General journals

“To meet the needs of modern Britain, the NHS must understand the people it serves.” That’s the argument Emma Runswick, deputy chair of BMA council, puts forward in a new report looking at faith literacy in the NHS.1A collaboration between Muslim think tank Equi and the British Islamic Medical Association (BIMA), the report brings together insights gained from 31 in depth interviews with healthcare practitioners and health inequalities experts, as well as the findings from a small survey of 54 Muslim healthcare staff carried out by BIMA.Among its key findings, the report highlights that all people surveyed thought that understanding a patient’s faith needs could improve health outcomes. But just two respondents said that they felt fully equipped with the training and knowledge to meet their patients’ faith related needs.Additionally, 74% of those surveyed said that they were occasionally or regularly discriminated against on account of their faith. And 60%... [...]

A doctor who was sacked for giving Lucy Letby sensitive patient information has been named following his death.Mark Deakin, a married father of two, was granted lifelong anonymity as a witness at Letby’s trial for the murder and attempted murder of babies at the Countess of Chester Hospital.But after an application by Associated Newspapers, publishers of the Daily Mail and Mail on Sunday, the Court of Appeal ruled that he could be named following his death.Deakin, who died in July this year, was the senior registrar in paediatrics at the Countess of Chester Hospital between September 2015 and September 2016. He went on to become a consultant in paediatrics at Alder Hey children’s hospital in Liverpool and in December 2016 supported Letby to get observational experience in theatre there.By then she had been transferred to administrative duties at the Countess of Chester because of consultants’ concerns about her.Deaken’s dismissal from... [...]

There is a “significant risk of future deaths” among doctors who are working too much without proper checks by their employers, a coroner has warned.The warning was issued in a recent prevention of future deaths report that focused on the death of Naeem Ahmed.1Ahmed, aged 50, was found slumped in a chair in the anaesthetists’ on-call room at Poole Hospital in Dorset on 21 June 2025, next to two syringes and a half empty bottle of whisky.The report follows an inquest into Ahmed’s death in June, during which it was reported that postmortem tests had shown that he had taken fentanyl and that his alcohol level was about half the drink-drive limit.2The cause of death was combined alcohol and fentanyl toxicity, and the inquest, held in Bournemouth, ruled the death to be by “misadventure.”Ahmed had worked nine 13 hour hospital shifts in a row and had organised his work schedule... [...]

After qualifying in medicine, two members of the Darwin family, each of whom had received some of their medical education in the Edinburgh Medical School in the second half of the 18th century, set up in medical practice, Erasmus Darwin in Lichfield and his son Robert Waring Darwin in Shrewsbury. William Withering, who had also graduated from the Edinburgh Medical School, was at the same time practising in Birmingham. None of the three had been contemporaries in Edinburgh. In 1788 Withering was consulted by an apothecary in Wellington, Shropshire, about the case of a woman, Mrs Houlston, whom Robert Darwin had attended the day before. Withering thought that Darwin’s prescription had been inappropriate and changed it. This led to a series of vituperative epistolary exchanges between the two. Erasmus, Robert’s father, may have been involved in the affair, by urging his son to attack Withering and by helping him to write his letters. [...]

A commonly used antidepressant is likely to be unavailable in the UK until later this year.The Department of Health and Social Care has issued a tier 2 medium impact alert warning of supply shortages of venlafaxine 75 mg immediate release tablets.The tablets are expected to be unavailable across the whole of the UK until November, health officials said.Venlafaxine—part of the serotonin-noradrenaline reuptake inhibitor class of antidepressants—is thought to work by increasing the levels of serotonin and noradrenaline in the brain, helping improve a patient’s mood.It is mainly used to treat depression but can also be prescribed to treat anxiety, panic attacks, and menopause symptoms such as hot flushes in women with breast cancer.1Official prescribing data show that 488 814 patients in England took venlafaxine in 2025-26.2The shortage only affects the 75 mg immediate release version of the medication, which is taken multiple times a day.Alternative formulations—including modified release 37.5 mg,... [...]

Patients with cancer who received most of their immunotherapy treatments earlier in the day experienced longer overall survival than those who received their treatments later in the day, new findings suggest.1The findings made national headlines, but independent experts and the researchers of the study themselves have urged caution over interpreting the results, explaining that further study and randomised trials would be needed to confirm the findings.Lead study author Paul Lorigan, consultant medical oncologist at the Christie NHS Foundation Trust in Manchester, said, “The most important message from this research is that there appears to be a signal worth investigating further.”What was the study?Published in the British Journal of Cancer, the study analysed outcomes for 2631 patients with advanced cancer who received immune checkpoint inhibitors at the Christie hospital between January 2018 and December 2023.The study included patients with metastatic lung cancer (45%), melanoma (23%), renal carcinoma (18%), head and neck... [...]

An invasive species of mosquito that can transmit viral diseases such as dengue, Zika, and chikungunya has been discovered breeding in the UK for the first time.The UK Health Security Agency (UKHSA) has increased surveillance and trapping activities after invasive Aedes aegypti mosquitoes and larvae were detected at residential properties in east London.The agency said that the risk to the public remained low, as—despite recent heatwaves—the UK climate is too cold for the species to survive long term.It is the fourth time Aedes aegypti has been detected in the UK in recent years, but this is the first time that it has been identified breeding, health officials said.The species is typically found in tropical and subtropical regions and can transmit diseases including dengue, chikungunya, yellow fever, and Zika. It is not a vector for malaria.It has previously been known to “hitchhike” from its native range in vehicles, baggage, and imported... [...]

