Gary Kim Kuan Low

Background: Hospital inpatient hypoglycaemia is a common complication associated with poor patient outcomes. With the rising prevalence of diabetes mellitus (DM) and approximately 20% of hospital beds occupied by patients with DM, inpatient hypoglycaemia is an important safety concern. We aimed to determine the incidence of and risk factors for inpatient hypoglycaemia and their association with mortality and hospital length of stay (LOS). Methods: A retrospective single-centre case–control study was conducted at Nepean Hospital, New South Wales, Australia, over 12 months (July 2018–June 2019). The cases were inpatients who experienced hypoglycaemia, defined as capillary blood glucose <4 mmol/L. Patients with hypoglycaemia were stratified into those with and without DM. The controls were randomly selected inpatients with DM admitted during the same period who did not experience hypoglycaemia. Results: A total of 251 episodes of hypoglycaemia occurred in 234 patients; 202 events (80%) occurred in 187 patients with DM and 49 (20%) in 47 patients without DM. In the patients with DM, the factors associated with hypoglycaemia included basal–bolus insulin (aOR 26.6; 95% CI 7.9–106.6), premixed insulin (aOR 5.9; 95% CI 1.6–25.9), sulfonylureas (aOR 3.2; 95% CI 1.1–9.6), and malnutrition (aOR 4.2; 95% CI 1.2–18.0). Compared with the controls, patients with DM and hypoglycaemia had higher inpatient mortality (10.2% vs. 3.0%), 12-month mortality (20.9% vs. 5.5%), and a longer median LOS (12 vs. 4 days). The twelve-month mortality was 36.2% in patients without DM who experienced hypoglycaemia. Conclusions: Inpatient hypoglycaemia is associated with high mortality and increased LOS, highlighting the need for greater awareness and effective prevention strategies.

Background: Medication related osteonecrosis of the jaw (MRONJ) is a debilitating condition associated with antiresorptive and antiangiogenic therapies. As the use of these medications continues to increase, dental practitioners play a critical role in prevention and management of at‐risk patients. This survey evaluated the awareness, knowledge and practice patterns of Australian dental practitioners regarding MRONJ. Materials and Methods: A cross‐sectional online survey of registered Australian dental practitioners was conducted. The 26‐item questionnaire assessed knowledge of MRONJ diagnosis, clinical features, risk factors and practice patterns. Responses were analysed descriptively. Results: A total of 343 dental practitioners participated. Overall MRONJ awareness was high, with 88.6% correctly identifying the principal diagnostic criteria. Knowledge of antiresorptive medications was strong, but familiarity with antiangiogenic agents was limited, with 25% unable to identify any associated medication. Only 62.4% were comfortable assessing MRONJ risk before extraction and just 37.9% comfort in performing extractions in at‐risk patients. Public practitioners reported greater MRONJ‐related education and clinical confidence than private practitioners. Conclusion: Australian dental practitioners demonstrated strong awareness of MRONJ. However, confidence in providing invasive treatment for at‐risk patients remained limited, particularly among private dental practitioners. These findings highlight the need for targeted education and clinical support as the use of MRONJ associated medications continues to increase. Clinical Relevance: Although overall awareness of MRONJ is high among Australian dental practitioners, ongoing knowledge and confidence gaps may contribute to variation in clinical practice. Addressing these gaps through continuing professional education, evidence‐based guidance, and structured risk assessment may enhance patient safety and optimise the prevention and management of MRONJ.

Background: Dengue vector control plays an important role in reducing the burden of dengue infection. Conventional meta‐analysis can only include interventions that can be directly compared. Hence, this study aimed to compare the effectiveness of all interventions for dengue vector control directly and indirectly through a multilevel Bayesian network meta‐analysis. Methods: Cluster randomised controlled trials (cRCTs) and randomised controlled trials (RCTs) were included. Screening and full‐text review were performed independently by two reviewers, with resolution by a third reviewer if there was disagreement. Outcomes measured for the included studies considered were entomological indices and epidemiological measures. The Cochrane risk of bias tool was used to assess the quality of the studies by two independent reviewers, with a third reviewer to resolve any discrepancies. Results: A total of 48 cRCTs and 13 RCTs were included in this study. The quality of cRCTs and RCTs was overall deemed at high risk of bias except for two studies with low risk of bias. The network meta‐analyses and narrative synthesis indicate that most interventions are not significantly superior to one another. Despite the lack of statistically significant results in the network meta‐analyses, a standalone intervention appears to be less effective than combined interventions. Conclusions: Although most interventions were not found to be significantly superior to one another in the network meta‐analyses, it is noteworthy that standalone interventions were shown to be less effective than combined interventions. These results reinforce the importance of promoting integrated, multi‐faceted vector control strategies for dengue prevention.

