Over the last 3 decades, Australian general practice has undergone profound digital transformation. From handwritten prescriptions and paper files to comprehensive practice management systems, each technological wave has promised efficiency while introducing new layers of complexity.

Over the last 3 decades, Australian general practice has undergone profound digital transformation. From handwritten prescriptions and paper files to comprehensive practice management systems, each technological wave has promised efficiency while introducing new layers of complexity.

The COVID-19 pandemic acted as a catalyst, embedding telehealth and e-prescriptions as core elements of routine care. The emergence of cloud systems and artificial intelligence represents a new frontier, offering opportunities to streamline workflows and refocus care on the patient. Drawing lessons from past implementation efforts, this paper argues that success will depend on designing technologies grounded in usability, interoperability, equity and trust to ensure that innovation strengthens rather than fragments the therapeutic relationship.

The spread of misinformation during the COVID-19 pandemic highlighted the importance of evidence-based information. The SANGYAN podcast promotes evidence-based knowledge on health-related issues in multiple languages in a simple, cost-effective, and concise manner. This provides individuals access to the appropriate information in an accessible manner.

The study's goal is to assess user preferences for health information on a digital health platform designed to address COVID-19 misinformation.

SANGYAN was developed by integrating the principles of social cognitive theory and information processing theory. The SANGYAN podcast was created to promote the importance of evidence-based information in order to address the spread of misinformation. The study design was a quasi-experimental study; prior to introducing the SANGYAN podcast, participants' sociodemographic information was collected, and health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine, Revised scale. After listening to the podcast, participants were interviewed about its usability, and they completed the System Usability Scale and the Client Satisfaction Questionnaire - 8. Data were collected from a total of 500 participants, 250 each from the Rural Health Training Center and Panimalar Medical College Hospital & Research Institute. The participants were older than 18 years when they were included. Descriptive and bivariate analyses were performed.

A total of 500 participants were enrolled in the study, 50% (250/500) from rural areas and 50% (250/500) from urban areas. The majority of the participants were 45 years to 64 years old (155/500, 31%), were women (289/500, 57.8%), had poor health literacy (384/500, 76.8%), and had a high school education or less than a high school certification (241/500, 48.2%). The mean overall System Usability System score was 70.9 (SD 17.73), with those aged 18 years to 24 years having the highest mean score (81.2, SD 15.48). High user satisfaction was present, with 97.6% (487/499) obtaining the desired information from the platform.

The study revealed that the SANGYAN podcast provides information to diverse individuals, as it is multilingual, and was found useful by the participants.

This study aims to describe the epidemiology, clinical features, microbiology and management of paediatric patients (<18 years) admitted to Christchurch Hospital with periorbital or orbital infections over a 10-year period.

A retrospective review was conducted of all patients under 18 years admitted with periorbital and orbital infections between 2013 and 2023. Cases were identified using surgical theatre records and discharge coding, with data extracted from electronic medical records. Clinical, demographic, microbiological and management data were analysed descriptively.

A total of 495 paediatric cases were identified, with 93% presenting with periorbital cellulitis and 7% with orbital cellulitis. Sinusitis was the predominant predisposing factor for postseptal disease, present in 83% of those cases. Orbital signs such as proptosis, pain with eye movement, reduced visual acuity and ophthalmoplegia were more frequent in orbital cellulitis. Orbital cases had longer hospital stays with a median of 4.5 days (range 2-33 days) compared to periorbital disease with a median of 1 day (range 0-8 days). Orbital cases also had a higher rate of surgical intervention (47%), most commonly functional endoscopic sinus surgery. Staphylococcus aureus was the most frequently isolated organism in both groups (45% periorbital, 42% orbital). Māori and Pacific children were disproportionately affected (comprising 20% and 10% respectively of periorbital cases and 17% and 19% of orbital cases).

The presence of orbital signs should prompt urgent imaging to exclude orbital disease. Sinusitis remains a key risk factor for orbital cellulitis, and Māori and Pacific children are disproportionately affected.