A doctor in Guernsey revealed sensitive confidential medical information about one patient by taking a phone call while examining another patient, it has emerged.The breach of confidentiality was outlined in the latest report from Guernsey’s Office of the Data Protection Authority.1This case came to light after the healthcare provider that employed the doctor reported the breach to the data protection regulator.The doctor remained in the examination room throughout the conversation, where the identifying details of the patient on the phone and sensitive details of their health were heard by the patient being examined and by others in the room.“The information was heard by people who had no legitimate reason to receive it and who were unconnected to the care of the patient on the phone,” the Data Protection Authority’s report reads.“The breach involved the unauthorised disclosure of special category data and created a risk of distress and loss of privacy... [...]

Global health is entering an era of financial retrenchment and fragmented leadership. Development assistance for health fell sharply in 2025, driven largely by cuts in US funding, and is at its lowest level since 2008.1 This has encouraged speculation that China might fill the financial gap. That illusion should be rejected. Such substitution would be financially implausible, politically inconsistent with China’s approach to development cooperation, and undesirable for regions seeking more national sovereignty, such as that envisioned in the Africa-led Accra reset to reform the global health architecture.2China nevertheless has compelling reasons to engage more deeply in global health and governance. The 2003 SARS outbreak exposed weaknesses in domestic surveillance, reporting, and emergency response, while disrupting trade, travel, and economic growth; covid-19 reinforced the lesson on an unprecedented scale.3 China’s engagement reflects overlapping motivations: national risk management, international commitments and responsibilities, south-south solidarity, and economic and technological interests.34 More importantly... [...]

The US Centers for Disease Control and Prevention (CDC) has refused to include two measles associated deaths reported by the state of Pennsylvania1 in its national tally of measles deaths, sparking a rift between state and national health authorities.Pennsylvania’s Department of Health reported2 last week that the state had recorded its first measles associated deaths in 35 years—the first in the US in 2026.But the CDC has challenged that claim, updating its website to exclude the two fatalities from the national total.3“This week’s measles outbreaks update will not include the two measles-associated deaths reported by the Pennsylvania Department of Health on August 25 while CDC reviews additional information regarding the circumstances and causes of death,” a statement added to the website reads.“At this time, available information does not establish whether measles caused or contributed to the deaths or whether the individuals died from other causes while infected with measles.”Died “with... [...]

In the Channel 4 documentary The Great ADHD Myth broadcast on 18 August 2026, psychiatrist and journalist Max Pemberton questioned whether attention deficit/hyperactivity disorder (ADHD) is a “genuine neurodevelopmental disorder, or a social construct.”1 The documentary has contributed misinformation and confusion to the already fraught discourse around ADHD.A wealth of robust research supports the view that ADHD is a well established, extensively evidenced neurodevelopmental condition.2 The disorder is associated with serious adverse outcomes, including substance misuse, suicide, and premature mortality.2 Substantial evidence from randomised controlled trials shows that ADHD responds to treatment.34 This evidence was omitted from the documentary, which is concerning given that the care health professionals provide might be informed by it.The programme failed to clarify fully how an ADHD diagnosis is made. Diagnosis requires clinically significant impairment, symptoms that are pervasive across settings, and evidence of onset in childhood.4 ADHD is included in the World Health Organization’s... [...]

Increasing numbers of young children are ending up in hospital emergency departments in a mental health crisis because their families or carers don’t know where else to turn, official data have indicated.NHS England data, obtained by the Royal College of Paediatrics and Child Health (RCPCH), also showed that waiting times of 12 hours were also on the rise among children aged 6-17 attending emergency departments with a recorded mental health related diagnosis or presenting complaint.1Data show that, in 2025, 75 491 children attended a hospital emergency department with a recorded mental health concern—a 36% increase since 2019.The sharpest rise was seen among 6-9 year olds, up by 62% in six years, from 3870 in 2019 to 6269 in 2025.There was a 41% increase in admissions for 9-15 year olds over the same time period, a 28% increase among 16 year olds, and a 19% increase among 17 year olds, the... [...]

This Perspective outlines a framework for clinicians navigating physiologic data from wearable devices, referred to as “results of unknown significance,” including the need for universal evidentiary standards and shared language. [...]

To the Editor A recent article reported that adoption of ambient AI scribes across 5 academic health systems was associated with modest reductions in total EHR time without a significant overall reduction in after-hours EHR work. The authors suggested that time saved on note creation may be reallocated to reviewing prior documentation, addressing test results, answering messages, or conducting medical record review. This finding prompts a discussion of what part of “documentation burden” AI-powered scribes are actually solving. [...]

To the Editor A recent study provided timely and important evidence on the real-world implementation of artificial intelligence (AI)–enabled scribes across multiple academic health systems. In an era marked by growing enthusiasm for AI as a potential means of addressing clinician burnout, the authors offer a careful, data-driven assessment of how these tools influence electronic health record (EHR) use and clinical productivity. [...]

In Reply We appreciate the thoughtful commentaries about our recent article, which enable us to highlight the complexities of characterizing the impact and nuances of any new clinician-facing technology. [...]

