General journals

Patients waiting for specialist care were dropped off the electronic referral service (e-RS) without warning, a national safety watchdog has warned.A Health Services Safety Investigations Body (HSSIB) report earlier this month found that from February to July 2026 over 120 000 referrals, including advice and guidance requests and referrals for review, disappeared from the e-RS.1The watchdog warned that these disappearances came to light only after GPs raised the alarm that patients had not heard from a provider about their referrals and otherwise might have been missed.The HSSIB’s report found no evidence of patients being harmed because of these referral disappearances. However, it acknowledged concerns that some patients could have avoided invasive treatment had they been seen earlier.The e-RS is a web based digital platform supplied by NHS England for referring patients to specialist providers.Responding to the HSSIB’s report, NHS England said that the e-RS was not designed for current referral... [...]

bmj;395/oct30_12/e101175/F1F1f1Initially having qualified in dentistry but changing to medicine, George decided to pursue a career as a maxillofacial surgeon. As no training posts were available, he changed to vascular surgery. He undertook basic surgical training at the Royal Victoria Infirmary in Newcastle. He was awarded a Hunterian professorship by the Royal College of Surgeons (RCS) and the prestigious Jacksonian prize for his research on blood transfusion and transplantation, the subject of his MD thesis. He was a skilled vascular surgeon, joined the transplant team, and was involved in a support group for transplant patients.George had a kindly manner towards patients and staff and was well respected. He was heavily involved in teaching and training and was the regional adviser on surgery for the RCS in London. He opened the first RCS provincial office in Newcastle in 1995. He was much involved in examining trainee surgeons, both in the UK and... [...]

bmj;395/oct30_11/e101174/F1F1f1Rama (known to many of his UK colleagues as “Ron”) was born in Bihar, India, in 1949. His father was an acclaimed general surgeon and, after Rama’s mother died suddenly, he was raised by his beloved second mother, a nurse. The eldest of four siblings, he was raised in Patna, a historic city on the banks of the Ganges. There he attended St Xavier School before transferring to Darbhanga for further college. In his teens he developed a lifelong passion for cinema and at one stage was keen to be an actor himself, before deciding to devote his life to medicine.He graduated from Darbhanga Medical College, Bihar, in 1972. He obtained his masters in general surgery in 1976 and moved to the UK in 1979. He worked in various hospitals and was subsequently appointed as a consultant in emergency medicine at Withybush General Hospital in Wales. From there he moved... [...]

Ministers have scrapped plans to abolish Healthwatch England and local Healthwatch groups, after pushback from health leaders and organisations.Launched in 2012, Healthwatch functions as a statutory independent voice for patients, helping the public hold the NHS accountable and push for patient centred improvements.Plans to abolish the Healthwatch network, consisting of 153 local groups and the national body Healthwatch England, were introduced as part of the Health Bill in May,1 amid wider governmental efforts to “simplify the patient safety landscape” of the NHS.It was proposed that the functions of the local Healthwatch organisations would be transferred to NHS integrated care boards, while the role of Healthwatch England would be transferred to the Department of Health and Social Care.2 This would mean an increased reliance on the NHS App for patient feedback. But critics warned that a loss of independence would have led to “health and care services marking their own homework.”Now,... [...]

“Questions must be asked” about the lack of warning before hundreds of practice websites went offline after an online provider entered administration, GP leaders say.They have also questioned why there doesn’t seem to be a coordinated national contingency plan for the failure of a provider delivering critical NHS infrastructure.Hundreds of general practice websites in England and Wales suddenly went offline on 28 October after their online provider—Silicon Practice—entered administration.The software company claimed on its website to provide services for more than 1000 general practices.NHS England said that less than 500 practices had been affected—under 10% of the total number of practices in England and Wales.Reacting, Sarah Jacques, GP co-lead of the Doctors’ Association UK. said: “The sudden loss of websites and online consultation services across hundreds of [general] practices is deeply concerning.”“These are no longer optional extras; they are essential routes through which patients access care.”A notice of administration was... [...]

An “ethical policy” that prevented assisted dying campaign groups from hosting events at the Royal College of General Practitioners will be “reviewed and amended,” the college pledged today.This reversal comes after the campaign group Dignity in Dying was prevented from hosting a GP led event at the college’s London headquarters, prompting outrage among RCGP members and terminally ill patients.Dignity in Dying said that terminally and incurably ill people had hoped to share their experiences with clinicians, parliamentarians, and policy makers at the event.Until Thursday the RCGP website listed assisted dying alongside various groups and industries, including those involved in arms manufacturing, adult entertainment, and fossil fuel exploration, that are banned from holding events at the college’s 30 Euston Square headquarters.1“30 Euston Square is not permitted to accommodate meetings, events, or corporate membership from any organisation engaged with assisted dying or any event where its purpose is to promote and lobby... [...]

India has ordered a cap on the marked up prices of 137 cancer drugs amid increasing concern that high prices are pushing households into debt or putting treatment out of reach.The nation’s drug price regulator, the National Pharmaceutical Pricing Authority (NPPA), said trade margins on the drugs would be capped at 30% of their maximum retail price (MRP), excluding tax, from 9 November.1The measure aims to lower prices charged to patients by limiting the margins added by distributors and retailers but does not directly cap the prices initially charged by manufacturers.Previously, only 20% of India’s estimated Rs125bn ($1.3bn; £986m; €1.2bn) cancer drug market was under NPPA price control. An NPPA analysis of market data, published in October, found that non-scheduled cancer drugs had an average trade mark-up of around 170%, reaching 700% or more in some cases.2The 137 drugs covered by the order include abemaciclib, bevacizumab, cetuximab, pemetrexed, palbociclib, pembrolizumab,... [...]

Busby and Uppal highlight the unacceptable diagnostic delays faced by women with suspected endometriosis.1 A delay of almost a decade is indefensible. But this discussion risks creating the impression that earlier diagnosis alone will transform outcomes. For many patients, it will not.As someone who has had severe pelvic pain for years, I find myself asking a more uncomfortable question: what happens after diagnosis?Laparoscopy is invasive, costly to health systems, and carries surgical risks. Understandably, patients welcome the possibility of non-invasive biomarkers. But obtaining a diagnosis is only the beginning of the journey. Many women, despite finally receiving confirmation, are offered hormonal treatments that have already failed or prolonged analgesia, or they are placed onto waiting lists for surgery, where they can stay for years. Even expert excision surgery is not universally curative, recurrence remains common, and many people continue to live with chronic pain despite “successful” treatment.The consequence is that... [...]

For the optimists among us, two election results this week portend hope for two more next week. Serbia’s student led movement defeated the country’s former president, strongman leader Aleksandar Vucic, in its 24 October prime ministerial election, six months after Hungary rejected its long serving populist prime minister, Viktor Orban. On 26 October, Brazilians delivered a surprise re-election of President Luiz Inacio “Lula” da Silva, defeating the far right candidate Flavio Bolsonaro. By 1 November a final result should be known of how Israelis voted in what’s seen as a referendum on Benjamin Netanyahu’s leadership, ahead of the US midterm elections on 3 November, where tough guy Donald Trump’s supporters and his stranglehold on Congress will be tested by the growing discontent of American voters. A rebound of liberal or progressive values is being read into these election trends—but they are, in truth, accompanied by stark divisiveness and contestation.The broader... [...]

