General journals

“Better to die from Ebola than the attacker who would come and cut my head off.” That was what Yap Boum II’s driver told him as he arrived this week in Beni, North Kivu, a province of the Democratic Republic of the Congo (DRC).Boum is head of the emergency preparedness and response division for the Africa Centres for Disease Control and Prevention (Africa CDC). He is also regional incident manager for the Ebola response. In early June he visited an Ebola treatment centre in Beni. A week before his trip more than 30 people were killed in attacks on nearby villages. Multiple victims were beheaded.1“When you listen to that, you change your perspective on what your role is in the response,” Boum told The BMJ. “The most important thing we have is the trust of the community—which is not a given.”Since the current Ebola outbreak emerged in mid-May2 there have... [...]

The UK’s drug regulator has approved a daily pill version of the obesity drug semaglutide (Wegovy) for weight loss.The tablet form of Wegovy, manufactured by Novo Nordisk, is the first glucagon-like peptide-1 (GLP-1) receptor agonist pill to be approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) for weight loss and weight management in the UK.The drug has until now been approved only in injectable form. However, oral semaglutide is already approved in the UK for treating type 2 diabetes under the brand name Rybelsus.1The MHRA’s approval of the drug for weight loss opens the door to more UK patients taking the oral version, but it will first have to be evaluated by the National Institute for Health and Care Excellence (NICE) before it can be used in the NHS.The treatment—which is cheaper than the traditional injectable version and has a more easily disturbed mechanism of action—was approved in... [...]

Thousands of young people across England, Wales, and Scotland will be offered the meningitis B (MenB) vaccine for the first time this summer.123Eligible students—those finishing year 13 this summer (aged 17 and 18), together with people under 25 starting university or other residential further education—will be offered two doses of the vaccine, at least four weeks apart, before they start further education this autumn.The programme is being launched after the major outbreak seen in Kent in March, which led to two deaths.4The Department of Health and Social Care described the outbreak as the “fastest growing and largest ever seen in the UK” but said there had also been “more clusters than normal this year, some of which have been bigger than expected.”Young people eligible for the vaccine will be contacted directly through the NHS app, text, email, or letter, depending on records held by the health service.Announcing the expanded vaccination... [...]

The NHS must be less risk averse in adopting digitalisation, technology, and artificial intelligence, the new health and social care secretary James Murray has said.In his first major speech since replacing Wes Streeting last month.12 Murray also said ministers “cannot go further” in boosting the pay of resident doctors, who are due to go on strike again from Monday 15 June.Speaking at the NHS ConfedExpo conference in Manchester on 11 June, Murray said the NHS “too often” let concern over potential risks overshadow thinking about benefits of new technology.Instead, the NHS needed to “innovate and take the right risks,” he told the conference. “Too often the question is, ’What if it goes wrong?’—and of course that is an entirely legitimate question to ask, especially in health and social care where we are talking about profound consequences,” he said.“We also need to balance that question by giving equal weight to another... [...]

Hospitals in England cared for around 90 000 patients last month—nearly 3000 a day—in corridors or other inappropriate treatment areas, new figures show.NHS England data on corridor care, published for the first time on 11 June, show how far ministers are from eradicating an “unacceptable” practice that doctors’ leaders and health analysts say has become “normalised.”“It should be a source of national shame this has been allowed to happen to our health service in the 21st century,” said Den Langhor, emergency medicine lead for the BMA’s Consultants Committee. “Treating patients in corridors isn’t just inappropriate: it’s undignified and often unsafe.”NHS England describes corridor care as a “significant patient safety and experience issue”1—defined as when patients in emergency departments and inpatient wards spend more than 45 minutes in a clinically inappropriate place where they cannot be assured of essential equipment or dignity.This includes patients in emergency departments receiving treatment, those waiting... [...]

The president elect of the American Diabetes Association (ADA) has resigned following uproar at the association’s annual meeting, when five doctors were forcibly ejected after handing out copies of an editorial criticising the administration of the US president, Donald Trump.1Jennifer Green, professor of medicine at the Duke Clinical Research Institute, was due to lead the ADA from January 2027. But multiple sources cited by the MedPage Today news site,2 which broke the story, said that Green had resigned after the incident.Mark Atkinson, chair of the ADA’s Scientific Sessions Planning Committee, has also reportedly resigned over the incident.Dozens of experts had walked out of the presidential address session at the annual meeting on 7 June, holding a sign reading, “We stand with science.”The ADA has formally apologised to the five doctors expelled. In a video uploaded on 10 June3 Charles Henderson, ADA chief executive, said, “I recognise the impact that experience... [...]

The debate on prostate cancer screening is life, the universe, and everything boiled down to one question — and the answer isn’t 42. Whether or not men should be routinely screened for prostate cancer seems simple enough to answer, but only on the face of it. As two position statements from the UK’s National Screening Committee show — one on multicancer detection tests (doi:10.1136/bmj-2026-089868),1 the other on surrogate outcomes (doi:10.1136/bmj-2026-629407)2 — screening decisions are steeped in complexity.Albert Einstein is credited with saying, “Everything should be made as simple as possible, but not simpler.” This is advice that medical professionals and journals are well advised to heed. Certainly, the screening committee has mastered it: you may not agree with the committee’s verdicts, but you can’t fault the detailed clarity of its explanations.The clamour for screening is everywhere. If you can test for it, you should screen for it. A missed or... [...]

Doctors and health unions have urged the government to halt the development of the highly anticipated NHS workforce plan, warning that it is overly reliant on assumptions that AI will be a “silver bullet.”The concerns have been raised in an open letter to the new health and social care secretary, James Murray, signed by the Royal College of Emergency Medicine (RCEM), Royal College of Nursing, BMA, Society for Acute Medicine, Queen’s Institute of Community Nursing, and the union Unite.The NHS workforce plan is expected to be published this month. But the six organisations said there had been little engagement with doctors and nurses over what it includes and warned that it currently fails to recognise the realities on the NHS frontline.RCEM president Ian Higginson said that “from what little we have seen” the plan is “built on untested assumptions about productivity and efficiency.”He said, “The plan seems to be heavily... [...]

Two children in England have died from measles so far this year, and more than 100 new cases have been confirmed in the last two weeks alone, the UK Health Security Agency (UKHSA) has warned.1In its latest update the agency said that 736 measles cases had been confirmed in the first half of this year (as at 8 June), against 959 for the whole of 2025. In May there were 182 confirmed cases, the highest monthly figure so far this year.The worst affected areas over the past four weeks have been London, the East of England, and the West Midlands.“Measles activity increased earlier this year, mainly due to outbreaks in London and the West Midlands, with the majority of cases in unvaccinated children aged 10 years and under,” the UKHSA said.Two children have also died. “One was an acute measles death in a child, and another is a death in... [...]

Leaked UK Biobank datasets were still online three months after the confidential patient records were compromised earlier this year despite the research charity’s attempts to take them down, The BMJ has learnt.In March dozens of UK Biobank datasets were discovered on the online code sharing platform GitHub.12 The next month medical details from 500 000 participants in the health data charity were found for sale on the Chinese e-commerce site Alibaba.Despite Biobank’s insistence that it has a grip on the issue, The BMJ found that datasets originally posted in the GitHub leak in March were still available up until 10 June on a so called “mirror site,” Software Heritage, run by the National Institute for Research in Digital Science and Technology in France.Mirror sites are an exact copy or replica of an existing website hosted on a different server to make sure that publicly available source code survives attacks or... [...]

Three years ago GP Nathaniel Aspray switched his smartphone for a “dumbphone” and gained the gift of time.Using a phone with limited functionality removes the ability to constantly scroll and frees up time to focus on family and friends, says Aspray, a GP at Bramblys Grange Medical Practice in Basingstoke and a research fellow at City St George's, University of London.Since having a dumbphone, he has also rediscovered the ability to focus on one thing at a time. “For a time, I didn't read many books. Now I'm reading a lot again.”As well as time, Aspray has gained more headspace now that he is no longer scrolling on his smartphone. “I am much more comfortable with my own thoughts. I enjoy going for walks, looking around, seeing what there is to see. It's nice having space to think.”Aspray describes having a smartphone as a net loss rather than a net... [...]