Why are editors so fastidious about titles of manuscripts? Clearly, a title is not just a name, even when it is an eponym. It should have some logical link with the manuscript’s topic. [...]

This randomized clinical trial assesses whether high-dose vitamin D3, compared with standard-dose vitamin D3, added to standard chemotherapy improves progression-free survival in patients in the US National Clinical Trials Network with previously untreated metastatic colorectal cancer. [...]

This study examined whether high-dose vitamin D3, compared with standard-dose vitamin D3, added to standard chemotherapy improves progression-free survival for patients with previously untreated metastatic colorectal cancer. [...]

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

This Viewpoint discusses the potential for consumer-facing digital health technologies to influence health-related decisions; highlights the regulatory challenges posed by their increased use; and calls for regulatory standards for these technologies that are evidence-based, transparent, understandable by consumers, and proportionate to potential benefits and harms. [...]

Poetry, despite its reputed elusiveness, has many ways of instructing its readers, especially teaching how to cope with difficult times. Medicine, filled with challenges, stress, and grief, all refracted through our patients’ voices, provides ample occasions for such poetic education. Poetry can point to beauty in darker moments and can model grace in confronting such harrowing experiences as the death of a loved one, perhaps even offering guidance for survivorship. “The Chicken Ladies” offers a bittersweet example of poetry, and our patients, as teachers, as the speaker witnesses and learns from the conflicting emotions expressed by the wife of a dying patient. The poem’s structure offers a means for holding themselves together, the repeated 3-line stanzas connecting young physician, patient, and the advice-giving wife. Entertaining, lighthearted chicken anecdotes during their interactions—the patient’s wife is a chicken enthusiast—teach that not only can levity be a welcome distraction from grief, but that humility (implicitly, the physician is not the only expert here) is also important. The speaker’s unspoken sense of her own inadequacy is expressed when the wife “confesses that she does not think she can do this” during her husband’s final hours, the 2 joined again in poetry’s wise embrace. By the poem’s conclusion, all that the speaker has learned seems expressed in “On my way out I trade stained scrubs for a fresh pair/And as I drive home, I listen to The Chicken Ladies,” transformed by her deepened empathy as she finally absorbs what she initially thought she had little need for. [...]

The US Centers for Disease Control and Prevention (CDC) reported that cases of Candida auris infection increased from 2022 to 2024. [...]

To the Editor Dr Drum and colleagues provided a comprehensive review of methods for identifying intravascular volume overload. This work is vital given the growing recognition that venous congestion is not only a marker of fluid status but also predicts severe end-organ injury. We agree with the authors that a combination of physical examination, chest radiography, basic POCUS, and BNP can accurately assess volume overload in most cases. However, in borderline cases, this assessment can be further enhanced by incorporating the venous excess ultrasound (VExUS) framework. [...]

Liposuction was superior to conservative therapy in reducing leg pain and improving quality of life in patients with lipoedema, but was associated with a higher rate of serious adverse events. Liposuction has the potential to be a promising treatment option for patients with lipoedema. [...]

I am optimistic about the future for WHO. Still, despite the passionate protestations of the agency's current Director-General (DG), Tedros Adhanom Ghebreyesus—namely, that the need for a strong WHO has never been greater—the reality is that the world's only intergovernmental health institution is at its weakest moment since the nadir of 1998. At that time, Hiroshi Nakajima bequeathed an agency in crisis, badly mishandling the global response to an emerging AIDS pandemic and widely mistrusted by countries after allegations of electoral corruption. [...]

Lipoedema is an emerging disease almost exclusively affecting women, with studies suggesting a worldwide prevalence of approximately 10%.1 A recent analysis of German health insurance data reported a near-doubling of documented prevalence between 2017 and 2021, reaching an estimated 338 200 affected women by 2021, corresponding to a prevalence of 0·95%.2 [...]

Can improved outcomes in total knee replacement (TKR) be attributed solely to the choice between robotic-assisted and conventional surgical techniques? When one considers the possible TKR alignment strategies (mechanical, functional, kinematic, and anatomical)1 and the natural heterogeneity of patient expectations, the equation becomes much more complicated. The alignment strategy is chosen by surgeon preference and, in the case of functional, kinematic, or anatomical alignment, is tailored to the patient's specific anatomy. [...]

Nobel laureate and pioneer in molecular biology and neuroscience. Born on Sept 5, 1939, in Nagoya, Japan, he died on July 11, 2026, in San Mateo, CA, USA, aged 86 years. [...]

“Embedding rural voices in research and policy isn’t optional, it is essential to delivering equitable health care”, notes Anna Ugalde, Professor of Health Services Research at Deakin University in Melbourne, VIC, Australia, and lead of the Equitable Cancer Outcomes across Rural and Remote Australia (ECORRA) research programme. “A lot of our policy projects and key research projects are coming from urban health services, sometimes with very little consideration for what they mean for people who live outside of those areas.” [...]

SK, the lead author of this article, was born with cerebral palsy, is supported by personal assistants for daily living activities, and uses a power wheelchair. Thanks to his family's advocacy and steadfast belief in his capacities, he was educationally mainstreamed with peers, which was atypical at the time in Japan. His application to medical school sparked a debate about whether he could become a doctor. A faculty member visited SK's apartment to assess him and met the group of people who were part of his care community. [...]

