MEDICAL FORUM | January 2025 Magazine - Public by Medical Forum WA

Slip, slop, slap In this edition | WA clinical trials, anxiety in children, belly lesions and vulval conditions

MAJOR PARTNER

January 2026 www.mforum.com.au

Matt knows loyalty has its rewards. That’s one of the reasons why he stays with Avant. Financial rewards for eligible medical indemnity members: • Premium discounts in your first 4 years with our Getting Started in Private Practice Program~

Dr Matt Doane Avant member

• Premium deductions through our Loyalty Reward Plan* • Dividends through our Retirement Reward Plan^

By your side, with more member rewards

Find out how Avant gives back to its members. avant.org.au | 1800 128 268

IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. Please read the relevant Product Disclosure Statement or policy wording, available at avant.org.au/medical-indemnity-insurance before deciding whether to acquire, or continue to hold the product. ~The GSIPP discounts do not apply to previous or existing members of the Getting Started in Private Practice scheme and only apply from the first year a member becomes eligible and subject to eligibility rules. For the eligibility rules and full details, please read the Getting Started in Private Practice Member Eligibility Rules at avant.org.au/new-private-practice or by contacting us on 1800 128 268. *Eligible members receive a deduction from their premium ranging from 4% to 12% depending on their individual tenure with Avant. Not all members are eligible for a Loyalty Reward Plan (LRP) reward. Please see eligibility criteria, categories and rates on the website avant.org.au/lrp. The provision of any future LRP reward is not guaranteed. ^The Retirement Reward Plan (RRP) reflects the current policy of the Board for determining which members of Avant are eligible to participate in the RRP and any Retirement Reward Dividends declared by Avant. The RRP is entirely at the discretion of the Board and no member will be eligible to receive a Retirement Reward Dividend until such time as the Board declares a dividend in favour of that member. The RRP is subject to change, suspension or termination by the Board at any time. The current eligibility criteria and allocation rules are available at avant.org.au/arrp. © Avant Mutual Group Limited 2025. 02/25 (MIM-722)

EDITORIAL Andrea Downey | Managing Editor

Sun safety first GPs should be reminding patients that sun safety always comes first – even when you see headlines about SPF failing testing.

Summer in Perth is unbeatable – we’ve got gorgeous beaches and perfect weather with a never-ending supply of sunshine. It’s one of the things I love most about Perth. But that sunshine is also deadly. Australia has the highest melanoma rate in the world, and it is our third most common cancer. It’s why the recent scandal surrounding SPF testing and efficacy garnered such widespread attention and concern that it might put some people off wearing sunscreen. I am sun smart at all times – I wear SPF50 every day, even in winter. You bet I was straight on the TGA website to make sure the sunscreen I use was not impacted (and still regularly checking). But not everyone will want or know how to check if their sunscreen is meeting SPF standards. That’s where GPs have an important role to play. As a nation our sun smart messaging has always been strong, but that doesn’t mean we don’t need reminding to slip, slop, slap.

YOU ASKED, WE DELIVERED: WE ARE NOW CPD VERIFIED Complete your CPD with Medical Forum. Scan the QR code at the bottom of each article in this edition to complete your self-reflection.

As we head into the peak of summer and we’re all outside enjoying the weather, GPs should be reminding patients that sun safety always comes first – even when you see headlines about SPF failing testing. And if people see any changes in their skin, they should book a skin check. That’s the main message in this edition’s feature delving into the SPF scandal. It should be a summer of fun, we’ve all earned it, but it should also be a summer of sun safety.

SYNDICATION AND REPRODUCTION Contributors should be aware the publisher asserts the right to syndicate material appearing in Medical Forum on the mforum.com.au website. Contributors who wish to reproduce any material as it appears in Medical Forum must contact the publisher for copyright permission. DISCLAIMER Medical Forum is published by Medforum Pty Ltd (Publisher) as an independent publication for health professionals in Western Australia. Neither the Publisher nor its personnel are medical practitioners, and do not give medical advice, treatment, cures or diagnoses. Nothing in Medical Forum is intended to be medical advice or a substitute for consulting a medical practitioner. You should seek immediate medical attention if you believe you may be suffering from a medical condition. The support of all advertisers, sponsors and contributors is welcome. To the maximum extent permitted by law, neither the Publisher nor any of its personnel will have any liability for the information or advice contained in Medical Forum. The statements or opinions expressed in the magazine reflect the views of the authors and do not represent the opinions, views or policies of Medical Forum or the Publisher. Readers should independently verify information or advice. Publication of an advertisement or clinical column does not imply endorsement by the Publisher or its contributors for the promoted product, service or treatment. Advertisers are responsible for ensuring that advertisements comply with Commonwealth, State and Territory laws. It is the responsibility of the advertiser to ensure that advertisements comply with the Competition and Consumer Act 2010 (Cth) as amended. All advertisements are accepted for publication on the condition that the advertiser indemnifies the Publisher and its personnel against all actions, suits, claims, loss or damages resulting from anything published on behalf of the advertiser. EDITORIAL POLICY This publication protects and maintains its editorial independence from all sponsors or advertisers. Medical Forum has no professional involvement with advertisers other than as publisher of promotional material. Medical Forum cannot and does not endorse any products.

JANUARY 2026 | 1

CONTENTS | JANUARY 2026

Inside this issue 34 8

FEATURES

IN THE NEWS

8 12

Editorial: Sun safety first – Andrea Downey

4 7 21

Update on bulk billing incentives

SPF scandal: encouraging sun safety Full speed ahead for clinical trials

LIFESTYLE 34 Summer entertainment in WA 38 Fierce women against the odds

Subscribe for free to Medical Forum

ED wait times hit national high New cycle, new solutions? – Dr Joe Kosterich

B SU

R I BE F O R F R E

O M

L IC A ED

A SUMMER OF FUN

FORU M

It’s shaping up to be a hot summer, and we’ve got plenty of hot entertainment to match. Take a read of our round up of summer shows, gigs and events on page 34 to see what takes your fancy. There’s plenty to delight and excite at Perth Fringe and laughs to be had at the Perth Comedy Festival. If getting outside is more your style then Sculpture by the Sea at Cottesloe Beach returns after a one-year hiatus, or combine the outdoors with culture at Ballet at the Quarry. As we kick off 2026 Medical Forum will be back with more competitions, news, features and educational content to keep you informed and entertained throughout the year. Remember to subscribe to our newsletters to keep informed on WA news and updates from local specialists.

CONNECT WITH US /medicalforumwa

/medical-forum-wa-magazine

/medicalforum_

info@mforum.com.au

2 | JANUARY 2026

www.mforum.com.au

CONTENTS PUBLISHERS Alice Miles – Director Fonda Grapsas – Director Tony Jones – Director

Guest Columns

EDITORIAL TEAM Managing Editor Andrea Downey 0437 909 904 andrea@mforum.com.au Clinical Editor Dr Joe Kosterich 0417 998 697 joe@mforum.com.au Graphic Design Studio Scotts hello@studioscotts.com.au ADVERTISING

Giving children courage to face anxiety Prof Jennie Hudson and Chloe Lim

Changing the narrative on respiratory & palliative care Jacqueline Rapaic and Jennifer Lamb

Clinicals

Advertising Manager Bryan Pettit 0439 866 336 bryan@mforum.com.au Advertising Account Manager and Clinical Services Directory Rita Murphy 08 9203 5222 rita@mforum.com.au

Belly lesions Dr Michael Collin

Exercise in cancer care Mary Kennedy

CONTACT MEDICAL FORUM Suite 3/8 Howlett Street, North Perth WA 6006 Phone: Fax: Email:

08 9203 5222 08 6154 6488 info@mforum.com.au

www.mforum.com.au OUR PRINTER’S ACCREDITATIONS

Vulval conditions Dr Amy Fitzgerald

Environment ISO 14001

ADHD and men Matt Tilley

This magazine has been printed using solar electricity, and the paper is manufactured with elemental chlorine-free pulps. Both printer and paper manufacturer are certified to ISO 14001, the world’s highest environmental standard.

MAJOR PARTNER

Infectious cases of pulmonary eosinophilia Dr Sumit Mehra, Dr Alice Culliford and Dr Mabel Gaastra

Complete your CPD with Medical Forum. Scan the QR code at the bottom of each article to complete your self-reflection.

The shoulder joint Dr Sheldon Moniz

JANUARY 2026 | 3

NEWS

Hundreds sign up to bulk billing program More than one hundred GP clinics in WA have signed up to the federal government's Bulk Billing Incentive Program since it launched in November.

Nationally, figures suggest almost 3000 clinics have signed up for the incentives which would see them take home a 12.5% incentive payment, split between the practice and individual GPs. The $7.9 billion program aims to see 90% of GP practices fully bulk billing all consultations by 2030. Just one month after the incentives came into play on November 1 the number of bulk billing practices across the country appeared to be increasing. Speaking during Parliamentary Senate Estimates in December, First Assistant Secretary of the Primary Care Division Mark Roddam confirmed that as of November 30 some 2902 clinics across Australia had signed up to the program. Of those, 1675 – or 58% - were already registered as fully bulk billing practices. Some 1092 were previously registered as mixed billing and 135 were entirely new to MyMedicare with no established billing information. In WA, 176 clinics had signed up to the program. Of those, 80 were already fully bulk billing practices. Nationally the figures were: NSW

1160

(776 previously bulk billing)

VIC

QLD

505

148

TAS

ACT

(271)

(51)

(8)

4 | JANUARY 2026

803

(449)

176

(80)

(18)

(22)

Federal Health Minister Mark Butler faced questions on the bulk billing program at GP25.

