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Feedback is fundamental to surgical training, underpinning skill acquisition, clinical decision-making, and the development of safe, competent surgeons. Despite its recognised importance, the consistent delivery of high-quality, effective feedback remains a significant challenge within busy clinical environments, including those in Australia and New Zealand (ANZ). This paper synthesises current evidence to provide practical guidance for surgical educators and trainees. A literature review was conducted using major biomedical databases (PubMed/MEDLINE, Embase) focusing on feedback in postgraduate surgical education. Search terms included "feedback," "surgical training," "surgical education," "assessment," "performance," and specific feedback models. The review synthesised evidence on feedback models, effectiveness, implementation challenges, best practices, the role of technology, and factors pertinent to the ANZ context. Results/Key Principles: Effective feedback appears to be timely, specific, based on direct observation, objective, actionable, and delivered respectfully within a supportive relationship. While various models exist (e.g., Pendleton, SET-GO (What I Saw, what Else did I see, what Thinking was involved, what Goals arise, Offers/Opportunities)), their optimal application depends on context and goals. Key challenges include time constraints, inconsistent supervisor skills, inadequate observation, and cultural factors impacting feedback exchange. Best practices involve establishing psychological safety, collaborative goal setting, and focusing on behaviour. Simulation and video review offer valuable adjuncts for feedback delivery outside the operating theatre. Specific considerations for ANZ include the The Royal Australasian College of Surgeons (RACS) training structure and geographical diversity. Optimising feedback in surgical training requires a multifaceted approach, moving beyond ad-hoc comments towards structured, evidence-based practices. Implementing established principles, training supervisors, leveraging technology, and fostering supportive institutional cultures are crucial steps for enhancing surgical performance and patient safety in the Australasian setting and potentially internationally. This synthesis provides actionable strategies for surgeons, trainees, and educators committed to improving surgical education outcomes.

Asparaginase is a critical component of modern multi-agent chemotherapy regimens for paediatric acute lymphoblastic leukaemia and lymphoblastic lymphoma, with inadequate exposure leading to inferior patient outcomes. To develop a clinical practice guideline for the use of asparaginase products in the Australasian context. This clinical practice guideline was developed following consultation and a review of the available published data and is designed to standardise treatment across the region. This paper reports the position of the Australian and New Zealand Children's Haematology/Oncology Group (ANZCHOG) on key areas including established and new asparaginase products and their use in Australasia, monitoring and interpretation of serum asparaginase activity, care in the setting of hypersensitivity and management of suboptimal asparagine depletion. This clinical practice guideline will assist clinicians in the Australasian region who provide care to children, adolescents and young adults receiving asparaginase therapy.

The inauguration of the Australian Association of Neurologists 75 years ago in October 1950 was a major event in the history of Australasian neurology. Already behind many of the world centers in terms of professional organization and leadership, Australian neurology arrived rather late on the international scene, firmly establishing its professional roots a full half-century after many global counterparts. Yet from the vantage point of today, this lapse in professional formation is hardly noticeable. An important reason for this discrepancy is the determination and vision of the founding generation of Australian neurologists. Two central players in particular-Leonard Bell Cox (1894-1976) and Edward Graeme Robertson (1903-1975), both Melbournian neurologists-are frequently credited with first forming the Association. By reviewing primary sources recording their individual influences and important contributions to the Association, we come to find some of the earliest indicators of its future prosperity and success.

