Coronary artery calcium (CAC) scoring is increasingly recognised as a non-invasive tool to refine cardiovascular risk assessment, particularly in asymptomatic individuals at intermediate risk. However, its clinical use remains inconsistent, shaped by varying recommendations across international and local guidelines. This systematic review compares the major guideline documents from the Cardiac Society of Australia and New Zealand (CSANZ), the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC), focusing on three core endpoints: eligibility criteria, therapeutic thresholds and recommendations for repeat testing. While broad agreement exists on the utility of CAC scoring in intermediate-risk populations, key differences were identified. These include divergent definitions of risk, the use of formal recommendation frameworks and inconsistencies in guidance for pharmacotherapy initiation, particularly regarding statins and aspirin. The review also highlights a lack of clarity in the role of repeat scanning and variable alignment with national risk calculators. These differences may contribute to clinical uncertainty and inconsistent implementation. In the context of rising interest in precision prevention, further research evaluating CAC-guided decision-making is needed to help eventually achieve guideline harmonisation. Clearer evidence-based guidance is needed to support equitable and effective integration into routine cardiovascular risk assessment.

General internal medicine is a specialty that is heterogeneously implemented across the world. In some places, it includes physicians who have undergone basic internal medicine training with no subspecialisation, whereas in other places, these physicians undergo further training to become 'advanced internists' (with the corollary name of advanced internal medicine). General internists run inpatient medical wards and ambulatory care services, provide consultation to general practitioners and/or have their own primary care practice. Within the hospital, the role of the general internist had traditionally been ambiguous - often serving as a 'catch-all' medical service for patients deemed unsuitable to be managed under subspecialty teams. Over the years, different models of care within general medicine have been trialled to varying effects, ranging from the 'generalist-specialist' model (also known as the hospitalist model, where the general internist coordinates care for multimorbid patients with liaison with relevant subspecialties) and 'acute medicine' model (general medicine care only for the first 72 h of admission in an acute medical unit, after which patients who require continued admission go to a subspecialty) to the 'specialist-generalist' model (where all specialists are to care holistically for general medical issues beyond the specific condition that warrants subspecialty review). In this article, we advocate for a renewed framework of general internal medicine that focusses on managing undifferentiated, complex and multimorbid patients, providing clinical care that addresses prevailing gaps in hospital-based practice, developing robust hospital-at-home services and championing quality improvement, education and administrative excellence within the medical ecosystem.

Intestinal transplant is a rare procedure reserved for patients with intestinal failure who cannot be sustained on total parenteral nutrition due to severe, life-threatening complications. This study aims to describe the activity and outcomes of intestinal transplantation undertaken in Australia. Observational retrospective cohort study of all adult and paediatric patients who have received an intestinal transplant in Australia. The primary outcomes were patient and graft survival, with secondary outcomes including incidence of post-transplant enteral autonomy and post-transplant complications. Nineteen patients (14 adults, five children) received a total of 20 intestinal transplants in Australia between 2010 and 2026. One-year conditional graft and patient survival was 87% and 93% respectively, with 5-year conditional graft and patient survival rates of 67% and 75% respectively. The median time to cease total parenteral nutrition and achieve enteral autonomy after transplant was 21 days (interquartile range: 17-30 days). Median body mass index was within ideal range for adult patients by 12 months post-transplant and growth centiles improved for paediatric patients. Eight patients (40%) experienced a total of 14 episodes of rejection at a median onset of 7.5 months after transplant, of which five were graded severe. Rates of post-transplant lymphoproliferative disorder and graft-versus-host disease were low (5% each). The Australian Intestinal Transplant Service demonstrates excellent patient outcomes, with short- to medium-term graft and patient survival similar to that of leading international centres and enteral autonomy achieved in all patients. Intestinal transplant is now an acceptable, life-saving procedure in appropriately selected patients in our region.

Fatigue is a common and debilitating symptom in inflammatory bowel disease (IBD), yet it remains under-recognised in clinical practice. This study aimed to quantify fatigue among Australian patients with IBD and examine associations with disease control, psychological distress and quality of life (QoL). We conducted a cross-sectional study of adult patients with IBD at a tertiary centre. Participants completed four validated questionnaires: Functional Assessment of Chronic Illness Therapy-Fatigue, IBD-Control 8, Short Inflammatory Bowel Disease Questionnaire and Hospital Anxiety and Depression Scale. Associations between fatigue and other patient-reported outcomes were analysed, and multivariate regression identified independent predictors of fatigue. Of 1179 patients invited, 327 (28%) participated; 166 (51%) had Crohn disease, 152 (46%) ulcerative colitis and nine (3%) IBD-unclassified. Severe fatigue was reported in 46% of participants. Depression and anxiety were present in 29% and 41% of patients respectively. Fatigue was significantly associated with poorer disease control and QoL (P < 0.0001). On multivariate analysis, independent predictors of fatigue included depressive symptoms (β = -1.03, P < 0.0001), anxiety (β = -0.41, P = 0.003), reduced disease control (β = 0.70, P < 0.0001) and lower QoL (β = 0.23, P = 0.0006). Notably, in a subgroup of 55 patients (17%) with well-controlled disease, fatigue remained strongly linked with psychological distress and impaired QoL. Fatigue is highly prevalent in IBD and persists even among patients with good disease control. Psychological distress, poor disease control and reduced QoL are independently associated with fatigue, underscoring the need for routine screening and multidisciplinary management.