The figures were revealed in response to questions from Shadow Health Minister Senator Anne Ruston on the program's progress and the government’s roadmap to achieving its ambitious target.

A small-scale survey of West Australian GPs carried out by Medical Forum showed just two of 29 who responded said their clinics were signing up to be part of the program.

She said the government had released "big headlines” around bulk billing targets but no roadmap on how these targets would be met.

All GPs who said they would not be signing up to the program said it was not financially viable.

She also queried whether practices had begun to receive the incentive payment since signing up to the program. Department of Health officials confirmed that while practices may have signed up, they would need to provide confirmation that all consultations are fully bulk billed before receiving the incentive payment. In WA GPs have remained sceptical on whether the bulk billing targets will be met, despite billions in funding.

Bulk billing was also a hot topic at the 2025 RACGP annual conference (GP25) where Federal Health Minister Mark Butler was grilled on how he expected the program to work. Minister Butler has repeatedly suggested that under the scheme GPs who offer universal bulk billing would earn more than $400,000, and that three quarters of GPs already earn $280,000 a year. But this figure has been widely questioned by GPs and leading doctors, including the AMA (WA).

NEWS & VIEWS

Professor Jonathan Carapetis steps down After 14 years at the helm of The Kids Research Institute Australia Professor Jonathon Carapetis is set to depart. Professor Carapetis has overseen major advancements in child health research and policies that influenced practice, including the recent adoption of free RSV vaccinations in WA. He will step down in July 2026. The infectious diseases consultant physician at Perth Children’s Hospital, and professor at UWA, took on the role of executive director of what was then Telethon Kids Institute in 2012. Prof Carapetis said: “It was very important to me that I chose to leave at the right time – with The Kids well positioned for the future. That time is now. “We have a fabulous strategic plan underway that I genuinely believe will redefine how we do medical research in this country, by focusing on how we can

Ahpra fees ‘unfair’ An investigation by the National Health Practitioner Ombudsman (NHPO) found that some practitioners had experienced “unfair financial outcomes” due to the way Ahpra’s fees were charged. Those taking or returning from parental leave, applicants registering for the first time and practitioners changing registration types appeared to be more negatively affected by the way fees were charged. NPHO Richelle McCausland published her findings and suggestions for improvement following an investigation into the charging model. She found the way registration fees were charged could lead to unfair financial outcomes for practitioners registering outside of their profession’s standard registration cycle. The investigation was prompted by complaints to the Ombudsman by three health practitioners in 2022, who stated it was unfair they were required to pay a registration fee to Ahpra twice within three months. The situation can occur due to the requirement for practitioners to pay their registration renewal on a set date each year.

bring the greatest benefit to those we serve – kids and families. “We have a distinctive new brand that allows us to reach new audiences, and we are in a strong financial position. This is a great time for a new leader to step in and help take The Kids from strength to strength.” An international recruitment process will be undertaken to find his successor.

For example, a medical practitioner who paid an application fee and a registration fee in July would also be required to pay a registration renewal fee by September 30 of the same year – totalling about $3600 in fees within a three-month period. Ahpra accepted the Ombudsman’s findings, adding it was “committed to ensuring that the charging model is fair, transparent, and responsive to practitioner needs”.

ADHD med poisonings rise Doctors are urged to remember the importance of careful counselling around dosing for ADHD medications after a study found poisonings had increased. University of Sydney researchers found the number of Australians poisoned by ADHD medications in 2023 was four times what it was a decade earlier. While the number of people diagnosed with ADHD has increased, that increase was not considered proportionate to the rise in poisonings, researchers said. The study showed there were 3242 poisonings in 2023 compared to 795 in 2014, a quadrupling during a time when diagnoses only doubled.

Using nationwide data from the NSW Poisons Information Centre, researchers found more than half of the 17,000 self-reported cases in the period surveyed resulted in hospital admission, with more than 9000 having involved children under 15 years of age. Chair of the RACGP WA ADHD Working Group Dr Sean Stevens said clonidine was used in the strengths the medication currently comes in when being used as a blood pressure medication, but for ADHD it is often prescribed in parts of a tablet. He said for that reason “it’s very easy for the doses to be inadvertently mixed up”. Dr Stevens said specialists must be clear in their discussions around medications. He added that while GPs may not be initiating these medications, they could play an educational role. “Making sure that it’s used appropriately and as prescribed, making sure that it’s out of reach of kids, making sure that people understand the risks of overdose,” he said. For more news visit mforum.com.au and hit the ‘news’ tab

JANUARY 2026 | 5

GP Continuing Professional Development

I had an interesting cardiology case real world cases with practical insights for GPs A Saturday symposium featuring an engaging day of case discussions, networking opportunities, and practical tips to support your everyday practice. TOPICS AND PRESENTERS INCLUDE The valve whisperer - Dr Gerald Yong, Cardiologist Fitbits & algorithms - Dr Sekaran Gana, Cardiologist Cardiology in the ED - Dr Suzanne Grey – ED Physician Anticoagulation post AF ablation - Prof Rukshen Weerasooriya, Cardiologist PCI without the bling - Dr Thato Mabote, Cardiologist 3D echos - Dr Tuğba Kemaloğlu Öz, Cardiologist HF update - Dr Yuli Ten, Cardiologist Valvular disease - Dr Eric Slimani, Cardiothoracic Surgeon Aorta surgery - Dr Pragnesh Joshi, Cardiothoracic Surgeon Holistic heart care - Ms Jean Bunt, Cardiothoracic Clinical Care Nurse Specialist Pacing updates - Dr Siang Ung, Cardiologist Cardiometabolic - Dr Phil Currie, Cardiologist AF and PFA - A/Prof Kushwin Rajamani, Cardiologist Panel moderator - Dr Pasko Dedic, Cardiologist LEARNING OUTCOMES • Identify early signs of valvular disease and when to refer for specialist care. • Describe a general practice protocol for managing cardiac emergencies. • Outline the role of echocardiography - when to order and how to interpret reports. • Identify the GPs role as part of an MDT approach to cardiometabolic risk management for patients with multiple comorbidities.

Scan to register

It’s easy to register

The Ballroom, University of WA Uniclub, Hackett Drive, Crawley 6009

www.hollywoodprivate.com.au Saturday 7 February 2026 RSVP Monday 2 February

toplisss@ramsayhealth.com.au 0438 763 256

Chair | Prof Rukshen Weerasooriya, Cardiologist Sponsored by

6 | JANUARY 2026

NEWS & VIEWS

ED wait times hit national high Western Australia had the longest emergency department wait times nationally in the last year. Here's how the state's public health system is faring.

West Australians waited the longest in emergency departments over the last year, new data from the Australian Institute of Health and Welfare show. On average, 90% of patients who visited an ED were seen within 229 minutes. In some other states patients were seen in less than half that time. The wait time for the majority of patients across all Australian hospitals was 118 minutes. In WA, just 46% of patients were seen on time according to their triage category, with this number trending down over the past five years from 58% in 2020/2021. Nationally, 67% of patients were seen on time for their triage category, including 100% of those requiring immediate care (resuscitation). AMA (WA) President Dr Kyle Hoath said he was not surprised that WA had the longest ED wait times in the country, but he was disappointed. “We all know the winter that we’ve had, and we all know that something has to be done. It’s not surprising, not acceptable, but really not a surprise at this point,” he said. WA hospitals saw almost 5000 additional presentations compared to the previous year, with ED presentations increasing 0.5%. However, this was slightly less than the national increase of 0.8%. WA Minister for Health Meredith Hammat acknowledged the

figures were of concern but said WA was dealing with increasingly complex patients. “I think what those figures are telling us is that the increase in demand is not always about additional people, it is about the complexity that people have when they come to hospital and we’ve seen much more of that,” she said. “People presenting with not just one health condition but sometimes multiple conditions that need to be managed." She reiterated the government's ongoing work to reduce ambulance ramping and increase hospital capacity in the state, however Dr Hoath said more needed to be done. “We’ve been consistent in our concern that the number of beds and number of services available to West Australians was insufficient,” he said. “There just wasn’t enough and that’s really what led to our record ramping issues.” He said the AIHW figures highlighted that further investment was needed to avoid repeats of 2025’s winter, which also saw some elective surgeries postponed to manage hospital capacity. Patients are also spending more time in the ED at WA hospitals, with the average time rising from 9h22mins last year to 10h49mins this year. Nationally, 6% of patients waited longer than 365 days to be admitted for elective surgery. In WA 5.3% of patients waited longer than a year for an elective surgery.

