. Most patients were premenopausal (29/31, 94%). PASH was most commonly identified as an incidental or associated stromal finding, particularly in fibroadenoma-spectrum lesions (18/31, 58%). On ultrasonography, the predominant appearance was an oval, parallel-oriented, hypoechoic lesion with circumscribed margins, although suspicious findings such as indistinct margins and non-parallel orientation were also observed. Mammographic findings ranged from negative examinations to mass-like densities and calcifications. MRI appearances were heterogeneous and included both mass and non-mass enhancement patterns. Two young patients demonstrated rapidly enlarging dominant diffuse/nodular PASH lesions with diffusion restriction on MRI, raising preoperative suspicion for angiosarcoma and ultimately requiring surgical management. Conclusion Breast PASH demonstrates substantial biologic and radiologic heterogeneity, ranging from incidental stromal findings within benign proliferative lesions to rapidly enlarging diffuse/nodular masses with aggressive imaging features mimicking angiosarcoma. Because imaging findings may reflect both the PASH component and associated breast pathology, radiologic–pathologic correlation is essential for accurate diagnosis and appropriate management. [...]

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

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

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

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

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

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

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

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

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

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

ABSTRACT Objective Women in rural and remote Queensland face greater challenges in accessing fertility care than those residing in large regional or metropolitan centres of Australia. This study aims to explore the experiences of women accessing fertility care while living in a rural or remote area of Queensland and their perspectives on ways to improve fertility care. Setting Interviews were conducted either in-person (Townsville, Emerald, Cloncurry, Mount Isa), via telephone or Microsoft Teams. Participants Persons currently or previously accessing fertility care, while living rurally in Queensland, identifying as female at birth, being fluent in the English language, and aged 18 years or older participated. Design Qualitative semi-structured interviews, with data analysed via reflexive thematic analysis, were followed by a descriptive content analysis of participants' ideas for improving rural fertility care. Results Two main themes with 18 sub-themes emerged from the data. Theme 1: experiences of participants in accessing and receiving fertility care, whilst living in a rural or remote area, and Theme 2: participants' perspectives on how to improve the fertility care experience in rural and remote areas. Residence in a rural or remote location added to the complexity of fertility-related experiences. Rural living influenced fertility knowledge and information access, the accessibility of services, fertility care choice, privacy and social support. Participants articulated strategies from the availability of local information hubs to policy changes aimed at mitigating fertility care postcode-related disadvantage. Conclusion Rural and remote persons accessing fertility care have highlighted not only the challenges experienced but have proposed strategies to improve rural fertility care. [...]

Australian Journal of Rural Health, Volume 34, Issue 4, August 2026. [...]

10.1542/6401048052112Video AbstractPEDS-VA_2026-0769896401048052112BACKGROUNDRoutine direct antiglobulin test (DAT) screening in newborns at risk of isoimmune hemolytic disease is a long-standing practice. Advancements in prophylactic care and noninvasive hyperbilirubinemia monitoring warrant reevaluating the value of DAT. We investigated the clinical utility of routine DAT screening for mature newborns with ABO incompatibility and ABO-compatible newborns with RhD incompatibility born to mothers without active alloimmunization.METHODSWe conducted a retrospective cohort study of infants born after 35 weeks or more of gestation undergoing DAT screening. Infants were stratified into ABO-incompatible and ABO-compatible/RhD-incompatible cohorts. Bivariable correlations, logistic regression, and area under the receiver operating characteristic curve (AUC) were used to assess predictors for phototherapy requirements.RESULTSAmong 618 infants included in the analysis, within the ABO-incompatible cohort (N = 310), DAT positivity was associated with higher transcutaneous bilirubin (TcB) and increased phototherapy requirement. However, TcB alone robustly predicted the phototherapy requirement (AUC = 0.887). Incorporating DAT minimally enhanced the predictive capacity (AUC = 0.896). In the ABO-compatible/RhD-incompatible cohort (N = 308), 14.0% of infants had a positive DAT attributed to passive maternal anti-D, showing no correlation with TcB. Only 1.0% of these infants required phototherapy.CONCLUSIONSOur data showed routine DAT screening provides minimal predictive value beyond TcB monitoring for ABO-incompatible infants and offers no clinical utility for RhD-incompatible infants exposed solely to passive anti-D. These findings validate the 2022 American Academy of Pediatrics guidelines, suggesting that discontinuing routine DAT in these low-risk populations safely optimizes laboratory resources. Importantly, maternal antibody screening remains essential, and DAT must be performed if maternal screening is incomplete or unavailable. [...]

