Mater Adult Hospital

The rising incidence of skin cancer places a significant burden on Australia's health workforce. To support workforce planning, we estimated the supply of dermatologists and general practitioners (GP) working in skin cancer medicine, service demand and need across Queensland in 2023. We built a supply-, demand- and needs-based health workforce model using publicly available data. We collated data on the numbers of clinicians and clinical full-time equivalents (FTE), Medicare-reported skin cancer services and melanoma incidence. We quantified health workforce supply and clinical workload, clinical FTE per 100,000 population, number of Medicare claims for skin cancer services per clinical FTE and incident cases of melanoma per clinical FTE for all of Queensland and across 19 Level 4 Statistical Areas. Queensland had 7179 GPs (852 adjusted FTE) and 124 (71 adjusted FTE) dermatologists servicing 5,527,369 residents, with an estimated 17 FTE skin cancer clinicians per 100,000 population. Ten (53%) SA4 areas had no dermatologists, with none residing in central or western Queensland. Seven of the nine SA4 levels with dermatologists were in southeast Queensland (78%), and 47% of all FTE dermatologists practised in Brisbane Inner City. GPs were well distributed relative to population size. Access to dermatology services is limited for Queensland residents living outside the southeast region, with few providers available within reasonable proximity. GPs are managing a growing skin cancer workload in Queensland. This could be eased by increased use of telemedicine, upskilling other health professionals in skin cancer medicine and improving care efficiency.

<title>Abstract</title> Climate change is one of the main threats to global food security that affects food availability, accessibility, utilisation, and stability at all levels, especially in Sub-Saharan Africa (SSA), including Tanzania, where the majority of livelihoods depend on rain-fed agriculture. This study explores the effects of long-term changes in climate variability on food security in Kongwa District, Dodoma Region, Tanzania, based upon four dimensions of food security: availability, accessibility, stability, and utilisation. A qualitative research method was used, and the data were obtained from semi-structured interviews, focus group discussions, and key informant interviews in the field with a total of 46 respondents from small-scale farmers, agricultural extension officers, and district agricultural officers. The results indicate that climatic variability, expressed by increases in temperature, erratic rainfall, prolonged droughts, and escalating incidence of pests and diseases, harms agricultural productivity and household food security. Crop yield losses, price rises, loss of food safety and nutritional value, as well as instability in food supply, have occurred due to the impact of climate change. While increased CO ₂ levels have some limited monetary compensation effects on yields, the positive effect is more than offset by negative impacts from extreme weather and land degradation. The study concludes that climate variability has greatly exacerbated food insecurity in Kongwa district and suggests specific adaptation and mitigation measures such as improved water management, investment in climate-resilient technologies, rural infrastructural development, and institutional support, as well as enhancing financial support for smallholder farmers to cope with food insecurity associated with climatic challenges.

Epilepsy is a prevalent chronic neurological disorder marked by recurrent seizures, affecting over 70 million people worldwide. This review offers an up-to-date guide for general physicians, general practitioners and general neurology trainees on diagnosing and managing epilepsy, emphasising the importance of early referral to specialist teams. It discusses the epidemiology, significant societal burden and common comorbidities-including cognitive, psychiatric and cardiovascular conditions-which contribute to reduced quality of life and increased mortality, including sudden unexpected death in epilepsy. The article outlines a structured approach to first seizures and their mimics, emphasising the role of electroencephalographyand neuroimaging in diagnosis. Medical management centres on seizure control through anti-seizure medications (ASMs), but up to one-third of patients develop drug-resistant epilepsy, necessitating specialist interventions such as epilepsy surgery or neuromodulation. Accurate seizure classification and tailored treatment plans, including consideration of ASM teratogenicity in women of childbearing age, are essential. Case vignettes illustrate complex scenarios requiring specialist multidisciplinary evaluation. This review reinforces that timely specialist input can significantly enhance outcomes in patients with challenging or refractory epilepsy.

Previous stage I-III colon cancer trials demonstrated improved peri-operative and similar long-term oncological outcomes with minimally invasive approaches compared with open surgery. Subsequent technical developments, including intracorporeal anastomosis, complete mesocolic excision (CME), refined pathologic grading systems and robotic approaches are increasingly used despite minimal supporting evidence. This international phase II trial aims to assess patient, surgical and pathological outcomes following robotic (RRHC) with laparoscopic right hemicolectomy (LRHC) for right sided colon cancer. Prospective, international multicentre pilot randomised phase II trial for patients with right colon adenocarcinoma, randomised 2:1 to robotic (RRHC) or laparoscopic (LRHC) surgery performed by accredited surgeons. Primary outcome was 90-day surgical morbidity measured using the Comprehensive Complication Index (CCI). Standardised pathology reviews, patient reported quality of life and surgeon task load index data was captured. RRHC vs. LRHC surgery allocation was 19 vs. 10, mean operative time 3.8 vs. 3.1 h with no operative mortality, all had R0 resection, CME rate 53 vs. 50% and intact mesocolon 94 v 100%. CCI was significantly lower at 30 and 90 days after RRHC (median (Q1, Q3): 0 (0, 9) vs. 21 (21, 26); median difference: 21; 95% CI 9-26; p = 0.005 at 30 days; p = 0.008 at 90 days). No significant differences in pathological nor quality of life data was observed. Surgeons task load data tended to favour robotic procedures. Median follow-up was 6 months. Limited funding led to early study closure. RRHC improved short-term surgical morbidity and surgeon physical demand and performance whilst obtaining similar quality of life and pathological specimen quality compared to LRHC for right sided colon cancer, supporting the case for larger randomised trials. ACTRN12620001378910.