Some 102,845 West Australians were added to the waitlist in the last year, while 89,649 underwent their surgery and were removed from the list. This follows some years of variability in elective surgery numbers in Australia due to disruptions to hospital services caused by the COVID-19 pandemic. The new figures come as the AMA warned Australia’s public hospitals were in crisis. National President Dr Danielle McMullen cautioned “the time for bandaid solutions and patch-up approaches was over”. “The next National Health Reform Agreement (NHRA) must fix the crisis, or to put it simply, patients will die,” Dr McMullen said. The AMA is calling on the federal government to meet its commitment to reach 45% of total funding by 2030 rather than the originally agreed 2035. Conservative estimates put the cost of the investment at $34.7 billion across five years, and potentially up to $49.8 billion if public hospital costs continue to increase at a rate of 5.6% each year. Based on AMA projections, states and territories will need to find $17.6 billion, and potentially up to $36.7 billion, if hospital costs continue to grow at that rate. On December 11 Prime Minister Anthony Albanese announced an additional $21 billion over five years for public hospital funding.

JANUARY 2026 | 7

FEATURE

SPF scandal: Reassuring patients on sun protection The second half of 2025 saw a number of brands take their sunscreen products off the shelves and Australia’s medicines regulatory authority probing SPF ratings. With questions marks over the efficacy of SPF ratings, how can GPs ensure patients are being sun safe?

By Aleisha Orr It’s been widely touted as an SPF scandal. In June 2025 consumer advocacy organisation Choice revealed shocking inconsistencies in the SPF ratings of several sunscreens many Australians relied on. It has caused widespread confusion and speculation surrounding SPF ratings, with a concern people may lose faith in the effectiveness of sunscreen. For GPs, it means they need to know what information and advice to provide their patients. Medical Forum has broken down what the Therapeutic Goods Administration (TGA) is doing and spoken to the Cancer Council and a local dermatologist to provide an overview of the current situation.

8 | JANUARY 2026

FEATURE Failing the test Choice has been testing products on the Australian market for decades to provide consumers with information about value for money on products from electronics to grocery items. While it may be interesting to know which tinned tomatoes ranked highest for chunky texture and rich colour, the potential health ramifications of incorrect SPF ratings saw the results of sunscreen testing garner a fair share of media coverage – and for good reason. Each year more than 1300 West Australians are diagnosed with melanoma, the deadly skin cancer caused by ultraviolet radiation which comes from the sun. Nationally it remains one of our biggest killers. While the human toll is enormous, so are the economic costs, estimated to be close to $2 billion a year nationally. As a result, Australia has had robust health messaging around sun safety for decades, with the importance of SPF well understood. Sunscreens are required by law to have accurate and truthful labelling. Choice’s initial investigation found 16 of 20 SPF50 or SPF50+ sunscreens did not meet their claimed SPF ratings. One popular sunscreen sold by the brand Ultra Violette returned an SPF rating of just 4. While Ultra Violette and a number of other brands initially defended the testing they had relied upon, the TGA reviewed the situation and found issues with a specific base formula used by numerous brands. It also discovered certain overseas testing laboratories that were depended upon by the manufacturers were unreliable. The Ultra Violette product identified in initial testing was recalled and the TGA cancelled its listing with the Australian Register of Therapeutic Goods (ARTG). Other companies also made the decision to pull their products from sale, or were paused by the TGA, including McoBeauty, Ethical ZincDaily, Naked Sundays, Bondi Sands and Aspect Sun.

Slip, slop, slap Encouraging the application of sunscreen has been part of public health messaging to Australians for decades now. As well as slipping on a shirt and slapping on a hat, the public is told to slop on sunscreen, seek shade and slide on sunglasses to reduce their risk of skin damage that can lead to melanoma. Sunscreen is designed to prevent the damage UV rays can have on the skin’s DNA. Perth dermatologist Dr Helena Collgros explained that sunscreen can block or absorb that UV. “There are two different types of sunscreens. Mineral sunscreens block and the chemical sunscreens absorb,” she said. “Mineral sunscreens contain titanium dioxide or zinc oxide and those basically reflect and absorb the radiation – that's what's reducing the amount of UV that is reaching the skin. "Then the chemical blocks absorb the UV, reducing the amount of harmful UV and subsequently sunburn."

An SPF rating is meant to represent the time it takes for skin to redden while wearing the product, compared to the time it would take for the skin to burn if it were unprotected. This differs depending on a person’s skin type. “When you say that a sunscreen is 50+, it means that you can stay in the sun without getting burned 50 times longer than without sunscreen,” Dr Collgros said. “Let's say if someone would get burned after five minutes, but if they use SPF20 that gives them 100 minutes.”

Stick with it Melanoma skin cancer is the third most commonly diagnosed cancer in Australia and it is estimated about 1455 Australians died from it in 2025. The Melanoma Institute of Australia has not been commenting on the SPF saga, holding the position that it's an issue for the regulator and brands. However it told Medical Forum that “sunscreen remains a critical element of the five sun-safe rules”. continued on Page 11 JANUARY 2026 | 9

Women’s Health Spot the Difference!

TOPICS

WHEN

Peripheral vascular disease, Dr Rob Tewksbury, Vascular surgeon

WHERE

Gender differences in the diagnosis and management of heart disease, Dr Wasing Taggu, Cardiologist

Gender disparity in pain presentations and management, Dr Rajiv Menon, Pain physician Cervical screening update and follow up protocols Dr Mike Kamara, Obstetrician & Gynaecologist POI and rare ectopic pregnancies, Dr Mat Epee-Bekima, Obstetrician & Gynaecologist Surveillance post breast implants – risks for malignancy, Dr Yang Huang, General surgeon – breast Eating disorders, Dr Belinda Russell-Smith, JHC GP Liaison GP

joondaluphealthcampus.com.au 10 | JANUARY 2026

Saturday 21 February 2026 9.00am – 4.15pm Rendezvous Scarborough Hotel 146 The Esplanade Scarborough WA 6017

Online GP Events | Joondalup Private Hospital Scan to register

FEATURE

continued from Page 9 That message is backed up by Australia’s leading cancer charity, the Cancer Council.

SPF testing The TGA is considering what measures could be put in place to increase the consistency of SPF testing for all therapeutic sunscreen products in Australia.

It is relevant to note that the Cancer Council, which works across cancer research, prevention and support and promotes the SunSmart campaign, had some of its own sunscreens fail the Choice testing.

The current method of sunscreen SPF testing uses human subjects, which means there are a number of variable factors including skin type and how skin redness is assessed.

Cancer Council’s National Skin Cancer Committee Chair Sally Blane urged GPs to discuss skin cancer prevention with their patients. “Health professionals play a pivotal role in providing preventative information to patients and reducing future burden of skin cancer in Australia,” she said. “The Council urges GPs to discuss skin cancer prevention with their patients and encourage everyone to use all five forms of sun protection whenever UV levels are three or above: slip on clothing, slop on broad spectrum, water resistant spf50 or spf50+ sunscreen, slap on a hat, seek shade, and slide on sunglasses.” Ms Blane said GPs may want to inform patients on the TGA’s role as a regulator to ensure all sunscreens are safe to use and offer significant protection when applied properly. She also encouraged GPs to remind patients about the importance of skin checks, and if they noticed any changes to book an appointment with them.

Getting coverage right The TGA warns that no sunscreen is ever 100% effective at blocking UV radiation, which is why sunscreens are not allowed to use the term ‘sunblock’. It states that when applied correctly, an SPF30 sunscreen filters approximately 97% of UVB rays, while an SPF50 sunscreen filters approximately 98%. So, even sunscreen that effectively protects at SPF50 allows 2% of UVB rays to penetrate the skin. That is why the TGA also advises the use of other measures to protect against harmful rays. “Even an SPF20 sunscreen still filters approximately 95% of UVB

rays and therefore provides a much better level of sun protection than no sunscreen at all,” it advises. Dr Collgros said people should be reminded about the importance of applying sunscreen correctly. “You need to put on such a big amount, for the face and neck you need a teaspoon,” she said. “People often apply just a fingertip, so about half of the quantity needed. “If it's an SPF30, that becomes an SPF15 if you put on half of the quantity.” Dr Collgros said people should also follow instructions for the specific products they use and reapply often. “If it’s a mineral block it works instantly, but if it's a chemical one you need about 20 minutes for the chemicals to be absorbed in the skin to work. “You need to reapply every two hours, which most people don't do, after coming out of the water, or if you've dried with a towel.

most likely it's the fault of the person and not the sunscreen.” While issues with SPF ratings are still being identified and addressed, Dr Collgros advises that people should use the highest SPF rated sunscreen. “I would go for the highest, so SPF50 or 50+, because we never apply enough quantity or often enough,” she said. “People still need to use an SPF, but also rely on all the other protective behaviours that are important.” The Cancer Council provides professional development opportunities for GPs, practice nurses, and primary care health professionals across the cancer continuum, including prevention, which can be found on their website. ED: You can find Cancer Council education opportunities at cancerwa.asn. au/health-professionals/general-practice The latest updates on SPF alerts can be found at www.tga.gov.au/ products/medicines/therapeuticsunscreens#latest-alerts

“There are so many things that can reduce the amount of sunscreen that is effectively on your skin. I think when people say ‘I put on sunscreen and I got burned’ JANUARY 2026 | 11

FEATURE

Full speed ahead on clinical trials roadmap There are solid benefits that come from clinical trials, for patients, doctors and researchers alike. Now a WA roadmap is trying to accelerate the way forward.