Allogeneic stem cell transplantation (AlloSCT) has established curative potential in mantle cell lymphoma (MCL). As therapies for MCL evolve, outcomes with AlloSCT require reassessment. This study aimed to report the outcomes of AlloSCT for MCL across Australia and New Zealand. Data were collected through the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR) for all patients undergoing AlloSCT for MCL between January 2009 and December 2019. Forty-six patients underwent AlloSCT for MCL between 2009 and 2014 and 40 between 2015 and 2019. The median patient age was 56 years (range 32-72), nine of 15 patients tested (60%) had TP53 mutation, and 14% of patients underwent myeloablative conditioning (MAC). A higher proportion of patients in the 2015-2019 period were BTKi-exposed (68% vs. 0%, P = 0.00). Non-relapse mortality (NRM) at 1 year and 5 years was 23% (95% confidence interval (95% CI) 14-32) and 31% (95% CI 21-42) respectively. The 100-day cumulative incidence of grade II to IV acute graft-versus-host disease (GVHD) was 21% (95% CI 13-30), and the 3-year cumulative incidence of chronic GVHD was 31% (95% CI 22-41). At 5 years, overall survival (OS) was 48% (95% CI 36-59) and progression free survival (PFS) was 38% (95% CI 27-50). The use of MAC was independently associated with inferior PFS (hazard ratio [HR] 2.33, 95% CI 1.05-5.17, P = 0.038) and OS (HR 3.11, 95% CI 1.39-7.00, P = 0.006). There was no difference in outcomes for patients transplanted between 2009 and 2014 versus 2015 and 2019. AlloSCT can achieve durable remissions for MCL in the modern era, and the use of MAC is associated with inferior outcomes.

Coastal wetlands in Fujian, eastern China, are an important component of the regional wetland system of south-eastern China and function as a key node along the East Asian-Australasian Flyway (EAAF). As a key segment of this migratory corridor, coastal wetlands in Fujian support substantial populations of migratory waterbirds by providing essential breeding habitats, stopover sites and stable overwintering refuges. Notably, coastal wetlands in Fujian support several IUCN threatened species, including the Endangered Platalea minor (Temminck & Schlegel, 1849) and Anser cygnoides (Linnaeus, 1758), as well as the Vulnerable Aythya ferina (Linnaeus, 1758) and Chroicocephalus saundersi Swinhoe, 1871. Therefore, maintaining the ecological integrity of coastal Fujian is critical for conserving biodiversity at regional and broader scales.This dataset originates from a synchronised survey of wintering waterbirds conducted in coastal Fujian Province, China, in February 2006. The survey aimed to assess the distribution and abundance of waterbirds across the coastal wetlands of the region. The geographical extent of the survey ranged from 23°43'N to 27°17'N and from 117°19'E to 120°18'E, covering a total area of 2,657.56 km². Systematic observations were conducted at 191 fixed survey points within 21 wetlands, encompassing 25 wetland nature reserves. In total, 108,125 waterbirds were recorded during the survey, including 102,036 identified individuals belonging to 64 species and 39 genera. The top 10 species accounted for 84% of all individuals, comprising four shorebirds, three ducks, one gull, one egret and one cormorant. All records have been organised according to the Darwin Core standard, ensuring data comparability and reusability. This dataset provides essential information on the distribution patterns and abundance of wintering waterbirds in coastal Fujian, supporting long-term monitoring of species distributions and population dynamics, as well as waterbird conservation planning and policy-making. Here, we present a comprehensive dataset on waterbirds from coastal wetlands in Fujian, China. The dataset comprises 64 waterbird species and 108,125 individuals recorded at 21 coastal wetland sites in February 2006. All observation records have been standardised following the Darwin Core format and the dataset has been made publicly available via the Global Biodiversity Information Facility.

BackgroundThe recent global shortage of sterile saline highlighted a lack of published information and guidance regarding the components used in tumescent anaesthesia (TA) for endovenous interventions of venous disease. The aim of this study was to identify current practices in the usage of TA.MethodsAn online survey was sent to members of the Australasian College of Phlebology and the mailing list of the International Union of Phlebology.Results87 medical practitioners either partially or fully completed the survey, with the majority of respondents being Phlebologists (54%). The vast majority of survey participants use lignocaine (92.5%), adrenaline (55%), sodium bicarbonate (67.1%) in a base fluid of sterile normal saline (90.8%) in the preparation of TA. The majority of administration was through mechanical pumps (68.1%), with 27.8% using syringes. 21.7% reported reusing the same tumescent bag for more than one patient. Only 36.2% obtained consent specifically for TA. Two thirds recorded the anaesthetic dose, as mg/kg (23.5%), or total dose (45.6%) Only 40.6% of participants reported storing intralipid. 7.9% of respondents in this survey had experienced Local Anaesthetic Systemic Toxicity, with one death reported.ConclusionsThe survey identified some variability in the volume of components used, and considerable variability in consenting practices, documentation, patient observations, the storage of Intralipid and the re-use of single use intravenous fluid bags between patients.