Safety concerns and medication shortages may influence prescribing practices in rheumatology. This study aimed to explore the impact of Janus kinase inhibitor (JAKi) safety warnings and the COVID-19 pandemic on biologic and targeted-synthetic disease-modifying antirheumatic drug (b/tsDMARD) prescription patterns from 2002 to 2024 in the western region of Melbourne. A retrospective audit was conducted on data from rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients who attended Western Health and Western Rheumatology clinics between 2002 and January 2024 inclusive. b/tsDMARD switching was analysed based on the first date of b/tsDMARD prescription using interrupted time series analysis, with ethics approval granted by the Western Health Office for Research (HREC/23/WH/101783). There were 3124 new b/tsDMARD prescriptions. Following the 2021 United States JAKi boxed warning, the JAKi prescription rate decreased to -0.04/month (-0.20, 0.11) from 0.30/month (0.18, 0.42), P = 0.002. Supply shortages during the COVID-19 pandemic led to 44 b/tsDMARD switches. The most common cause of switching was inefficacy (32.6% of new prescriptions for AS, 42.6% for RA and 46.1% for PsA (P < 0.001)). Less than 5.4% of new prescriptions were from adverse events, underscoring b/tsDMARD safety. b/tsDMARD switches were primarily driven by inefficacy. Black box warning issuance led to decreased JAKi prescriptions. The COVID-19 pandemic led to minimal b/tsDMARD switches. Switching due to adverse events was infrequent, highlighting the overall safety of b/tsDMARDs in clinical practice.

Immune checkpoint inhibitor(ICI) therapies have revolutionised the management of a range of malignancies. However, the syndrome of ICI induced cardiomyotoxicity, also reported as triple "M" syndrome (myasthenia gravis, myositis and myocarditis) is an unfortunate severe consequence in up to 1%-2% of patients receiving ICI, with an associated mortality of up to 50%. Based on international evidence and local experience, we have developed a clinical pathway in our institution as a guide to the early identification and targeted management of this condition.

Artificial intelligence (AI) is rapidly evolving worldwide, enabling greater flexibility and applicability to the field of language translation within healthcare. Australia is currently one of the most culturally and linguistically diverse countries in the world, creating a growing pressure on translators to ensure there is equitable and culturally safe access to healthcare services. Emerging research supports the use of AI as an adjunct to the current translator framework in being able to support low-risk communication tasks, such as appointment coordination or simple instructions, but it should be avoided in high-stakes contexts including informed consent or complex management discussions. Importantly, human oversight is needed to ensure clinical accuracy and patient safety during all translations.

Identification of appropriate patients for hospital-in-the-home (HITH) remains a significant challenge. We hypothesise that a human-centred design (HCD) approach can assist in developing a computerised clinical decision support system (CDSS) to address this issue via leveraging data within the electronic medical record (EMR). We describe the design, development, validation and implementation outcomes of the HITH Eligibility Identifier (HEI), a CDSS for identifying inpatients suitable for HITH in Melbourne, Australia. Approaches include: (a) describing digital algorithmic design and workflow development via the iterative HCD process; (b) validation of the HEI algorithm, interface and performance using Message Understanding Conference and Miettinen-Nurminen analyses; and (c) evaluation of system impact and outcomes post-implementation. The HEI CDSS integrates algorithmic decision support with clinician judgement through an interactive user interface embedded within the EMR. It ranks hospitalised patients from most to least likely eligible for HITH using administrative data, clinical information and markers of illness severity. Validation of HEI performance found that high-ranking patients were twice as likely to be eligible for HITH (improvement in eligibility probability of 46%; 95% confidence interval: 38%-54%). Post-implementation metrics show improvements in HITH utilisation, service delivery and efficiency. The HEI CDSS illustrates the importance of an HCD approach in ensuring local relevancy and clinical adoption of digital healthcare projects. Principles from its design and implementation can improve patient identification for HITH programs and be adapted for other CDSSsrelevant to hospitalised patient cohorts.