Objective: This study aimed to systematically review the methodological quality of dengue clinical practice guidelines (CPGs) available globally. Methods: This systematic review included CPGs on dengue clinical management (clinical diagnosis, investigation and treatment), and the development process of the guidelines, required to be evidence-based and including an expert review process. An electronic search was performed using Google, Google Scholar and PubMed. The search was last performed in September 2025. No language restriction was imposed. The selection of CPGs and cross-checking of data extracted were performed by two independent reviewers with a third to resolve any discrepancies. The Appraisal of Guidelines for Research and Evaluation II (AGREE-II) was used to assess the quality of CPGs by four independent reviewers. Results: A total of 29 CPGs published from 2009 to 2025 in 18 countries were included for review. Overall, six CPGs rated as high quality. Among these six CPGs, only three reported the recommendations with GRADE. Four CPGs adapted other CPGs without transparent review process. Majority of the CPGs fail to demonstrate a robust scientific development process. Conclusion: Despite the variability in the quality of the CPGs assessed in this review, several high-quality guidelines were identified as suitable for use. In contrast, a number of CPGs were found to rely heavily on adaptations of existing guidelines while lacking sufficient methodological rigour. Therefore, CPGs that adapt recommendations from other sources should still undertake a full and systematic development process consistent with the AGREE II framework.

Background: Unplanned paediatric hospital readmissions are key indicators of healthcare quality, often reflecting issues in discharge planning and continuity of care. The COVID-19 pandemic significantly disrupted healthcare delivery and utilisation, yet its impact on paediatric readmission patterns in Australia remains unclear. Methods: A 5-year single-centre retrospective cohort study of 21,262 paediatric admissions and unplanned readmissions at a non-tertiary metropolitan Australian hospital between 21 March 2017 and 20 March 2023 was conducted. Admissions up to 20 March 2020 were classified as pre-pandemic, and those from 21 March 2020 as during the COVID-19 pandemic. We analysed patient characteristics, including gender, age, First Nations status, primary diagnosis, and socio-economic status, to identify UHR trends. Results: During the COVID-19 period, total paediatric admissions declined by nearly 30%, and the readmission rate decreased from 7.5% to 4.6% compared with the pre-pandemic period. Across both cohorts, higher readmission rates were observed among male patients, infants aged 0–12 months, and children from more socio-economically advantaged areas. Readmissions among First Nations children and those with communicable diseases declined during the pandemic period. Conclusions: A higher proportion of males and patients under 12 months of age had higher readmission rates across both periods. These findings highlight the need for targeted early intervention, age-specific discharge planning, and strengthened follow-up care for high-risk groups. Further research should extend the study period beyond the pandemic and include larger cohorts to better characterise long-term trends and improve generalisability.

Background: This study compared the reasons for dental presentations between Indigenous and non-Indigenous Australian adults at the Nepean Centre for Oral Health, NSW, Australia. Methods: A retrospective cohort study was conducted on adult patients presenting between 1 July and 31 December 2019. Clinical notes were audited and categorized as either ‘emergency’ (pain, dental infection, dental trauma, loose teeth or dental implants, bleeding) or ‘conservative’ (dental check-ups, examinations, prosthodontic, restorative, periodontal, or non-emergency endodontic therapy). Results: A total of 4663 patients met the inclusion criteria; 61.6% were female, and 6.4% were identified as Indigenous Australians. Overall, 41.3% of presentations were for emergency dental care. Indigenous Australians were significantly more likely to present for dental emergencies compared with non-Indigenous (58.2% vs. 40.2%; χ²(1, N = 4663) = 53.4, p < 0.00001; OR = 2.07, 95% CI: 1.64–2.63), and were also more likely to undergo emergency tooth extractions (p < 0.05). Conclusions: Indigenous Australians demonstrated a higher proportion of emergency and oral surgery-related presentations and underwent tooth extractions as the primary treatment compared to their non-Indigenous counterparts. These findings suggest a higher burden of oral disease and delayed access to general dental services among Indigenous Australians, highlighting the need for targeted and culturally appropriate public health interventions.