The expansion of telehealth services, particularly during the COVID-19 pandemic, has transformed health care delivery in the United States. Telehealth promises greater access and resource efficiency by reducing wait times and appointment lengths, especially in specialties like psychiatry, behavioral health, bariatrics, and sleep medicine. However, disparities exist in adoption based on demographics, geography, and socioeconomic status, raising concerns about equitable access and optimal resource use.

This study aims to evaluate how telehealth impacts health care resource use across 4 specialties by examining 2 key metrics: patient-to-provider ratios and appointment durations. It seeks to understand how factors such as patient demographics, facility characteristics, and social determinants influence telehealth adoption and efficiency using a national dataset spanning from 2018 to 2023.

We analyzed a deidentified dataset from Epic Cosmos, covering outpatient visits across 48 US states (2018-2023). After data preprocessing and feature engineering, we applied 3 machine learning (ML) models (random forest, extreme gradient boosting, and deep neural networks) to predict resource use. Using the model performing the best, feature importance was assessed using Shapley Additive Explanations values. We then used k-means clustering to group facilities into clusters per specialty. Comparative analyses were conducted to evaluate differences in use among clusters, during and after the pandemic.

Telehealth use peaked in 2020 and has remained above prepandemic levels since then. In 2018-2023, telehealth adoption reached 36.9% (4,543,021/12,311,710) in psychiatry, 23.9% (5,321,099/22,264,013) in behavioral health, 21.2% (924,333/4,360,061) in bariatrics, and 16.8% (851,803/5,070,256) in sleep medicine. Telehealth visits were consistently shorter than office visits (mean reduction 12.24 minutes; SD 3.33 minutes; P=.18), while patient-to-provider ratios varied significantly across specialties. Among ML models, extreme gradient boosting regression achieved the best performance (patient-to-provider ratios: R²=0.96-0.99; appointment durations: R²=0.61-0.69). Shapley Additive Explanations analysis identified visit type, telehealth use, facility size, rurality, and Social Vulnerability Index household vulnerability as the strongest predictors. Comparative analyses showed significant differences across clusters (all P<.05).

Telehealth has become a sustainable component of health care, enhancing access and efficiency across both rural and urban areas. However, its impact varies across specialties and regions, highlighting the need for targeted strategies such as staffing support for vulnerable populations, infrastructure investments in rural facilities, and reimbursement models that reflect telehealth's resource use. This study provides robust evidence from ML and clustering analyses, demonstrating how telehealth shapes resource use and offering actionable insights for equitable and sustainable integration.

Loneliness affects 12% of older adults globally, with concerns exacerbated by the COVID-19 pandemic. While digital health interventions (DHIs) show promise, evidence of their effectiveness remains mixed.

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted in the PubMed, Cochrane, Web of Science and Embase databases (2010-25). Inclusion criteria were adults aged 60 years, with loneliness as the primary or secondary outcome. Study quality was assessed using GRADE and Cochrane risk of bias tools. Subgroup analyses explored intervention type, measurement scales, national development level, pandemic timing and some secondary outcomes.

Seventeen studies (n = 2423) showed DHIs significantly reduced loneliness scores (standardized mean difference [SMD] = -0.39, 95% CI -0.77 to -0.01). Subgroup analyses revealed significant reductions for social cognitive training (SMD = -0.82, 95% CI -1.47 to -0.16). Greater effectiveness was observed in developed countries (SMD = -0.30, 95% CI: -0.51 to -0.09) and during the pandemic period (SMD = -0.54, 95% CI: -1.03 to -0.06). DHIs also improved mental health (SMD = 0.98, 95% CI: 0.12 to 1.84) and marginally reduced depressive symptoms (SMD = -0.73, 95% CI: -1.45 to 0.00).

DHIs show promise in reducing loneliness scores among older adults, particularly through cognitive-focused interventions in supportive digital environments. However, the overall effect is modest and highly heterogeneous, with benefits that appear context-dependent and short-lived. Future research should prioritise standardised measurement, diverse populations and long-term follow-up to optimise DHI design.