A few days after playwright Tom Stoppard's death on Nov 29, 2025, British surgical oncologist Michael Baum revealed an unexpected connection with Stoppard's masterpiece Arcadia in a letter to The Times. Upon seeing Arcadia when it opened in 1993, Baum said he had a “Damascene conversion” because the explanation of chaos theory in the play made him think that such theory might apply to the behaviour of breast cancer cells; a consequence of this idea was, Baum noted, the development of adjuvant systemic chemotherapy which improved survival among patients with breast cancer. [...]

Medicine is changing what it computes. Conventional clinical prediction isolates a variable or endpoint, a risk score, laboratory value, or diagnosis and asks what it foretells. A new class of temporal artificial intelligence (AI) foundation model instead takes the patient journey and produces a computable representation. The medical record is not the patient; it is the partial trace of a patient's encounters with a health system, fragmented across institutions and time. Tokenisation—the digital representation of health data—aims to make those fragments jointly computable over time: to turn rows in a database into a reusable representation of a clinical journey. [...]

The social media giant will make changes across its platforms, which health experts have welcomed as a step in the right direction. Talha Burki reports. [...]

Politicians and health experts have raised concerns about data protection in the health assistance agreements between the USA and several African countries. Paul Webster reports. [...]

Pregnancy places substantial demands on the cardiovascular system, with physiological changes that can exacerbate pre-existing cardiovascular disease or expose cardiovascular vulnerability for the first time. This heightened risk causes a substantial burden of maternal morbidity and mortality. New onset cardiovascular disease—such as gestational hypertension, maternal stroke, or peripartum cardiomyopathy—complicates up to 15% of pregnancies and accounts for up to one-third of maternal deaths. A substantial proportion of this harm is potentially preventable, but opportunities for intervention are being missed. [...]

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 Background Prolonged fasting has been linked to metabolic benefits in younger adults, but its effects on chronic diseases in older populations remain unclear. Objective To examine the association between habitual fasting duration and 15-year chronic disease accumulation in older adults, overall, within organ systems, and between age groups. Methods Data were drawn from the Swedish National study on Aging and Care in Kungsholmen, a longitudinal population-based cohort of 2981 predominantly community-dwelling adults aged ≥60 years. Habitual fasting duration was the longest interval between two typical eating occasions within a 24-h window. Multimorbidity was the total number of chronic diseases (out of 60) at each visit, analyzed overall and within cardiovascular, neuropsychiatric, and musculoskeletal organ systems. Multivariate linear mixed models estimated the association between habitual fasting duration and the annual rate of multimorbidity accumulation, overall and stratified by age ( [...]

Abstract Background Adrenal crisis is a life-threatening emergency. Despite preventive strategies, previous reports suggest increasing incidence and substantial mortality, but robust validated data are limited. Objective To assess temporal trends in adrenal crisis incidence and identify associated risk factors. Methods We studied 1040 patients with autoimmune or idiopathic primary adrenal insufficiency enrolled in the Norwegian Addison Registry. Medical records were reviewed for crisis-related hospitalizations between 2000 and 2023. Overt adrenal crisis was defined by acute clinical deterioration with hemodynamic or biochemical abnormalities, whereas incipient crisis was defined by typical symptoms without objective abnormalities. Results During a median follow-up of 15 years, 660 patients (63%) experienced crisis-related hospitalizations, and 265 (25%) had an overt adrenal crisis after diagnosis. The incidence of overt crises was 3.2 per 100 person-years and that of incipient crises was 6.9 per 100 person-years. Admission rates for incipient crises increased significantly over time (p  [...]

Abstract Background Brain health across the glycemic spectrum in older adults remains poorly understood, particularly in prediabetes, a biologically heterogeneous condition. We aimed to explore cognitive performance and neuroimaging markers across the glycemic spectrum and to examine whether these associations vary according to cerebral microvascular dysfunction and diabetes onset. Methods We included 930 participants (mean age 65.7 years; 52% female) from a population-based study in Singapore with a 6-year follow-up. Participants underwent repeated medical assessments and a single neuropsychological testing and brain magnetic resonance imaging at follow-up. Cerebrovascular disease, brain atrophy, and biological aging were assessed. Results Higher HbA1c was associated with poorer brain health, with significant effects observed only at the diabetic stage. HbA1c and (pre)diabetes interacted with white matter hyperintensities, affecting cognition and brain atrophy. Over a mean (standard deviation) follow-up of 5.6 (2.1) years, among 310 participants with prediabetes, 103 (33.2%) reverted to normoglycemia, 151 (48.7%) remained as prediabetes, and 56 (18.1%) progressed to diabetes. Compared with participants who reverted to normoglycemia, those who progressed to diabetes showed greater cognitive impairment and more pronounced structural brain abnormalities. Conclusions Hyperglycemia is strongly associated with poor brain health, particularly reaching the diabetic stage. Despite the absence of a direct effect of prediabetes on brain health, its impact is amplified by cerebral microvascular dysfunction and progression to diabetes. Longitudinal studies are warranted to confirm these findings. [...]