By Cathy O’Leary

For patients with life-threatening illnesses, being offered a place on a clinical trial can be a lifebuoy amid dwindling treatment options. And in recent years, efforts to remove some of the delays and red tape has made the clinical trials process smarter and more responsive. Beyond the benefits for individual patients, clinical trials are a $1.6 billion contributor to the Australian economy, as well improving career pathways for clinicians and researchers and helping to attract skilled clinical trials investigators to WA. But despite the lure of magic bullet clinical trials, there are many funding and logistical challenges to overcome, particularly for clinicians and researchers trying to get cutting edge treatments to desperate patients. In efforts to make it easier to navigate a path through the clinical trials maze, the state government launched WA’s first Clinical Trials Roadmap earlier this year, setting out a plan to bring together universities, hospitals, medical research institutes, industry sponsors, consumers and the WA Health system. It emphasises the need to expand the state’s clinical trials capacity and provide better access as part and parcel of routine clinical care. The roadmap argues that clinical trials not only give hope to patients who have exhausted all treatment options, they can also lead to earlier diagnosis and more effective, less invasive treatments with fewer side effects. There are benefits even for patients who are not on trials, because the benefits of increased knowledge and clinical surveillance still flow on to them. But while the medical and research communities have welcomed moves to create a type of clinical trials GPS, they say it will only be possible if resources are made available in terms of funding, infrastructure and workforce. The WA Chapter of the Association of Australian Medical Research Institutes (AAMRI), which represents six independent institutes, strongly backs efforts to strengthen the state’s clinical trials capacity. It says WA hosts just 17% of the nation’s clinical trials, well behind New South Wales (31%), Victoria (30%), Queensland (22%) and South Australia (22%). 12 | JANUARY 2026

FEATURE AAMRI WA chair Professor Jonathan Carapetis, who leads The Kids Research Institute Australia, said clinical trials were a way for patients to get access to new treatments, while more broadly acting as a pipeline to develop new products, antibiotics, therapies and diagnostics. “We have to put them through this rigorous process of clinical trials to make sure they work and they’re safe, and if we want health to improve, we need to have the ability to trial new ideas and products,” he said.

Smarter thinking Prof Carapetis told Medical Forum that COVID had taught researchers that they could accelerate trials if there was a degree of urgency and sufficient investment. “There are new methodologies for clinical trials that have been developed – things like adaptive trials rather than setting out at the start how the trial is going to work, how many people will be involved and what is the end point, and then waiting to see if it works,” he said. “With the new methodologies you can bring on new people in realtime, you can randomise them to one arm of the trial, and then you can monitor the results as you go. “If it looks like something is showing up – either the drug is working, or it’s not – you can start to randomly allocate people more to one of the arms than the other, so it gives you an accelerated outcome and sometimes you can save years.” Prof Carapetis said another new path was platform trials, which could enrol people who had a particular condition and randomise them to a range of different treatments, so researchers could assess not just one but multiple treatments. “While clinical trials can take ages and be very expensive, there are new ways to do these trials, and certainly WA is right at the forefront of that,” he said. “For individual patients, particularly those with very serious illnesses, this is the only way they get access to the latest cutting-edge treatments. “So, if you’ve got a cancer and you’re in a category that has a poor

outcome, there might a clinical trial where they’re trialling a brand new treatment against the existing standard of care. While there is always the risk you get into the wrong arm, if you want to potentially get access to what could be an even better treatment, you can only do that through a clinical trial.” With some very rare diseases, researchers needed the capacity to randomise perhaps one patient a year to new cuttingedge therapy, and that required infrastructure and support. “Up until recently in Perth we haven’t been great at that, so people have needed to fly to Sydney or America and pay a fortune. We need to have the capacity for anyone in WA, if they want to, to enrol in these cutting-edge clinical trials because hopefully that’s lifesaving therapy they get access to.” Prof Carapetis said that while pharmaceutical companies sometimes funded the drugs used in clinical trials, that was only part of the picture. “It’s not just the cost of the drug because you need a whole lot of infrastructure, existing skilled people and dedicated clinical spaces, and people with dedicated time to give it,” he said. “You also need data and pharmacy management capacity, and often you need to take highly sophisticated blood tests.” It was not as simple as saying to a clinician “start a clinical trial” because there was often a lot of investment needed to make a place clinical trial-ready. “And it’s not just drug company sponsored trials; there are a lot of clinical trials that are developed by doctors, academics and researchers that might not be ready for a drug company to run.

“And increasingly drug companies are less inclined to invest in earlystage trials because there is a high risk of them not succeeding,” he said. “We need the ability to invest in investigator-initiated studies, which are the pipeline of the therapies of tomorrow, and are run by the scientists, doctors and nurses. “But inevitably, unless there is quarantined time for clinicians and researchers, and the skilled support staff and the culture that supports it, then understandably clinical care will take priority and trials will drop to the bottom of the list.” Prof Carapetis said there was good evidence that hospitals actively involved in clinical trials had much better outcomes for patients, even if patients were not involved in particular trials. “That’s because it says this is a place that values participating and advancing our knowledge. Staff are happier and have greater morale, and you attract much better talent, as well as getting access to cutting edge therapies of tomorrow.” Prof Carapetis said there was traction to get more funding – federally through the Medical Research Future Fund and the National Health and Medical Research Council, and at a state level through the Future Health Research and Innovation Fund. There were also moves nationally to streamline ethics and governance processes, because it could be disheartening for researchers who wanted to do a multi-site clinical trial but had to go through a lot of red tape to enrol patients in perhaps five or six hospitals. continued on Page 15 JANUARY 2026 | 13

Medical Forum Podcast Our podcasts bring you the latest updates and key insights into new treatment options available. Join our clinical editor Dr Joe Kosterich in conversation with WA specialists to learn more about developments to improve patient outcomes. Our podcasts are now CPD verified. Look for the CPD logo to complete your self-reflection and claim your time. Learn more about: Aortic stenosis: managing low-risk patients with Dr Gerald Yong Is it pelvic venous congestion? With Dr Marek Garbowski Rethinking radiation oncology with A/Prof Yvonne Zissiadis & Celia Byatt Lung Cancer Screening with Prof Fraser Brims How to approach acute and chronic knee pain with Dr Jean Louis Papineau

Listen on your favourite podcast platform – scan the QR code to follow us! 14 | JANUARY 2026

FEATURE

continued from Page 13 “At a state level we’re seeing real commitments like the Clinical Trials Roadmap, so progress is happening, but we do think it could be accelerated and amplified, and it needs to come along with a commitment from the health services themselves,” he said. “It’s not just researchers saying we need this – it’s about the health systems saying it’s important and we’re going to quarantine time for our clinicians to be involved and provide the infrastructure they need.”

GPs are crucial The roadmap also emphasises the crucial role of GPs to bridge the gap between researchers and patients. They are often the first point of contact for many patients to be told about clinical trial opportunities and referred to specialists or trial sites. This meant GPs needed the necessary resources, information, training and professional development opportunities. While there were potential benefits for GPs, including a revenue stream, this was often offset by the time and effort needed to be involved in clinical trials, particularly for rural GPs. Australia’s first rural general practice-based clinical trials network is calling on GPs across WA to integrate high-quality research into their everyday practice. The PARTNER Network supports more than 100 regional, rural and remote general practices across Australia to participate in clinical trials. The first trials started in Bunbury, Busselton and Albany, and it is now seeking more general practices to sign up, particularly in underrepresented areas including the Wheatbelt, Great Southern, Midwest, Goldfields, Pilbara and Kimberley regions. Initial trials are focusing on insomnia and chronic obstructive pulmonary disease; conditions commonly managed in general practice. The network, supported by WA Academic Lead Associate Professor Andrew Kirke, is working within the Rural Clinical School of WA to help link up interested practices and national trial teams. PARTNER Network State coordinator Kerry Leggett told

Kerry Leggett and Professor Andrew Kirke are working to make clinical trials more accessible for those living in rural and regional areas.

Medical Forum that a lot of rural GPs might want to be involved in clinical trials and research but did not have many opportunities. “At the moment there isn’t much protected time, and even the time it takes to read an email from a clinical trials team, maybe 15 minutes, is time when you could be seeing a patient,” she said. “In a hospital setting, if there is a research project, then staff will get put on that project and there is protected time to work on it. But a lot of what has happened historically is that GPs who are involved in research – even in metropolitan cities but especially in rural areas – is that it’s done out of pure love. “There’s not a lot of financial incentives, or even time incentives, because they’re overburdened and often already doing more than they can handle.” Ms Leggett said there were strong benefits from being involved in clinical trials, including getting access to innovative models of care which sometimes could be translated directly into practice. Being part of research efforts was good for career progression and patient satisfaction, and there were also opportunities for additional income.