Thousands of men in England with prostate cancer are to be offered high powered “precision” radiotherapy that will cut their number of treatment sessions from 20 to five.The pioneering multibeam radiotherapy, known as stereotactic ablative radiotherapy (SABR), will treat the condition far more quickly and with fewer side effects, said NHS England (NHSE).Standard external beam radiotherapy delivers several beams of radiation to the treatment area and is typically given as a number of daily doses over a period of weeks. But SABR uses many smaller, focused beams of radiation directed from different angles that meet at the tumour, thus giving it a high dose of radiation while the surrounding healthy tissues get a much lower dose, lowering the risk of damage to normal cells.SABR is already offered to some patients with lung, liver, pancreatic, or brain cancer. The announcement on 10 June means that it will now also be available... [...]

This Viewpoint presents the history of the Health Resources & Services Administration (HRSA) 340B Drug Pricing Program and 340B Rebate Model Pilot Program, summarizes their controversies and limitations, and calls for action by Congress and HRSA to address these issues and strengthen support for safety-net hospitals and clinics. [...]

JAMA Senior Editor Derek C. Angus, MD, MPH, spoke with Gil Rabinovici, MD, a neurologist and director of the University of California San Francisco Alzheimer Disease Research Center, about the latest developments in dementia and Alzheimer disease research. [...]

Classically, type 1 diabetes has been diagnosed only after patients have lost a critical threshold of beta cell mass, resulting in symptoms of hyperglycemia due to insulin deficiency. Despite advances in glycemic monitoring and insulin delivery, patients with clinical type 1 diabetes experience enormous mental burden and health care costs and are at risk of developing complications from chronic hyper or hypoglycemia. Natural history studies have shown that type 1 diabetes can be diagnosed in presymptomatic stages via detection of 2 or more islet autoantibodies. Stage 1 is defined by the presence of 2 or more islet autoantibodies with normoglycemia and stage 2 by the presence of 2 or more islet autoantibodies and abnormal glucose metabolism. Stage 3 marks the clinical diagnosis of type 1 diabetes, characterized by hyperglycemia. Options for disease modification to intervene in the presymptomatic stages and delay insulin requirements are becoming available clinically or through prevention trials testing agents shown to have efficacy in stage 3 disease (NCT07222137 and NCT07216391). As these advances in prediction and disease modification evolve, the long sought–after possibility of prevention of clinical type 1 diabetes is now approaching reality. With this possibility for intervention, screening for presymptomatic type 1 diabetes begins to meet the criteria for the principles and practice of screening by Wilson and Jungner, which state that screening programs should target health conditions that are detectable at an early stage, have an effective intervention when applied early, and have a valid, reliable, and acceptable test available. In addition, Wilson and Junger outline the importance of cost-effectiveness and the existence of intrastructure and systems to support diagnosis, treatment, and follow-up to ensure that benefits outweigh potential harm. [...]

A remarkable aspect of modern medicine is the ever-growing array of medications that fundamentally alter disease trajectories and improve quality of life. At the same time, persistent inequities in access to these medications remain a reality. Pharmacoequity, a term coined in a 2021 article in JAMA, is a specific component of health equity focused on fair and just access to appropriate medications, regardless of race, ethnicity, income, insurance coverage, and other social factors. [...]

To the Editor The 10-year follow-up of the APPAC trial provides valuable long-term data supporting antibiotics as a feasible treatment option for uncomplicated acute appendicitis. However, several aspects of the analysis and its interpretation warrant clarification. [...]

To the Editor A recent study of 10-year follow-up results from the Appendicitis Acuta (APPAC) trial reported a 37.8% true appendicitis recurrence rate and a 44.3% cumulative appendectomy rate among patients initially treated with antibiotics for uncomplicated acute appendicitis. While the authors concluded that antibiotics remain a viable treatment option for uncomplicated appendicitis, we wish to highlight several concerns about the generalizability, safety, and practicality of this approach. [...]

In Reply We appreciate the Letters about our recent study. With currently available knowledge, treatment of uncomplicated acute appendicitis is no longer about correct vs incorrect management but rather a comprehensive assessment of 2 different treatment strategies, with implications ranging from patient-reported outcomes to health care cost savings. Similarly, for diagnosis of acute appendicitis—it is no longer yes or no—all outcomes, from treatment success to appendiceal tumor prevalence and resource savings, are closely related to the accurate diagnosis of appendicitis severity. The judicious use of CT advocated by Dr Dai and colleagues is important to limit unnecessary radiation exposure, especially because many patients with suspected acute appendicitis are young adults. However, imaging has been considered mandatory to achieve satisfactory accuracy in assessing appendicitis severity, which is achievable using low-dose CT with a marked radiation dose reduction without compromising diagnostic accuracy, underlining the importance of adapting these low-dose imaging protocols. Dai and colleagues also express concern about the use of broad-spectrum antibiotics. Ertapenem was initially selected to standardize the study group treatments for efficacy because ertapenem effectively covers all pathogens that can cause appendicitis. However, there is current evidence that some patients with uncomplicated acute appendicitis may have resolution of symptoms without antibiotic treatment, and most patients can be safely discharged from the emergency department. Therefore, future studies should examine the optimized nonoperative treatment of uncomplicated acute appendicitis in an outpatient setting. [...]

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

In this narrative medicine essay, a palliative care physician composes letters in her head to the mothers of aging veterans and to the physician who may one day care for her son as a way to speak for patients who have no one to speak for them. [...]

This trial investigates the diagnostic yield of transbronchial lung biopsy with a 1.1-mm cryoprobe vs 2.0-mm forceps. [...]

This trial assessed whether the diagnostic yield of transbronchial lung biopsy is higher with a 1.1-mm cryoprobe compared with 2.0-mm forceps in adults needing bronchoscopy for pulmonary evaluation. [...]

JAMA+ AI Associate Editor Yulin Hswen spoke with Emily Tat of Columbia University Irving Medical Center and NewYork-Presbyterian Hospital and Peter Brodeur of Beth Israel Deaconess Medical Center for JAMA+ AI Conversations about a research network dedicated to the evaluation of clinical AI. [...]

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

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

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

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

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

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

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

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

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

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

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

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

Abstract Type 2 diabetes (T2D) is a major global health concern strongly associated with atherosclerosis and subsequent macrovascular complications. These complications are the leading cause of death among T2D patients. Despite a decline in cardiovascular events over the last decade, individuals with T2D still have an approximately doubled risk compared to those without diabetes. This shows an urgent need for therapies targeting biological processes specific to T2D-associated atherosclerosis. Nevertheless, more research is needed to identify exactly which processes can be targeted therapeutically. Current therapies either target lipid metabolism or inflammation, two processes commonly considered important in T2D-associated atherosclerosis. However, more recent human plaque tissue studies show no differences in plaque levels of lipids nor inflammatory markers, possibly reflecting improved clinical treatment strategies. Other distinct differences in plaque tissue composition in T2D have been put forward, including thin fibrous caps and large necrotic cores. Moreover, T2D may influence several biological processes affecting both plaque formation and progression (such as oxidative stress and efferocytosis). These mechanisms could potentially also be targeted to prevent atherosclerotic cardiovascular complications. This review focuses on the shifting epidemiology of T2D-associated cardiovascular complications, as well as biological changes in T2D plaques, and how these changes can guide future clinical approaches to further reduce atherosclerotic complications. [...]

Abstract Background Angiopoietin-like protein 3 (ANGPTL3) is a key circulating regulator of triglyceride metabolism and a promising pharmacological target. The physiological consequences of profound ANGPTL3 deficiency can be explored in individuals with inherited loss-of-function (LOF) variants, who show reduced lifetime risk of atherosclerotic cardiovascular disease. Methods ApoB48, apoB100 and TG metabolism were investigated in chylomicrons, VLDL1, VLDL2, IDL and LDL in 3 ANGPTL3 LOF homozygotes (undetectable plasma ANGPTL3), 4 LOF heterozygotes (ANGPTL3 45.0 ± 7.4 ng/mL) and 10 matched controls (ANGPTL3 110.5 ± 27.6 ng/mL). Studies were performed under post-prandial conditions to comprehensively characterize TG transport and apoB-containing lipoprotein kinetics. Results Chylomicron and very-low-density lipoproteins (VLDL) production rates were similar in ANGPTL3-deficient subjects and controls. The defining abnormality in LOF homozygotes was the extremely rapid lipolysis of chylomicrons and VLDL, with circulating residence times of minutes rather than hours and accelerated conversion of VLDL to IDL and LDL. LDL particles in LOF homozygotes were TG-enriched, cholesterol-depleted, metabolically heterogeneous and cleared more rapidly than in controls or LOF heterozygotes. LOF heterozygotes showed a less pronounced increase in chylomicron and VLDL lipolysis, with normal IDL and LDL kinetics. Conclusion Complete loss of ANGPTL3 results in a rapid acceleration of the triglyceride-rich lipoprotein lipolysis pathway and promotes the formation of metabolically and compositionally abnormal LDL with accelerated clearance. These findings provide mechanistic insight into ANGPTL3 deficiency and are directly relevant for the development and safety assessment of ANGPTL3-targeted therapies. [...]