An independent review of NHS productivity and future ringfenced spending on prevention have been announced in the government’s 2026 budget, the first under prime minister Andy Burnham.An additional £190m was announced to support the NHS response to winter pressures. But no direct share of this pot has been set aside to support general practices.Unveiled by chancellor John Healey on 28 October, the budget had, overall, much less on the NHS and adult social care than in previous years, with the main focus instead on household bills.The BMA’s chair of council, Tom Dolphin, said, “For a government that claims to put the NHS at the heart of its priorities, this budget falls worryingly short.“The failure to set out meaningful action to tackle crumbling buildings or ensure we have enough doctors to meet future demand raises serious questions about the government’s commitment to the health service’s long term future.”David Williams, deputy director... [...]

Artificial intelligence (AI) systems suggest medical tests and treatment plans that are more than three times as expensive as those recommended by doctors, a study has found.1A small head-to-head evaluation by Israeli and US researchers analysed how 24 AI systems responded to 200 real outpatient and emergency department clinical notes.These notes were sourced from MTSamples, a public collection of deidentified US format clinical notes contributed by practising clinicians.Each AI system received the notes as they were recorded by the treating physician. The AI then produced its own assessment and plan, which was compared with the physician’s plan documented in the original notes.Orders from both plans were priced at 2026 Medicare rates. New medicines were counted rather than priced.Publishing their findings in the New England Journal of Medicine,1 the researchers found that the primary reason AI treatment plans were more expensive was because the algorithms suggested more diagnostic tests, medications, and... [...]

Consultant geriatrician Elena Mucci had no idea what Instagram was before creating an account, on the advice of her trainees, at age 45. Five years later, she is still making short videos in which she shares the medical knowledge she has amassed over 25 years of clinical practice.Her magnetic social media presence has attracted 290 000 followers and even a couple of visits from presidents of African countries, who have flown to see her in her private clinic in Hastings.Speaking at a Royal Society of Medicine debate on whether being on social media is an advantage to doctors, Mucci said, “If you’re a doctor with all that knowledge, you need to share it. That knowledge is now consumed via social media.”Nearly one in four people in the UK reported turning to social media and artificial intelligence chatbots for health guidance, in a survey of 2000 people conducted by the health... [...]

In Reply We appreciate the thoughtful letters in response to our Viewpoint. We agree with Dr Ziegelstein that the simplest solution to the ethical quandaries of advertising in AI-powered CDS tools would be for the AI-powered CDS companies that use advertisements and/or the pharmaceutical companies that partner with them to end this practice altogether. However, this is unlikely to happen, given that advertising is a potentially more lucrative revenue source than other options such as subscriptions. Ziegelstein’s suggestion that clinicians recognize they have other options and choose CDS tools that do not embed advertisements seems more realistic, particularly if their organizational employers nudge them in this direction. Historically, once Epocrates (a free drug information app) began supporting ads at the point of care, its credibility with its physician users eroded and other services such as UpToDate ultimately won out. [...]

Few explicit policies exist to address cognitive decline among aging physicians, a study published in JAMA Health Forum found. [...]

Stroke is a feared complication of atherosclerotic carotid artery stenosis. After years of debate regarding the value of revascularizing asymptomatic carotid stenosis in the modern era of intensive medical prevention with antiplatelet therapy and high-intensity statins, the CREST-2 trial revisited this question in a pair of randomized clinical trials: one trial comparing carotid endarterectomy plus best medical management vs medical therapy alone and the other comparing carotid artery stenting plus best medical management vs medial therapy alone. The topline findings showed that carotid artery stenting, but not carotid endarterectomy, significantly reduced the risk of the primary outcome of a composite of stroke or death within 44 days or ipsilateral stroke within up to 4 years compared with medical therapy alone among patients without contralateral stenosis who were good procedural candidates. [...]

The incidence of autism spectrum disorder in South Korea remained stable across cohorts born from 1998 to 2010, according to a study published in JAMA Pediatrics. [...]

“Do I need to treat this blood pressure?” is one of the most common questions to pass through the minds of acute care pediatricians during a typical day in the hospital. Blood pressure generally increases with somatic growth, reflecting developmental changes in stroke volume, vascular structure and function, and neurohumoral regulation. As a result of interindividual variation across the developmental stages of childhood, there is a wide range of acceptable blood pressure values. There is also long-standing ambiguity about what should be considered the limits of acceptable blood pressure, particularly among hospitalized children. Age-based reference values offer a starting point, although the threshold used to identify an unusually low blood pressure may differ from the pressure needed to maintain adequate organ perfusion. This uncertainty can create substantial tension when a clinician faces the decision whether to manage potentially low blood pressure in a child. Treatments for potentially low blood pressure can also vary widely, from temporary stimulation to administration of vasopressor and inotropic medications through a central vascular catheter. The clinical question of whether to manage low blood pressure is driven by concern that withholding treatment could cause harm that is hard to measure. [...]

The US Centers for Disease Control and Prevention (CDC) issued a health advisory in response to reports of increased human exposure to rabid or possibly rabid animals. [...]

This Medical News article discusses a randomized clinical trial that compared the metabolic effects of 10% weight loss with a Mediterranean diet, a very low-fat, plant-forward diet, and a very low-carbohydrate ketogenic diet. [...]

To the Editor The recent cost-effectiveness study by Dr Lee and colleagues provided important evidence supporting integrated gastric and colorectal cancer prevention through Helicobacter pylori stool antigen (HPSA) and fecal immunochemical test (FIT) co-testing. Co-testing with HPSA and FIT may offer a promising and economically attractive strategy in populations with high incidence of both gastric and colorectal cancers. Beyond demonstrating the potential value of this approach, the Taiwanese experience may also provide valuable lessons for countries seeking to strengthen cancer prevention programs. [...]

In Reply We thank Dr Huynh and colleagues for their thoughtful comments on our economic evaluation of HPSA-FIT co-testing. Rather than modeling a program developed de novo, we evaluated the incremental value of integrating HPSA testing into an established colorectal cancer screening program. Accordingly, infrastructure development costs were not included in our analysis; however, this should not be interpreted as suggesting implementation requires only minimal investment. Health system readiness varies considerably across countries, but we regard such heterogeneity as support for a staged implementation strategy rather than a limitation: countries with established FIT programs can readily add HPSA testing to existing stool-based testing pathways, whereas those with less mature systems may need to strengthen registries, laboratory networks, referral pathways, and treatment capacity. [...]

To the Editor The article by Mr Mann and colleagues reported that regional participation in a population-based cell-free DNA–based multicancer early detection (MCED) trial was associated with a modest increase in diagnostic delay for patients referred for suspected head and neck, lung, and upper gastrointestinal cancers. The authors concluded that this delay is unlikely to materially influence the interpretation of trial results. [...]