The costs “From the patients’ point of view, people in rural areas don’t have equity of access, and if they travel to a metropolitan centre to be involved in a trial, that might mean time away from work and family,” she said. “Costs of trials often won’t cover things like accommodation or airfares, and some can last weeks

or months, so often it’s not viable for patients to take part. In some cases, it can have a big difference on quality of life if they are able to be part of a clinical trial.” She said GPs were in the best position in rural areas to know the medical needs of the community. “They might see patterns that they think would make an interesting research question but there’s no support there, or easy way to link them into an institution, particularly if the GP doesn’t have any prior research experience,” she said. Ms Leggett said the network tried to reduce some of the administrative burden, using data privacy software tools that could help reduce time in patient identification, and it could act as a facilitator between trial teams. Academic GPs were able to vet trials as they came in, to ensure they made sense to be going into primary care, and as clinicians they had insight into the challenges in primary care. “There’s a lot of interest and we get a lot of feedback from GPs who are enthused and excited, but there are still significant barriers,” Ms Leggett said. “There’s appetite for it, but even if you want to do it, it can just be too hard, especially when you can’t retain staff and you’ve got doctors working through their lunch break. “We’re advocating for more resources, more protected time, and a way to overcome all the things that get in the way.” ED: For more information about becoming a GP member of the PARTNER Network contact kerry.leggett@rcswa.edu.au.

JANUARY 2026 | 15

Upcoming GP Education Events Rural Emergency Advanced Clinical Training (REACT+) REACT+ is a high-level CPD emergency course that goes beyond the basics, preparing participants for the complex, high-stakes realities of rural and remote emergency care. It’s a fast-paced, immersive course where experienced doctors are challenged to perform under pressure in realistic, high-fidelity simulations. Eligibility: REACT+ participants are expected to have foundational knowledge in basic and advanced airway management, Basic Life Support (BLS) and Advanced Life Support (ALS) protocols, and the structured A-E assessment of critically unwell patients. Familiarity with emergency and simulation environments is also recommended. Date: 21-22 February 2026 Where: Perth

Paediatric Emergencies and Clinical Healthcare Scenarios (PEaCHS) A one-day CPD workshop in paediatric emergency scenarios and skills. It will give delegates real-life examples and the opportunity to manage sick orinjured children in a safe environment. It includes: • Hands-on simulation – practise common scenarios and structured care

Interesting cardiology case - real world cases with practical insights for GPs Speakers: Professor Rukshen Weerasooriya, Dr Gerald Yong, Dr Sekaran Gana, Dr Thato Mabote, Dr Yuli Ten, Mr Eric Karim Slimani, Mr Pragnesh Joshi, Dr Keng (Siang) Ung, Dr Philip Currie, A/Prof Kushwin Rajamani, Dr Pasko Dedic - Cardiology. Date: February 7, 8:00am Where: UWA Uniclub Ballroom, Hackett Drive, Crawley RSVP: February 6

• Short presentations by experienced paediatric emergency physicians

Women’s Health – Spot the Difference

• Comprehensive handbook of lecture materials and practical skills

Speakers: Dr Robert Tewksbury, Dr Wasing Taggu, Dr Rajiv Menon, Dr Mike Kamara, Dr Navin David Palayoor.

• ‘Resuscitation reminders’ card for your ID badge clip.

Date: February 21, 8.30am

Date: 6 February 2026

Where: Grand Ballroom, Rendezvous Scarborough Hotel, Scarborough

Where: Denmark

RSVP: February 13

Medical Forum will be introducing live GP Masterclasses in 2026 Delivering RACGP accredited education by your local WA specialists – have your say on the topics and speakers you’d most like to see on the program.

Scan the QR code to help design your perfect masterclass 16 | JANUARY 2026

CPD VERIFIED

GUEST COLUMN

Giving children courage to face anxiety Helping children face their fears may hold the key to tackling anxiety, writes Professor Jennie Hudson and Postdoctoral Researcher Chloe Lim. In Australia one in 14 children experience anxiety that interferes with their daily lives. Yet they don’t all receive the appropriate care and support to manage their anxiety levels. Researchers within the Child Mental Health team at Black Dog Institute are exploring how helping children face their fears in a safe, playful way can help them build confidence and resilience. The Courage Quest Plus study is recruiting families of children aged 8-12 whose fears or worries interfere with daily life. The study aims to understand which strategies work best to help children overcome anxiety. Researchers aim to support children to face their fears in a positive, fun environment in a bid to change the narrative around that fear.

Anxiety in children In Australia, 6.9% of children aged 4-11 years old have clinical levels of anxiety, but only 19% of these children are likely to receive evidence-based care. The recommended first line of treatment for anxiety disorders in children is Cognitive Behavioural Therapy (CBT). The likely key active ingredient of CBT for child anxiety is exposure: practising repeated tasks to face one’s fears, such as speaking in class or sleeping in your own bed. Exposure works because children create new, positive memories that compete with old fearful ones. When children face scary situations while feeling positive emotion, it might help consolidate learning and make bravery stick. That’s part of what we’re exploring in this clinical trial.

10 weekly online modules in the convenience of their own home. Children and parents receive psychoeducation on anxiety and exposure, guidance on how to create exposure activities, and opportunities to practise their exposure activities to face their fears. Parents also receive three support sessions with a trained psychologist.

How it can help

disorders, such as obsessivecompulsive and related disorders, they don’t have to have been diagnosed yet, as this is assessed during the clinical trial. Children may also present with secondary mental health challenges, such as depression, ADHD, or autism, but these are not directly addressed through the program.

What GPs can do

The intervention will provide exposure-focused therapy to children, encouraging them to learn strategies on managing and facing their fears.

If you would like to share the Courage Quest Plus study with families that you see, you can direct them to the study sign-up page: blackdoginstitute.org.au/researchstudies/courage-quest-plus/

Exposure is thought to work by creating new and more helpful/less scary memories around feared situations, and these new memories compete with existing, unhelpful, and anxious memories.

For more information or for flyers to print for your clinic you can email the research team at couragequest@blackdog.org.au.

It therefore aims to equip children with strategies that they can continue using even after the 10-week program.

The Courage Quest Plus program

The intervention is ideal for families seeking support for their child’s anxiety, especially for children who aren’t already receiving support for anxiety or are on a waitlist.

The program teaches children and parents about exposure through

While the program is for children with anxiety and anxiety-related

ED: Professor Jennie Hudson is lead researcher on the Courage Quest Study and Postdoctoral Researcher Chloe Lim is involved in the study.

This was part of our December 2025 CPD catalogue. Scan here to claim your time.

JANUARY 2026 | 17

CPD VERIFIED

GUEST COLUMN

Changing the narrative on respiratory and palliative care Changing the conversation around respiratory care and palliative care begins in the consultation room, respiratory nurses Jacqueline Rapaic and Jennifer Lamb write. Palliative care in respiratory health is not just about the final days of life, it’s about improving the way people live with serious, chronic conditions. Yet, for many clinicians and patients, the term still carries a stigma of ‘giving up’. For general practitioners, who are often the first to recognise declining function or increased symptom burden, reframing palliative care as a proactive, supportive approach to quality of life is both a clinical and cultural opportunity In respiratory medicine, palliative care focuses on managing breathlessness, fatigue, and psychosocial distress in conditions such as chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), severe asthma, or pulmonary fibrosis. Unlike some cancers, these illnesses follow an unpredictable course, with acute exacerbations and gradual decline. Early integration of a palliative approach can reduce hospitalisations, support care at home, and ensure treatment aligns with patient preferences. With early support, patients can prepare and plan their care journey rather than facing hospital admissions and reactive decisions in their final days.

The picture in WA Demand for palliative care is growing across Australia. In 2022– 23, there were more than 100,000 palliative care hospitalisations, according to the Australian Institute of Health and Welfare (AIHW) and around 882,000 non-admitted palliative care services, with 18 | JANUARY 2026

most delivered outside hospitals, often in people’s homes. Palliative Care Australia estimates that four in ﬁve people who die each year could beneﬁt from palliative support. In Western Australia: • About one in nine people live with asthma, and one in four adults over 60 have COPD • In 2020, 24 people died from asthma, most over 75 • The WA End-of-Life and Palliative Care Strategy 2018– 2028 highlights respiratory health as a key priority • The National Palliative Care Standards 2024 emphasise that compassionate, appropriate care should be provided equally across all healthcare settings.

Changing the conversation Reframing palliative care in respiratory health isn’t just about language, it’s about when, how, and by whom this care is introduced. Early integration improves outcomes: Patients with advanced respiratory disease often experience severe breathlessness, anxiety, and

fatigue well before the terminal phase. Early palliative involvement improves symptom management, enhances wellbeing, and can reduce emergency admissions. Misconceptions persist: Many patients and clinicians still associate palliative care with ‘endof-life’ or ‘stopping treatment’, delaying referrals and limiting access to valuable support. WA’s geography matters: Regional and remote patients face additional barriers, including fewer local specialists and longer travel times. GPs often play a central role in identifying palliative needs and coordinating multidisciplinary care.