Very preterm infants (<32&#x2009;weeks gestation) have an undeveloped primary endogenous circadian rhythm and are deprived abruptly of vital maternal circadian inputs after delivery. Postnatal care in neonatal intensive care units is characterised by constant levels of lighting and noise. Stress arising from disrupted cues for circadian rhythmicity likely disrupts development of coordinated circadian rhythms critical for neurogenesis, organ growth and development. We hypothesise that cycled environmental light and noise commenced soon after birth and continued until discharge home will improve cognitive outcomes compared with infants whose postnatal care comprises constant light (bright or dim) and constant noise. Australasian multicentre, two-arm, parallel-group, prospective, randomised, open, blinded-endpoint superiority trial in 868 infants born less than 32 weeks' gestation. Infants are randomised to cycled environmental light and noise or routine care in a non-cycled hospital environment from soon after birth until discharge home. The intervention comprises wearing eye-masks and ear plugs from 20:00 to 6:00, followed by removal of these devices and exposure to normal environmental noise and 300-600&#x2009;lux light from 6:00 to 20:00. The primary outcome is composite cognitive score on Bayley-4 developmental assessment at 2 years corrected postnatal age. The trial is approved by the Child and Adolescent Health Service Human Research Ethics Committee under the National Mutual Acceptance Scheme in Australia. Infants are randomised to intervention or control group after informed parental consent is obtained. Results of the CIRCA DIEM Study will be disseminated widely via presentations at local, national and international conferences, publication in international peer-reviewed journals and inclusion on the study website. Information about trial findings will also be communicated directly to the parents/guardians of trial participants through the regular study newsletter. The trial investigators will seek opportunities to communicate study results to the lay public through media and social media avenues. ANZCTRN12618000371291.

ASCOLT compared adjuvant aspirin versus (vs) placebo in 1587 patients with colorectal cancer (CRC) and reported no significant improvement in disease-free survival (DFS). Subsequently, two randomised controlled trials (RCTs) reported benefit of adjuvant aspirin in CRC patients with somatic PI3K-related mutations. The ASCOLT Translational Research (TR) study was a preplanned subgroup analysis by PIK3CA mutation status and COX-2 overexpression, and an exploratory analysis including PTEN mutation status. Among 778 participants who commenced study medication, tissue was evaluable for targeted next generation sequencing of PIK3CA and PTEN in 289 tumours and by Sanger sequencing for PIK3CA exon 9 or 20 (9/20) mutations in a further 108. PTGS2/COX-2 expression was assessed by immunohistochemistry in 450. Hazard ratio (HR) and 95% confidence intervals (CI) for DFS of aspirin vs placebo in subgroups were assessed in Cox models. A systematic review of completed RCTs of adjuvant aspirin in CRC patients with PIK3CA mutations was also undertaken. NCT00565708 and ACTRN12614000513617. Among 397 patients with tumour assessable for PIK3CA, there were 80 recurrences, 40 deaths and 86 DFS events after 5 years follow-up. Among 69 (17%) with PIK3CA mutations (any exon), there were 8 vs 8 DFS events on placebo vs aspirin (HR 0.93 (95% CI 0.35-2.47); in 45 (11%) with exon 9/20 mutations, 7 vs 4 events (HR 0.72 (95% CI 0.21-2.46) and in 84 (21%) with PIK3CA or PTEN mutations, 8 vs 9 events (HR 1.23 (95% CI 0.47-3.19). Tumours were positive for COX-2 overexpression in 307 (69%) with 28 vs 34 events (HR 0.99 (95% CI 0.60-1.63). A meta-analysis of trials in patients with PIK3CA exon 9/20 mutations showed reduced DFS events with HR 0.61 (95% CI 0.39-0.96). In ASCOLT TR, adjuvant aspirin was not associated with significantly improved DFS in CRC with PI3K-related mutations or COX-2 overexpression, albeit with wide confidence intervals. Combined results of the three published trials showed improved DFS among patients with PIK3CA exon 9/20 mutations. Moderate, but important, effects of aspirin in other patient groups have not been excluded. National Health and Medical Research Council, Australia; Cancer Australia; National Cancer Centre Singapore Cancer Fund; Rising Tide Foundation; SingHealth Duke-NUS Academic Clinical Programme; Lee Foundation; Lee Kim Tah Foundation; Silent Foundation; Australasian Gastro-Intestinal Trials Group.