In Reply We appreciate Dr Froehner’s thoughtful comments on our article reporting differentially higher diagnostic delay rates in regions participating in a population-based cell-free DNA–based MCED trial. As Dr Froehner notes, many health conditions are associated with poverty, as in the case of the lung, head and neck, and upper gastrointestinal cancers that we focused on in our study. Long-standing disparities in who receives preventive care, screening tests, and diagnostic follow-up contribute to these inequities. [...]

In the Original Investigation titled “Bivalent RSV Prefusion F Protein–Based Vaccine for Preventing Cardiovascular Hospitalizations in Older Adults: A Prespecified Analysis of the DAN-RSV Trial,” published in the October 28, 2025, issue of JAMA, a coding error caused incorrect calculation of the confidence intervals for vaccine effectiveness. These confidence intervals have been corrected in the Abstract, Results section of the text, Figure 2, Figure 3, Table 2, and Supplement 3. None of the corrected confidence intervals change the statistical interpretation of the results, no point estimates or P values are affected, and the overall conclusions of the study are unchanged. The accompanying Editorial has also been updated to reflect the changes. These articles were corrected online. [...]

Although single markers resulted in variable and limited performance when compared to histology for detecting at-risk MASH, multimarker panels showed great potential, with a proteomic panel showing strong diagnostic performance. These findings could support the selection and implementation of non-invasive testing strategies in MASLD and inform future clinical guidelines, regulatory evaluation, and clinical trial design. [...]

We found no evidence to support prone positioning or HFOV as first-line strategies to improve ventilator-free days in patients with early, moderate-to-severe PARDS. Thus, the routine use of these strategies in this population is not recommended. [...]

Paediatric acute respiratory distress syndrome (PARDS) is a common, severe manifestation of direct or indirect lung injury in children. Management focuses on the careful implementation of lung protective strategies with high-frequency oscillatory ventilation (HFOV) and prone positioning often deployed in the most severe cases. As such, we read the Prone positioning and high-frequency oscillatory ventilation in early paediatric acute respiratory distress syndrome (PROSpect) trial by Martha A Q Curley and colleagues published in The Lancet with great interest. [...]

The authors of The Lancet's Series on men's health1–3 provide a genuinely world-scale picture of the issues. Their approach links biological with social process, and emphasises intersectional perspectives. The Series papers offer valuable case studies, and a suite of proposals to move health policy in new directions. [...]

Non-invasive tests (NITs) are central to clinical decision making in metabolic dysfunction-associated steatotic liver disease, including risk stratification, treatment decisions, referral pathways, and recruitment into clinical trials.1 As pharmacological treatments for metabolic dysfunction-associated steatohepatitis (MASH) become more widely available, the importance of accurately identifying fibrosis stage has grown considerably. In clinical drug trials on MASH, the objective is usually to identify patients with substantial (≥F2) or advanced fibrosis (≥F3) who are most likely to benefit from pharmacological therapy. [...]

The Lancet Countdown on health and climate change celebrated its tenth anniversary this week. The Countdown was preceded by two Lancet Commissions that sought to mobilise multiple disciplines within universities to address the climate crisis. The first Commission, in 2009, identified climate change as the greatest threat to global health this century. The second Commission, in 2025, took a different approach, describing climate change as the greatest opportunity for global health in the 21st century. [...]

Having worked for WHO for 5 years at the end of a career as an academic in global health, I was keen to read Richard Horton's Offline on the tragic fallacy of global health reform.1 Although the Offline summarised the reasons why current efforts might fail, I was disappointed that Horton did not make any suggestions for what he thought should be done instead, as well as the inference that WHO might not include voices from Latin America, Asia, the Middle East, or civil society in their deliberations related to reform. [...]

Saima Wazed, the Regional Director for WHO's South-East Asia Regional Office, resigned in September, 2026.1 Wazed's appointment drew considerable public attention and controversy, particularly when her qualifications were compared with those of other candidates.2,3 [...]

In his recent Offline on the upcoming elections for the new Director-General of WHO,1 Richard Horton mentions several of the previous Director-Generals, starting with Hiroshi Nakajima (1988–98); however, I believe the achievements of Halfdan Mahler (1973–88) should also be highlighted.2,3 [...]

In 2027, WHO will be embarking on a process to elect its next Director-General. It is clear that the new Director-General will have to continue dealing with important health issues globally, such as the health impacts of climate change, continuously evolving pathogens, pandemic preparedness, resurgence of diseases linked to low vaccination rates and anti-vaccine sentiments, and the task of guiding and assisting WHO's member states to reach the wide-ranging health objectives within the Sustainable Development Goals by 2030. [...]

The Lancet Editorial1 on skin diseases rightly argues that vitiligo trials such as Viti-Up, in which more than 70% of participants were White, should enrol patients who reflect the population affected and measure what lies beyond the visible: stigma, comorbidity, and quality of life. The same oversight, however, occurs throughout observational literature, shaping how we judge health care. [...]

Many men are failing to thrive. Shorter life expectancies for men than for woman first emerged in the 19th century and the gap has continued to widen (albeit with geographical variations). Men have a higher burden of illness: global disability-adjusted life-years are 16% greater among men than women. The primary drivers of these differences include non-communicable diseases (cardiovascular disease, cancer, and diabetes), external causes (suicide, road traffic injuries, falls, and interpersonal violence), communicable diseases (respiratory infections, tuberculosis, HIV/AIDS, and hepatitis), and substance use (alcohol-related and drug-related harms). [...]

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

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

Abstract Health inequalities are seen between populations, social groups in the same population and across populations ranked by social position. This paper focuses on trends in inequalities between countries and socio-economic inequalities in mortality within them. Mortality in most countries has improved since 1950 with some exceptions, notably: Younger adults in parts of Sub-Saharan Africa were associated with civil war, structural adjustment programmes and human immunodeficiency virus during the 1980s/1990s; the former USSR after the rapid adoption of neoliberal economic policies; European countries which implemented austerity in the 2010s; and globally in the shadow of COVID-19. Mortality differences between countries have narrowed, with the gap between the best and worst thirds of countries declining from 20.5 years for males and 22.6 years for females in 2000 to 15.6 years and 16.0 years, respectively, by 2021. Data for within-country inequalities are sparse and subject to measurement issues. Where trend data are available, they vary according to location and political context. For example, across many high-income countries, mortality inequalities improved in absolute terms between the 1990s and the early 2010s; however, relative inequalities widened. Inequalities in parts of Europe widened after 2012, reflecting austerity policies impacting the social and economic determinants of health, particularly for the poorest. Comparisons of between-country levels of inequality are problematic due to uncertainties of data recording and comparability; nonetheless, existing evidence demonstrates wider inequalities within particular ‘neoliberal’ political contexts. Future challenges include addressing such political determinants alongside the overlapping threats of climate change, social polarization, misinformation and erosion of democratic structures. [...]

