Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver disease. Our retrospective audit of patients with cirrhosis presenting to the emergency department (ED) over a 2-year period with altered mental status found that 37% of computed tomography (CT) head scans were performed unnecessarily, yielding no abnormalities. Findings support limiting CT use in low-risk cases to reduce radiation exposure, ED duration and healthcare costs.

Sarcoidosis is a multi-system inflammatory disease characterised by granulomas, primarily affecting the respiratory system, but it has extra-thoracic involvement. Sarcoidosis may have different presentations and disease courses based on ethnicity; however, limited data exist on its differences in Māori and New Zealand (NZ) Europeans. To investigate the clinical characteristics, treatment and disease progression of sarcoidosis in Waikato District Health Board (DHB) patients, and compare these in Māori and NZ European ethnic groups. A retrospective cohort analysis was conducted using Waikato DHB electronic records (2019-2021) for 158 patients with confirmed sarcoidosis. Baseline demographics, radiologic grading, lung function and treatments were collected and analysed. Differences between Māori and NZ European patients were assessed using χ2, analysis of variance and Mann-Whitney tests, with P < 0.05 considered statistically significant. The cohort (mean age: 56 years; 17% Māori, 70% NZ European) exhibited high rates of co-morbidities, notably obesity (46%). There was extra-thoracic involvement in 39% of patients, which was commonly ocular and cutaneous. Diagnosis relied on radiological methods solely or endobronchial ultrasound transbronchial needle aspiration in most cases. Māori patients displayed significantly higher extra-thoracic sarcoidosis involvement (P = 0.045) and lower rates of lung fibrosis. No significant differences were found in lung function decline, respiratory-related hospitalisations or mortality between groups. Our cohort demonstrates heterogeneous staging and prevalent extra-thoracic manifestations. Māori patients have greater extra-thoracic involvement and lower lung fibrosis than European patients without significant differences in treatment or disease course but with significant metabolic comorbidities. Systemic steroids are well tolerated, but steroid-sparing agent use is limited.

The recent NEJM Evidence trial questioned the benefit of enoxaparin for venous thromboembolism (VTE) prevention among older hospitalised medical patients. We conducted a retrospective, observational audit of 142 elderly inpatients at a large Australian tertiary institution; most received enoxaparin unless contraindicated, with excellent adherence to guidelines. Clinical events were rare with two VTE (1.4%) and five minor bleeds (3.5%) recorded and no major bleeding observed. Approximately 10% of patients were ambulant and prescribed thromboprophylaxis outside guideline criteria, yet bleeding rates were low. Our findings suggest high guideline compliance and minimal bleeding associated with enoxaparin prophylaxis in this population. There is a need for simple and practical risk stratification tools with clear ambulation definitions, routine mobility assessments where appropriate and consideration of patient-accepted approaches such as oral thromboprophylaxis options.

Obstructive sleep apnoea (OSA) is common in Australia but underexamined among First Nations peoples. We conducted a retrospective cross-sectional analysis of 1563 adult sleep studies in South East Queensland (2022-2023). Thirty-eight participants (2.4%) identified as First Nations, of whom 74% had OSA. Comorbidities were more frequent among the First Nations cohort, though small sample size limited certainty. These findings reveal both under-identification of First Nations status and a substantial OSA burden, emphasising the need for culturally informed, community-led approaches to OSA care in Queensland.