GPs can build confidence Identify patients early Tools such as the Supportive and Palliative Care Indicators Tool (SPICT) and the ‘surprise question’ (Would I be surprised if this patient died within 12 months?) can help identify when to introduce a palliative approach. Reframe the conversation Use clear, patient-centred language. Talk about comfort care, quality of life, or extra support. Position palliative care as part

CPD VERIFIED

GUEST COLUMN

of best-practice chronic disease management, not as giving up.

uniquely positioned to bridge the gap between respiratory and palliative care.

Collaborate with specialists

Through early conversations, proactive symptom management, and collaborative planning, they can help patients live better for longer, not simply die more comfortably.

Connect with respiratory physicians, palliative care teams, and community nursing services. Shared care plans support continuity, prevent duplication, and help keep patients out of emergency departments.

Changing the conversation begins in the consultation room. When GPs approach palliative care as living well care, they not only ease suffering but empower patients and families to ﬁnd dignity and control within the realities of chronic respiratory illness.

Access practical resources • Palliative Care WA, RACGP, and Primary Health Networks (PHNs) offer education on non-cancer palliative care • Online tools like CareSearch, PalliAGED, and HealthPathways WA provide clear, evidence-based advice • Use My Health Record to document advance care planning and make patient preferences visible across the health system. Lead by normalising palliative care When palliative care is raised routinely alongside other treatment discussions, patients are more receptive and less fearful.

Normalising these conversations helps reduce stigma and makes future care transitions easier.

Looking ahead WA’s Palliative Care Strategy 2018–2028 envisions palliative care as everyone’s business. For GPs, this means leading the way in early identiﬁcation, communication, and coordinated care for respiratory patients.

ED: Jacqueline Rapaic is a Respiratory Care WA Respiratory Educator, and Jennifer Lamb is Respiratory Care WA Clinical Lead - Adult Services.

This was part of our December 2025 CPD catalogue. Scan here to claim your time.

While workforce and access challenges remain, GPs are

Support over the holidays Free mental health and emotional support are on hand at Medicare Mental Health Centres in Armadale and Midland throughout the festive season, including all public holidays. Walk-in support is available, or patients can book an appointment for counselling. Open 10am – 8pm daily

No Medicare card or referral needed Medicare Mental Health

1800 595 212

JANUARY 2026 | 19

ChestRad Mandurah Home to the Mandurah region’s only Dual Source CT machine

ChestRad are specialists in Cardiac CT, Chest CT and Lung Cancer Screening Chest Rad Dec pg 42

Cardiologists – Dr Edmund Brice, A/Prof Abdul Ihdayhid, A/Prof Chris Judkins, Dr Sam Tayeb, Dr Justin Teng and Dr Tashi Zhaxiduojie Cardiothoracic radiologists – Dr Conor Murray and Dr Shriv Srigandan

ChestRad's rooms are at the Mandurah Specialist Centre on Minilya Parkway, Greenfields (near the Peel Health Campus)

All Medicare rebated services in Mandurah BULK BILLED!

www.chestrad.com.au 20 | JANUARY 2026

OPINION Dr Joe Kosterich | Clinical Editor

New cycle, new solutions? Last year was full on for many people in many ways. Numerologically it apparently marked the end of a nineyear cycle, meaning 2026 is the start of a new cycle.

I suspect we need a rethink of the health system, including a slashing of bureaucracy and red tape. Maybe the new numerology cycle will bring surprises?

Numbers and stars seem no less accurate than other forms of prediction in these somewhat crazy times we live in. Hopefully some of you are reading this while lazing somewhere pleasant. Work-life balance is something we often talk about with patients but don’t always apply to ourselves. It strikes me that the younger generations do this better than previous ones. Pressure on doctors is relentless and support is negligible, in both the public and private sector. This has real world consequences, including doctors working less hours in clinical roles. This leads to increased waiting times and less access to care. Bringing in doctors from overseas helps to a degree, but Australia is competing with many other countries for doctors. The federal government thinks the answer to access is to drive down doctor incomes via pressure to bulk bill in general practice and to look at caps on fees in specialty practice. This is not the solution as the problem is workforce numbers and the pressure to do more for less. I suspect we need a rethink of the health system as it is currently configured, including a slashing of bureaucracy and red tape. Maybe the new numerology cycle will bring surprises? As we enter the new cycle, we are bringing you some of our best from the old cycle. This month we are reprinting some of the most popular clinical updates of 2025. For those on holiday, enjoy. For those not, start planning the next one.

ARCHITECTURAL | INTERIORS | PERTH HEAD OFFICE

AWARD WINNING HEALTHCARE PRACTICES

1300 728 133 | www.medifit.com.au

MEDIFIT_MedicalForum_2025_StripAd.indd 1

26/11/2025 4:26:14 PM

JANUARY 2026 | 21

CLINICAL UPDATE

Pushing the buttons for belly lesions By Dr Michael Collin, Paediatric Surgeon, Subiaco, Joondalup & Murdoch There are a number of lesions that occur at, or near, the umbilicus during childhood, especially during infancy. Their natural history and management are dependent on clinical diagnosis.

Umbilical hernias Persistent paediatric umbilical hernias are caused by the failure of the umbilical cicatrix to scar down and close through early childhood, leaving a defect in the abdominal musculature that allows intra-abdominal contents to protrude through the defect into a sac under the umbilicus. The normal natural history of the umbilicus after delivery involves the Wharton’s jelly surrounding the vessels becoming scarified and the navel formed by the remnant umbilical cord stump. Beneath the umbilicus, the cicatrix is formed as the small umbilical ring closes and scars down. This process can continue to occur through the first few years of life. While all babies are born with the umbilical defect, at least 20% will persist clinically through the first

Figure 1: Umbilical hernia visible in an infant after abdominal surgery for another reason (diaphragmatic hernia). This umbilical hernia was observed and closed spontaneously.

22 | JANUARY 2026

Key messages Most babies are born with a small umbilical defect that closes in 98% of cases in the first few years, even if it appears to get larger in the first few months Lesions that are unlikely to resolve include supraumbilical or epigastric defects or remnant embryological structures, persistent polyps and cysts While the risk of complications from these lesions is small, they can be symptomatic and require formal surgical management.

year of life, some even getting larger initially. Although 98% will resolve by 3-4 years of age. Umbilical hernias that persist beyond this period could be considered for repair. Complications are exceptionally rare, with entrapped omental or pre-peritoneal fat much more common than bowel incarceration.

with pain, and may also cause issues in adulthood. Families may elect to observe uncomplicated, asymptomatic umbilical hernias. Repair, if offered, usually involves an infraumbilical incision and primary closure of the defect. Unlike adults, use of mesh in the paediatric population is exceptionally rare.

Supraumbilical hernias While an umbilical hernia is most likely to resolve, a supraumbilical hernia is unlikely to do so. Unlike umbilical hernias, which have a concentric swelling of the umbilicus, a supraumbilical hernia can be identified by the bulge creating a more prominent infraumbilical crease with a flattened appearance superiorly (see Figure 2). To achieve a good cosmetic result, an infraumbilical incision and separation of the cicatrix to access the hernia, with subsequent umbilicoplasty (reconstruction) is preferred.

Epigastric hernias

Umbilical hernias may be symptomatic, most commonly

Epigastric hernias are defects in the linea alba (midline fascia between the recti) that occur in

Figure 2: Unlike the umbilical hernia in Figure 1, a supraumbilical hernia demonstrates a superior flatter bulge with a much more pronounced inferior crease.

Figure 3: The differential for a simple granuloma should include a remnant of vittelo-intestinal or urachal structures, beware any cherry red appearance of mucosa.

CLINICAL UPDATE A common differential is divarication of the rectus musculature, which occurs with a laxity of the linea alba that causes swelling all the way from the xiphisternum through to the umbilicus, with the muscle edges visible laterally to the bulge. There is no actual defect in the linea alba and as the child grows the bulge/divarication should become less pronounced or resolve completely. There is no role for surgical correction of divarication.

Other umbilical lumps Figure 4: A small epidermoid cyst present within the umbilicus, planned for surgical excision.

the line between the xiphisternum and the umbilicus. They are often small and most commonly contain pre-peritoneal fat from the falciform ligament. They may be symptomatic even if small. Repair is achieved easily through a small incision over the defect.

Small umbilical granulomas or polyps can form as a result of granulation tissue forming in the umbilicus after Wharton’s jelly fails to completely scarify. In a general practice setting, a small flat granuloma can be safely managed with cauterisation with silver nitrate sticks, with or without paraffin around the lesion on the normal skin to protect it. A more polypoid lesion, especially with a narrow base, can be managed with a simple suture

ligation. Place a suture tie with double throw or slip knot at the base of the lesion and tighten to ensnare and strangulate the polyp. The lesion should become ischemic and auto-amputate within a week. A failure of outpatient-based management may require surgical excision. The differential for these granulomas includes lesions related to a persistent vitello intestinal duct or urachus, or a distinct remnant of these. These structures are embryological remnants of the foetal yolk sac and allantois. Beware of a cherry red appearance of mucosa, discharge from the umbilicus – especially if chyme/ faeculant or urinary in nature – or any clearly patent lumen. A true remnant of these structures will require formal surgical excision. A cystic lesion within the umbilicus and covered with skin may be a simple epidermoid cyst, although these will also likely benefit from formal excision. Author competing interests - nil

Happy New Year from the Medical Forum Team Connect with us in 2026

Scan the QR code to follow us and subscribe

JANUARY 2026 | 23

Complete your annual CPD hours

with Medical Forum Make Medical Forum your go-to place to complete your CPD. From next year we will be a RACGP CPD provider, offering EA, RP and MO content developed by WA specialists for you. Every module you complete will be added straight to your RACGP CPD home and put towards your yearly requirements.

