Blacktown & Mount Druitt Hospital

We present a case of necrotising amoebic colitis (NAC) from a low-risk demographic in Sydney, Australia. A 75-year-old Caucasian male presented critically unwell with an acute abdomen and sepsis following 4 weeks of constipation and progressive abdominal pain. Computed tomography showed pneumoperitoneum, diffuse right-sided colonic wall thickening with multiple hypodense hepatic lesions. With a working diagnosis of perforated right-sided colonic cancer with liver metastases, the patient underwent an open extended right hemicolectomy. Subsequent histopathology demonstrated amoebiasis in the resected specimen. Despite active treatment, the patient died due to septic shock. As NAC is uncommon in Australia, it is often not considered as a differential diagnosis in the acute abdomen. More common diagnoses such as perforated colorectal cancer are often considered instead. Early recognition and initiation of anti-amoebic therapy, along with complete surgical resection of the affected bowel, are associated with improved survival outcomes.

Patients with type 2 diabetes mellitus and established coronary artery disease (CAD) carry a very high cardiovascular risk, requiring aggressive lipid management. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i) are widely used for glycemic control, but their effects on lipid profiles in high-risk patients remain unclear. To evaluate the association between SGLT2i and DPP4i therapies with low-density lipoprotein cholesterol (LDL-C), additional lipid parameters, and clinical outcomes in patients with type 2 diabetes and established CAD. We retrospectively analyzed diabetic inpatients with angiographically confirmed CAD, stratified by use of SGLT2i, DPP4i, combination therapy, or neither at admission. The primary outcome was the difference in LDL-C, assessed using multivariable linear regression adjusted for statin use and cardiometabolic comorbidities. Secondary lipid parameters were analyzed similarly. Clinical outcomes included a composite of all-cause mortality and major adverse cardiovascular events (MACE), analyzed using Cox regression, with Fine-Gray competing risk models for individual components. A total of 423 patients (74% male, median age 65) were included: 68 on SGLT2i, 76 on DPP4i, 31 on combination therapy, and 248 on neither. After adjustment, SGLT2i use was associated with reduced LDL-C (β=-0.39mmol/L; 95% CI -0.67 to -0.10), as was combination therapy (β=-0.38mmol/L; 95% CI -0.75 to -0.02), with no change observed in the DPP4i group. SGLT2i monotherapy was also associated with lower total cholesterol and non-high-density lipoprotein cholesterol. Over 2.8 years, SGLT2i monotherapy was linked to reduced risk of the composite outcome (hazard ratio0.55; 95% CI 0.31 to 0.97), whereas DPP4i and combination therapy showed no association. SGLT2i use in patients with diabetes and CAD was associated with modest LDL-C reductions and lower risk of mortality/MACE, supporting further evaluation of their potential lipid-modifying role in secondary prevention.

A major limitation to robotic training internationally is sufficient access to console and bedside operating time. It is important that trainees are “robot ready” when clinical opportunities arise. Delivering the didactic component of training in advance of hands-on training opportunities is needed to maximise the efficiency of console time. This study describes the development and implementation of a platform agnostic online curriculum (Foundations in Robotic Surgery -IMRA) that provides an overview of robotic surgery as didactic learning prior to hands-on experience. Curriculum development is reported using Kern’s model. A literature review was conducted in accordance with the PRISMA statement. A mixed-methods approach, incorporating surveys and semi-structured interviews, defined learning objectives and curriculum content. Curriculum outcomes were assessed via surgeon surveys, and modifications were made based on feedback from the Royal Australasian College of Surgeons. The literature review revealed a gap in vendor-neutral online curricula for robotic surgery. Six experts comprising of general surgeons and urologists, identified key learning objectives on safety, communication, and surgical technique. This gap was addressed by developing an online curriculum comprising of ten theory modules. In the development group (n = 28; 16 responses), Kirkpatrick assessment showed a 60% increase in participants rating their knowledge as good or excellent. Confidence in bedside assistance and console training rose by 37.5%. In the rollout group (n = 108; 88 responses), 89.8% rated the content quality as good or excellent. Development and implementation of the IMRA Foundations in Robotic Surgery Curriculum demonstrated improvements in learners’ self-rated knowledge and confidence in both bedside and console aspects of multi-platform robotic surgery.

