Clare Heal

Introduction: The potential association between Parkinson’s disease (PD) and melanoma has received increasing attention in the literature, yet its strength and direction remain incompletely understood. Previous studies vary considerably in diagnostic ascertainment, temporal relationship between the two conditions and analytic approach. This systematic review and meta-analysis aimed to evaluate this association while accounting for these methodological differences. Methods: A comprehensive search of four databases from inception to May 25, 2025 was conducted. Methodological study quality was evaluated using Newcastle-Ottawa Scale and JBI Analytical Cross-sectional checklist. GRADE was applied to assess the overall certainty of evidence. A random-effects model with restricted maximum likelihood estimation and Hartung-Knapp adjustment was performed to calculate pooled odds ratios with 95% confidence intervals. Heterogeneity was assessed using I2. Results: Eighteen studies met the inclusion criteria for this review, of which three were eligible for the meta-analysis. The pooled odds ratio was 2.55 (95% CI: 0.09-73.07). Although the point estimate was above the null, the confidence interval was extremely wide and included an OR of 1.0. Between-study heterogeneity was observed (I2 = 82.2%), and the certainty of evidence was rated as very low. Conclusion: The available evidence regarding the association between PD and melanoma remains very uncertain. Although the pooled OR was above the null, the wide confidence interval, substantial heterogeneity and very low certainty of evidence prevent the drawing of firm conclusions regarding the magnitude or direction of this association. Current evidence is insufficient to support PD-specific melanoma screening recommendations, and further methodologically robust studies are warranted.

Background: Fear of procedural pain is a significant barrier to intrauterine device (IUD) uptake. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are commonly used in IUD insertion for their analgesic and anti‐inflammatory properties; however, evidence for their effectiveness remains inconsistent. Aims: This systematic review and meta‐analysis aimed to synthesise current evidence regarding the effectiveness of NSAIDs for pain relief during outpatient IUD insertion. Materials and Methods: A search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL and Scopus was performed from inception to March 3, 2025. The search strategy was developed using the Population, Intervention, Comparator, Outcome (PICO) framework. Two reviewers independently selected studies, extracted data and assessed included studies for bias using the Risk of Bias 2 (RoB 2) tool. Trials comparing pain scores between NSAID and placebo were pooled in a meta‐analysis. Results: Twenty‐two studies, published between 2006 and 2024, met inclusion criteria. Ibuprofen ( n = 6) was most used, followed by diclofenac ( n = 4) and naproxen ( n = 4). NSAIDs were administered orally ( n = 17), intramuscularly ( n = 2) and rectally ( n = 2), with route not specified in one study. A meta‐analysis of fourteen studies comparing NSAID with placebo, with a total sample size of 3358, found a statistically significant reduction in pain scores (mean reduction 0.77, 95% CI −1.29, −0.25). Side effects and adverse events did not differ significantly between groups. Conclusions: Our review demonstrates an analgesic role for NSAIDs during IUD insertion, with a significant reduction in pain scores when compared to placebo. This evidence, limited by clinical and statistical heterogeneity, is of low certainty.