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

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

Abstract Several somatic diseases have been consistently linked with an increased dementia risk. However, the underlying neuropathological substrates remain poorly characterized. This narrative review aims to summarize evidence on the association between common age-related somatic conditions (i.e., heart diseases, type 2 diabetes, kidney disease, liver diseases, lung disease, and anemia) and neuropathological findings, encompassing both Alzheimer's disease (AD)-related pathology (amyloid and tau deposition) and non-AD co-pathologies (i.e., neuronal loss, neuroinflammation, cerebrovascular lesions, and non-AD proteinopathies). We conducted a PubMed search for human studies examining these associations using postmortem data, brain imaging, or cerebrospinal fluid biomarkers. Evidence was qualitatively synthesized and graded according to its strength. Strong and consistent associations were observed between most examined somatic diseases and global neuronal loss or brain atrophy, as well as cerebrovascular lesions. In contrast, evidence associating these conditions with amyloid and tau pathology was limited and inconsistent. No studies systematically examined neuroinflammation or non-AD proteinopathies in relation to somatic diseases. Together, the available evidence suggests that somatic diseases are unlikely to primarily drive AD pathology but instead contribute to brain damage through a combination of non-AD processes, particularly cerebrovascular injury and diffuse neuronal loss. These findings highlight the need to increase our knowledge of “mixed dementia” and move beyond a purely brain-centric view of dementia, especially in older adults with complex clinical profiles. [...]

Journal of Internal Medicine, Volume 300, Issue 1, Page 1-1, July 2026. [...]

Journal of Internal Medicine, Volume 300, Issue 1, Page 2-4, July 2026. [...]

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

Abstract Background Whether aspirin or non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) initiation may unmask unknown bladder cancers (BCs) by hematuria remains controversial. Objectives To evaluate unmasking, we compared cystoscopy rates, BC prevalence at cystoscopy, and invasive stage prevalence at diagnosis in aspirin or NSAID initiators with never-users. Methods Using the Danish population-based registries, we identified all new aspirin or NSAID users in 2005–2023 and a matched never-using comparison cohort. Second, we identified all first-time cystoscopy recipients in 2005–2022 with aspirin or NSAID initiation within 1 year prior or never-use in 10 years preceding cystoscopy. Comparing these groups, we computed hazard ratios of cystoscopy during 1-year follow-up, prevalence ratios of BC at cystoscopy, and invasive stage disease at diagnosis. Results Among 50,771 aspirin initiators (median age: 67 years, 51% men) and 156,191 NSAID initiators (age: 45 years, 50% men) adjusted hazard ratios of cystoscopy were 1.54 (95% confidence interval [CI]: 1.38–1.72) and 1.56 (95% CI: 1.43–1.70) compared with never-users. Cystoscopy recipients included 683 aspirin (age: 70 years, 69% men) and 1414 NSAID initiators (age: 60 years, 63% men); standardized morbidity ratio weighted (SMRW) prevalence ratios were 0.97 (95% CI, 0.76–1.22) and 0.65 (95% CI, 0.51–0.82) compared with never-users. The SMRW invasive stage prevalence ratios were 0.81 (95% CI, 0.63–1.03) and 1.07 (95% CI, 0.85–1.34) in the aspirin and NSAID comparison. Conclusion The combination of more cystoscopies and a lower prevalence of invasive stage at BC diagnosis may suggest the unmasking of asymptomatic BC in aspirin initiators. We did not find indications of unmasking with NSAID initiation. [...]

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

Abstract Aim Amiodarone increases the risk of thyroid dysfunction, but the prognostic significance of this complication in patients with heart failure (HF) is uncertain. This study investigates the association between amiodarone-related thyroid dysfunction and risk of HF hospitalization or death in a nationwide cohort. Methods Cases and controls were identified from a source population of all HF patients who initiated treatment with amiodarone from 1996 to 2021. Patients diagnosed with and/or treated for thyroid dysfunction within 3 years of starting amiodarone were classified as cases and comprised the study population together with controls matched 1:2 based on age, sex, calendar year, and HF duration. The primary outcome was a composite of HF hospitalization and death within 1 year from onset of thyroid dysfunction, analyzed using Kaplan–Meier curves and Cox regression models adjusted for comorbidities. Results Of 21,947 HF patients who initiated amiodarone, 2972 (14%) developed thyroid dysfunction. After matching, the study population consisted of 2953 cases and 5857 controls, mean age 70 years, and 65% men. At 1-year follow-up the primary outcome occurred in 1154 (39%) cases and 1826 (31%) matched controls, yielding an adjusted hazard ratio (HR) of 1.30 (95% CI 1.21–1.40). This increased risk was observed for both HF hospitalization (30% vs. 23%, HR 1.35 [1.24–1.47]) and all-cause death (19% vs. 15%, HR 1.21 [1.08–1.34]). Conclusions In this nested case–control study derived from a nationwide cohort of amiodarone-treated HF patients, new-onset thyroid dysfunction was associated with a 30% higher risk of a composite of HF hospitalization and death within 1 year. [...]

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

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

ABSTRACT Background Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures and provides good functional outcomes in both rheumatoid arthritis (RA) and osteoarthritis (OA) patients. However, RA patients face higher risks of adverse post-operative outcomes. Despite recognising the unique risks of RA autoimmunity and drug therapy, there remains minimal RA-specific evidence to guide arthroplasty surgeons. Methods This study analysed the rate of all cause revision, and revision for infection, dislocation, periprosthetic fracture, and aseptic loosening for 3657 RA and 446 428 OA patients who underwent primary THA recorded in the Australian Orthopaedic National Joint Replacement Registry (AOANJRR). Results Key findings of this study indicate that RA is associated with a younger age at THA, an increased risk of all-cause revision (HR 1.35; 95% CI 1.16–1.56; p = 0.001), and an increased risk of revision for infection (HR 1.48; 95% CI 1.12–1.98; p = 0.006), dislocation (HR 1.87; 95% CI 1.45–2.42; p  [...]

A Children's Hospital operating theatre staff survey showed preferences for dark blue over light blue scrubs, and those with an elastic waistband and trouser style pockets. Thematic reasons include: comfort/fit/availability, professionalism, functionality/practicality, dignity/self-esteem, modesty/privacy, stains/sweat/dirt and safety. Lighter scrubs show sweat and blood more obviously, including staff menstrual bleeding. ABSTRACT Background There are studies on parent, patient and child preferences regarding hospital staff attire, but no corresponding studies on staff preferences. The COVID-19 pandemic in Australia coincided with a rapid change to scrubs as standard staff attire on hospital wards. These are often at staff choice, whereas theatre scrubs are typically mandated and supplied by the hospital. There is therefore choice outside theatre, but no choice for theatre staff. Objectives Survey staff preferences regarding two styles and colours of hospital-provided scrubs, along with reasons underpinning staff preferences. Methods Anonymous survey of all in-theatre staff in response to a recent change in scrub uniforms. Mixture of survey and free-text responses to questions. Results A total of 267 staff responded, with the majority completing the survey. There were ~20 000 words of free-text responses to analyse. There was a clear choice for dark colour, elastic waistband and trouser-style pockets over the alternative. Reasons fell into seven major categories: Comfort/fit/availability, professionalism, functionality/practicality, dignity/self-esteem, modesty/privacy, stains/sweat/dirt and safety. There was no clear preference for own scrubs vs. supplied scrubs, or for multiple options vs. everyone looking the same. Female staff particularly did not like lighter scrubs, with their risk of strikethrough menstrual bleeding. Interpretation Staff have clear reasons for scrub preferences. Poorly designed scrubs present a hazard to physical safety and well-being. Light colours show stains, sweat and blood more. Underwear can be visible through poorly designed or light-coloured scrubs. There is a pride which comes from wearing well-fitting and functional theatre attire. [...]