Identity exploration is a central developmental task of adolescence. As proposed by Erikson1 and subsequent research, adolescence is a critical period for answering fundamental questions: “Who am I? What do I believe? Who do I want to become?” Pediatricians witness this process during well-child visits as adolescents navigate shifting interests, peer dynamics, and family tensions. Increasingly, however, this exploration is taking place not with people but with artificial intelligence (AI). [...]

OBJECTIVETo examine long-term trends in overall and pathogen-specific late-onset sepsis (LOS) incidence among very preterm infants (VPIs) in a statewide, population-based network.METHODSWe analyzed data for infants born at 22 to 31 weeks’ gestation in the California Perinatal Quality Care Collaborative from 2010 to 2023. LOS was defined as a positive blood and/or cerebrospinal fluid culture obtained more than 3 days after birth. Annual percentage changes (APCs) were estimated using Poisson regression, with and without adjustment for gestational age.RESULTSAmong 66 441 VPIs, 6012 (9.0%) had at least 1 LOS episode, with 15.4% mortality. Of 6817 pathogens, 64.7% were gram-positive bacteria, 28.3% gram-negative bacteria, and 7.0% fungi; coagulase-negative staphylococcus (CoNS, 34.5%), Staphylococcus aureus (18.1%), Escherichia coli (10.9%), and Klebsiella species (7.2%) were the most common pathogens. From 2010 to 2017, LOS incidence declined from 15.0% to 8.2% (adjusted APC [aAPC] −5.5% [95% CI, −6.6% to −4.4%]). From 2018 to 2023, LOS incidence increased (aAPC 2.1% [95% CI, 0.6% to 3.6%]), driven by non-CoNS gram-positive (aAPC 5.4% [95% CI, 3.1% to 7.9%]) and gram-negative (aAPC 5.3% [95% CI, 2.4% to 8.2%]) pathogens. S aureus LOS increased in both periods (aAPC 4.3% [95% CI, 1.0% to 7.6%] and 7.7% [95% CI, 4.4% to 11.1%]), and Klebsiella LOS increased during 2018–2023 (aAPC 9.9% [95% CI, 4.2% to 15.8%]).CONCLUSIONSIn this contemporary VPI cohort, LOS incidence declined during 2010–2017 but increased thereafter, driven by rising non-CoNS gram-positive and gram-negative infections, particularly S aureus. Targeted prevention strategies should address the evolving pathogen epidemiology of LOS. [...]

BACKGROUNDToddler milk is a breastmilk substitute for young children, yet its marketing and nutritional profile across the Americas has not been systematically synthesized.METHODSWe conducted a content analysis documenting the prevalence of front-of-package claims and imagery on 389 toddler milk products from 14 countries in the Americas. We also compared the nutritional profile of toddler milk with plain cow’s milk and chocolate-flavored cow’s milk.RESULTSNearly all products (99%) displayed at least one front-of-package claim. Claim categories included nutrition-related (97%), health-related (56%), and other marketing (25%). Nutrition-related claims highlighting breastmilk-related components were common; for example, “Contains docosahexaenoic acid” appeared on 52% products. The most common health-related claims referenced brain and cognitive benefits (29%), such as, “Supports brain development.” Among other marketing claims, endorsements (eg, “#1 recommended by pediatricians”) appeared on 11% of packages. Imagery appeared on 92% of packages. Visual metaphors included shields (32%) and hearts (27%). Nutritionally, toddler milk contained an average total sugar of 6 g/100 mL, higher than plain cow’s milk (5 g/100 mL, P  [...]

The American Academy of Pediatrics has endorsed the following publication: American Association for Pediatric Ophthalmology and Strabismus. Policy Statement: Orthoptists as Physician Extenders. American Association for Pediatric Ophthalmology and Strabismus; May 2015; Reaffirmed March 2017; Reaffirmed February 2026. Available at: https://aapos.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=6f6f5e1b-3536-3d03-2279-27a0c7926410&forceDialog=0 [...]