Background: Cellulitis is a common bacterial skin infection usually requiring antibiotic treatment. Accurate diagnosis and management are crucial for patient prognosis and antibiotic stewardship. Phenoxymethylpenicillin is usually the recommended first‐line antibiotic for suspected streptococcal nonpurulent cellulitis. This study investigated antibiotic prescribing patterns and temporal trends for new diagnoses of cellulitis by Australian general practice registrars (speciality trainees in general practice [family medicine]). Methods: Analyses of the Registrar Clinical Encounters in Training (ReCEnT) study utilised registrars’ 2010–2021 consultation data involving new diagnoses of cellulitis. The proportion of consultations involving the prescription of antibiotics was calculated. Univariable and multivariable logistic regression examined longitudinal changes in the prescription of the two most prescribed antibiotics (cefalexin vs. flucloxacillin/dicloxacillin), adjusted for patient, registrar, practice and consultation factors. Results: A total of 3852 registrars provided data. Of 2708 new diagnoses of cellulitis, flucloxacillin/dicloxacillin was most commonly prescribed ( n = 1209; 43.6% [95% CI: 41.8, 45.5), followed by cefalexin ( n = 1191; 43.0% [95% CI: 41.1, 44.9]). Phenoxymethylpenicillin was prescribed in 0.6% of cases [95% CI: 0.3, 0.9]. Cephalexin prescription relative to flucloxacillin/dicloxacillin did not change over the 12‐year period (OR 0.99 per year [95% CI: 0.96, 1.03]). Prescription of cefalexin, compared to flucloxacillin/dicloxacillin, was associated with (compared to the age group 25–44 years) ages less than 5 years (OR 2.75 [95% CI: 1.70, 4.43], 5–14 (OR 2.51 [95% CI: 1.63, 3.89]) and 65 years and older (OR 1.51 [95% CI: 1.15, 1.99]). Cefalexin prescription was less likely when registrars sought in‐consultation information from ‘Therapeutic Guidelines (Antibiotic)’ guidelines (OR 0.58 [95% CI: 0.43, 0.80]), supervisors (OR 0.69 [95% CI: 0.51, 0.94]) or other sources (OR 0.64 [95% CI: 0.43, 0.96]). Conclusions: Phenoxymethylpenicillin was prescribed in only 0.6% of presentations, whereas cefalexin and flucloxacillin/dicloxacillin accounted for over 86% of prescriptions. This may reflect a lack of guideline specificity regarding first‐line treatment options and/or registrars’ aetiological diagnostic uncertainty. Prescribing patterns remained relatively stable over time.

Perioperative euglycaemic diabetic ketoacidosis (EuDKA) is a rare but life-threatening complication associated with sodium-glucose co-transporter-2 inhibitors (SGLT2i). It is characterised by ketonaemia, acidosis, and normal serum glucose. Whilst guidelines advise withholding SGLT2i prior to elective surgery, limited guidance exists for emergency procedures. This systematic review aimed to describe EuDKA cases following emergency surgery, identify patient characteristics, and examine contributing risk factors. A search of electronic databases up to April 2024 identified 30 cases from 21 publications. In most cases, EuDKA onset occurred within three days postoperatively (range: intraoperative to 10 days). Reported risk factors included inadequate SGLT2i withholding time, poor glycaemic control, morbid obesity, major surgery, intercurrent illness, suboptimal intraoperative diabetes management, and delayed gastrointestinal absorption. Morbidity was significant: ten patients required intensive care, two required intubation and ventilation, two received dialysis, and one underwent exploratory laparotomy. No deaths were reported. Due to atypical biochemical findings and non-specific symptoms, EuDKA remains under-recognised. Clinicians are advised to maintain a high index of suspicion, ensure appropriate perioperative insulin management, conduct vigilant laboratory monitoring, and provide patient education to reduce the risk in emergency surgical settings.

This study investigates the effectiveness of two interventions to prevent surgical site infection after below-knee surgery.

The purpose of this study was to develop a clinical prediction rule based on identified risk factors for surgical site infection in a large general practice patient cohort.

Background: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted medical education. This study aimed to determine how COVID-19 affected students’ opportunity to practice core clinical skills across specialty rotations and their self-perceived proficiency at performing these. Methods: Routinely administered surveys of fifth year medical student’ experiences and perceptions of medical training from 2016 to 2021 were analysed. Number of times core clinical skills were performed and self-perceived proficiency of each skill were compared pre- (years 2016-2019) and during-COVID (years 2020-2021). Results: Data from 219 surveys showed a reduction in the opportunity to perform “a cervical screen test” (p<0.001), “a mental health assessment” (p=0.006), “assess the risk of suicide” (p=0.004) and “bladder catheterisation” (p=0.007) during-COVID. Self-reported skill proficiency was also less during-COVID for performance of: “a mental health assessment” (p=0.026) and “an ECG” (p=0.035). Conclusions: The impact of COVID-19 on mental health skills was greatest, potentially due to a shift toward telehealth services and consequent reduced ability for students to engage in consultations. In a time of potential long-term change in the healthcare landscape, it is imperative to ensure adequate opportunity to practice all core clinical skills during medical training. Inclusion of telehealth earlier into the curriculum may benefit student confidence.