ANZ Journal of Surgery, Volume 96, Issue S1, Page 3-7, June 2026. [...]

ANZ Journal of Surgery, Volume 96, Issue S1, Page 8-20, June 2026. [...]

ANZ Journal of Surgery, Volume 96, Issue S1, Page 21-28, June 2026. [...]

ANZ Journal of Surgery, Volume 96, Issue S1, Page 29-32, June 2026. [...]

ANZ Journal of Surgery, Volume 96, Issue S1, Page 33-65, June 2026. [...]

ANZ Journal of Surgery, Volume 96, Issue S1, Page 66-68, June 2026. [...]

ANZ Journal of Surgery, Volume 96, Issue S1, Page 69-76, June 2026. [...]

ANZ Journal of Surgery, Volume 96, Issue S1, Page 77-120, June 2026. [...]

ANZ Journal of Surgery, Volume 96, Issue S1, Page 121-123, June 2026. [...]

ABSTRACT Background Prophylactic cranial irradiation (PCI) has traditionally been a cornerstone of treatment in limited-stage and extensive-stage small cell lung cancer (SCLC). Recent evidence suggests that active MRI brain surveillance may result in comparable overall survival (OS) and progression-free survival (PFS). This systematic review and meta-analysis aims to compare patient outcomes between PCI and active MRI brain surveillance. Method Medline, Embase, Cochrane Library, Scopus and Web of Science databases were searched from inception until 30th April 2025 to identify all studies comparing PCI against active MRI brain surveillance in adult SCLC patients. Risk ratios (RR) and hazard ratios (HR) were pooled and analysed using a random-effects model. Result Fourteen studies comprising 2881 patients were included. In patients with limited-stage SCLC, PCI significantly improved OS (HR 0.67, 95% CI 0.53–0.84, p  [...]

ABSTRACT Rationale and Objectives This study aimed to evaluate the relationship between mild autonomous cortisol secretion (MACS) caused by adrenal adenomas and hepatic fat fraction (HFF) measured by dual-echo Dixon chemical shift–encoded MRI (dual-echo CSE-MRI). Methods This retrospective study included 151 patients with 169 adrenal adenomas evaluated between November 2023 and November 2025. According to post-1 mg dexamethasone suppression test (DST) cortisol levels, patients were classified as having MACS or non-functioning adrenal incidentalomas (NFAI). HFF was quantitatively assessed using dual-echo CSE-MRI. Clinical, biochemical, and imaging findings were analyzed. Correlation analyses and multivariate regression models were used to identify factors associated with hepatic fat fraction and MACS. Results Forty-five adrenal adenomas (26.6%) were classified as MACS. HFF was significantly higher in patients with MACS compared with those with NFAI (16.0% ± 13.3% vs. 7.1% ± 7.6%, p  [...]

ABSTRACT Background Previous studies have investigated the concordance between pre-TAVI coronary CT angiography (CTA) and invasive coronary angiography (ICA). Purpose To evaluate the agreement between pre-TAVI coronary CTA and ICA and to determine the relationship between coronary artery disease and one-year survival: Materials and Methods Coronary CTA findings were compared with invasive coronary angiography in patients undergoing TAVI for severe aortic stenosis at our tertiary care center between November 2023 and November 2024, with 50% and 70% stenosis used as diagnostic cut-off values. Results Ninety-five patients who underwent both coronary CTA and invasive coronary angiography prior to TAVI were included. Obstructive CAD was defined as ≥ 70% stenosis in the right coronary, left anterior descending, or circumflex artery, or ≥ 50% stenosis in the left main coronary artery. CTA findings showed strong agreement with invasive coronary angiography across all coronary arteries. At the 70% stenosis threshold, CTA demonstrated high sensitivity and specificity, with excellent interobserver agreement. Obstructive CAD was present in 82.1% of patients, with single-, two-, and three-vessel disease observed in 15.8%, 18.9%, and 47.4%, respectively. Severe carotid artery stenosis (> 70%) was observed in a minority of patients. One-year survival was 93.7% and was not associated with the presence of CAD (p = 0.466). Conclusion Pre-TAVI coronary CTA shows strong agreement with invasive coronary angiography for detecting obstructive coronary stenosis and represents a practical, noninvasive option for coronary assessment before TAVI. [...]

ABSTRACT The Australian Magnetic Resonance Imaging (MRI) Linear Accelerator program (MRI linac) was a major research project that aimed to build and test a unique MRI linac prototype for cancer treatment. It aimed to improve radiotherapy anatomical targeting and explore physiological targeting. The purpose of this report is to summarise the development and achievements of the program so as to provide an example of a successful large-scale research project in Australian radiation oncology. The project involved six Australian universities and international collaborators. We developed and built a unique MRI linac configuration comprising a 1 T magnetic field and a 6 MV accelerator, with the beam delivered in line with B0 and the patient placed across B0 in the split between the two halves of the magnet. The broad research domains were personalised disease targeting, medical device innovation, and biodiscovery. Specific projects included Artificial Intelligence image enhancement, radiation dosimetry in high magnetic fields, MRI characterisation of cancer heterogeneity in human tumours, and animal and human studies. Over $27 million was obtained to support the program from competitive sources. The program published over 120 papers and supported 25 PhD completions. The learnings from the Australian MRI linac program are that Australia has world-class radiotherapy research in physics and engineering, that major projects need a lot of time and a lot of collaboration, and that large, novel radiotherapy projects can attract significant funding and produce significant results. [...]

ABSTRACT Uterine artery embolisation (UAE) is an evidence-based treatment for symptomatic fibroids and adenomyosis. Ultrasound is commonly utilised for assessment post UAE given its wide availability and low cost; however, contemporary studies describing the typical ultrasound findings post UAE are limited, with a preference for discussion of Magnetic Resonance Imaging (MRI) findings over recent years. However, MRI is not funded in many jurisdictions, leaving patients to bear the costs. As such, there remains an important role for ultrasound follow-up in this cohort. This article presents the common and expected ultrasound appearances after UAE. At 6 months post-treatment, fibroids are expected to have decreased in volume by 40%–70%, have no central vascularity, and appear heterogeneous but generally more hypoechoic than pre-treatment. Based on first principles, adenomyosis features, including myometrial-endometrial junctional thickening and myometrial thickening, may diminish after UAE, along with infarction of an adenomyoma if present. Retrospective review of 107 primary uterine artery embolisation cases in patients with symptomatic uterine fibroids (n = 95) and/or adenomyosis (n = 17) demonstrated a significant correlation between persistent vascularity in a fibroid or adenomyoma and seeking further treatment due to ongoing symptoms (p  [...]

ABSTRACT Introduction Elderly patients make up a large proportion of those diagnosed with glioblastoma. There are multiple treatment options available for elderly patients including conventional and hypofractionated chemoradiotherapy, chemotherapy monotherapy and best supportive care; therefore, management decision-making can be complex. This retrospective study aims to compare overall survival (OS) and review prognostic factors in patients aged 65 and above who received either long-course or short-course chemoradiotherapy in regional New Zealand. Method A regional New Zealand Neurosurgical database identified patients aged ≥ 65 who received the EORTC-NCIC long-course radiotherapy (60Gy in 30 fractions) or the NCIC-CTG short-course radiotherapy (40Gy in 15 fractions), both with concomitant and adjuvant temozolomide. Results 76 patients diagnosed between 2006 and 2018 were included for analysis. Median OS for those receiving long-course (n = 59) was 15.4 months and for those receiving short-course (n = 17) was 16.9 months. 12-month estimated OS probability was 73% for long-course and 65% for short-course. 24-month estimated OS probability was 22% for long-course and 18% for short-course. There was no statistically significant difference in OS between the two treatment regimes. In a median-regression testing analysis there was insufficient evidence to show that extent of surgical resection, timing of radiotherapy from surgery and use of steroids during radiotherapy were prognostic factors. MGMT methylation status was seldom available for patients during this time. Conclusion In this study, median OS of elderly patients receiving long-course or short-course chemoradiotherapy was similar. Short-course chemoradiotherapy should routinely be considered in all elderly patients. [...]