Abstract Periodontitis is a common chronic inflammatory disease that has traditionally been considered primarily within the domain of dentistry. Increasing evidence, however, associates periodontitis with systemic inflammatory conditions, particularly atherosclerotic cardiovascular disease. Dysbiotic subgingival microbial communities, disruption of the periodontal epithelial barrier, transient bacteremia, microbial products, and locally generated inflammatory mediators provide biologically plausible pathways through which periodontal inflammation may influence systemic vascular biology. Epidemiologic and mechanistic studies support an association between periodontitis and cardiovascular disease, although direct causality has not been established. Importantly, periodontal treatment has been associated with improvement in endothelial function and reductions in selected systemic inflammatory biomarkers, but evidence that treatment prevents myocardial infarction, stroke, or cardiovascular mortality remains insufficient. For the practicing internist, the principal message is therefore both practical and appropriately cautious: Periodontal health should be recognized as one component of overall health, and closer collaboration between physicians and dental professionals may strengthen preventive care. This Perspective reviews the clinical evidence linking periodontitis with systemic disease, using cardiovascular disease as the principal example, and considers its implications for prevention, interdisciplinary care, and future research. [...]

Abstract Estimated glomerular filtration rate (eGFR) is indispensable for detecting, staging, prognosticating, and managing chronic kidney disease (CKD), but it measures filtration rather than defining the underlying disease. A reduced eGFR can reflect many different processes, including nephron loss, altered renal hemodynamics, glomerular injury, tubulointerstitial disease, vascular damage, congenital abnormalities, obstruction, systemic inflammation, recurrent acute kidney injury, or combinations of these mechanisms. Thus, patients with the same eGFR may have different kidneys, diseases, trajectories, prognoses, and treatment opportunities. Current CKD classification already incorporates cause, GFR category, and albuminuria category, but in clinical practice and research eGFR often remains disproportionately influential in language, referral pathways, trial eligibility, and treatment decisions. This simplification can obscure active or treatable disease, encourage over-investigation of stable vascular or age-related impairment, and create biologically heterogeneous trial populations that dilute treatment effects. Albuminuria substantially improves risk stratification, but it does not by itself define disease phenotype or mechanism. This review argues for broader implementation of the cause–GFR–albuminuria framework and for interpreting eGFR within a broader clinical and biological phenotype. A more comprehensive assessment should integrate albuminuria or proteinuria, urine sediment, longitudinal eGFR and albuminuria trajectories, hemodynamic context, medication and nephrotoxin exposure, systemic features, family history, kidney imaging, and targeted use of cystatin C, serology, monoclonal protein testing, genetic testing, kidney biopsy, and molecular biomarkers when clinically appropriate. The aim is not to replace eGFR but to place it in context. Precision nephrology will depend on distinguishing filtration level from disease identity, activity, chronicity, reversibility, and treatment responsiveness. [...]

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

Abstract Background Tea consumption has been associated with vascular health, but evidence regarding multidimensional tea-drinking characteristics and their joint associations with other lifestyle factors remains limited. Objectives To examine associations of multidimensional tea-drinking characteristics with vascular disease (VD) and assess joint associations and interactions with smoking and physical activity (PA). Methods We included 485,934 participants from the China Kadoorie Biobank (CKB). Multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for total VD and 12 subtypes. Dose–response relationships and joint associations and interactions of tea consumption with smoking and PA were evaluated. Results During a mean follow-up of 9.05 years, 14,863 incident VD cases occurred. Habitual tea consumption was associated with lower total VD risk (HR = 0.888, 95%CI 0.857–0.921) and several major cardiovascular and cerebrovascular outcomes. Associations varied by tea-drinking characteristics: Black tea showed more consistent inverse associations than green tea, moderate-strength tea was associated with lower risk, whereas ‘burning hot’ tea was associated with higher VD risk (HR = 1.160, 95%CI 1.090–1.236). Tea intake showed non-linear dose–response associations, with the lowest estimated risk at approximately 6–8 cups/day among weekly drinkers. The combination of habitual tea consumption, non-smoking and high PA was associated with the lowest VD risk (HR = 0.548, 95%CI 0.492–0.609), with evidence of sub-additive tea–PA interaction. Conclusion Habitual tea consumption was associated with lower VD risk, with associations varying by drinking characteristics and intake level. Tea consumption combined with non-smoking and high PA was associated with the lowest risk. These findings support considering multidimensional tea-drinking and lifestyle patterns in vascular health research. [...]

Abstract Dengue is the most rapidly expanding mosquito-borne viral disease worldwide. The worst year on record was 2024, with over 100 countries reporting 14.4 million cases and over 11,000 deaths. Since then, and up to August 2026, another 7.4 million cases and over 5000 deaths have been reported. The region of the Americas was impacted the most, followed by South-East Asia and the Western Pacific. Both the spread of dengue viruses (DENV) and their primary vectors, Aedes aegypti and Aedes albopictus, are driven by several factors. Globalization has accelerated vector dispersal, particularly through international trade and transportation networks. The movement of desiccation-resistant eggs in used-vehicle tyres and the inadvertent transport of adult mosquitoes via trucks and passenger vehicles have enabled the establishment of vector populations in previously uncolonized regions. Human mobility and unplanned urbanization further contribute to dengue emergence by introducing DENV into susceptible populations where competent vectors circulate. Climate change has enhanced dengue transmission potential by altering temperature and rainfall patterns that influence mosquito survival, reproduction, biting behaviour and viral replication. Containing or even reversing this global dengue expansion will require a complementary set of interventions that rely on proven and novel control strategies, including sterile insect techniques, Wolbachia-infected mosquitoes, virus-resistant mosquito strains through CRISPR-Cas9 gene drive, vaccines, antiviral drug prophylaxis and urban interventions that eliminate Aedes habitats. Building climate-resilient urban environments through sustainable development to minimize the urban heat island effect and advancing climate-informed early warning systems are long-term strategies for effective dengue control. [...]

Abstract Prader–Willi syndrome (PWS) is a rare, neurodevelopmental, multisystemic syndrome caused by lack of expression of paternal genes on chromosome 15q11.2–13. PWS is characterized by muscular hypotonia, abnormal body composition, hormone deficiencies, cognitive dysfunction and behavioural issues, including hyperphagia, increasing the risk of severe obesity. A single causative gene for hyperphagia has not been identified, and regulation of hunger and satiety is complex and multifactorial, making it difficult to identify a specific neuropeptide or hormone as the most important. Cornerstone treatments are a strict, controlled diet and regular physical activity. Several clinical trials with different pharmacological agents have been performed attempting to reduce or treat hyperphagia and obesity. However, many drug programmes have been discontinued due to adverse events or not reaching endpoints. In this review, we have focused on phenomenology and management of hyperphagia, treatment with oxytocin (OT), glucagon-like-peptide-1 receptor agonists (GLP-1RA) and diazoxide choline. We conclude that controlled food access is crucial; managing expectations about food mitigates food-related behaviour; OT treatment of infants with PWS results in less severe hyperphagia at ages 3 and 4 years old; and that the effects of GLP-1RA on body weight seem modest. Studies of diazoxide choline extended-release (DCCR), the first approved treatment of hyperphagia in PWS, have shown promising results, particularly in managing severe hyperphagia, reducing fat mass and improving behavioural issues. Thus, although progress is being made in targeted pharmacological therapies to control hyperphagia, controlled food access remains crucial to prevent obesity but is not sufficient for management of food and behaviour. [...]