Down syndrome (DS) is associated with an increased risk for an inflammatory arthritis termed Down syndrome-associated arthritis (DA). Clinical awareness of DA may prevent morbidity, but there is currently no consensus approach to screen for DA. A DS musculoskeletal (DS-MSK) screening tool was developed and piloted in clinics to identify inflammatory arthritis in individuals with DS. The prevalence of DA and the feasibility of the DS-MSK screening tool were also evaluated. Through a non-randomized, cross-sectional, multicenter study, patients with DS were enrolled by eight institutions that provide specialized comprehensive care to individuals with DS. A novel tool was developed to screen all patients for DA through DS-MSK history and DS-physical exam. Feasibility was assessed through the assessment of additional time the screening tool added to clinical visits. Of the 1111 participants with an average age of 10 years (SD 6.7), there were 1019 pediatric patients and 92 adult patients. There were 62 (6%) positive screens; of those, 21 (34%) were diagnosed with DA by a rheumatologist. Reports of joint swelling, redness, warmth, and stiffness were most associated with a diagnosis of DA. DA is an important consideration in the comprehensive care of individuals with DS. The condition can be aggressive and debilitating if misdiagnosed. We developed a simple, feasible DS-MSK screening tool that can identify DA. Future studies should focus on a shorter, less time-consuming tool that maintains positive predictive value for diagnosing DA that can easily be implemented into routine care for people with DS.

To evaluate whether adherence to an acute care bundle (ACB) for decompensated cirrhosis is associated with improved patient outcomes, including 90-day mortality, in an Australian tertiary hospital setting. This retrospective cohort study included all patients admitted with decompensated cirrhosis between June 2016 and March 2018 at a tertiary metropolitan teaching hospital. ACB adherence was assessed among six domains during the first 24 h of admission. Outcomes included in-hospital, 30- and 90-day mortality, hospital readmission and long-term survival. A total of 157 admissions from 85 patients were included. Median follow-up was 7 years, during which the overall mortality rate reached 74%. Short-term (30-day) mortality was not significantly associated with ACB adherence. However, 90-day mortality was significantly lower in patients with ≥70% adherence (13.8% vs 25.4%, P < 0.05) and ≥80% adherence (9.7% vs 25.9%, P < 0.01), independent of Model for End-Stage Liver Disease(MELD) score, Child-Pugh class or admitting team. No significant differences were observed in readmission rates or long-term survival. Greater adherence to ACB components in the first 24 h of admission was associated with improved 90-day mortality in patients with decompensated cirrhosis, regardless of disease severity or admitting service. These findings support the use of the ACB as a pragmatic quality improvement tool. Prospective validation is warranted.

We appreciate the insightful comments by Vos and colleagues on our expert position statement on the role of intestinal ultrasound (IUS) in luminal contents assessment [1]. IUS is a rapidly evolving area emerging as an alternative modality for the assessment of disorders of gut-brain interaction (DGBI) [2]. Patients with DGBI are exposed to more ionising radiation than healthy controls; IUS offers safety, cost effectiveness, and accuracy over conventional assessment methods [3]. Until recently, however, IUS for functional assessment has remained in the realm of paediatrics, with a paucity of adult studies and a lack of description or validation of sonographic parameters [4]. Our position statement [2] was intended to serve as initial guidance and a summation of current evidence. A narrative review has further summarised available evidence on luminal contents assessment [5]. A study performed in a DGBI cohort did not find a correlation between sonographic findings and symptoms, but did suggest that IUS was useful in identifying those patients who would benefit from therapy for constipation rather than treatment of diarrhoea due to identification of faecal loading [6]. Together, these set the scene for IUS in the assessment of luminal contents in clinical practice. However, they clearly illustrate knowledge gaps and the need for further research. Small studies have shown that IUS is as accurate as computed tomography [7, 8]. However, prospective, blinded, and centrally read studies are required to measure the accuracy and validity of IUS in measuring luminal contents, to improve reliability and uptake in both clinical trials and practice [9]. The Sonographic Examination and Assessment of Ulcerative Colitis Associated Constipation (SEE UCAC trial, ACTRN12622001207707) is the first prospective, blinded, and centrally read study to directly compare the accuracy of luminal contents assessment against CT scan with ultrasound. Interim results of 63 patients suggest close correlation between IUS and CT in assessing luminal contents as well as excellent inter-rater agreement between sonographic parameters [10]. The body of evidence supporting the use of IUS in clinical practice has remained in the assessment of inflammation, particularly in adults. It is now with great optimism that we see the increasing interest and growing potential of IUS in the assessment of DGBI and luminal contents emerging from the shadows into the spotlight. Ryan M. Mathias: conceptualization; writing – original draft. Thomas M. Goodsall: writing – review and editing. Claire E. Parker: writing – review and editing. Alice S. Day: writing – review and editing. Yoon K. An: writing – review and editing. Brandon Baraty: writing – review and editing. Chamara Basnayake: writing – review and editing. Jakob Begun: writing – review and editing. Ray K. Boyapati: writing – review and editing. Rebecca Burgell: writing – review and editing. Michael T. Dolinger: writing – review and editing. Giovanni Maconi: writing – review and editing. Kerri L. Novak: writing – review and editing. Shintaro Sagami: writing – review and editing. Rebecca L. Smith: writing – review and editing. Ashish R. Srinivasan: writing – review and editing. Stuart A. Taylor: writing – review and editing. Vipul Jairath: writing – review and editing. Christopher Ma: writing – review and editing. Robert V. Bryant: writing – review and editing; Supervision. The authors declare no conflicts of interest. This article is linked to Mathias et al. papers. To view these articles, visit https://doi.org/10.1111/apt.70250 and https://doi.org/10.1111/apt.70300. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.