ABSTRACT The landscape of cervical cancer in Australia has evolved considerably over recent decades. Implementation of the national HPV Vaccination Program and National Cervical Screening Program (NCSP) has driven sustained declines in incidence and mortality, making elimination as a public health problem potentially achievable within the next decade. Concurrent advances in surgical techniques, radiotherapy delivery and systemic therapies have improved treatment efficacy and safety, resulting in incremental gains in disease control and survival. Australian researchers have contributed significantly to this progress, and clinical outcomes reported in local institutional series and population-based analyses are consistently comparable to international benchmarks. Nevertheless, several challenges remain. These include sustaining brachytherapy expertise amid falling case volumes, addressing inequities in access, and integrating emerging systemic agents. These and other issues will demand continued engagement and coordination among clinicians, policymakers and stakeholders. This review outlines the principal developments that have shaped contemporary cervical cancer care in Australia, summarises current practice, and identifies key challenges and future directions for the field. [...]

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

ABSTRACT Background Isolated fetal pyelectasis is a common finding on second-trimester ultrasound; however, optimal follow-up strategies remain variable, often leading to inconsistent use of imaging and specialist services. This study aimed to evaluate clinical management pathways and outcomes and to identify factors associated with persistence. Methods A retrospective cohort study was performed of 221 pregnancies with isolated fetal pyelectasis detected on routine second-trimester ultrasound within a large tertiary healthcare network. Results Final outcome data were available in 214 cases. At initial third-trimester follow-up, pyelectasis had resolved in 167/214 cases (74.2%), increasing to 180/214 cases (84.1%) by final antenatal follow-up. Persistence was observed in 34/214 cases (15.9%). Male foetuses demonstrated significantly higher persistence rates than female foetuses (20.4% vs. 7.7%; OR 3.07, 95% CI 1.16–8.12, p = 0.022), while persistent cases had larger median renal pelvic diameters than resolved cases (5.6 mm [IQR 5.0–8.0] vs. 4.7 mm [IQR 4.2–5.3], p = 0.0003). Conclusion Isolated fetal pyelectasis demonstrates a high rate of spontaneous resolution, with relatively low persistence on follow-up imaging. These findings support a more risk-based approach to follow-up, with potential to reduce unnecessary imaging and optimise utilisation of specialised fetal diagnostic services. [...]

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

ABSTRACT Purpose To evaluate the feasibility of 68Ga-FAPI PET/CT in pancreatic cancer by comparing radiotracer uptake, lesion detection, and diagnostic value with 18F-FDG PET/CT. Methods Ten participants (seven male, three female; mean age 68 years) with suspected or confirmed pancreatic cancer underwent both 68Ga-FAPI and 18F-FDG PET/CT. Imaging was assessed for uptake, lesion detection, and diagnostic usefulness as determined by clinicians. Results Ten participants (seven male, three female; mean age 68 years) underwent imaging. Mean SUVmax of the primary lesion was higher for 68Ga-FAPI compared with 18F-FDG in participants with an identifiable primary lesion (n = 9) (13.8 [range 6.2–19.6] vs. 7.0 [range 0.0–12.5]). 68Ga-FAPI identified additional lesions in three participants, resulting in imaging-based upstaging in three cases. Clinicians considered FAPI more diagnostically useful in five participants and equivalent in the remainder, based on comparison of lesion detection, delineation, and staging impact. Increased uptake was also seen in areas of presumed inflammation. No adverse events were reported. Conclusions This feasibility study shows that 68Ga-FAPI PET/CT is safe, demonstrates higher uptake than FDG, and can reveal additional lesions that influence staging. Imaging-based upstaging was observed in three participants, supporting further investigation of FAPI as a complementary tool in pancreatic cancer imaging. Larger prospective studies are needed to determine the clinical impact of 68Ga-FAPI PET/CT in pancreatic cancer. [...]

ABSTRACT Background Sarcoidosis is a multisystem granulomatous disease that commonly affects the lungs and intrathoracic lymph nodes. On imaging, characteristic patterns of lymphadenopathy, such as the lambda sign on fluorodeoxyglucose positron emission tomography (FDG PET), are considered suggestive of the disease and can assist in differentiating sarcoidosis from differential diagnoses. FDG PET/CT is increasingly used to assess disease extent, identify extrapulmonary involvement, guide biopsy and monitor inflammatory activity. The prevalence and imaging characteristics of the lambda sign and periportal/portocaval lymphadenopathy, termed the 1–2–3-4 sign on FDG PET/CT in sarcoidosis, remain poorly defined. Methods A retrospective cohort study was performed of patients with sarcoidosis who underwent FDG PET/CT imaging at a tertiary centre in 2019. PET studies were assessed for the presence of the lambda sign and for FDG-avid periportal and/or portocaval lymph nodes. The frequency of the lambda and 1–2–3-4 sign, nodal distribution, and metabolic activity were analysed, including maximum standardised uptake values (SUVmax). Results The lambda sign was identified in a substantial proportion of patients. FDG-avid periportal and/or portocaval lymph nodes were observed in a subset of cases, although only one patient demonstrated the complete 1–2–3-4 sign. Periportal and portocaval nodes showed FDG uptake comparable to intrathoracic nodal disease. Conclusion FDG-avid periportal and portocaval lymphadenopathy may occur alongside classic intrathoracic nodal patterns in sarcoidosis, although the complete 1–2–3-4 sign appears uncommon. Recognition of this imaging pattern on FDG PET/CT may support diagnostic confidence in appropriate clinical contexts and help differentiate sarcoidosis from alternative causes of mediastinal and abdominal lymphadenopathy. [...]

ABSTRACT Objective To describe an evidence-informed, experience-based co-design process used to adapt metropolitan early palliative care referral models for implementation in a regional Australian health service. Methods A scoping review of palliative care delivery and early referral models to inform evidence-informed, experience-based co-design workshops involving consumers, clinicians, and health service staff. Design Sequential mixed-methods development study comprising evidence synthesis to identify model components, followed by two iterative workshops to construct and refine a context-appropriate outpatient early referral model. Setting A regional public health service in Victoria, Australia, seeking to establish an outpatient early referral palliative care clinic for people with advanced cancer. Participants Purposefully sampled stakeholders (patients/carers, oncologists, palliative care clinicians, cancer care coordinators, Aboriginal health worker, managers, and researchers) took part in two online workshops. Main Outcome Measures Co-designed model structure and components, perceived feasibility in a resource-constrained regional context, and agreed service scope and patient eligibility. Results The process generated a regionally tailored early referral pathway incorporating needs-based screening, prioritisation to manage limited capacity, and staged roll-out initially focused on selected cancer groups. These adaptations, while pragmatic, highlight the resourcing disparities faced by rural and regional services and the equity implications of resource-driven variation in care delivery. Conclusions Evidence-informed co-design enabled pragmatic adaptation of metropolitan palliative care models to a regional setting and offers a transferable approach for other rural and regional services. [...]

ABSTRACT Problem The Rural Health Academic Network aims to build research capacity through partnering with rural health services. However, describing its work and achievements is difficult. This paper presents the development of an illustrative conceptual model (the model) to promote the Network within rural healthcare. Setting The Network was introduced by a university department of rural health in 2006. Currently, research coordinators are embedded in four rural health services in northern Victoria, Australia. Measures for Improvement The model development was informed by an established checklist for reporting Theory of Change concepts in public health interventions. Strategies for Change Commencing in 2021, collaborative, interdisciplinary group discussions initiated the model design. These involved the research coordinators and university supervisors. Effects of Change The model describes the ‘what’ and ‘how’ of the Network, conceptualised through strategies, outputs, expected outcomes (short, medium, long-term), and desired impacts. Examples from the four sites emphasise the diverse contexts, the importance of partnerships and collaboration, and the dynamic nature of the work. Lessons Learnt Sharing the development of the model highlights the benefits of applying a common understanding of building research capacity. It acknowledges the challenges of reporting impact as a rural research collective involving multiple unique sites. [...]