Abstract Glucagon-like peptide-1 (GLP-1) receptor agonists provide benefits in weight reduction, glycaemic control in Type 2 diabetes, and cardiovascular and renal outcomes. Their widespread use has given rise to concerns regarding rare but potentially serious adverse events. This narrative review appraises evidence regarding seven serious adverse events linked to GLP-1 receptor agonists: thyroid cancer, non-arteritic anterior ischaemic optic neuropathy (NAION), suicidal behaviours and self-harm, diabetic retinopathy complications, acute pancreatitis, gallbladder and biliary disease and intestinal obstruction. Evidence from mechanistic studies, spontaneous reports, randomized trials and cohort studies is considered. Gallbladder and biliary disease has the most consistent evidence supporting a causal association. Worsening of diabetic retinopathy appears most consistent with early worsening after rapid glycaemic improvement in patients with pre-existing retinopathy. For thyroid cancer, NAION, suicidal behaviour and self-harm, acute pancreatitis and intestinal obstruction, evidence regarding causality remains uncertain. Rare events, incomplete ascertainment in trials and residual confounding in observational studies limit inference. Because these events are rare, even substantial relative risk increases generally correspond to small absolute risk increases in broad populations but may become relevant in patients with high baseline risk. Treatment decisions should consider the strength and uncertainty of safety evidence, individual baseline risk, expected benefits relative to available alternatives and patient preferences. [...]

 . Abstract Background Liver cirrhosis is often diagnosed in working-age adults and carries a poor prognosis. A better understanding of variation by employment status and occupation may support earlier and more targeted diagnostic evaluation. Objectives To assess the odds of liver cirrhosis across labor-market status and occupations in working-age adults and whether these patterns differed by etiology. Methods In this nationwide case–control study, individuals aged 35–65 years with cirrhosis during 2002–2021 were identified from Swedish national registries and matched to up to four controls on age, sex, and municipality. Labor-market status in the year before diagnosis was classified as employed, unemployed, disability/activity benefit, long-term sick leave, or other. Employed individuals were classified into occupations. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals, with physical and engineering professionals as the reference group. Results We included 23,033 cases and 92,106 controls. Cases were less often employed than controls (25.7% vs. 66.2%) and more often belonged to labor-market strata associated with a lower socioeconomic status. In analyses, including employed and unemployed individuals (7485 cases; 63,747 controls), unemployment was associated with the highest odds of cirrhosis. Among employed individuals, food preparation workers and refuse and recycling workers had the highest odds. Stratified by etiologies, associations were strongest for alcohol-related cirrhosis. Patterns across sex strata were similar, with generally larger effect sizes in men. Conclusion Among working-age adults, unemployment and selected occupations were strongly associated with incident cirrhosis. Routinely collected employment information may help identify groups who could benefit from earlier liver evaluation. [...]

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

Following the introduction of Aotearoa New Zealand's Bowel Screening Programme pilot, acute colorectal cancer presentations at a single centre fell by 61% and patients who still presented acutely were less likely to have metastatic disease or die within 1 year. ABSTRACT Background The Bowel Screening Programme (BSP) in Aotearoa, New Zealand, was introduced to facilitate earlier detection of colorectal cancer (CRC), yet its impact on acute CRC presentations remains incompletely characterised. This study evaluated changes in the incidence and clinical features of acutely presenting, previously undiagnosed CRC before and after BSP implementation. Methods A single-centre retrospective cohort study was conducted at North Shore Hospital, Auckland. Adults (≥ 16 years) acutely admitted with a first diagnosis of CRC were identified in the 3 years preceding the BSP pilot (2009–2011) and the 3 years following national rollout (2018–2020). The primary outcome was the age-standardised population incidence of acute CRC. Incidence rate ratios (IRRs) were estimated using age-adjusted Poisson regression. Results Three-hundred twenty three patients were included (pre-BSP n = 215; post-BSP n = 108). The age-standardised incidence of acute CRC declined from 9.71 per 100 000 population (95% CI: 7.56–12.27) in 2009 to 3.79 per 100 000 (95% CI: 2.70–5.17) in 2020. Following BSP implementation, acute CRC presentations were reduced by 61% (IRR 0.39, 95% CI: 0.31–0.49, p  [...]

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

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

The aim of this study is to investigate intraoperative surgical complications through a video presentation and to emphasize protective measures. This is a retrospective cohort study which includes patients with donor nephrectomy. All patients underwent laparoscopic transperitoneal donor nephrectomy. The complications during operations are presented. Among 1011 living-donor nephrectomies, we observed 68 (6.7%) complications like splenic injury, adrenal bleeding, renal artery bleeding, lymphatic leakage, and so forth. Videos of the complications are presented. Preventive changes are mentioned. Laparoscopic donor nephrectomy is an advanced surgery with low complication risks. Basic rules of laparoscopic surgery (I-VITROS) should be kept in mind. ABSTRACT Background Laparoscopic living-donor nephrectomy improves graft function and reduces morbidity. Intraoperative complications in donor nephrectomy are rare and can be avoided by basic precautions. We aimed to investigate intraoperative surgical complications through a video presentation and to emphasize protective measures. Methods This is a retrospective cohort study. We included patients who underwent donor nephrectomy between December 2015 and December 2025. All patients underwent laparoscopic transperitoneal donor nephrectomy. We obtained donors' medical data from the hospital system. We identified intraoperative complications recorded in the operation notes and obtained operation videos of complicated cases from hospital archives. Results Our center performed 1011 living-donor nephrectomies. There were 816 laparoscopic left nephrectomies and 195 laparoscopic right nephrectomies. The mean postoperative hospitalization time for donors was 2.8 days (min-max: 2–5 days). The mean donor BMI was 28.35 (min-max: 19.33–41.73). We observed 68 (6.7%) complications. Videos of the complications are presented. One case required conversion to open surgery. Conclusion Laparoscopic donor nephrectomy is an advanced surgery with low complication risks. Experienced surgeons can manage complications laparoscopically. [...]

This scoping review identified 43 articles reporting 10,401 outcomes on infection prevention during sacral nerve stimulator implantation. Preoperative chlorhexidine washing and shallow pocket depth emerged as key considerations. However, evidence supporting many perioperative strategies remains limited, with no clear consensus on optimal infection prevention practices. ABSTRACT Aims Sacral nerve stimulators (SNS) are used to treat refractory urinary symptoms, bowel symptoms, and pelvic pain. There is a risk of surgical site and implant infection; however, manufacturers have not released guidelines regarding infection prevention during their implantation. There are limited data on the pre-operative, intra-operative, and post-operative considerations for infection prevention. We present a scoping review detailing the current strategies for infection prevention during implantation of SNS and propose a protocol for perioperative infection control strategies based on current available literature. Methods A scoping review was conducted using Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA). A search strategy using search terms “sacral nerve stimulation,” “infection,” “infection control,” and “infection prevention” was used. A search was conducted on medical databases, and a grey literature search was performed. Results Forty-three articles were included for data extraction, published between 2003 and 2022. A total of 10,401 outcomes were reported. Pre-operative, intra-operative, and post-operative considerations and outcomes were extracted. Significant peri-operative considerations included the use of pre-operative chlorhexidine wash and the use of shallow pocket depths. There was limited data to support other infection control considerations and variability in practices within the SNS implanting community. Conclusions Despite implant infection being a highly morbid and detrimental outcome for the patient, there is no clear consensus on what infection control measures should be routinely performed to reduce the risk of infection during the implantation process. The peri-operative considerations currently covered in the literature have little reported evidence to support the implementation of certain infection prevention considerations, and it seems their use is primarily driven by surgeon preference. [...]