Scan the QR code to help design your perfect masterclass 24 | JANUARY 2026

CPD VERIFIED

CLINICAL UPDATE

Exercise in cancer care: It is time to deliver By Mary Kennedy PhD, Exercise Physiologist The days when rest was considered the best option for people with cancer are long past. Decades of research demonstrates clear benefits of exercise to improve health outcomes before, during, and after cancer treatment.

Key messages Exercise is medicine for people with cancer A substantial body of evidence supports integrating exercise into clinical care

A 2019 review showed exercise has a role in positively impacting eight common side effects of cancer treatment, including improved health-related quality of life and physical function, bone health, and sleep, and decreased cancer related fatigue, anxiety and depression. Further research supports the role of exercise in the improved survival rates of breast, colon, and prostate cancer.

refer patients to accredited exercise physiologists or physiotherapists.

Yet some clinicians still question the true impact of exercise due to the observational nature of most exercise oncology studies. A recent randomised controlled trial (889 people, 55 centres primarily in Canada and Australia) investigated if structured exercise could improve survival outcomes for people with stage III or high-risk stage II colon cancer after the completion of surgery and chemotherapy.

But patients report they trust their care team, so even a brief conversation or referral can make a difference.

Participants were randomly assigned to either a three-year supervised exercise program (intervention group) or received health education materials only (control group). The results demonstrated significantly longer disease-free survival for people in the exercise group and were consistent with longer overall survival for exercisers too.

Start the conversation about exercise with your patients today.

Yet, a recent study found that while 94% of healthcare professionals agree exercise is beneficial, only 35% routinely apply COSA’s recommendations in practice. The reason for the low participation rate? Many feel it is not their role, or they lack the time, training, or resources.

Exercise isn’t just a “nice to have” – it’s evidence-based care, and health professionals need to promote that message.

Helpful resources Whilst not necessary to upskill as an exercise professional to promote exercise to patients, it is important to start the conversation reinforcing that exercise is an important part of care, not an optional extra.

This is the first randomised trial showing that exercise can directly improve survival in people with colon cancer – reinforcing the importance of providing exercise as part of cancer care.

Exercise is Medicine Australia offers a variety of resources to guide healthcare professionals to incorporate exercise screening, assessments, discussions, and referrals into their practice. The practical tools are free and are designed to be integrated into clinical care.1

The Clinical Oncology Society of Australia (COSA) calls for exercise to be embedded as a standard part of cancer care. COSA encourages all healthcare professional to talk about exercise, recommend it, and

The Exercise and Sports Science Australia (ESSA) Professional Directory is a practical tool helping locate qualified providers, making referrals easier and more accessible. The tool allows for screening by

location and specialty area (e.g. cancer) of the professional. 2 Cancer Council WA offers the Life Now Exercise program—a free 12-week supervised group program for people diagnosed with cancer and their primary carers. 3 General practitioners have a particularly important role in providing exercise for people living with and beyond cancer. A Chronic Disease Management Plan (CDMP), allows eligible patients, including anyone with a cancer diagnosis, to access Medicare-funded exercise sessions. People are eager to receive exercise guidance. A recent focus group in Western Australia explored the experience and desires of breast and prostate cancer survivors for receiving exercise information from their health care providers. A key finding from the study: people wanted more. One breast cancer survivor noted: "I would like to be referred to someone… to help me with everything, like, how to exercise, what kind of exercises." 1 www.exerciseismedicine.org.au/ resources/tools-forms/ 2 www.essa.org.au/find-aep 3 www.cancerwa.asn.au/cancer-support/ get-support/emotional-physicalwellbeing/life-now-exercise-andmeditative-courses Author competing interests – the author is supported by a Cancer Council of Western Australia Postdoctoral Fellowship and serves on the ACSM Exercise is Medicine® Moving Through Cancer Task Force.

This was part of our August 2025 CPD catalogue. Scan here to claim your time.

JANUARY 2026 | 25

CPD VERIFIED

CLINICAL UPDATE

Updates in the management of common vulval conditions By Dr Amy Fitzgerald, Gynaecologist, Subiaco The vulva comprises mostly of skin but is subject to a unique set of influences including reproductive hormones and its specific microbiome. It is also affected by what can be a harsh physical environment, impacted by heat, friction and moisture. This can make managing vulval conditions and infections challenging. The impact of vulval conditions on patients should not be underestimated. Wellbeing, sexual function, mood, self-esteem and body image, can all be affected.

Key messages Lichen Sclerosus is a lifelong condition requiring steroid ointment suppression and follow up to prevent loss of vulvar architecture, dyspareunia and maligancy Not all itching is thrush, consider alternative diagnosis particularly in post-menopausal women Concurrently treating male and female partners to prevent BV recurrence is recommended.

Vulval conditions can be debilitating. The stigma associated with them often leads to late presentations contributing to delays in diagnosis and management.

Characteristic appearance of Lichen Sclerosis with thin, crinkled, white areas commonly in a figure of eight distribution around the vaginal introitus and anus, accompanied by associated anatomical changes with fusion of the clitoral hood, labial resorption and narrowing of vaginal aperture. Available at https://dermnetnz.org/ topics/vulval-lichen-sclerosus-images

Mainstays of vulval care include avoiding drying soaps by using a soap free wash, with a paraffinbased ointment and reducing exposure to irritants including heat, moisture, soaps, bleaches, dyes, urine and faeces. This can be done by wearing lose cotton underwear, increasing underwear free time at night, using ‘leak proof’ or period underwear instead of pads or liners, limiting time in tight clothing, especially post workout or wet bathers, and treating and managing urinary and faecal incontinence.

Benign vulval dermatosis Lichen Simplex (Chronicus) is characterised by localised well circumscribed thickened plaques typically affecting the labia majora and is the result of the itch-scratch cycle. It can occur due to multiple dermatoses, for example allergic, contact or irritant dermatitis, systemic disease, and psychiatric conditions. Management centres around removing irritants, breaking the itch-scratch cycle, treating underlying conditions and reestablishing the normal skin barrier. 26 | JANUARY 2026

Lichen Simplex. Characteristic bilateral erythematous thickened plaques on the labia majora with normal vulva architecture. Available at: https://dermnetnz.org/topics/vulvallichen-simplex-images

Topical corticosteroid ointment and vulval care as described above are mainstays of treatment. Steroid ointments is preferred. Tricyclic antidepressants may be used in severe refractory cases when simple measures fail.

Lichen Sclerosus Lichen Sclerosus is a lifelong autoimmune condition, which can occur at any age and has a bimodal distribution affecting premenarchal girls and more commonly peri and post-menopausal women. Itch is the most common feature; however, some women are

asymptomatic. The disease is characterised by periods of control with recurrent flares. Ultrapotent topical steroids, such as 0.05% betamethasone dipropionate ointment in optimised vehicle or compounded clobetasol propionate 0.05% ointment, are mainstays of treatment. Apply daily or twice daily for twoto-four-weeks to induce remission before gradually weaning down to twice per week maintenance. A less potent steroid can be used for mild cases. Ideally use the least potent steroid that achieves control two to three times per week for lifelong maintenance. Long term sequelae of LS include permanent changes in vulval architecture, narrowing of vaginal aperture, dyspareunia and approximately a 2-5% lifetime risk of progression to vulval intraepithelial neoplasia (VIN) and squamous cell carcinoma of the vulva.

CPD VERIFIED Suppressive steroid treatment appears to reduce the risks. Unilateral lesions or ulcers should prompt suspicion of malignancy and early review for biopsy. LS requires lifelong steroid therapy and follow up, typically yearly with a gynaecologist or dermatologist.

Vulval infections Symptoms of recurrent, chronic and difficult to treat vulvovaginal candidiasis include pruritus and burning, with resultant dysuria and dyspareunia. Vaginal discharge can be present but is often not the white cottage cheese like discharge of acute VVC. Symptoms often worsen in the premenstrual phase of the cycle. Chronic VVC pathogenesis is thought to be a hypersensitivity reaction to candida. It requires a well oestrogneised vagina and is rare in postmenopausal women without risk factors like diabetes and recent antibiotics. Recurrent VVC is commonly defined as over four infections per year. Treatment regimens vary but commonly require induction with po fluconazole 150mg daily every three days for three doses, then 150mg weekly for six months.