ABSTRACT Objective Disparities in colorectal cancer exist for incidence and survival in disadvantaged and rural areas. This study created a composite indicator of multiple modifiable risk factors for colorectal cancer to visualise relative prevalence across Australia at the small-area level and by socio-economic status. Design Cross-sectional ecological analysis. Setting The Australian 2020–2021 National Health Survey. Participants 9796 participants sampled from the Australian adult population (18 years +), living in 2350 small areas. Methods Data on the prevalence of smoking, alcohol consumption, body mass index, and physical activity were used to generate colorectal cancer risk index scores. Index scores were calculated for each person, and mean scores were created for each small area using Bayesian spatial modelling. Index scores were compared across area-level socio-economic quintiles and geographical remoteness subgroups. Results Although limited data was available in remote areas, observed patterns indicated that locations outside of major cities tended to have moderate-to-high index scores (mean 0.44, SD 0.25), while major cities showed higher proportions of areas with lower but more variable scores overall (mean 0.34 SD 0.21). Risk scores were higher in disadvantaged areas (0.39, SD 0.21) than advantaged areas (0.33. SD 0.21). This trend was consistent across education, occupation, and economic resources indices. Conclusion People living further away from major cities and in socioeconomically disadvantaged areas may be more likely to have multiple modifiable health behaviours for colorectal cancer. When applied to a geographically representative dataset, the Index may be used to inform targeted health promotion interventions and localised community-based actions to reduce colorectal cancer risk and close the socio-economic and geographical gaps in incidence and mortality. [...]

ABSTRACT Introduction Australian rural and remote communities face challenges accessing allied health services due to a range of workforce, funding and service challenges. The Allied Health Rural Generalist Education and Training Scheme (TAHRGETS) was introduced to provide training, supervision and workplace project opportunities for early career allied health professionals across rural and remote private and non-government services in Australia. The purpose of this study was to explore the enablers and barriers to implementing rural generalist training positions in private and non-government settings and make recommendations for sustainable implementation. Methods A qualitative study utilising semi-structured interviews was undertaken utilising thematic analysis which was then mapped against the Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Results Twenty-five allied health professionals, 21 managers and supervisors and five project team members were interviewed. Twenty-six characteristics were identified including 19 enablers and 11 barriers to implementation. Enablers included the structured nature of the training positions, study time at work, funding provided to organisations, facilitation of the programme and support provided by managers and supervisors. Barriers included recruiting participants while transitioning into the workforce, time constraints, workload pressures and limited incentive for completion. Conclusion Rural generalist training positions for private and non-government organisations across rural and remote Australia were enabled through tailored support mechanisms and robust facilitation; however, policy level recognition is required for ongoing sustainability. [...]

Australian Journal of Rural Health, Volume 34, Issue 3, June 2026. [...]

ABSTRACT Introduction Partnerships with research users (e.g., communities, clinicians) are effective in supporting virtual health innovation (VHI) projects to co-develop, implement and evaluate sustainable, relevant innovations that improve care access in rural communities. However, building trusting relationships with underrepresented groups is challenging and time-intensive. Objective To synthesise partnership processes (principles, strategies) and effects (outcomes/impacts) from rural VHI projects. Design A scoping review of peer-reviewed articles on rural VHI partnership projects (2020–2024) identified through five databases. Partnership principles (norms/beliefs), strategies (observable actions) and outcomes/impacts (short- to long-term effects) were extracted and analysed using directed content analysis. Reporting followed the PRISMA-ScR checklist. Findings Of 7413 abstracts, 85 articles met inclusion criteria. VHI partnership projects were conducted in 15 countries, covering telehealth, digital education and health apps. Nearly half (45.9%) involved partnerships with Indigenous communities. We identified 149 principles and 80 strategies. Principles commonly related to relationship building (55.3%), shared decision-making (51.8%) and knowledge co-production (49.4%). From nine evaluation studies, 36 outcomes/impacts were extracted, of which 81% were positive. Discussion While a range of partnership processes and effects were identified, reporting was inconsistent, and few studies incorporated formal evaluations. Future research should adopt systematic approaches to report and evaluate their partnership engagement, thereby expanding the evidence base and facilitating shared learning for more effective and meaningful engagement with rural communities. Conclusion This systematic overview of partnership processes and effects lays the groundwork for more effective, culturally safe engagement. Strengthening partnerships in these contexts can improve healthcare access and reduce rural health disparities. [...]

ABSTRACT Problem Accessing professional support such as professional development, clinical supervision and peer support can be difficult for rural and regional allied health (AH) clinicians and may have a negative impact on workforce recruitment and retention. Setting The Loddon Mallee Health Network, a Health Service Partnership of 19 health services in North-Western Victoria. Professions included were AH therapy professions. Key Measures for Improvement Five professional support and workforce capacity building strategies were implemented, relating to clinical supervision, building capacity to provide student placements, professional development, graduate support and building AH clinical educator capacity. Program logic was used as the overarching methodology to evaluate the implementation of these strategies. Strategies for Change The project engaged AH managers, clinical educators and clinicians from across the region to collaboratively develop and implement the identified professional support strategies. Effects of Change Access to professional support and building the capacity of the workforce improved through shared approaches including the following: clinical supervision, professional shadowing and peer support for educators and shared student placements. Lessons Learnt Benefits to using a regional approach to plan, deliver and evaluate professional support for AH were identified. Recommendations are made to inform collaborative approaches to professional support in regional settings. [...]

ABSTRACT Objectives Building research capacity among clinicians is essential for bridging the research–practice gap and improving patient outcomes. This is critical given growing evidence that clinician engagement in research is associated with improved patient outcomes, service delivery and health system performance. The Research Ready Grant Program (RRGP) is a co-designed initiative to support clinicians in regional settings to develop and implement research projects grounded in clinical practice. This paper reports the design, governance and operationalisation of the programme as informed by Cooks principles for successful research capacity building. Methods This paper presents a framework-guided account of the design and operationalisation of the Research Ready Grant Program (RRGP), examining how the programme has been iteratively developed across multiple cycles to respond to the needs of a regional health service. The paper foregrounds the programme's multidisciplinary structure and dual-university collaboration model, offering transferable design insights for institutions seeking to embed sustainable research capacity building in rural and regional healthcare settings. Results (Design Indicators) The design and implementation indicators demonstrate how these principles were translated into programme components (including education, paid mentorship, governance and dissemination supports) and iteratively refined across successive programme cycles using participant feedback and programme records. These findings describe programme operationalisation and evolution rather than outcomes or effectiveness. Conclusion The RRGP provides a framework-guided approach for designing and sustaining research capacity building in regional and rural health services. By making visible the programme's multidisciplinary structure and dual-university collaboration model, this paper offers practical design insights for institutions seeking to embed sustainable research capacity within rural and regional healthcare settings. [...]

ABSTRACT Purpose To assess the scope and distribution of rural health workforce policies at both national and state (Queensland) levels through a systematic analysis of their status and characteristics. Methods A mapping review was adopted, with rural health workforce policy documents identified and extracted from websites of the national Department of Health and Aged Care, Queensland Health, and Queensland's Rural Workforce Agency. Documents were coded for demographic data, policy type, health profession, and overarching strategic focus on health workforce supply, distribution, and performance. Findings From the total of 12 921 rural health workforce policy documents identified in national and state repositories, 118 documents (67 national and 51 Queensland state) were included for synthesis. Analysis showed that the national rural health workforce policy is dominated by short-term mixed policy instruments—grants, programs, and sub-programs. After 2018, national policy showed a more balanced coverage of supply, distribution, and performance, compared with the stronger supply emphasis evident among policies issued before 2018. Queensland-specific policy places greater emphasis on retention, primarily through incentives embedded in employment policies, including financial allowances, leave, development opportunities, and workload management provision. However, these policies give limited attention to broader drivers of retention that are well established in the literature, including social, cultural, and work environment factors. Policy attention to performance is relatively narrow, focusing more on individual or professional outcomes than on system-level workforce outcomes. Conclusion Findings highlight the complexity and underlying fragmentation of Australia's rural health workforce policy. The layering of multiple nationally driven programs alongside state-level employment policy makes it difficult to assess the individual scope, overall coherence, interaction, and impact of health workforce policy in rural and remote regions. [...]