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

This expert comparative review of two of the most described radical pancreatoduodenectomy approaches, Level 3 SMD-PD/CA–HA dissection (East) and the TRIANGLE operation (West), revealed that despite divergent descriptions, both techniques clear the same anatomical area: the soft tissue within the triangle bordered by the superior mesenteric artery, celiac axis, and portal vein. ABSTRACT Pancreatic cancer remains a leading cause of cancer-related mortality, and pancreatoduodenectomy is the only potentially curative treatment. Despite surgical resection, local recurrence rates remain high. Three surgical procedures have been described to improve oncological outcomes: Pancreatoduodenectomy with Systematic Mesopancreas Dissection (SMD-PD) using a Supracolic Anterior Artery-first Approach, Staged Approach for Dissection Along the Celiac and Hepatic Artery (CA–HA System) During Pancreaticoduodenectomy, and the TRIANGLE operation. In this expert comparative review, we considered the SMD-PD and the CA–HA system as a single combined approach (Level 3 SMD-PD/CA–HA system) and compared it with the TRIANGLE operation. We analysed the two surgical techniques, focusing on their surgical principles, technical descriptions, and anatomical extent. Although described using different terminology and dissection strategies, analysis of their representative images reveals that both approaches clear the same anatomical area: the soft tissue within the triangle bordered by the superior mesenteric artery, celiac axis, and portal vein. This convergence in actual anatomical clearance, despite divergent descriptions, represents the central finding of this review. Given the available evidence suggesting lower local recurrence rates with these radical approaches, wider adoption is encouraged, while acknowledging that further studies are still needed to confirm long-term oncological outcomes. [...]

Tertiary retrieval for rural abscesses is predominately driven by anatomical airway risks rather than physiological instability. Integrating telehealth triage, formal hub-and-spoke networks and multidisciplinary airway support offers a safer, more sustainable pathway to reduce avoidable transfers and enhance rural surgical equity than isolated procedural upskilling. ABSTRACT Background Abscesses are resource intensive presentations in Australian Emergency Departments (EDs). At Mount Gambier and Districts Health Service (MGDHS), the absence of onsite subspecialty services necessitates interhospital transfer to tertiary centres for anatomically high-risk infections. This study identifies drivers of retrieval to inform regional service optimisation while maintaining surgical safety standards. Methods A retrospective cohort study was conducted on all abscess presentations to MGDHS over a 2-year period (2023–2024). Demographic, clinical and laboratory data were analysed to identify predictors of tertiary retrieval. Results Of the total cohort (N = 455), tertiary retrieval (n = 23) was overwhelmingly driven by anatomical location rather than physiological instability, with head and neck presentations accounting for 91% of transfers. Retrieved patients demonstrated a significant, three-fold increase in median C-Reactive Protein (156.7 vs. 50.64 mg/L, p ≤ 0.001). While 83% required subspecialty tertiary input, 57% of retrieved patients were managed with bedside incision and drainage (I&D) within the tertiary environment rather than the operating theatre. Regional management remained effective, with a 5% failure rate of conservative management and an 8.6% 30-day re-presentation rate. Estimated retrieval expenditure totalled $230 000, with $130 000 attributed to cases requiring only ward-based intervention. Conclusion Tertiary retrieval at MGDHS is predominantly driven by anatomical location and airway compromise risk rather than procedural complexity. Implementing telehealth triage, hub-and-spoke networks and multidisciplinary airway support can safely mitigate avoidable transfers. Supporting subspecialty services and these targeted approaches decreases costs, reduces tertiary strain and enhances equitable rural surgical care without compromising patient safety. [...]

ABSTRACT Introduction and Objectives To review the efficacy and cost-effectiveness of third-line overactive bladder (OAB) managements, including percutaneous tibial nerve stimulation (PTNS), intravesical botulinum toxin A (Botox) and sacral neuromodulation (SNM) in the urology department of a tertiary public hospital. Materials and Methods A prospective review was performed to determine the therapeutic outcomes of PTNS, Botox and SNM from 2019 to 2023. Costings data were obtained from the government healthcare portal to determine the overall cost and cost effectiveness of each treatment. Results Twenty-Eight patients underwent basic SNM lead insertion trial during the study period, with a response rate of 84%. Twelve patients proceeded to full implant insertion. The cost of SNM insertion is AU$23736. Comparatively, intravesical Botox has a unit cost of AU$2105 per treatment, with 67% efficacy in our patient cohort. PTNS was performed on 27 patients, with observed efficacy of 42%, at a cost of AU$200 per session. Comparing SNM and Botox, it would take 11.3 Botox treatments to generate equivalent cost to SNM. The Medtronic InterStim II Neurostimulator has a median battery life of approximately 6.2 years; if Botox was given 9-monthly during this time it would require 8.3 treatments, with a cost saving of over AU$6000. Each treatment is cost-effective when compared to the economic burden associated with OAB, with Botox being most cost-effective. Conclusion OAB significantly impacts quality of life and has significant financial and economic burdens. Third-line OAB treatments including PTNS, Botox and SNM differ significantly in their cost, efficacy and durability of effect. The availability of SNM in public hospitals has long been limited due to perceived cost ineffectiveness. Our series suggests a high efficacy associated with SNM in a public hospital setting, and cost-effectiveness when compared to the economic burden associated with OAB. Botox remains the most cost-effective option at our institution. [...]

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

This 10-year retrospective cohort study included 431 children who underwent initial gastrostomy. Intra-operative complications (2.3%), gastrostomy-related complications (14.0%) and 1-year gastrostomy-related readmission did not differ significantly between techniques. Comparable safety across PEG, LAPEG, LAP and Open gastrostomy shows that appropriate case selection is the key determinant of outcomes. ABSTRACT Background Gastrostomy is a common intervention for enteral nutrition in children. While originally an open procedure, techniques now include percutaneous endoscopic (PEG), laparoscopic (LAP) and laparoscopic-assisted PEG (LAPEG). This study compared outcomes across these four techniques over a 10-year period at a single tertiary paediatric centre. Methods A retrospective cohort study was conducted on all initial gastrostomies performed between January 2014 and September 2024. Data collected included patient demographics, clinical characteristics and procedural details. Primary outcomes were intra and postoperative complications. Secondary outcomes included procedure time, length of stay and gastrostomy-related readmission within 1 year. Statistical analysis utilised chi-squared, Fisher's exact tests and Kruskal–Wallis test. Results A total of 431 patients underwent gastrostomy (PEG = 318, LAPEG = 53, LAP = 36, Open = 24). PEG demonstrated the shortest procedure time, while Open gastrostomy was significantly longer (p  [...]