ABSTRACTThere have only been a limited number of case reports that have described vulval lichen sclerosus in patients receiving immune checkpoint inhibitor (ICI) therapy. We describe 11 cases of vulval lichen sclerosus in patients with melanoma treated with ICIs, and in nine of these cases, the lichen sclerosus symptoms began after ICI commencement. This represents the largest reported series to date and highlights the need for clinician awareness of this potential immune‐related adverse effect.

Mechanical thrombectomy (MT), in combination with intravenous thrombolysis, have been widely accepted as effective therapies for acute ischemic stroke (AIS) secondary to large vessel occlusion. However, the presence of calcified cerebral emboli (CCE) has been associated with worse angiographic and clinical outcomes. Therefore, this systematic review aimed to evaluate the efficacy and safety of MT in the management of AIS secondary to CCE. Asystematic review was registered and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (CRD420251031539). PubMed, Ovid Medline, SCOPUS, The Cochrane Library and EMBASE were searched for publications until 13th April 2025. The search yielded 2102 publications. 14studies met inclusion criteria (160 patients with AIS due to CCE). Two multi-centre studies reported recanalisation rates of only 57.5% and 57% respectively across 75participants. Only 11.1-28.0% of patients in the included case series and cohort studies had amodified rankin score 2at 3months, suggesting that most patients did not regain functional independence following MT for CCE. MT for CCE was also associated with a3-month mortality rate of 0-62.5%. Haemorrhagic complications were the most common adverse effect associated with MT. The available evidence from 14studies elucidated poor recanalisation rates and functional outcomes when MT was used in the management of AIS secondary to CCE. However, the available evidence is primarily low-level evidence from observational studies, hence the conclusions should be interpreted with caution.

BackgroundPleural infection remains a significant clinical challenge, requiring hospitalisation, intravenous antibiotics and early chest drain insertion. Medical thoracoscopy (MT), a minimally invasive procedure used electively in the UK for malignant effusions, has demonstrated good outcomes when applied to acute pleural infection in retrospective case series. However, it has not been evaluated as a first-line intervention in the UK in a randomised controlled trial (RCT).ObjectivesThe Studying Pleuroscopy in Routine Pleural Infection Treatment (SPIRIT) trial assessed the feasibility of conducting a full-scale RCT comparing MT with chest drain insertion for acute pleural infection within UK National Health Service (NHS) hospitals.MethodsSPIRIT was an open-label, randomised feasibility trial conducted across seven NHS centres between 2017 and 2019. Adults with suspected pleural infection were prescreened; eligible patients were randomised to either chest drain insertion (control) or MT (performed the same or following day) with 90-day follow-up. The primary outcome was feasibility, assessed through a composite of prescreen, screen and allocation failure rates. Secondary outcomes included inpatient-stay duration, mortality, radiological and microbiological outcomes, second-line interventions, patient-reported outcomes and adverse events.ResultsOf 193 patients prescreened, 181 (93.8%) were excluded due to at least one criterion. Key factors included lack of MT deliverability (49.2%), a not truly infected effusion (45.1%) and contraindications to drainage or study involvement (44.0%). Consequently, the primary feasibility endpoint was not met. All 12 eligible patients were randomised with no attrition. MT lasted 15 min longer than drain insertion, but chest drains remained in situ over 3 days longer (p=0.17) with a longer hospital stay (p=0.57). Radiological improvement, microbiological yield and symptom scores were similar. Adverse events occurred in one control and three MT patients.ConclusionA full-scale RCT is not likely to be feasible in an NHS setting on the proposed protocol. Targeted recruitment from centres equipped for emergency MT may enhance feasibility.Trial registration numberISRCTN98460319.