Unaccompanied migrant children and families seeking humanitarian protection face health and well-being risks throughout the migration journey. US immigration policies and enforcement practices that subject children and families to detention and separation compound these risks. Grounded in the Best Interest of the Child (BIOTC) framework, this policy statement recontextualizes reception and proposes recommendations to ensure the safety and well-being of children and families seeking humanitarian protection. [...]

BACKGROUND AND OBJECTIVESNeonatal tracheal intubation is a high-risk procedure, and multiple attempts are associated with adverse events. At our tertiary neonatal intensive care unit, the baseline first-attempt success rate was 45%, which we aimed to increase to over 55% through a quality improvement (QI) initiative.METHODSA multidisciplinary team conducted a QI project using the define-measure-analyze-improve-control framework. Root cause analysis identified poor glottic visualization and patient instability as primary drivers of failure. Plan-do-study-act cycles were carried out (April 2023–July 2024), followed by a sustainability phase (August 2024–May 2025). Key interventions included the phased implementation of video laryngoscopy (VL) as the primary intubation device and the standardization of oxygenation during laryngoscopy using nasal high flow. First-attempt success was tracked using statistical process control, and bimonthly VL use was monitored as a process measure.RESULTSA total of 642 intubations were analyzed. By control chart analysis, the first-attempt success rate increased from a baseline of 45% to a sustained process mean of 61% during the intervention and sustainability phases. VL use increased from 0% at baseline to 70% to 90% during the sustainability phase. Success rates improved across all clinician types and locations. Notably, first-attempt success in infants weighing less than 1000 g increased from 38% at baseline to 62% during the intervention phase.CONCLUSIONA systematic QI initiative focused on VL and standardized oxygenation improved and sustained neonatal intubation success rates, exceeding the project aim. The maintenance of high-success rates confirms the durability of these safety improvements. [...]

Genomic testing is increasingly being integrated into clinical care.1,2 Genetic testing has also become more complex, transitioning from hypothesis-driven targeted testing to broad-based testing that includes over 20 000 genes.3 Prior to the 2010s, genetic testing largely included karyotypes, fluorescence in situ hybridization, chromosomal microarrays, and sequencing of select single genes, which respectively allowed for detection of chromosomal deletions, duplications, and structural abnormalities and variants in select target genes. Completion of the human genome sequence and declining technological costs allowed for development of gene panel testing, which permits detection of sequence and copy number changes in one or multiple genes associated with a given disease or phenotype. These targeted testing methodologies are being replaced with exome and genome sequencing, which simultaneously interrogate all genes and can detect single nucleotide variants, copy number variants, and trinucleotide repeat expansions in an unbiased manner.4 Although the advancement of genomic testing represents a triumph in clinical diagnostics, these tests have limitations and there are important considerations for ensuring accessibility to genetic testing and professionals trained in test selection, interpretation, and follow-up. [...]

Early identification of developmental delays and timely initiation of early intervention (EI) services can enhance outcomes for children and families.1 Pediatric professionals can play a critical role in this process given their near-universal access to young children, frequent contact with families, and opportunities to leverage caregiver-clinician relationships to connect families to other professionals.2 Yet, most children who are identified with developmental delays in pediatric primary care are not linked to EI services.3 The difference between the number of children identified with developmental delays in pediatric primary care and those who go on to receive services is a stark reminder that silos between sectors prevent systems from working for children and families. [...]

10.1542/6399096485112Video AbstractPEDS-VA_2024-0693156399096485112BACKGROUND AND OBJECTIVESEarly screening for developmental concerns enables timely diagnosis and referral, yet many families face barriers accessing services. Prior work showed that early childhood care coordination could improve timely service connection. This study assessed developmental outcomes among children participating in a randomized controlled trial of Information and Referral Federation of Los Angeles County (211LA).METHODSParticipants, aged 21–42 months, were randomized to usual care or the 211LA intervention. Developmental and behavioral measures, including the Parental Evaluation of Developmental Status Developmental Milestones Assessment Level (PEDS-DM-AL) and the Child Behavior Checklist (CBCL), were collected at baseline and 24 months later. The sample included 499 participants, 250 in the 211LA intervention and 249 in usual care. Primary analyses examined changes in PEDS-DM-AL and CBCL scores over the 24-month period by study arm. Post hoc analyses compared family characteristics between intervention and control families who enrolled in services.RESULTSDevelopmental and behavioral measures showed some clinically insignificant change over time, but these changes did not differ by condition (expressive/receptive language skills mastered: P > .9; autism, attention, aggression, and externalizing behavior T scores: P > .4). Post hoc analyses identified potentially relevant imbalances between the treatment arms at baseline as well as in the subgroup that enrolled in services, with families assigned to the 211LA intervention being more likely to have a non–US born parent and a parent with limited English proficiency compared with families assigned to usual care. Intervention families enrolled in services also used telehealth more frequently and received a lower duration of services than those receiving usual care.CONCLUSIONSThis study measured the indirect influence of service enrollment through 211LA care coordination on developmental outcomes. Although increased service enrollment through 211LA did not affect developmental outcomes, we hypothesize this may be because of several factors, including overrepresentation of a subset of historically underrepresented families in the 211LA intervention, suboptimal performance of our developmental assessment tool, and complexity of conducting a trial of this magnitude during the COVID-19 pandemic, which may have diminished the ability of this trial to demonstrate developmental benefits despite demonstrated service enrollment gains. [...]