ANZ Journal of Surgery, 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 Benign breast lesions, anatomical variants, and imaging artefacts can closely mimic malignancy on screening mammography and are a frequent diagnostic challenge in the assessment setting. This pictorial review showcases a spectrum of benign lesions encountered in a high-volume breast screening assessment setting that initially raised suspicion for malignancy but were subsequently confirmed as benign through a combination of digital breast tomosynthesis (DBT), targeted ultrasound, and clinicopathological correlation. Examples include cutaneous lesions, sebaceous cysts, intramammary lymph nodes, hamartomas, fat necrosis, vascular lesions, simple cysts and summation artefact. Through illustrative cases, we highlight key imaging features that support accurate lesion characterization and demonstrate the complementary roles of mammography, DBT, and ultrasound in distinguishing benign entities from breast cancer. Familiarity with these imaging appearances can improve diagnostic confidence, reduce false-positive recalls, and minimize unnecessary biopsies within breast screening programs. [...]

ABSTRACT Introduction There is a shortage of radiologists practicing in regional and rural Australia. The Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Government have published their commitment to address this workforce maldistribution. This project aims to identify the future work intentions of radiology registrars training in South Australia (SA) and the Australian Capital Territory (ACT), focusing on attitudes toward a career in rural radiology practice. Methods A cross-sectional study of SA and ACT RANZCR registrars was performed via an online questionnaire consisting of tick box and short answer questions relating to demographics, previous rural exposure, future work intentions, and perceived barriers to rural practice. Results A total of 72 (82%) registrars responded to the survey. While 59% agreed they would enjoy living and working rurally, 19% intend to work in regional/rural areas. Although 15% intend to live and work in these locations, 38% of registrars intend to contribute to the rural workforce through irregular locum work. Registrars who spent at least 1 year at a rural clinical school were more likely to intend to practice in a regional/rural area. Qualitative analysis revealed barriers to a rural career centred on familial opportunity, while key facilitators centred on work-life balance and collegial support. Conclusion Most radiology registrars in SA and the ACT intend to base their practice in metropolitan Australia. Rural exposure during medical school significantly influenced rural practice intent, consistent with the broader literature. Coordinating funding and training opportunities with key barriers and facilitators can help build a sustainable rural radiology workforce. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S197-S208, October 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S1-S3, October 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S19-S43, October 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S4-S18, October 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S44-S84, October 2026. [...]

Journal of Medical Imaging and Radiation Oncology, Volume 70, Issue S2, Page S85-S196, October 2026. [...]

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

Australian Journal of Rural Health, Volume 34, Issue 6, December 2026. [...]

Australian Journal of Rural Health, Volume 34, Issue 6, December 2026. [...]

ABSTRACT Objective To describe the experience of non-government organisation (NGO) staff implementing a community-based stroke recovery program based on the principles of environmental enrichment. Design A qualitative descriptive study to capture staff experiences. Semi-structured interviews with staff were analysed using reflexive thematic analysis. Setting A community-based NGO service in regional New South Wales, Australia. Participants Eight staff members employed in a regional NGO and involved in the implementation of the program, including a program coordinator, a physiotherapist, allied health assistants, creative artists and managers. Results Four themes were identified: (1) We've got a great space here—highlighted the importance of the physical environment, access and location; (2) There's an order to it—described the program's strong foundations formed through training, defined processes and support; (3) We make it work—demonstrated the flexibility and adaptability of staff in responding to individual needs and overcoming challenges and (4) Enriching lives—captured the sense of community, positivity and recovery outcomes. Staff experiences aligned closely with self-determination theory, reflecting feelings of capability, confidence and connection. Conclusion Staff in a regional NGO felt well-supported and capable of delivering a community-based stroke program. This demonstrates the potential role NGO services may play in addressing gaps in stroke recovery care in regional Australia. The methods used in this study can be used to implement this and other similar community-based programs with NGO services in the future. [...]

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

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

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

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

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

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

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

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

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

Errors occurred in the article by Parks SE et al, titled “A Resource to Understand and Prevent Sudden Unexpected Infant Deaths,” published in the August 2026 issue of Pediatrics (2026;158[2]: e2025075460; doi: 10.1542/peds.2025-075460). [...]

Nephrotic syndrome in children and atopic dermatitis (AD) share a common type 2 inflammatory substrate driven by interleukin (IL)-4 and IL-13 dysregulation. We report the case of a 9-year-old girl with AD and frequently relapsing steroid-sensitive nephrotic syndrome. Given the broad atopic phenotype and increasing relapse frequency despite dual immunosuppressive therapy, dupilumab 300 mg every 2 weeks was introduced. The patient achieved rapid and complete clearance of cutaneous lesions alongside sustained complete remission of nephrotic syndrome, maintained over nearly 2 years. Both corticosteroids and tacrolimus were fully discontinued within 2 months of dupilumab initiation, with no subsequent relapse of either condition. This case supports the hypothesis that dupilumab may represent an effective steroid-sparing therapeutic option in children with nephrotic syndrome arising in an atopic context. [...]

Errors occurred in the article by Laverty M et al, titled “Health Outcomes in Young Children Following Pertussis Vaccination During Pregnancy,” published in the May 2021 issue of Pediatrics (2021;147[5]: e2020042507; doi: 10.1542/peds.2020-042507). [...]

To the Editor: [...]

We thank Dr Cuc Do for their thoughtful questions regarding the article, “Maternal RSV Vaccination, Infant Nirsevimab, or Both: Interim Analysis of a Randomized Trial.” For this study, we performed an interim analysis to present timely data to inform clinical decision-making in the 2025 to 2026 respiratory season in the United States. Therefore, the cutoff for the interim analysis was based on a calendar date (May 15, 2025), which included immunogenicity data up to 3 months and safety data up to 4 months after delivery for a subset of participants. Since the available immunogenicity data were collected prior to Group 1c’s receipt of nirsevimab at 3 months, Groups 1a and 1c were combined for analysis. By design, the interim analysis was not intended to capture a full respiratory season, the impact of the 3-month dose of nirsevimab, or the differential antibody kinetics over time. These important measures will be included in the final study report, where we plan to include safety and immunogenicity data through 12 months, stratified by study group. [...]

OBJECTIVETo characterize clinical manifestations and complications of children with Zika-related microcephaly in the first 5 years after birth.METHODSA cohort of children with Zika-related microcephaly were observed up to age 60 months as part of the Microcephaly Epidemic Research Group Pediatric Cohort.RESULTSAmong the 181 children, 43.1% were male and 77.2% were born at term. The median birth weight was 2700 g, with 64.8% classified as small for gestational age. Notably, 22.3% were diagnosed with microcephaly after birth, and 48.8% had severe microcephaly. Most common phenotypic characteristics were craniofacial disproportion (54.1%), arthrogryposis (35.9%), and exacerbated occipital protuberance (35.5%). Approximately one-third (33.1%) presented with dysphagia (n = 151 evaluated at median age of 28.2 months), and 13.3% of children had gastrostomies (median age of 24 months). Hearing anomalies were detected in 9.7% (n = 93 evaluated at median age of 30 months). In ophthalmological evaluation, 30.4% showed changes in the retina and 28.5% in the optic nerve; strabismus was observed in 53.4%. During neurological assessment (median age at first assessment of 15.9 months), 73.8% presented with abnormalities. Imaging examinations showed ventriculomegaly and cortical atrophy in 75.3% and 64.4% of the children, respectively. Electroencephalography was performed based on clinical indication in 84 children, of whom 92.9% had pattern alterations. Over the 5 years, 62.4% were hospitalized, mainly for respiratory problems and seizures.CONCLUSIONSThe study highlights the severity of Zika-related microcephaly. Future research should prioritize continued systematic monitoring of these children to understand the frequency and timing of late-onset manifestations and complications, including death. [...]