To evaluate the clinical effectiveness and cost-effectiveness of the integrated Geriatric Emergency Medicine (iGEM) Short Stay Unit (SSU) model in the management of patients presenting from residential aged care facilities (RACF) to the Emergency Department (ED). This is a retrospective cohort study comparing patients admitted to the iGEM SSU in July 2024 (Cohort Ia) with matched contemporaneous (Cohort Ib) and historical (May 2024, July 2023) controls who met iGEM criteria but were managed under standard ED pathways. Inclusion criteria comprised geriatric RACF patients presenting with stable, low-acuity conditions such as uncomplicated infections, minor trauma, dehydration, or requiring transfusions suitable for short-stay management. A total of 531 geriatric patients from RACFs were included. A progressive improvement in service efficiency was observed with the iGEM SSU model. The average ED length of stay decreased from 18.3 h in July 2023 (Cohort III) to 6.5 h in July 2024 (Cohort Ia), accompanied by a reduction in inpatient admission rates (51% to 5.3%) and overall hospital LOS (8.1 days to 1.7 days). Quality outcomes also improved, with lower readmission and complication rates observed in cohort Ia compared with earlier standard-care cohorts, supporting the model's clinical efficiency. The iGEM SSU model was associated with greater efficiency, reduced inpatient admissions, shorter hospital length of stay, and potential cost savings compared to standard geriatric emergency care in this retrospective case-control study. These findings suggest that iGEM may help to alleviate ED pressures and optimise hospital resource utilisation without compromising patient safety.

This study aims to better understand factors driving the rising burden and costs of primary liver cancer (PLC) in Australia, identify key epidemiological trends, and ascertain investment in PLC research, relative to its disease burden. Funding statistics of the National Health and Medical Research Council and the Medical Research Future Fund were adapted from published reports. Grant-related statistics are based on applications containing the relevant search terms for each cancer. Epidemiological data in Australia are based on cancer reports of the Australian Institute of Health and Welfare. Cancer mortality data are based on those reported by the National Mortality Database. Compared to other common cancers, the incidence and mortality rates of PLC have increased in the past 10years and are more evident among populations of lower socioeconomic status, Indigenous Australians, residents in remote areas, and culturally and linguistically diverse populations. In contrast to the downward trend in disability-adjusted life years (DALYs) in other common cancers, PLC shows a significant increase in DALYs between 2015 and 2022; 23.3% of total DALYs loss occurred in those aged 40-59years. The health, social, and economic impacts are disproportionally reflected in research investment. In Australia, PLC is a significant health, social, and economic burden. Disparities between the burden of PLC and research investment reinforce the need for greater awareness and targeted investment. Collaborative efforts involving multiple stakeholders spanning policy, public health, implementation, and funded research are required to tackle the challenge.

Bronchiolitis is the leading cause of hospitalisation in infants under one year. While evidence-based guidelines exist, including the updated Australasian Bronchiolitis Guidelines (2025), variations in care persist. Improving care in regional and rural hospitals is challenging due to limited access to paediatric expertise and evidence-based resources, contributing to continued use of low-value interventions. This mixed methods study will use a human-centred design approach to co-design and evaluate the usability of the Regional and Rural Translation Bronchiolitis (RART-Bronch) platform, an interactive online tool targeted at non-metropolitan settings. The platform will feature bronchiolitis educational resources, implementation support, a benchmarking and feedback tool, and family education materials. Participants will be regional and rural clinicians and parents of infants hospitalised with bronchiolitis in these settings. Data will be collected through co-design meetings, usability surveys, semi-structured interviews, and think aloud methods. Engagement with the co-design process will also be evaluated. We will develop a user-friendly, evidence-based platform specific to regional and rural contexts that supports bronchiolitis guideline adherence and enhances clinical decision-making. Effectiveness will be evaluated in a future cluster randomised controlled trial and may inform future implementation strategies for improving care, quality and equity across regional and rural healthcare. This study aims to reduce variation in bronchiolitis care by co-designing an interactive online platform, RART-Bronch, with clinicians and parents from regional and rural settings. The platform aims to support sustainable reductions in low-value care and improve outcomes for infants with bronchiolitis. It will deliver evidence-based guidance to clinicians working in regional and rural hospitals with limited paediatric expertise. Findings will inform future implementation of tailored education, audit and feedback strategies in acute care. This work aims to enhance paediatric care quality in under-resourced settings and contribute to scalable, equitable improvements in bronchiolitis management across Australia.