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

Abstract Background Liver cirrhosis (LC) is frequently complicated by adrenal dysfunction; however, whether cirrhosis drives the coordinated, pathway-specific reprogramming of cortisol metabolism remains unclear. Objectives We aimed to characterize axis-specific alterations in cortisol metabolism in patients with LC, those with adrenal insufficiency (AI), and controls using integrated serum and salivary steroid profiling. Methods This prospective study included adults with LC (n = 33) and control participants without cirrhosis who underwent cosyntropin-stimulation test following transsphenoidal surgery for a nonfunctioning pituitary adenoma (controls, n = 27; AI, n = 10). Serum and saliva samples were collected at baseline, 30 and 60 min after stimulation and profiled for 26 serum and 12 salivary steroids through liquid chromatography–tandem mass spectrometry. Multivariate models were constructed to identify cirrhosis-associated steroid features, and their associations with disease severity. Results LC was characterized by axis-specific steroid remodeling, including suppressed 11β-hydroxysteroid dehydrogenase 1 and A-ring reduction activity with the 20α-reduction pathway activation. Representative changes included a lower peak cortisol-to-cortisone ratio and reduced tetrahydrocortisone-to-cortisone ratio, alongside increased 20α-reduced metabolites (all p  [...]

Abstract Background Sepsis remains a major global health challenge. International guidelines exist, but their implementation is inconsistent, and supporting evidence largely comes from high-income settings. The objective of this study was to generate international, multidisciplinary expert consensus on controversial aspects of sepsis management within the framework of sepsis code programs. Methods A multinational modified Delphi study was conducted with 164 experts from 22 countries, 12 specialties, and 105 scientific societies. Seven domains were evaluated: early diagnosis, biomarkers, diagnostic microbiology, hemodynamic monitoring, source control, antimicrobial therapy, and hemodynamic management. Consensus was defined as ≥70% agreement across three iterative rounds using Likert scales (Rounds 1–2) and binary format (Round 3). Results Consensus was achieved for 40 statements. Strong endorsement (82%–95%) was reached for structured hospital sepsis programs, NEWS-2 as the preferred early recognition tool, biomarker use (notably procalcitonin) to complement clinical assessment, urgent source control within 6 h independent of hemodynamic status, rapid molecular diagnostics integrated with antimicrobial stewardship, and norepinephrine as first-line vasopressor therapy. Experts also supported pharmacokinetic- and pharmacodynamic-guided antibiotic dosing, prolonged infusion of time-dependent agents, and dynamic rather than fixed fluid strategies. No consensus was reached on routine reliance on Sepsis-2, Sepsis-3, or qSOFA; high mean arterial pressure targets; or universal combination antimicrobial therapy. Conclusions These results provide multidisciplinary guidance for sepsis management, with emphasis on rapid recognition, targeted antimicrobial therapy, timely source control, and hemodynamic management guided by patient physiology. The recommendations are applicable to high- and middle-income healthcare systems. [...]

Higher BMI was associated with increased 90-day readmission and longer hospital stay following hip and knee arthroplasty in a regional Australian cohort. Socioeconomic disadvantage was associated with longer stay following hip arthroplasty, while rurality was not associated with readmission or length of stay. ABSTRACT Background Socioeconomic disadvantage, body mass index (BMI) and geographic location influence healthcare access and outcomes. This study examined associations between socioeconomic status, rurality and BMI with outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a regional public referral centre. Methods A retrospective cohort study of all primary THA and TKA admissions between 2017 and 2024 was performed. Variables included socioeconomic indices (SEIFA), rurality (Modified Monash Model classification), age, sex and BMI. The primary outcome was unplanned 90-day readmission. Secondary outcomes were length of stay (LOS) and intensive care unit (ICU) admission. Multivariate regression was performed. LOS was analysed as a continuous variable, and BMI and socioeconomic indices were modelled continuously to assess dose–response relationships. Results A total of 3364 admissions were analysed (1862 THA; 1502 TKA). Mean age was 66.63 years (THA) and 69.22 years (TKA). Mean BMI was 30.87 and 34.02, respectively. Increasing BMI demonstrated a dose–response association with 90-day readmission, with a stronger effect in THA (OR 1.08, p  [...]

ABSTRACT Acute necrotising pancreatitis with infected pancreatic necrosis has a significant mortality of up to 23.5%, with survival dependent on achieving a complete necrosectomy. In recent years, several minimally invasive techniques have been developed including laparoscopic and endoscopic approaches, which are feasible, well-tolerated and beneficial for the patient when compared with open surgery. Percutaneous drainage with radiologically guided drains has limited efficacy as pancreatic necrosis is mostly solid tissue, but these drains can guide the surgeon to areas of infected necrosis. We present our experience in utilising 10 mL syringes as ports for retroperitoneal access to perform staged pancreatic necrosectomies, allowing the operator to use both the nephroscope and the gastroscope to visually guide the removal of necrotic tissue, the drainage of infected fluid and the placement of drains. This is a cost-effective technique using widely available equipment and can be easily adopted. [...]