Robust medicines governance is an essential component of good clinical governance for health service organisations. Standardisation of hospital medicines governance supports consistency in clinical care and equity in medicines access for patients both within those hospitals and at transitions of care. Medicines and Therapeutics Committees (MTCs) provide the strategic lead for medicines governance in Australian hospitals and have done so for many decades. Changes to the healthcare environment in which MTCs operate, however, have necessitated adaptation and evolution of these committees. Contemporary guidance is therefore required to support MTCs to provide consistent, high-quality medicines governance in Australia's modern healthcare environment. Achieving effective medicines governance: Guiding principles for the roles and responsibilities of Medicines and Therapeutics Committees in Australian hospitals was released in July 2025 with recommendations for the purpose, functions, structure, processes, documentation, communication and resourcing for Australian MTCs. The guidance is accompanied by a checklist to measure the performance of MTCs and other supporting resources. Australian hospital MTCs are encouraged to measure their practice against these guiding principles, using the associated tools, to achieve the best possible medicines governance within their available resourcing. Practice across jurisdictions is variable, and working to align individual MTC practices with the guiding principles will promote standardisation in approach to hospital medicines governance.

Niemann-Pick disease type C (NP-C) is the fifth most prevalent lysosomal disorder in Australia. Diagnostic delay is common, impacted by disease heterogeneity, limited awareness within clinical gateway services and exclusion from state-based newborn screening programmes. A formal diagnosis, once established, places a substantial burden on the whole family, the negative impact of which is far-reaching. A clear understanding of diagnostic pathways and management objectives in NP-C is critical for optimal care. To develop an Australian standard of care for individuals diagnosed with NP-C and their families, reflecting international best practice and tailored to the Australian healthcare system. The Australian NPC Disease Foundation Inc. convened a national, multidisciplinary collaboration including NP-C treating clinicians, allied health professionals and a community advisory group. Using an iterative consensus approach, published international guidance statements were reviewed, ratified, excluded or modified to align with the Australian context. Consensus outputs included a diagnostic algorithm, a multidisciplinary care framework and management-centred management statements. The collaborative process resulted in a unified Australian standard of care for NP-C. This framework incorporates the carer perspective, emphasises shared decision-making and situates NP-C within the broader context of 'childhood dementias.' Consensus statements provide practical, evidence-aligned guidance on early recognition, diagnostic referral pathways and multidisciplinary management throughout disease progression. This initiative represents the first Australia-specific standard of care for NP-C. It is hoped that adoption of the framework will lead to improved experiences for Australians living with NP-C and their carers as they navigate the healthcare setting.

Urinary albumin measurement is vital in the screening and monitoring of diabetic kidney disease, but is substantially under-performed. We analysed pathology data from St Vincent's Pathology, Melbourne, between 2022 and 2024 to assess urinary albumin-creatinine ratio (ACR) testing rates in diabetes. Among 19 198 adults, only 23.7% had ≥1 ACR value recorded. Testing increased with risk markers (age, male sex, high hemoglobin A1c, low estimated glomerular filtration rate) but remained low, underscoring significant screening and monitoring gaps.

This review of omalizumab use in chronic spontaneous urticaria (CSU) in Auckland City Hospital's immunology department in 2023 showed that rates of baseline investigations were high but did not clearly improve CSU management. There were associations between raised C-reactive protein and higher doses of omalizumab, and lower C-reactive protein and CSU remission. Most patients had angioedema and atopy. Median symptom duration was 5 years and the majority needed at least 1 year of omalizumab treatment. Fewer Māori/Pasifika patients in this cohort may reflect barriers to accessing health care.

The data that supports the findings of this study are available in the supplementary material of this article. Supplementary Table S1. High vs Standard/Other Dosing of Janus kinase Inhibitors. Derived from the “Monthly Index of Medical Specialties”, accessed November 2024. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Chronic respiratory diseases, including chronic obstructive pulmonary disease and asthma, pose substantial challenges to healthcare systems worldwide, which are projected to grow in coming years. Variations in care represent a threat to health equity and must be identified and remedied. Robust auditing systems can improve healthcare effectiveness and efficiency by identifying strengths and weaknesses in existing service models. The Australia New Zealand Respiratory Audit Programme (ANZRAP) is a new funded research and quality improvement programme commencing in 2025 aiming to improve quality of care, clinical outcomes and health service provision for people with respiratory illness across Australia and New Zealand. This paper describes the development, plans for implementation and likely outcomes of the ANZRAP.