Wild waterfowl constitute the primary natural reservoir of influenza A viruses, and wetlands at the convergence of major migratory flyways serve as critical hubs for viral genetic exchange. Baikal Siberia, situated at the intersection of the East African-West Asian, Central Asian, and East Asian-Australasian flyways, represents a unique yet understudied region in this context. Here we report the results of long-term virological surveillance of wild birds in the Lake Baikal basin conducted between 2018 and 2024. A total of 1036 cloacal swab samples from 28 bird species were screened, yielding 42 influenza A virus isolates belonging to 12 HA/NA subtype combinations: H1N1, H3N1, H3N2, H3N5, H3N6, H3N8, H4N6, H6N1, H6N2, H6N3, H6N8, and H12N5. Among the detected subtypes, H6 viruses-identified with four distinct neuraminidase combinations (N1, N2, N3, N8)-are of particular public health relevance owing to their documented capacity for dual-receptor binding and potential for zoonotic transmission to mammals, including humans. Full-genome sequencing followed by cluster analysis of internal gene segments identified 16 distinct segment constellations, indicating extensive reassortment. BLAST searches against the GISAID database revealed closest genetic relatives in Mongolia, South Korea, Japan, China, and Western Siberia, with more distant links to Bangladesh, Europe, and a possible intercontinental connection via the Pacific flyway. Maximum-likelihood phylogenetic analysis of the HA and NA segments confirmed that all isolates belong to the Eurasian genetic lineage, yet they are distributed across multiple clades rather than forming a single monophyletic group, reflecting the role of Buryatia as a mixing zone for genetically diverse viral populations. These findings substantially expand the understanding of influenza A virus ecology in the Lake Baikal basin and underscore the importance of continued surveillance at this key migratory crossroads in Northern Asia.

The incidence of early-onset colorectal cancer (CRC), commonly defined as diagnosis prior to age 50, is increasing. Studies of patients diagnosed prior to age 35 as a distinct subset of all early-onset patients have yielded inconsistent results. We extracted prospectively collected data from consecutive patients with metastatic colorectal cancer (mCRC) entered in the multi-site Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) Australasian registry. We focused on comparing demographic and clinicopathologic characteristics of those diagnosed <&#x2009;35Y with remaining early-onset patients (35-49Y) whilst including a comparison to older patients (&#x2265;&#x2009;50Y) as a reference point. Molecular data were examined from 2015 when testing became reflexive. From July 2009 to December 2023, we identified 4399 patients with mCRC, including 133 (3.0%) <&#x2009;35Y, and 537 (12%) 35-49Y. The proportion of <&#x2009;35Y among newly diagnosed mCRC increased per calendar year (odds ratio 1.07, 95% CI 1.02-1.11). Gender, ECOG performance status and primary tumour location were similar for <&#x2009;35Y and 35-49Y. Compared to 35-49Y, <&#x2009;35Y had more de novo metastatic disease (79% vs. 70%; p&#x2009;=&#x2009;0.04), BRAF V600E mutations (32% vs. 10%, p&#x2009;<&#x2009;0.001) and deficient mismatch repair (dMMR) tumours (9.8% vs. 2.8%, p&#x2009;=&#x2009;0.008). Rates of chemotherapy, rates of liver resection and overall survival (OS) were similar between <&#x2009;35Y and 35-49Y. Multiple differences were observed between <&#x2009;fand 35-49Y, most notably a higher rate of BRAF V600E mutations and dMMR cancers. Collectively, these findings may inform the interpretation of clinical outcomes, refine screening approaches and advance understanding of CRC tumorigenesis in younger patients.

