Barwon Health

Staphylococcus aureus bacteraemia is a severe infection with potential sex-based disparities. While males have higher infection rates, females may experience poorer clinical outcomes. This study examines sex-based differences in the clinical characteristics, management approaches, and outcomes of community-onset S. aureus bacteraemia (COSAB) within a single-centre cohort. We conducted a single-centre retrospective study of 279 COSAB cases (2015–2020) at University Hospital Geelong, Australia. Clinical characteristics, diagnostic testing, and 30-day all-cause mortality were compared by sex using univariable binomial logistic regression models. Analysis of 279 COSAB cases (58.4% males, 41.6% females) showed a higher, though not statistically significant association between 30-day mortality rate in females (21.6%) compared to males (17.2%) (p = 0.36). There was no significant difference of age between the sexes (p = 0.38) or Charlson Age Comorbidity Index (p = 0.71). Males had longer median hospital stay (26 days, IQR: 33.25 compared to females (18 days, IQR: 34). Transoesophageal echocardiography (TOE) was performed less frequently in females than males (OR: 0.58, 95% CI 0.35–0.97; p = 0.04), despite comparable rates of infective endocarditis. Females were also associated with a methicillin-susceptible Staphylococcus aureus (MSSA) infection (OR: 2.10, 95% CI: 1.13–3.97, p = 0.02). This study identified sex-based differences in the management of COSAB, particularly the lower frequency of TOE performed in females. While there was no significant difference in 30-day mortality between sexes in this underpowered study, these disparities warrant further investigation. Understanding the underlying causes of these differences could help improve clinical practices and ensure equitable management for all patients.

Abstract Purpose To evaluate whether large language models (LLMs) can enhance clinician-patient communication by simplifying radiology reports to improve patient readability and comprehension. Methods A randomised controlled trial was conducted at a single healthcare service for patients undergoing X-ray, ultrasound or computed tomography between May 2025 and June 2025. Participants were randomised in a 1:1 ratio to receive either (1) the formal radiology report only or (2) the formal radiology report and an LLM-simplified version. Readability scores, including the Simple Measure of Gobbledygook, Automated Readability Index, Flesch Reading Ease, and Flesch-Kincaid grade level, were calculated for both reports. Statistical analysis of patient readability and comprehension levels, factual accuracy and hallucination rates for LLMs was assessed using a combination of binary and 5-point Likert scales, open-ended survey questions, and independent review by two radiologists. Results 59/120 patients were randomised to receive both the formal and LLM-simplified radiology reports. Readability of LLM-simplified reports significantly improved with the reading level required for formal reports equivalent to a university-standard (11 th -13 th grade) compared to a middle-school standard (5 th -9 th grade) for simplified reports (rank biserial correlation=0.83, p<0.001). Patients with both reports demonstrated a significantly greater comprehension level, with 95% reporting an understanding level greater than 50%, compared with 46% without the simplified report (rank biserial correlation = 0.67, p < 0.001). All LLM-simplified reports were considered at least somewhat accurate with a minimal hallucination rate of 1.7%. Importantly, no hallucinations resulted in potential patient harm. 118/120 (98.3%) patients expressed interest in simplified radiology reports to be included in future clinical practice. Conclusion This study provides evidence that LLMs can simplify radiology reports to an accessible level of readability with minimal hallucination. LLMs improve both ease of readability and comprehension of radiology reports for patients. Therefore, the rapid advancement of LLMs shows strong potential in enhancing patient-radiologist communication as patient access to electronic health records is increasingly adopted. Highlights Radiology reports can be complex and difficult for patients to read and interpret Strong patient demand exists for simplified radiology reports Large language models (LLMs) such as GPT-4o show promise in simplifying radiology reports LLMs credibly simplify radiology reports with minimal hallucination rates LLMs improve both patient readability and comprehension of radiology reports

ABSTRACT Objective This article explores the potential benefits of peer-led spaces for young mental health family carer lived experience (FCLE) workers, in fostering connection, advocacy, and knowledge production. Method Using a co-operative inquiry collaboration process, ten young FCLE workers, lived experience researchers, and allies reflected on their engagement in peer-led workshops. Results Four key ways in which young FCLE workers experienced benefit from participating in peer-led spaces were identified, including fostering connection and agency, articulating under-recognised experiences, clarifying often ambiguous roles and career pathways, and building capacity in knowledge production. Discussion Peer-led spaces are shown to provide essential professional community-building and support mechanisms for young FCLE workers. The inquiry draws together the broader implications of these findings for supporting young FCLE workers in a context where young carers face significant barriers to entering the workforce, roles can be isolated or systemically misunderstood, and young FCLE workers are under-represented in research. Links to existing frameworks with potential for implementing such peer-led spaces and processes are explored, namely role modelling, communities of practice and co-operative inquiry.