Intravitreal injections are an essential treatment modality for retinal vascular and macular diseases, yet nationwide evidence describing long-term trends, regional variation, drug composition, seasonality, and the impact of the COVID-19 pandemic in Japan remains limited. We conducted a nationwide retrospective observational study using aggregated National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data for fiscal years (FYs) 2017-2022 (April-March). Total intravitreal injection procedures were identified using procedure code G016, and drug-specific counts of aflibercept, ranibizumab, brolucizumab, and faricimab were extracted using drug codes. Crude utilization rates (per 100,000 population) were calculated using official population estimates. Annual trends were assessed using linear regression, regional variation was summarized descriptively and compared across predefined geographic groupings, monthly patterns were evaluated using Friedman tests, and the pandemic impact was examined by comparing FY 2019 (pre-COVID), FYs 2020-2021 (COVID period), and FY 2022 (post-COVID). National total intravitreal injection procedures (G016) increased from 600,068 in FY 2017-936,715 in FY 2022 (anti-VEGF injections: 591,469-929,704), corresponding to an average increase of approximately 65,000 injections per year. The mean crude utilization rates rose from 478.6 ± 109.2 to 775.7 ± 143.1 per 100,000 population, while relative inter-prefectural variability decreased modestly (coefficient of variation 0.228 to 0.184). Aflibercept remained the predominant anti-VEGF agent, with diversification after the introduction of brolucizumab (FY 2020) and faricimab (FY 2022). Monthly volumes showed modest seasonality, with higher counts toward the end of the fiscal year. Injection volumes showed no marked decline during the pandemic; April-May 2020 totals (119,100 injections) were only 0.9% lower than the same months in 2019 (120,202 injections). These findings indicate sustained growth in intravitreal injection activity in Japan, persistent but modestly narrowing regional variation, and maintenance of injection services during COVID-19.

Pulmonary rehabilitation (PR) for patients with chronic obstructive pulmonary disease (COPD) improves exercise tolerance and COPD assessment test score (CAT). Oxygen supplementation during PR facilitates exercise physiological benefits. This study aimed to assess the feasibility of a trial comparing two oxygen supplementation methods, with the hypothesis that both would be effective and produce distinct outcomes.

This double-blind, crossover, randomized controlled trial compared two PR programs-Program A (including PR under FiO₂ 0.3) and Program B (including PR under FiO₂ 0.5)-using high-flow nasal cannula oxygen therapy in patients with COPD and exertional dyspnea (n = 6). Data on the 6-minute walk distance (6MWD), CAT, muscle strength, body composition analysis, respiratory function, and joint range of motion were collected. Participants underwent one month of regular PR followed by two months of oxygen-supplemented PR, with data collected again after this period. Statistical significance was set at 0.05 with a power of 0.8, and the required sample size was calculated accordingly.

The required sample size could not be calculated based on the 6MWD. The improvement in CAT by Program A was greater than that by Program B. The improvements in muscle parameters by Program B were greater than those by Program A. The standardized effect size and the corresponding required sample sizes for the CAT, quadriceps muscle power, lower leg circumference, trunk muscle mass, and leg muscle mass were 0.32/81, 0.66/8, 0.17/114, 0.27/88, and 0.24/56, respectively.

Given the small number of participants, the 6MWD and CAT were not appropriate primary endpoints for comparing the effectiveness of the two oxygen supplementations during PR in patients with COPD. However, the quadriceps muscle power was identified as the most suitable primary endpoint among all the investigated parameters.

