Narrative reviews

Adoptive cellular therapies (ACT), including tumour-infiltrating lymphocyte (TIL), T-cell receptor-engineered T (TCR-T) cell and chimeric antigen receptor T-cell (CAR-T) therapies, represent an evolving class of immunotherapies with established efficacy in selected haematological malignancies and emerging applications in solid tumours. Additional platforms under investigation include virus-specific T cells, tumour-associated antigen-specific T cells, natural killer (NK) cell therapies and dendritic cell-based therapies. The therapeutic scope of ACT is expanding beyond oncology into autoimmune and fibrotic diseases, infectious diseases and inherited metabolic and immune disorders, highlighting the broad potential of cellular immunotherapy platforms. In solid tumours, efficacy remains limited by tumour antigen heterogeneity, immunosuppressive tumour micro-environment and impaired immune cell trafficking and persistence. These barriers are driving development of next-generation cellular products and combination strategies. Characteristic immune-mediated toxicities, particularly cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), remain important considerations. Although potentially severe, these toxicities are generally manageable with early recognition, multidisciplinary care and prompt specialist intervention. As ACT indications expand in Australia, clinician familiarity with indications, mechanisms of action and toxicity profiles is essential to support informed patient discussions, appropriate patient selection, timely referral and prompt toxicity recognition and management. Non-oncology specialists have an important role in shared care, including patient identification, referral coordination, monitoring for delayed or late toxicities and provision of ongoing survivorship and supportive care. Achieving equitable national access to ACT will require streamlined health technology assessment processes, coordinated reimbursement and delivery funding models and structured referral networks with cross-institutional collaboration to support the specialised infrastructure required for their delivery.

Sarah Childs, David Ma, Anthony Rodrigues, Jennifer Massey, Rasha Cosman, Venessa Chin, Laila Girgis, James Lynam, Peter Lau, Barbara Withers, Anthony M. Joshua, Ben Tran, Jayesh Desai, Simon J. Harrison, John Moore, Jia Liu

Shift workers have temporal eating patterns characterised by irregular food intake and prolonged periods of eating with more energy intake occurring in night-time hours during night shifts. These patterns of eating against a backdrop of shift work exacerbate circadian misalignment, which impairs cardiometabolic profiles and increases the risk of developing overweight and obesity, diabetes and cardiovascular diseases. Limiting food intake at night and being mindful about food choices is beneficial on night shifts, but further research is required to determine appropriate timing and composition of food intake. Some food intake at night may be necessary in supporting individual alertness and performance at work and should be considered when recommending that shift workers minimise food intake at night. At the individual level, shift workers may benefit from minimising night-time food intake during night shifts. At the organisational level, healthy food consumption habits should be encouraged by improving access to healthy food at night, implementing scheduled meal breaks and providing information about healthy eating guidelines to employees. Medical professionals and Accredited Practising Dietitians (APD) should be aware of the impact of circadian misalignment on metabolic health and consider this when educating patients on adhering to healthy eating guidelines.

Yan Yin Phoi, Maxine P. Bonham, Jillian Dorrian, Michelle Rogers, Alison M. Coates

Adult liver transplantation practice in Australia and New Zealand has changed substantially over the past decade in response to shifting liver disease epidemiology and advances in donor organ preservation. Alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease have become leading indications for adult liver transplantation in Australia and New Zealand. Transplant recipients are increasingly older and medically complex, necessitating multi-disciplinary assessment including evaluation of frailty. Indications for liver transplantation have expanded to include selected patients with severe alcohol-related hepatitis, acute-on-chronic liver failure, extended-criteria hepatocellular carcinoma and other highly selected non-resectable liver malignancies including colorectal liver metastases and cholangiocarcinoma. In parallel, donor utilisation has evolved, with increasing use of expanded-criteria donors and donation after circulatory determination of death. Machine perfusion technologies are increasingly used in Australia to optimise marginal liver grafts and minimise waitlist mortality. Having an awareness of these evolving indications, recipient complexity and donor optimisation strategies is essential to support timely liver transplantation referral, improve inter-disciplinary understanding, allow equitable access and provide appropriate stewardship of limited donor organs.

Fadak Mohammadi, Alan J. Wigg, Ken Liu, Simone I. Strasser

Metabolic (dysfunction)-associated fatty liver disease (MAFLD) or metabolic (dysfunction)-associated steatotic liver disease (MASLD) is the most common and fastest growing cause of chronic liver disease worldwide. There has been a substantial increase in the epidemiological research regarding MASLD/MAFLD originating from Australia since 2020. This narrative review summarises these pivotal epidemiological studies investigating the disease prevalence, natural history, prognostication and management of this condition. The Australian literature demonstrates the prevalence to be between one-third and two-fifths of adults affected, depending on nomenclature, with a heightened risk of cardiovascular disease irrespective of terminology. Current local data support guideline-based disease staging with non-invasive tests of fibrosis and the management continues to centre on diet and lifestyle interventions, with directed therapy on the horizon.