Metal needles have traditionally been used for cannulation of arteriovenous fistula and grafts in haemodialysis. Plastic cannulae have emerged as a potential alternative, particularly for patients with newly formed arteriovenous fistula or graft, or those that require more arm mobility during dialysis. Despite the potential for improved clinical outcomes, the introduction of plastic cannula into haemodialysis units globally has been variable. Empirical evidence related to the clinical advantages of plastic cannula in haemodialysis remains limited. To map the existing literature to gain an understanding of global trends in the use of plastic cannula for arteriovenous fistula and arteriovenous grafts in patients with end-stage renal disease requiring haemodialysis. A review of literature from published 1990 to May 2025 is reported. MEDLINE Complete, CINAHL Complete, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials, ProQuest, Trove, and Google Scholar were searched. English language articles describing the use of plastic cannula in adults for haemodialysis in any setting were eligible for inclusion. Two reviewers independently assessed title, abstract relevant full text papers. Data were analysed using narrative synthesis. Papers (N=45) reporting randomised controlled trials, non-randomised experimental, cohort and cross-sectional studies, case reports, cost analyses, or literature reviews from Australia, Europe, the United States, Canada, New Zealand, and Asia met the inclusion criteria. Findings indicate increasing adoption of plastic cannulae in haemodialysis practice worldwide. Key barriers included the higher initial unit cost, and procedural complexities associated with implementing a new technique. Despite this, long-term cost-effectiveness was demonstrated, due to reductions in clinical interventions resulting from adverse outcomes. Plastic cannulae were linked to improved clinical outcomes such as less catastrophic tissue damage due to failed cannulations, lack of aborted haemodialysis sessions, and higher levels of patient comfort. There is a growing global interest in plastic cannulae for haemodialysis vascular access. Although emerging evidence points to potential clinical and economic advantages, widespread adoption remains limited due to logistical challenges and higher initial costs. Robust, high-quality trials comparing metal needles versus plastic cannulae are required to accurately determine relative effectiveness. Trial design must accommodate an appropriate period of plastic cannulae practice integration.

Islet autoantibodies herald early type 1 diabetes. However, less is known of the evolution of autoantibodies to the islet autoantigen ZnT8. Our primary aim was to characterise the development of islet autoantibodies in a pregnancy-birth at-risk cohort and to provide new knowledgeabout ZnT8A. Islet autoantibodies were measured every 3-6 months in 1277/1473 children with a first-degree relative with type 1 diabetes who were followed prospectively from pregnancy in the Environmental Determinants of Islet Autoimmunity (ENDIA) cohort for 7.0 (IQR 5.8-8.3) years. Islet autoantibodies were also measured in the mothers and/or in cord blood in 901 pregnancies with type 1 diabetes. The development of persistent IAA reached a probability of 0.02 by 2 years of age. A combination of IAA- and GADA-first, GADA-first and ZnT8A-first all reached a similar probability by 5 years of age. ZnT8A appeared as the first islet autoantibody, alone or in combination, in 43 (32%) of the 134/1473 children with persistent islet autoantibodies. Persistent single ZnT8A, detected only by ELISA, usually appeared after 4 years of age. ZnT8A that progressed to multiple islet autoantibodies or type 1 diabetes were detected in younger children (p=0.006) and in multiple assay formats. ZnT8A were confirmed in additional assay formats when present with multiple islet autoantibodies, but not when remaining as a single islet autoantibody, unlike IAA and GADA. Maternal islet GADA were detected until 15 months of age and transmission of any islet antibody/autoantibody did not relate to islet autoantibody development in the offspring (χ2=3.32, df=2, p=0.19). Persistent single ZnT8A, which are detected only by ELISA and no other test format, appear not to confer an increased risk of progression to type 1 diabetes.

The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

ObjectiveThis study evaluated the excess out-of-hospital healthcare costs associated with unintentional childhood injuries in Australia. This relationship was investigated within a longitudinal biennially surveyed cohort of 8,852 children aged 0–19 years. We assessed whether costs increased over age and with the duration of injury prevalence. Results were compared against cost estimates from similar studies in Australia and analogous developed nations.Data sources and study settingThe nationally representative Longitudinal Study of Australian Children provided linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) cost data for the Birth and Kindergarten cohorts, followed for 15 years.Study designWe used a mixed effects generalized linear model (GLM) with a gamma distribution and log link to estimate outpatient healthcare costs and assess the effect of injury status, controlling for sociodemographic characteristics. This model accounted for repeated measures over time and variability both within and between individuals.ResultsAnnual excess outpatient and pharmaceutical costs for injuries among 0–19 year-olds were A$39.1 million for those who were hospitalised and A$104.8 million for those only requiring community-based treatment. These estimates do not include inpatient hospital costs, which are not captured in the Medicare dataset.ConclusionsUnintentional childhood injuries in Australia incur significant financial burden on the public healthcare system, with costs per capita higher than other childhood conditions. Our figures are likely an underestimate. These excess healthcare costs support preventive efforts to reduce injury incidence among children.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40621-025-00582-0.