Since 2021, avian influenza A(H5N1) clade 2.3.4.4b viruses have spread widely among wild birds and domesticated poultry in the United States, with sporadic spillover into mammals. During November 2024-January 2025, 19 domestic cats in Los Angeles County, California, became ill after consumption of commercially purchased raw milk, raw meat, or raw pet food; nine cats tested positive for influenza A(H5N1) virus (clade 2.3.4.4b genotype B3.13). Overall, 139 persons were exposed to the 19 infected cats, and all were monitored for symptoms. Although 30 persons reported influenza-like illness symptoms, none received a positive influenza A(H5) reverse transcription-polymerase chain reaction (RT-PCR) test result. In April 2025, the Los Angeles County Department of Public Health and CDC invited all exposed persons to participate in an influenza A(H5N1) serosurvey to determine whether transmission of influenza A(H5N1) virus occurred, including in those without symptoms. Sera from 25 (18%) of the 139 exposed persons were tested. Among these, antibodies specific to A(H5N1) clade 2.3.4.4.b (antigenically similar to the clade 2.3.4.4.b influenza A[H5N1] virus isolated from the infected cats) were detected in serum from one veterinary professional, who was asymptomatic. This person did not use respiratory or eye protection during the exposure, did not report influenza-like illness after the exposure, and reported no other known risk factors for A(H5N1) infection. These findings represent serologic evidence of possible transmission of influenza A(H5N1) clade 2.3.4.4.b virus from a domestic cat to a human, highlighting concerns about potential cat-to-human transmission of influenza A(H5N1) virus and the importance of infection control practices in veterinary settings.

While systemic immune dysregulation is well-documented in HIV infection, its impact on blood and respiratory tract viromes remains poorly understood. This study characterizes HIV-associated alterations in viral communities and examines their clinical relevance. Using viral metagenomics, we compare 203 ART-treated HIV-positive individuals and 120 healthy controls. HIV infection significantly restructures the blood virome, shifting from bacteriophage dominance (96.2% in controls) to eukaryotic virus predominance (69.1%). Increased alpha diversity, significant β-diversity divergence, and heightened dispersion heterogeneity are observed in HIV cases. Consistent enrichment of Flaviviridae, Parvoviridae, and Anelloviridae is detected. Throat viromes maintain phage dominance (>90%) but exhibit strain-level diversification, including Microviridae proliferation. Network analysis reveals Retroviridae-Anelloviridae co-dynamics (r = +0.562) and identifies Picobirnaviridae as a key interactor. Functional analysis shows enriched viral replication and host modulation genes. Compartment-specific disruption patterns nominate Pegivirus C, parvovirus B19, and Anelloviruses as potential biomarkers. Cross-kingdom viral interactions suggest novel mechanisms influencing disease progression and support future virome-targeting adjunct therapies.

Pulmonary arterial hypertension (PAH) has a poor prognosis despite available treatments. TPN171H, structurally modified from traditional Chinese medicine (Epimedium), was reported to have a high affinity for phosphodiesterase type 5 and exhibited anti-inflammatory and vasodilatory effects in preclinical studies. This phase 2a randomized trial (NCT04483115) evaluated the hemodynamic effects and safety of TPN171H in PAH. Sixty patients with PAH were randomly assigned to receive placebo, TPN171H (2.5, 5, or 10 mg) or tadalafil (20 or 40 mg) and evaluated for hemodynamic changes for 24 h. The primary endpoint was the maximum change (%) in pulmonary vascular resistance (PVR) from baseline. The key secondary endpoint was the change (%) in PVR to systemic vascular resistance (SVR) ratio at each observation point from baseline. Compared to the placebo group, the least square mean differences in the maximum change in PVR were -16.8% (95% CI, -29.1 to -4.5, p = 0.008) in TPN171H 5 mg, -15.4% (95% CI, -28.2 to -2.7, p = 0.019) in tadalafil 20 mg, and -13.3% (95% CI, -25.6 to -0.9, p = 0.036) in the tadalafil 40 mg group. Moreover, TPN171H 5 mg, but none of the tadalafil doses, showed a significant reduction in PVR/SVR ratio at 2 h (p = 0.026), 3 h (p = 0.030), and 5 h (p = 0.046) compared to the placebo group. No serious adverse events occurred. TPN171H 5 mg demonstrated favorable acute hemodynamic effects and an acceptable short-term safety profile in this exploratory trial, supporting further evaluation in adequately powered trials.