ABSTRACT Introduction Digital technologies can significantly improve access to healthcare, education and social services. However, there is limited evidence on the extent of ownership and use of digital devices in remote Aboriginal communities. This study aimed to examine digital technology use, internet availability and use, intention to use technology for health and eHealth literacy in a very remote Aboriginal community in the Northern Territory (NT), Australia. Methods A face-to-face community-based structured survey was implemented by local Aboriginal community-based researchers in a very remote island community of the NT. Results Approximately 20% (n = 46) of the community participated in the study. Seventeen respondents did not own a digital device. While 17 reported having no internet access, two-thirds of those who had internet access (n = 29) were using prepaid mobile data. Twenty-three of the participants reported accessing health information online and eight reported having received a text message reminder about a health appointment. Only three individuals did not want to use a digital device for health. The mean score for eHealth literacy was 23.7; range 8–40. Overall, younger respondents (18–44 years) had higher eHealth literacy than those aged 45 and over. Conclusion The use of digital technologies was common; however, its application for healthcare was limited, despite community members' interest in using devices to access health information. Limited use, together with low eHealth literacy scores, and gaps in internet connectivity and mobile phone ownership suggest unmet needs for more accessible community digital infrastructure (e.g., community WiFi), and greater personal access to devices. [...]

ABSTRACT The National Health Reform Agreement 2026–2031 has now been published. As the primary framework governing health funding in Australia, the Agreement also sets the overarching policy direction and defines the roles, responsibilities and expectations of the Australian Government and all state and territory governments. The National Rural Health Alliance has long argued that the National Health Reform Agreement must explicitly prioritise rural health and clearly articulate the specific commitments required to address rural and remote health inequities. The Alliance welcomes the inclusion of a new schedule in the 2026–2031 Agreement—Schedule F: Better Health Equity for Rural and Remote Communities. This article contends that Schedule F creates an important opportunity for genuine and lasting reform to better support rural health in Australia. [...]

ABSTRACT Objective This study examines the barriers and challenges that affect the efficiency and effectiveness of patient safety reviews in rural healthcare services and proposes co-designed improvement strategies. Setting Rural health services in four Australian states and territories. Participants Health service staff working in rural Australia. Methods and Design We used a descriptive qualitative design. Data were drawn from a broader project that explored health service staff's perspectives on patient safety reviews. Participants of the focus groups were recruited from health services across four states and territories. Findings were thematically analysed and then informed co-design workshops that developed strategies to strengthen reviews. Results Findings show that (1) Health service staff often lack adequate oversight, monitoring and support due to the wide geographic spread of facilities, limited staffing, and resources. (2) Cross-border reviews and reliance on locum doctors and Visiting Medical Officers (VMOs) increase administrative complexity, particularly in their engagement with review interviews and the development and implementation of recommendations. (3) Rural health services frequently lack access to external subject matter experts (SMEs) and consumer representatives on review teams. When external SMEs are involved, they bring subject expertise, but they may not be familiar with rural healthcare contexts. There are limited internal SMEs to draw on due to small and close communities and potential conflict of interests risks a lack of diverse perspectives. Nurses are often the people who coordinate patient safety reviews and follow up implementation. However, their ability to influence doctors or drive broader changes was described as limited, particularly given ongoing workforce shortages and hierarchical dynamics. (4) Rural health services are further constrained by logistical challenges and resource constraints such as outdated facilities and diagnostic methods. Conclusion This paper highlighted key barriers to patient safety reviews in rural health services including resource limitations, workforce shortages, reliance on locums and VMOs and the challenges of dispersed facilities. Patient or Public Contribution Patient and public engagement was integrated into the design and delivery of the study. A panel of six consumers served as an advisory committee, assisting with framing research questions and offering their insights from working with health services staff on the review teams. [...]

There is a windswept hill on the eastern shore of Staten Island, NY, where stands an old hospital building, its boarded-up façade facing The Narrows of New York Harbor pockmarked with broken windows and overrun with creeping vegetation. The faraway glinting glass of towering Manhattan skyscrapers including One World Trade Center is visible on a clear day if you face the water and look over the train tracks to the left. The Verrazano Narrows Bridge glowers at you from the right, carrying more than 200 000 cars across Staten Island every day between New Jersey and New York with many riders never setting foot on the island or knowing about this place. Next to a long cordon of piled traffic barriers that are not obstructing anyone, plaintive street graffiti pleads, as if from the building itself, “WISH YOU WERE HERE.” [...]

We read with interest the study, Obesity and Severe Obesity in Youth Before and During COVID-19.1 Among important analyses about ultra processed foods and physical activity, the authors report that the prevalence of obesity “trended up from before to during the pandemic” and, although the 1.4% increase from 21.2% to 22.6% was not significant, the trend is clinically meaningful.1 Messiah et al. also reported obesity prevalence among non-Hispanic Black youth was 26.4% during 2017-March 2020 and 36% during August 2021–August 2023 (summing class I–II obesity in Tables 2 and 3).1 This is a 10 percentage point increase in prevalence over 2–3 years. [...]

10.1542/6392142918112Video AbstractPEDS-VA_2025-0711016392142918112CONTEXTChildren with congenital heart disease (CHD) are at risk of cerebral abnormalities. Current evidence is limited by small sample sizes, single-center cohorts, and single time points.OBJECTIVEConduct a systematic review and meta-analysis to determine the prevalence of structural cerebral abnormalities on magnetic resonance imaging (MRI) in children with CHD during prenatal, postnatal–preoperative, and postoperative periods.DATA SOURCESFive electronic databases from inception to August 4, 2025.STUDY SELECTIONStudies published in English in peer-reviewed journals that met the following criteria: 1) samples comprised fetuses from 24 weeks gestation to birth or children from birth to 21 years, with 2) isolated (nonsyndromic) CHD with or without surgical intervention within the first year of life, and 3) reported structural cerebral abnormalities on MRI, during 4) prenatal, postnatal–preoperative, or postoperative period.DATA EXTRACTIONData were extracted independently by 2 authors. Data were synthesized using random-effects modeling to determine pooled estimates.RESULTSOverall, 125 studies met the inclusion criteria. Sample size included 521, 1895, and 2443 fetuses and children with CHD for prenatal, postnatal–preoperative, and postoperative analyses, respectively, ensuring sample independence. The pooled overall prevalence of structural cerebral abnormalities was 23.1%, 36.7%, and 50.3% for prenatal, postnatal–preoperative, and postoperative periods, respectively.LIMITATIONSVariations in MRI strength, postnatal vs fetal MRI detection capacity, and the underlying rationale for neuroimaging.CONCLUSIONSStructural cerebral abnormalities are prevalent in a considerable number of fetuses and children with CHD. A further increase is evident postoperatively, indicating the potential adverse impact of surgical intervention and postoperative care on brain outcomes. [...]

We thank Dr Ogden and colleagues for their careful and thoughtful comment and for their long-standing contributions to the surveillance and interpretation of childhood obesity trends using NHANES data. We agree that estimates from the August 2021–August 2023 NHANES cycle must be interpreted with caution given the unique challenges of data collection during the COVID-19 pandemic. We specifically state in the limitations that “the absence of NHANES data from March 2020 to July 2021 limits our ability to assess short-term changes in obesity risk and related behaviors immediately following the onset of the COVID-19 pandemic. Additionally, differences in sample sizes between the pre- and during-pandemic samples may limit generalizability, as disruptions to NHANES data collection during the pandemic could have resulted in underrepresentation of more vulnerable populations.” Consistent with these limitations, we did not interpret the observed 1.4 percentage point increase in overall obesity prevalence as statistically significant, nor did we present it as definitive evidence of a true population-level change. Rather, we described this pattern as a non-significant trend and emphasized the need for cautious interpretation in light of the study design and data constraints. [...]