ABSTRACT Background Negative pressure wound therapy (NPWT) reduces wound complications following oncoplastic breast surgery, yet there is limited evidence supporting its use in mastectomy without reconstruction. This study evaluated the effect of NPWT on post-mastectomy wound complications in a rural Australian centre. Methods A single centre retrospective cohort study assessed simple mastectomy outcomes between 2020 and 2025. Wounds were grouped by post-operative dressing type (NPWT vs. no NPWT). The primary outcome was a composite of aspirated seroma, haematoma, wound dehiscence, and surgical site infection (SSI). Secondary outcomes were individual wound complications and intervention-related outcomes. Results The 131 mastectomy wounds were included (NPWT = 59). There was no significant difference in the composite wound outcome between NPWT and no NPWT (62.71% vs. 47.22%; p = 0.077). NPWT had significantly more aspirated seromas (59.32% vs. 40.28%; p = 0.030) but multivariate analysis did not identify a significant association (Multivariate Exp (β) (95% CI): 2.021 (0.958–4.265); p = 0.065). No significant difference was identified in the other secondary outcomes. Diabetes mellitus was independently associated with the composite wound complication (Multivariate Exp (β) (95% CI): 3.349 (1.242–9.031); p = 0.017) and increasing body mass index was associated with SSI (Multivariate Exp (β) (95% CI): 1.064 (1.012–1.119); p = 0.015). Conclusion NPWT was not associated with reduced wound complications following simple mastectomy. Aspirated seroma was more common for NPWT, but regression analysis found no significant association. A high rate of wound complications poses a significant burden for patients and this regional centre; prospective data is required to determine optimal the way to prevent and manage said complications. [...]

This study comprised an international Delphi study of 439 prehabilitation experts reaching consensus on nine psychological interventions endorsed across urogenital, gastrointestinal and thoracic cancer surgery. The findings provide a consensus-based core to standardise psychological prehabilitation and guide future implementation research. ABSTRACT Background Preoperative mental wellbeing is an important determinant of postoperative recovery, yet psychological care is frequently overlooked within multidisciplinary prehabilitation programmes. When included, psychological interventions are fragmented and inconsistently delivered. This study aimed to establish international multidisciplinary consensus on preferred psychological prehabilitation interventions for patients undergoing urogenital, thoracic or gastrointestinal cancer surgery, and to describe current practice. Methods A three-round Delphi was conducted between February and September 2025. An international multidisciplinary expert panel rated the perceived effectiveness of each intervention for urogenital, thoracic and gastrointestinal cancer surgery using a 5-point Likert scale. Predefined criteria classified interventions as effective, ineffective, contested or indeterminate. Round 1 also captured current models of psychological prehabilitation delivery. Results In total, 439 participants completed Round 1, with 191 and 234 completing Rounds 2 and 3, respectively. Nine interventions reached consensus as endorsed across all tumour types, with supportive counselling, personalised coping strategies, cognitive behavioural therapy and mindfulness-based techniques reaching the strongest agreement. Sexual health counselling was endorsed only for urogenital cancers. No interventions reached consensus as ineffective; however, hypnotherapy and eye movement desensitisation and reprocessing were contested in specific cancer groups, whilst metacognitive therapy remained indeterminate. International practice was heterogeneous, with limited routine screening, variable access to psychological services and funding/resource constraints as common barriers. Conclusion This international Delphi study identified a core set of consensus-based psychological prehabilitation interventions for cancer surgery, providing a foundation for clinical implementation. Future research should prioritise hybrid effectiveness-implementation designs, generating data on optimal providers, delivery formats and patient characteristics. [...]

This article describes a MIRP irrigation drainage system that facilitates saline or H2O2 debridement of pancreatic necrosis using cost-effective, readily available equipment. ABSTRACT This article describes a MIRP irrigation drainage system that facilitates saline or H2O2 debridement of pancreatic necrosis using readily available equipment. [...]

ANZ Journal of Surgery, Volume 96, Issue 7-8, Page 1805-1808, July-August 2026. [...]

ABSTRACT Introduction Optimal care pathways (OCP) were developed in Australia as a framework to define quality and timeliness targets. The 2022 National Pancreatic Cancer Roadmap highlighted a paucity of population-level data on pancreatic cancer management in Australia, such that compliance with OCP targets is uncertain. This study used real-world data to compare pancreatic cancer care in Victoria, Australia, against OCP targets. Methods Data collected on pancreatic cancer patients between January 2016 and July 2025 were extracted from the PURPLE registry for five Victorian tertiary hospitals. Care processes and timeliness outcomes were compared with OCP benchmarks. Results 1878 patients were identified, with a median age of 70 years. At diagnosis, 41% had metastatic disease and 69% were ECOG performance status 0–1. Median interval from diagnosis to surgery was 20 days (OCP benchmark ≤ 28 days) with 60% of patients operated on within the timeframe, and to adjuvant therapy 55 days with 88% of patients receiving chemotherapy within the OCP benchmark of ≤ 84 days. However, just 33% received neoadjuvant chemotherapy, and 38% received palliative chemotherapy within the 28-day timeframe for commencing systemic treatment. Palliative care referral occurred in 65% of patients with advanced disease and 61% were discussed at a multidisciplinary meeting. Marked inter-site variation was evident across metrics. Conclusion In Victoria, Australia, pancreatic cancer care variably met OCP targets. Real-world registry data can identify domains of care where performance is strong and highlight opportunities for process improvement and resource optimisation. Where OCP targets are rarely achieved, these findings support review of their real-world feasibility. [...]