OBJECTIVEChildren born very preterm (VP; [...]

10.1542/6404219308112Video AbstractPEDS-VA_2026-0767756404219308112CONTEXTHospital at Home (HaH) is an acute care model that delivers hospital-level services to the patient’s home as a substitute for conventional inpatient admission. Although pediatric HaH programs are well established internationally, the evidence base remains limited.OBJECTIVETo map the operational characteristics, outcomes, and evidence gaps of pediatric HaH programs.DATA SOURCESA comprehensive literature search was conducted for studies published between January 1, 2000, and July 25, 2025.STUDY SELECTIONEligible studies included programs with patients aged 18 years or younger and aligned with the World Hospital at Home Congress definition.DATA EXTRACTIONData were extracted on study characteristics; implementation, infrastructure, and program design; clinical safety and effectiveness; cost-effectiveness and economic impact; and patient, caregiver, and/or clinician perspectives and experiences.RESULTSThirty-four studies met eligibility criteria. Most were observational, with few randomized or nonrandomized controlled studies. Programs varied substantially in admission pathways, staffing, eligibility criteria, monitoring, and clinical populations. Studies demonstrated low escalation and readmission rates, infrequent serious adverse events, high caregiver satisfaction, and generally comparable or lower health care costs relative to conventional inpatient care. Few studies directly evaluated clinical effectiveness, included rigorous economic analysis, or incorporated child and clinician perspectives.LIMITATIONSThe literature was limited by heterogeneous study populations, program designs, outcome reporting, and variable definitions and descriptions of HaH models, introducing potential for misclassification.CONCLUSIONSPediatric HaH shows promise as a safe and family-centered alternative to conventional hospitalization, though the existing evidence remains limited and heterogeneous, highlighting the need for more rigorous evaluation. [...]

Children and adolescents whose parents have an alcohol or substance use disorder are at increased risk of short- and long-term sequelae, ranging from medical conditions to psychosocial, safety, and behavioral challenges. In the course of providing health care services to children, pediatricians and other pediatric clinicians are likely to encounter families affected by parental substance use and are in a unique position to support the well-being of both the child and family. The purpose of this clinical report is to briefly discuss the epidemiology of substance use during pregnancy and while parenting in the United States; highlight the influence of bias, racism, and other structural inequities on families affected by substance use; describe the known risks associated with prenatal and postnatal parental substance use; discuss use and interpretation of toxicology testing as part of a substance exposure evaluation; review approaches to screening for prenatal and parental substance use; propose key topics for anticipatory guidance in the pediatric clinic; identify and address concerning parental and child presentations related to parental substance use leading to concern for child abuse or neglect; and provide recommendations for pediatric clinicians involved in the care of children from families affected by substance use. [...]

10.1542/6402481027112Video AbstractPEDS-VA_2026-0768216402481027112OBJECTIVETo document prevalence of reasons for nicotine pouch (NP) use and associations with use patterns among US youth.METHODSData were from US youth reporting ever NP use in the nationally representative 2025 Monitoring the Future survey. We estimated (1) prevalence of 10 reasons for NP use (yes/no) and (2) association of each reason with past 30-day NP use (yes/no) and frequency (1–30 days). For comparison, we contrasted reasons for NP and e-cigarette use among youth reporting NP use (n = 57) or e-cigarette use (n = 397) on at least 10 of the past 30 days.RESULTSAmong 484 respondents reporting ever NP use (6.1% of youth surveyed on NP use and reasons), the most common reasons were experimentation (32.3%), nicotine buzz (30.5%), relaxation (22.7%), appealing flavors (17.4%), convenience (16.5%), socializing (16.0%), boredom (11.7%), and ability to conceal use (11.0%). To quit smoking (6.2%) and feeling addicted (2.1%) were less common. Flavors, convenience, and feeling addicted were positively associated with both past 30-day NP use (prevalence ratios [PRs] range = 1.50–2.35) and frequency (incidence rate ratios [IRRs] range = 1.60–2.55). Nicotine buzz, relaxation, socializing, concealment, and to quit smoking were only associated with past 30-day use (PRs range = 1.57–1.85). Experimentation was inversely associated with frequency (IRR = 0.42). The prevalence of reasons overlapped between NPs and e-cigarettes, with relaxation, convenience, nicotine buzz, and flavors most prevalent among youth regularly using each product.CONCLUSIONSPrevention and regulatory strategies addressing NP use reasons, particularly flavors and convenience, are warranted. Existing effective strategies targeting youth nicotine vaping may be applicable to NP use. [...]

This statement updates recommendations of the American Academy of Pediatrics (AAP) for use of influenza vaccines and antiviral medications in prevention and treatment of influenza in children during the 2026–2027 influenza season. A review of evidence supporting these recommendations is in the accompanying technical report (https://doi.org/10.1542/peds.2026-078779).The AAP recommends annual influenza vaccination of all children without medical contraindications starting at 6 months of age. Influenza vaccination is an important strategy for protecting children and the broader community as well as reducing the overall burden of respiratory illnesses when other viruses are cocirculating. Any licensed influenza vaccine appropriate for age and health status can be administered, as soon as possible in the season, without preference for one product or formulation.Antiviral treatment of influenza may reduce the duration of symptoms; reduce complications, including hospitalization and death; and potentially reduce transmission. The AAP recommends antiviral treatment for children with suspected or confirmed influenza who are hospitalized or have severe or progressive disease. In ambulatory settings, antiviral treatment should be offered to children who are at high risk of complications from influenza, including those with chronic medical conditions and immunocompromised patients. In all these situations, antiviral treatment should be started as soon as possible regardless of duration of illness or receipt of influenza vaccine. Antiviral treatment is an option in the ambulatory setting for all children with suspected or confirmed influenza.Antiviral chemoprophylaxis is an option in certain individuals, especially exposed children who are asymptomatic and are at high risk for influenza complications but have not yet been immunized or, if immunized, those who are not expected to mount an effective immune response. [...]

This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2026–2027 influenza season. The rationale for the American Academy of Pediatrics recommendation for annual influenza vaccination of all children without medical contraindications starting at 6 months of age is provided. Influenza vaccination is an important strategy for protecting children and the broader community against influenza. This technical report summarizes recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, and vaccination coverage and provides detailed guidance on vaccine storage, administration, and implementation. The report also provides a brief background on inactivated (non-live) and live attenuated influenza vaccines, available vaccines for the 2026–2027 influenza season, vaccination during pregnancy and breastfeeding, diagnostic testing for influenza, and antiviral medications for treatment and chemoprophylaxis. Strategies to promote vaccine uptake are emphasized. [...]