Around half of children admitted to hospital receive intravenous (IV) antibiotics, contributing to higher costs, vascular access complications and longer hospital stays. A single-site pilot in a tertiary Australian paediatric hospital implemented nationally endorsed Australasian Stewardship of Antimicrobials in Paediatrics (ANZPID-ASAP) IV-to-oral antibiotic switch guidelines, improving timely switch rates from 64% to 82%. Following this success, a broader study is planned to assess the feasibility of scaling this approach across hospitals of varying types and sizes within NSW, Australia. The HOMEFREE study hypothesises that implementation of an IV-to-oral antibiotic switch programme based on endorsed guidelines and supported by audit and feedback will increase the proportion of hospitalised children transitioned to oral therapy or antibiotic cessation within 24&#x2009;h of meeting eligibility criteria. The study will evaluate both effectiveness and implementation feasibility across tertiary paediatric and general hospitals in metropolitan and rural/regional settings. This paper presents the study protocol. Participating sites will select context-appropriate interventions to support guideline-concordant prescribing, informed by shared learning during the prospective phase. Effectiveness will be assessed using prospective audits, with key outcomes including timely guideline-concordant IV-to-oral switch and hospital length of stay. Implementation feasibility will be evaluated using the Consolidated Framework for Implementation Research through surveys of local project committee members conducted before and after 12&#x2009;months of audit and feedback. This study will assess the effectiveness and feasibility of translating and scaling best-practice IV-to-oral antibiotic switch guidelines for children in real-world hospital settings.

Emergency physicians (EPs) are acquiring ever-increasing expertise in cardiac point-of-care ultrasound (POCUS). We compiled this case series to demonstrate current practice by EPs diagnosing infective endocarditis (IE) using POCUS. This case series outlines 19 cases of IE diagnosed in the Emergency Department (ED) by Australasian EPs. It is a retrospective review of cases occurring between 2013 and 2022. Our cohort's characteristics: 84% male, with a mean age of 42, and 79% were&#xa0;people who inject drugs (PWID) intravenously. Left heart valves were affected in 68% of patients, with Streptococcus viridans species (37%) and methicillin-sensitive Staphylococcus aureus (MSSA) (53%) being the commonest pathogens identified on blood culture. Mean duration of acute hospitalisation was 30&#x2009;days, and the mortality rate was 21%. Echocardiographic diagnosis of IE by EPs is occurring with increasing frequency, and we expect this trend to accelerate further as skillsets and machine image quality improve. Early diagnosis of IE in the ED has high potential to reduce morbidity and mortality in this vulnerable patient group. Further research is needed to determine the sensitivity and specificity of EP-performed cardiac POCUS for identification of vegetations.

BackgroundCoronary artery bypass grafting (CABG) is associated with significant morbidity and mortality. Traditional risk scores, such as the Society of Thoracic Surgery (STS) and EuroSCORE II, have limitations in predicting outcomes, particularly in high-risk patients. Machine learning (ML) models may address these issues by detecting nuanced data patterns not captured by conventional methods. This systematic review and meta-analysis compared the efficacy of ML models with traditional risk scores in predicting outcomes after CABG.MethodsA comprehensive literature search of records up to August 14th 2025, was conducted using PubMed, Embase, Web of Science, and the Cochrane Library. Studies included used ML algorithms and traditional risk scores to predict all-cause mortality (in-hospital, 30-day, or longer term as reported by each study) following CABG. Data extraction and quality assessment were independently performed by two reviewers. Meta-analyses were conducted using a linear mixed-effects model, with C-statistics as the primary measure of discrimination.ResultsTwenty-six studies, comprising 565&#xa0;063 participants, met the inclusion criteria. The pooled C-statistic for ML models was 0.82 (95% CI 0.79-0.85), significantly higher than the 0.73 (95% CI 0.71-0.76) for traditional risk scores (P < 0.0001). The top-performing ML model achieved a C-statistic of 0.98 (CI 0.95-1.00). Calibration was reported inconsistently across studies and was synthesised narratively rather than quantitatively. Where reported, ML calibration was generally adequate but a robust head-to-head comparison with traditional risk scores was not possible. Subgroup analyses revealed consistent superior performance of ML models across various algorithms and covariate sets.ConclusionsIn this meta-analysis of predominantly internally-validated models, ML approaches showed higher pooled discrimination than traditional risk scores for mortality after CABG. However, given the small number of pooled studies, very high between-study heterogeneity (I2 = 98%), the predominance of high risk-of-bias studies, and the scarcity of external validation, these findings should be interpreted as supporting the promise of ML rather than establishing proof of clinical superiority. Confirmatory prospective, externally validated studies are required before ML can be recommended for routine pre-operative risk stratification.