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

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

Severe abdominal aortic calcification on preoperative CT may identify vascular frailty in patients undergoing pancreaticoduodenectomy. Integrated with fistula-risk scores and frailty assessment, it may inform discussion of standard PD versus planned total pancreatectomy in selected high-risk patients, while AAC alone is not an indication for TP. ABSTRACT Postoperative pancreatic fistula remains one of the most consequential complications after pancreaticoduodenectomy, particularly when it triggers post-pancreatectomy haemorrhage, sepsis, reoperation and failure to rescue. Current fistula risk models mainly capture local pancreatic factors, but they incompletely reflect systemic vascular frailty and the patient's capacity to tolerate major complications. Abdominal aortic calcification is frequently visible on routine preoperative computed tomography and may provide an opportunistic marker of systemic atherosclerosis, impaired microvascular reserve, sarcopenia, frailty and reduced physiological resilience. Emerging evidence suggests that severe abdominal aortic calcification, particularly when quantified by CT-based scores or volumetric methods, is associated with clinically relevant postoperative pancreatic fistula, major complications and poorer outcomes after pancreatic surgery. In parallel, contemporary data suggest that planned total pancreatectomy, although metabolically demanding, may be feasible in selected high-risk patients when supported by modern diabetes care, pancreatic enzyme replacement and structured follow-up. This narrative review examines whether severe abdominal aortic calcification should be integrated into risk stratification before pancreaticoduodenectomy and whether, in carefully selected patients with very high fistula risk and limited rescue capacity, it may contribute to the discussion between pancreatic reconstruction and planned total pancreatectomy. [...]

Outliers in Australian surgical registries. Through a review of published literature and guidelines, we examined clinical quality registry (CQR) outlier activities. Published literature shows that CQRs provide an opportunity to systematically track and report on surgical activity, including for outliers on defined indicators. Current guidelines are not clear on the review or management of outlier activity, and there are few published examples on how this is done. ABSTRACT Clinical quality registries (CQRs) are central to improving surgical safety and quality by enabling systematic monitoring of outcomes and proactive identification of outliers. Published guidelines provide important advice on methods and activities for CQRs. Guideline flexibility allows for the varied and unique requirements of each CQR, but some aspects around guideline implementation are less certain, particularly for outlier management. In order to describe activities in Australia and the UK, searches were undertaken for published examples of CQR analysis and reporting of outliers and the subsequent management of outlier surgeons. There are many examples of high quality CQRs which actively report relevant performance indicators, with dashboards that show inter-hospital variation including unwarranted (outlier) variance. A small number of reports from the UK provide insight to local responses to suspected outlier status, commonly identifying data errors or systemic failures of local care processes. In Australia, challenges include voluntary participation, incomplete datasets, varied benchmarks, complex governance across public and private systems, and in some the restrictions imposed by qualified privilege. Worryingly, no single body is responsible for the management of the outlier surgeon. Outlier management can build on existing governance practices such as morbidity and mortality meetings and professional development activities. The publication of outlier processes and outcomes provides transparency to participants and closes the feedback loop. Active participation in CQRs and effective local outlier management actions should be encouraged as part of quality improvement, to learn from mistakes, celebrate excellence, and improve patient outcomes. [...]

Handheld 3D surface imaging was compared with direct breast anthropometric measurements in 19 women undergoing scaffold-based breast reconstruction. Sternal notch-to-nipple measurements demonstrated acceptable agreement, while nipple-to-inframammary fold and base-width measurements showed greater variability, highlighting limitations when measuring contour-dependent anatomical landmarks. ABSTRACT Background Outcomes in aesthetic breast surgery are dependent on accurate pre-operative breast measurements. The accuracy of large scale 3-dimentional scanners has been reported, the use of handheld scanners has not been described. Objectives The authors aimed to determine the trueness of anthropometric measurements of breasts obtained from a handheld 3D scan compared to direct measurements. Methods Three raters measured the breasts of 19 women using three anthropometric measurements (direct) measurements: sternal notch to nipple (Sn-N), nipple to inframammary fold (N-IMF), base width (BW). The measurements were taken directly by two raters using a measuring tape, and digitally by one rater using the software on 3D scans acquired with the Artec Leo handheld 3D scanner. Statistical analysis was completed with Bland–Altman plots as well as scatter plots to identify bias between the two methods. Results The study found that the 3D scanner showed varying levels of bias when compared to direct breast measurements. Sn-N measurement showed smaller differences, while the N-IMF and BW measurements exhibited larger discrepancies. The 3D scanning process was significantly faster, taking only 30 s per scan, compared to roughly 5 min for direct measurements, with an additional 10 min for image processing and digital measurements. Conclusion Three-dimensional scanning is most accurate for Sn-N and is more variable when measuring BW and N-IMF due to obscured landmarks on frontal imaging. The BW and N-IMF measurements also showed the most inter-rater variability. Consistent with previous research 3D scanning has limited trueness when measuring N-IMF as it is a dynamic measurement. [...]

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

ABSTRACT Nerve blocks are excellent adjuncts to multimodal systemic analgesia in patients needing complex pain management, often producing days, weeks, or months of pain-free periods. Pain often debilitates patients with significant disruption to quality of life. Intercostal nerve injection and ablations are very useful procedures in patients suffering from pain caused by trauma, tumour, or inflammation. Traditionally done using anatomical landmarks, these procedures have been associated with a higher rate of complications. When imaging modalities (such as ultrasonography or computed tomography (CT)) are used for guidance, complications are significantly reduced, ensuring better outcomes in these vulnerable patients. A variety of other regional techniques can also be used as alternatives to intercostal nerve block such as epidural, paravertebral, erector spinae plane blocks, anterolateral and anteromedial chest wall plane blocks. Interventions for intercostal neuralgia are relatively easy to perform under imaging guidance, with reliable results and fewer complications. [...]