Karl Vaz, Daniel Clayton-Chubb, William W. Kemp, Stuart K. Roberts, Ammar Majeed

A review of current literature on generative artificial intelligence applications in clinical practice, focusing on clinical documentation, operational efficiency, patient safety, clinical decision making and patient self-care

Ian A Scott · Sandeep Reddy · Tanya Kelly · Tim Miller · Anton Vegt

Better integration of sex and gender considerations in health and medical research, in Australian clinical practice guidelines, and in health and medical education curricula, is needed to improve the quality of care for all people with anxiety disorders

Bronwyn M Graham

A multisectoral approach and stronger multilevel government coordination are required to address the health impacts associated with proximity to mining and exposure to toxic chemicals

Javier Cortes‐Ramirez · Ruby N Michael · Leisa‐Maree Toms · Melissa Haswell

A discussion on what is known about cancer in Aboriginal and Torres Strait Islander children, including a summary of literature on Indigenous childhood cancer around the world. Future areas of research and clinical advances are outlined.

Alexandra Truong · Kayla Williams‐Tucker (Ngarluma, Wongutha, Wudjari Noongar) · Ahmi Narkle (Whadjuk Goreng Noongar) · Eden Slicer (Gundungurra) · Jessica‐Elise Chapman (Kamilaroi, Bundjalung) · Jessica Lawler · Rishi S Kotecha · Hetal Dholaria · Justine R Clark (Adnyamathanha) · Alex Brown (Yuin) · Raelene Endersby · Nicholas G Gottardo · Jessica Buck (Kamilaroi)

A review of advancements in respiratory syncytial virus (RSV) prevention within Australia, focusing on the recent introduction of nirsevimab, a long-acting monoclonal antibody, and Abrysvo, a maternal RSV vaccine.

Sam T Barnett · Jane Tuckerman · Ian G Barr · Nigel W Crawford · Danielle F Wurzel

Updated epidemiology, clinical presentation, diagnosis and management of scabies, including emerging treatments

Laxmi Iyengar · Alvin H Chong · Andrew C Steer

Discussion of recent developments in the identification and management of gambling disorder and the remaining gaps in literature and research

Simone N Rodda · Stephanie S Merkouris · Nicki A Dowling

Foundational qualities of culturally safe and sustainable eHealth interventions for Aboriginal and Torres Strait Islander people

the eHRCATSIH Group

Assessment of the strategies adopted in the operating room to reduce waste and provision of an in-depth analysis of the barriers to scalable waste reduction strategies

Ludmilla Pillay · Kenneth D Winkel · Timothy Kariotis

Aboriginal and Torres Strait Islander peoples should define safety, benefit and sovereignty in precision cancer medicine research for their communities

Justine R Clark (Adnyamathanha) · Jessica Buck (Kamilaroi) · Amanda Richards‐Satour (Adnyamathanha and Barngarla) · Louise Lyons (Jaadwa) · Alex Brown (Yuin)

Substantial advances have been made associating cardiovascular disease to markers of genetic risk

Michael P Gray · Diane Fatkin · Jodie Ingles · Elizabeth N Robertson · Gemma A Figtree

Improving general surgery in rural areas relies on an increase in workforce numbers, tailored models of care and an improved focus on the wider multidisciplinary team

Jessica Paynter · Kirby R Qin · Janelle Brennan · David J Hunter‐Smith · Warren M Rozen

Despite advances in treatment, ovarian cancer remains a lethal disease which lacks an established screening program, and surgical prevention remains the gold standard for women at increased risk

Michail Sideris · Usha Menon · Ranjit Manchanda

A cardiac arrest system with integrated ECPR is a promising intervention for patients with refractory cardiac arrest

For the National ECPR Working Group

Hepatocellular carcinoma is a leading cause of cancer-related death worldwide, and is increasing in incidence in Australia

Samuel Hui · Sally Bell · Suong Le · Anouk Dev

Selecting a suitable CVD risk equation for the Australian population

Sinan Brown · Emily Banks · Mark Woodward · Natalie Raffoul · Garry Jennings · Ellie Paige

The long term impact of COVID-19 on neurological diseases remains uncertain and requires ongoing vigilance through longitudinal studies

Robb Wesselingh