Lung cancer is significantly more common in patients with idiopathic pulmonary fibrosis (IPF) than the general population. Whether this risk extends to other fibrotic interstitial lung diseases (ILDs) including hypersensitivity pneumonitis (HP) and connective-tissue disease ILD (CTD-ILD), remains uncertain. We aimed to characterise lung cancer prevalence and incidence across ILDs. We conducted matched case-control and cohort analyses using the Optimum Patient Care Research Database. Adults with incident ILD were matched up to 1:4 to controls by age, sex and practice. Pre-existing lung cancer was examined using conditional logistic regression. Lung cancer incidence rates were analysed using Fine-Gray competing-risk models. Analyses were conducted overall and by ILD subtype. We evaluated 15&#x2009;777 people with ILD (10&#x2009;030 IPF, 4347 CTD-ILD, 1400 HP) and 62&#x2009;417 controls. Prevalence of lung cancer at index date was 1.3% in ILD versus 0.4% in controls (OR 2.68, 95% CI 2.21-3.23). During follow-up (median 3.0 years, interquartile range 1.3-5.4), 540 (3.5%) ILD cases and 790 (1.3%) controls developed lung cancer. The incidence rate was 963.43 in ILD versus 367.57 in controls per 100&#x2009;000 person-years with a sub-distributional hazard ratio (sHR) of 1.93 (95% CI 1.72-2.17). Lung cancer risk was elevated in cases with IPF (sHR 2.36, 95% CI 2.08-2.69) and CTD-ILD (sHR 1.78, 95% CI 1.48-2.14) but not HP. Findings were consistent in never-smokers. A strong relationship between ILD and lung cancer exists, with increased risk in CTD-ILD and IPF compared to the general population. Findings of this study support consideration of targeted lung cancer surveillance within ILD management paradigms.

Carrier screening aims to identify couples at risk of having children with serious genetic disorders. However, screening panels vary markedly in size, gene content and price, with little guidance to assess clinical utility or value. We analysed 89 carrier screening panels from 30 global providers, modelling test performance using pathogenic variants from gnomAD v4.1.0 and ClinVar across ten ancestry groups and two synthetic populations (representing the United States and Australia). We evaluated how panel size, content, price and clinical utility interrelate. We also compared value per dollar spent to guide clinical decision-making and fair pricing. Clinical utility showed no consistent relationship with panel size or price. Instead, mid-sized, pan-ancestry "Goldilocks" panels delivered the greatest utility, outperforming both smaller and larger panels, while delivering more equitable outcomes. We developed a visual "clinical utility meter" to compare relative test performance and an "efficiency frontier" framework to identify the best value tests for a given price. This data-driven framework and visual tool can support rational test design and selection for value-based laboratory medicine.

Radical salvage surgery offers the only chance of cure for patients with locally recurrent rectal cancer (LRRC), yet up to 50% develop disease recurrence after surgery. Identification of those at highest risk of disease recurrence may improve selection for surgery and intensification of neoadjuvant treatment. This scoping review aimed to identify molecular determinants of oncologic outcomes following surgery for LRRC. This study was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. MEDLINE, Embase, CENTRAL, and Scopus databases were searched for articles published between 2005 and 2025 that reported associations between blood, tissue, or other molecular factors and postoperative oncologic outcomes (recurrence and survival) in patients undergoing treatment for LRRC. The search identified 2799 articles, of which 17 were included. Sample size varied from 21 to 213 patients. Locoregional recurrence rates after surgery ranged from 15% to 52% (various timepoints between 3 and 5 years), while 5-year overall survival ranged from 22% to 53%. Elevated carcinoembryonic antigen (CEA) was associated with shorter overall survival in 11 studies, and poorer relapse-free survival in 1 study. Elevated serum carbohydrate antigen 19-9 (CA19-9) was associated with shorter overall survival and disease-specific survival in two studies. No studies evaluating contemporary biomarkers (mutational profile, microsatellite instability, or circulating-tumour DNA) were identified. Evidence evaluating molecular biomarkers in LRRC is limited and has focused on traditional serum biomarkers such as CEA and CA19-9. Contemporary colorectal cancer biomarkers including mutational profile and ctDNA are yet to be studied in this population.