Congenital tuberculosis (TB) is a rare condition, and diagnosis is challenging due to its nonspecific clinical presentation and rarity. It has a very high case-fatality rate (estimated at 30%–50%).We report the case of a 2-week-old male neonate, born from an uncomplicated diamniotic, dichorionic twin pregnancy at 36 weeks 1 day’s gestation, who presented with poor feeding and low-grade fever. Blood, urine, and cerebrospinal fluid (CSF) cultures, as well as nasopharyngeal and CSF viral polymerase chain reactions were negative. However, persistent poor feeding and rising inflammatory markers prompted continued hospitalization. On the fourth day of admission, he developed acute hypoxemic, hypercarbic respiratory failure with apneas and progressive lung parenchymal disease requiring intubation. The diagnosis of congenital TB was confirmed through endotracheal aspirates. He was initiated on TB treatment but ultimately developed a paradoxical reaction, requiring readmission and initiation of corticosteroids.His mother, father, and twin brother were initially asymptomatic. His twin was subsequently admitted to the hospital and was diagnosed with congenital TB as well. His mother was ultimately diagnosed with genitourinary TB based on an endometrial biopsy.This case contributes to the limited literature on congenital TB, highlighting the broad clinical spectrum and complications in managing the disease. Additionally, the unique presentation of disseminated congenital TB in an infant with an asymptomatic mother and a fraternal twin who initially did not require hospitalization underscores the importance of heightened awareness of tuberculosis during pregnancy, particularly in populations at risk, to facilitate early diagnosis and prevent perinatal transmission. [...]

10.1542/6399100425112Video AbstractPEDS-VA_2025-0754076399100425112BACKGROUND AND OBJECTIVESStaphylococcus aureus is the most common causative pathogen for children with acute hematogenous osteomyelitis (AHO) and acute bacterial arthritis (ABA). National guidelines recommend empiric coverage for methicillin-resistant S. aureus (MRSA) at hospitals where the overall MRSA rate is greater than 10% to 20%. The objective of this study was to evaluate the frequency and appropriateness of empiric MRSA coverage for AHO and ABA among hospitalized children in the United States.METHODSHospital encounters from September 2015 through December 2024 for AHO and ABA were identified using the Pediatric Health Information System (PHIS) database and were categorized based on validated, pathogen-specific discharge codes. Hospital-specific rates of methicillin resistance among all S. aureus isolates were collected directly from participating PHIS hospital antibiograms.RESULTSA total of 15 841 hospitalizations from 46 PHIS hospitals were included. Among the 48% of children with a pathogen-specific discharge code assigned, 17% were MRSA. Most children without MRSA identified (58%) received empiric MRSA antimicrobial therapy. Most hospital antibiograms had an MRSA rate above 20%, although the rate of MRSA for AHO and ABA was consistently less than hospital-wide MRSA rates. Across all PHIS hospitals, the MRSA rate for AHO and ABA was half that of hospital-wide MRSA rates (0.5; range, 0.2–1.17).CONCLUSIONSMost children hospitalized in the United States for AHO and ABA receive empiric MRSA therapy, although few have MRSA identified. Hospital-wide antibiograms consistently have a higher MRSA rate than seen in patients with AHO and ABA, and development of AHO- and ABA-specific antibiograms may improve targeted empiric therapy for children with osteoarticular infections. [...]