Gender-based pay inequities persist in pediatrics, affecting women at all career stages and across subspecialties, even after accounting for work hours, duties, and productivity. These inequities are further pronounced between pediatrics, a women-dominated field, and men-dominated adult medicine and surgery. Contributing factors include systemic bias; unequal access to mentorship, sponsorship, and coaching; unequal promotion to leadership roles; part-time work; and inadequate parental leave policies. The consequences are profound, not only for the financial well-being and career satisfaction of women physicians, but also for the pediatric workforce and access to health care for pediatric patients. Subspecialties with more women often face workforce shortages and lower salaries for all. This policy statement from the American Academy of Pediatrics summarizes evidence of gender pay inequities, their causes, and strategies to achieve compensation equity. It recommends transparent pay practices, supportive parental leave policies, equitable promotion policies, and regular compensation reviews to address these inequities. Achieving pay equity is critical to building a diverse, sustainable, and fairly compensated pediatric workforce capable of meeting the health care needs of all children. Equity in pay is both a professional and public health imperative. [...]

Guidance from the American Academy of Pediatrics on generic drugs was last published in 1987. The regulatory process for development of a new generic product in place of the reference brand-name drug requires extensive US Food Drug and Administration (FDA) standards for similarity to ensure the same safety and effectiveness profiles as the reference drug. Since the last statement was published, the growth in biologic agents and the development of biosimilars as alternatives to the originator have become more common across the United States. Generic drugs are identical to the brand name drug and must meet the regulatory standard of bioequivalence, whereas biosimilars are “highly similar” but may differ in clinically inactive components and even molecular structure, as long as these differences are not “clinically meaningful.” Confidence in the development and approval of generic and biosimilar medications should guide providers toward generic and biosimilar substitution. The recommendations included in this policy statement are intended to support generic substitution and substitutions with interchangeable biosimilars in accordance with the FDA while promoting interdisciplinary interaction between pediatric prescribers and pediatric pharmacists. [...]

Guidance from the American Academy of Pediatrics on generic drugs was last published in 1987. The regulatory process for development of a new generic product in place of the reference brand-name drug requires extensive Food Drug and Administration (FDA) standards for similarity to expect the same safety and effectiveness profiles. Since the last guidance, the growth in biologic agents and the development of biosimilars as alternatives to the originator have become more common across the United States. As with generics, FDA requires extensive evidence of biosimilar agents as compared to the originator drug. Generic drugs are identical to the brand name drug and must meet the regulatory standard of bioequivalence whereas biosimilars are “highly similar” but may differ clinically inactive components and even molecular structure, as long as these differences are not “clinically meaningful.” Confidence in the development and approval of generic and biosimilar medications should guide providers toward generic and biosimilar substitution. This technical report summarizes domestic and global regulations, development of generic and biosimilar drugs, and the literature review of a variety of generic products and biosimilars. [...]

OBJECTIVETo estimate associations of more than minimal prenatal nicotine, alcohol, cannabis, and opioid exposures with gestational age, birth weight, and birth weight for gestational age.METHODSData were drawn from the HEALthy Brain and Child Development (HBCD) Study, a multisite, longitudinal study in the United States. Predefined recruitment thresholds for each substance were assessed using maternal self-report, maternal toxicology results, and newborn substance exposure-related diagnoses. Birth outcomes included gestational age at delivery (weeks), birth weight (grams), and birth weight for gestational age (centiles). Mean differences and risk ratios for the associations between substance exposure and birth outcomes were estimated using multilevel mixed-effect linear regression or multilevel mixed-effect Poisson regression.RESULTSAmong 660 mother-infant dyads, 17% (n = 115) of participants met recruitment thresholds for prenatal cannabis, 15% for nicotine (n = 102), 13% for alcohol (n = 86), and 5% for opioids (n = 32). In adjusted models, prenatal cannabis and opioid exposures were each associated with lower birth weight (cannabis: −272.2 [95% CI −444.6 to −99.8] g; opioids: −295.4 [95% CI −574.9 to −15.9] g) and birth weight centiles (cannabis: −8.2 [95% CI −15.3 to −1.1] centiles; opioids: −14.4 [95% CI −25.5, −3.4] centiles), although the results were sensitive to model specifications. Prenatal nicotine and alcohol estimates were in similar directions but not statistically significant. No significant associations between exposures and gestational age at delivery were detected.CONCLUSIONSIn this initial HBCD Study data release, more than minimal exposure to cannabis and opioids was associated with smaller birth size, adding evidence to an inconsistent literature. Future studies from HBCD can more deeply interrogate timing and dose of each substance and expand to childhood outcomes. [...]

Graduate medical education is grounded in a core commitment to the public: that individuals who complete a training program and are certified by their specialty board are “practice ready”—that is, they are able to meet the needs of their patients (and caregivers) upon entering practice. Beginning in 2028, the American Board of Pediatrics (ABP) aims to advance and operationalize this commitment by requiring program directors to attest that graduates are able to perform the essential activities of their discipline, as defined by the Entrustable Professional Activities (EPAs), to qualify for initial certification. To ensure that decisions about both graduation and certification eligibility are based on whether the new physician can meet the needs of their patients in real-world practice, we must clarify not only what graduates must do (the EPAs) but also how well and under what conditions and contexts they must perform them. This article provides that clarity: A “practice ready” trainee can provide safe and effective care without assigned supervision in the context of a posttraining collaborative practice environment in the discipline in which they have been trained. We unpack this definition and clarify key concepts, such as the importance of help-seeking and collaboration over independence, by introducing and applying a supervision scale to illustrative case examples. We conclude by outlining next steps for programs and future directions for the pediatric community and ABP, situating this foundational work within the broader implementation efforts required to ensure new pediatricians entering practice can meet their patients’ needs. [...]

Suicide is the second leading cause of death among United States youth.1 Firearms are the most lethal means of suicide,2 and access increases the risk of suicide death.3 Lethal means safety (LMS) planning involves decreasing access to firearms and other highly lethal means of suicide, and is one of the few evidence-based suicide prevention strategies.4 [...]

10.1542/6392143221112Video AbstractPEDS-VA_2025-0752766392143221112BACKGROUND/OBJECTIVESYoung adults, aged 18 to 24 years old, vape more than any other age group. Vaping is concerning due to health harms associated with nicotine and toxicant inhalation and potential for use to lead to smoking. Evidence on vaping cessation is limited. Using data from Wave 6 (2021) and Wave 7 (2022–2023) of the Population Assessment of Tobacco and Health Study, we examined factors associated with a vaping quit attempt and cessation.METHODSParticipants were included if they were 18 to 24 years old, vaped regularly in 2021, and had a follow-up in 2022 to 2023. Numerous variables were assessed for an association with a vaping quit attempt or cessation.RESULTSIn 2022 to 2023, 62.4% of young adults who vaped made a quit attempt and 18.6% quit. Making a quit attempt was associated with higher harm perceptions of e-cigarettes (odds ratio, 1.44; 95% CI, 1.13–1.84) and nicotine (odds ratio, 1.35; 95% CI, 1.11–1.64) and close family and friend disapproval (odds ratio, 2.53; 95% CI, 1.87–3.43). Dual use was associated with lower odds of a quit attempt (odds ratio, 0.58; 95% CI, 0.38–0.90). Vaping cessation was less likely in individuals with daily use (odds ratio, 0.45; 95% CI, 0.30–0.69) and in-home e-cigarette allowance (odds ratio, 0.58; 95% CI, 0.37–0.91). Use of quit methods was low, and cigarette substitution was the only method positively associated with vaping cessation (odds ratio, 2.61; 95% CI, 1.15–5.95).CONCLUSIONSAlmost two-thirds of young adults tried to quit vaping, and concerningly, the only method associated with cessation was substituting combustible cigarettes. There is an urgent need to develop safe and effective vaping cessation treatments for young adults. [...]

For decades, improvement science has been built on the foundation provided by the Donabedian Triad: structure (the settings, policies, resources, and tools available to health care teams), process (the “set of activities that go on within and between practitioners and patients”1), and outcomes (the “change in a patient’s current and future health status that can be attributed to antecedent health care”2). Quality measures represent “[a] standard for measuring the performance and improvement of population health or health plans, providers of services, and other clinicians in the delivery of health care services”3 and allow teams to assess whether the structures and processes we implement in practice in fact benefit the patients and communities we aim to serve. In this month’s Pediatrics, a trio of papers from the Pediatric Quality Measure Program (PQMP) lay out the current state of evidence for quality measures addressing 3 critical pediatric primary care activities: hearing,4 vision,5 and developmental6 screening and follow-up. [...]