ABSTRACT Improvements in cancer survival have led to more patients requiring radiotherapy within or near previously irradiated regions. Despite advances in diagnostic imaging, image guidance and highly conformal delivery techniques, reirradiation remains complex because of uncertainties in radiobiology, tissue recovery, dose summation and cumulative organ-at-risk tolerance. We implemented a multidisciplinary workflow to support safe and reproducible reirradiation practice in an Australian radiation oncology department. The pathway defines the roles of radiation oncologists, radiation therapists and radiation oncology medical physicists and integrates biological dose conversion, dose summation strategy selection, tissue recovery assumptions, independent verification and documentation of uncertainty. This article describes the rationale, operational steps and early experience in our department, providing a practical framework for clinical implementation and future audit. [...]

ABSTRACT Introduction Offline adaptive replanning is an appealing strategy in cervical cancer external beam radiotherapy (EBRT) to account for tumour shrinkage. It remains unclear whether volume reduction with adaptation improves geometric coverage in the presence of daily pelvic variation. This study evaluated the volumetric and geometric impact of offline EBRT adaptation in this setting. Methods Seventeen patients who completed definitive radio(chemo)therapy and brachytherapy were retrospectively assessed. An MRI in the last 2 weeks of EBRT was used to generate adaptive targets and organs at risk, which were compared with original volumes for changes in gross tumour volume (GTV), internal target volume (ITV) and planning target volume (PTV). Geometric coverage by the low-risk ITV (ITV-T-LR) and PTV was assessed on 128 cone-beam CTs. Results The mean GTV regressed by 47.9% (p = 0.0101), corresponding to a 24.2% reduction in ITV-T-LR (p = 0.0038) and a 10% reduction in PTV (p = 0.0011). Despite this, offline adaptation reduced ITV-T-LR coverage from 75% with the original volumes to 59% (p = 0.024). A 5 mm PTV margin increased coverage to 96% for the original plan and 77% for the adapted plan. On multivariable analysis, each 1% increase in on-treatment bladder volume relative to simulation was associated with a 1.3% increase in odds of anterior ITV-T-LR coverage (p = 0.0279) but a 0.7% decrease in odds of posterior coverage (p = 0.0017). Conclusions The offline adaptation approach used in this study reduced tumour and target volumes for this patient cohort, but worsened geometric target coverage, failing to compensate for daily pelvic anatomical variation. These findings raise concerns about the suitability of offline adaptation for cervical cancer EBRT. [...]

ABSTRACT Purpose Spinal metastases are a common complication of advanced malignancy and can result in significant pain, neurological dysfunction, and reduced quality of life. In patients with oligometastatic disease, stereotactic ablative body radiation therapy (SABR) offers the potential for durable local control. This study reports outcomes following spinal SABR at Waikato Hospital and compares these with published literature. Methods A retrospective single-centre cohort study was conducted of patients with oligometastatic spinal metastases treated with SABR at Waikato Hospital between September 2019 and December 2023. Patient, tumour, and treatment characteristics were collected from electronic records. The primary outcome was freedom from local failure. Overall survival and adverse events were also assessed. Results Twenty-seven patients received 30 courses of spinal SABR. Median age was 66 years (range 37–81), 74.1% were male, and prostate cancer was the most common primary malignancy (48.1%). Metachronous oligorecurrent disease was present in 53.3% of patients. Patients received either 24 Gy in 2 fractions (60.0%) or 35 Gy in 5 fractions (40.0%). Median follow-up was 29.7 months. No failures occurred within 12 months. Freedom from local progression was 95.2% (95% CI 86.6–100) at 18 months and 77.6% (95% CI 57.3–100) at 3 years. Overall survival was 88.9% (95% CI 77.8–100) at 1 year and 66.3% (95% CI 49.5–88.9) at 3 years. Vertebral compression fractures occurred in 13.8% of treated sites. Conclusion This study provides important outcome data from a New Zealand tertiary centre and demonstrates the feasibility of spinal SABR, with outcomes which are broadly consistent with those reported internationally. [...]

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

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

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

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

ABSTRACT Objective To systematically evaluate the effects of music therapy on physiological indicators and psychological states in patients undergoing large medical imaging examinations, providing evidence-based support for clinical auxiliary interventions. Methods A comprehensive literature search was conducted across English and Chinese databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Database, and VIP Database, from inception to May 2026. RCTs investigating music therapy interventions in patients undergoing medical imaging examinations were collected. Two independent reviewers performed literature screening, data extraction, and quality assessment. A meta-analysis was conducted on outcome indicators including heart rate, anxiety scores, depression scores, and examination cooperation rate. Heterogeneity among studies was evaluated using the I2 statistic. Results A total of 9 RCTs were included. The meta-analysis results demonstrated that music therapy significantly reduced patients' heart rates, with a pooled mean difference (MD) of −2.14 (95% CI: −2.21, −2.08; p  [...]

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

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue 5, Page 401-405, August 2026. [...]

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. [...]