CLINICAL UPDATE Speciation and sensitivities can be requested from vaginal swabs. Candida glabrata should be managed with boric acid pessaries 600mg PV nocte for 14 days. If symptoms are not improving on usual management, consider: • Swapping combined oral contraceptive pill to a low or non-oestrogen contraceptive • Ceasing SGLT2 inhibitors (flozin) which cause glycosuria leading to contact irritant dermatitis and contribute to candidiasis • 1% hydrocortisone ointment for co-existing dermatitis from topical antifungal cream bases which can be irritating • Treating asymptomatic partners. Candida diets and probiotics lack evidence and are not recommended.

Bacterial vaginosis Bacterial vaginosis is the most common cause of vaginal discharge in women of reproductive age, commonly presenting with a thin grey, white, malodorous discharge. It is due to vaginal microbiome dysbiosis with vaginal microbiota changing from lactobacilli dominating to increased anerobic bacteria numbers and diversity. BV is associated with increased risk

of miscarriage, premature labour, chorioamnionitis, endometritis and pelvic inflammatory disease (PID) and is worth treating. Options are Metronidazole 400mg PO bd for seven days, Clindamycin 2% intravaginal cream 5g nightly for seven nights, or Metronidazole gel 0.75% one applicator intravaginally nightly for five nights. These are considered safe in pregnancy. Male partner treatment requires seven days of po Metronidazole and bd topical Clindamycin cream and can reduce BV recurrence. Treat male-female couples synchronously and advise avoiding sexual contact during treatment. Condoms should be used if engaging in sexual contact during treatment, but Clindamycin cream can weaken latex condoms for 72 hours post the last dose. Author competing interests – nil

This was part of our May 2025 CPD catalogue. Scan here to claim your time.

Safety warning for weight loss drugs Australia’s medicines regulator has issued a safety warning for diabetes and obesity medications over the potential risk of suicidal thoughts and behaviours. Doctors are being urged to monitor the emergence or worsening of depression, suicidal thoughts or behaviours, or any unusual changes in mood or behaviour in patients using glucagon-like-peptide-1 receptor agonist (GLP-1 RA) medicines. The Therapeutic Goods Administration (TGA) undertook an investigation on adverse events reported to the regulator, including two reports of suicide, one of self-harm and 72 reports of suicidal ideation.

While the Advisory Committee on Medicines found that the evidence available was not sufficient to support an association between GLP-1 RAs and suicidal or selfharming behaviours, it found it required a class level awareness. “The ACM stressed that updates should not imply a causal association, but reflect a class level awareness,” the TGA advised. GLP-1 RAs currently available for use in Australia are semaglutide products, sold under the brand names Ozempic and Wegovy, liraglutide sold as Saxenda, dulaglutide sold as Trulicity and tirzepatide under the brand name Mounjaro.

The TGA said health professionals should consider the risks and benefits for individual patients before initiating or continuing therapy in patients with suicidal thoughts or behaviours. “Health professionals should monitor for the emergence or worsening of depression, suicidal thoughts or behaviours, or any unusual changes in mood or behaviour. “Advise patients to tell their health professional if they experience new or worsening depression, suicidal thoughts or any unusual changes in mood or behaviour.”

JANUARY 2026 | 27

CPD VERIFIED

CLINICAL UPDATE

ADHD and men in Australia By Matt Tilley, Curtin University & Clinical Psychologist, West Leederville ADHD has rightly gained much attention in recent years, with around one in 20 Australians receiving a diagnosis. Presentation is marked by a persistent pattern of hyperactivity/impulsivity and/ or inattention negatively impacting the persons executive function and day-to-day experiences. In adults, disruptions and difficulties are typically seen with the person's personal relationships and work experiences. There are three types of ADHD – hyperactive/impulsive type, inattentive type, and combined type (a mixture of both). Impact ranges from mild to severe. Although research is inconclusive with no absolutes, men seem to be more likely to exhibit externalising symptoms and be diagnosed with the hyperactive/impulsive type, and women seem to be more likely to exhibit internalising symptoms and be diagnosed with the inattentive type. Research into transgender and non-binary people is even less clear. Typically, the hyperactive/ impulsive type is characterised by constant fidgeting, restlessness, a tendency to talk excessively, and impulsive behaviours like interrupting and acting on thoughts or feelings without consideration. These symptoms are often more noticeable, making diagnosis easier. While women are more likely to be diagnosed with the inattentive type, men can also experience these difficulties. This ADHD type is characterised by disruptions with cognitive focus and attention (distractibility), listening skills, and difficulties with organisation. The combined type is most prevalent, characterised by a mixture of the symptoms discussed above, a combination of hyperactivity and impulsivity symptoms plus inattention and distractibility. Although ADHD is usually associated with hyperactive 28 | JANUARY 2026

behaviour, an adult can still have ADHD without being hyperactive.

frustration, scolding, messages of inadequacy, and even punishment.

Typical ADHD experiences

It is not uncommon for people with ADHD to report beliefs about themselves representing an internalisation of these experiences, thus shaping their adult beliefs and experiences.

As ADHD is a childhood-onset disorder, people would have had symptoms when they were younger, even if not diagnosed or realising it. Consequently, it’s common for men to report feelings of shame, embarrassment, and inadequacy which can foster beliefs about their abilities as adults which may not be true. These feelings and experiences may be further intensified if he was undiagnosed. For example, we know that children with ADHD can experience disruption in attention and impulsivity. The impact on their schooling can be significant; commonly represented by disorganisation and forgetfulness, poor academic achievements, and experiences of behavioural misconduct. These experiences are often met with negative attention from both parents and schools, for example

Men with ADHD are more likely to experience low frustration tolerance or irritability; frequent mood fluctuations/dysregulation; forgetfulness/often losing things; heightened distractibility; time management difficulties; often ‘on the go’ acting as if ‘driven by a motor’; excessive talking and interrupting; stimming behaviours (dopamine seeking); masking (acting in socially expected ways to fit in); rejection sensitivity dysphoria; negative self-image; hyper-focus; object constancy; sleep disruptions; and fatigue. In addition to well documented issues with relationship disruption and work or career stress, research indicates that compared to the general population men living with ADHD may be more likely to

CPD VERIFIED

Key messages An adult can still have ADHD even if they’re not hyperactive Not everyone with ADHD was diagnosed as a child, and a late ADHD diagnosis can be positively life changing There are many symptoms that can highlight an undiagnosed ADHD presentation; the ASRS-v1.1 psychometric test (free online) can offer clarity.

experience a higher number of sexual partners; more STI diagnoses; potentially risky hyper-sexual activities like sexual compulsivity and addiction; increased experiences of online risk behaviours; premature ejaculation; and Male Hypoactive Sexual Desire Disorder. Of course it’s not all negative, and it’s important to remember that there are also some common ADHD ‘superpowers’ like being empathetic, enthusiastic, spontaneous, creative, intuitive, imaginative, innovative, problem solvers, adventurous, and hyper focus on interests.

CLINICAL UPDATE What helps? Despite these reported difficulties, many men with ADHD thrive and learning about their ADHD can be positively life changing. Having ADHD does not define the person’s intelligence, strengths, capabilities, nor achievements. Diagnosis, treatment, and support for men with ADHD can assist them to manage their symptoms, build and maintain healthy relationships, and achieve their work and career goals. A multimodal approach is the most effective way to manage everyday life and behaviours associated with ADHD, with an aim to improve the management and experiences of the core symptoms, improve functioning, and increase wellbeing. Therefore, consider a combination of psychoeducation, psychotherapy, and pharmacotherapy. Psychoeducation assists to increase understanding of ADHD symptoms and experiences, and improve communication skills and time management, for example.

Evidence based psychological therapies like Cognitive Behavioural Therapy, Dialectical Behavioural Therapy, and potentially EMDR, can assist men to process their experiences of living with ADHD. There are several types of pharmacotherapies used to help manage ADHD symptoms. Stimulants are the most widely used and can work quickly but have side effects and finding the most effective regimen can be trial and error. Although a good option for many, medication does not necessarily address all ADHD symptoms, and not everyone responds well to them. Author competing interests – nil

This was part of our July 2025 CPD catalogue. Scan here to claim your time.

JANUARY 2026 | 29

CPD VERIFIED

CLINICAL UPDATE

Unusual infectious causes of pulmonary eosinophilia By Dr Sumit Mehra, Respiratory & Sleep Physician, Dr Alice Culliford, Respiratory Registrar & Dr Mabel Gaastra, Medical Registrar, Joondalup There is a wide differential for acute eosinophilia in association with respiratory symptoms, most commonly asthma, vasculitis and eosinophilic pneumonias. However unusual infectious causes, particularly parasites, should be considered, especially where a relevant history of travel is present. Interestingly, Type 2 inflammation, involving eosinophils and driving conditions such as asthma, eczema, chronic rhinosinusitis, eosinophilic esophagitis and food allergies, originally evolved to combat parasitic worms.

Loeffler’s syndrome This is a transient respiratory illness characterised by lung inflammation and pulmonary and peripheral eosinophilia. It results from larval migration through the lungs, where parasite invasion into the alveolar space triggers an eosinophilic response. Ascaris lumbricoides (Ascariasis) and Strongyloides stercoralis (Strongyloidiasis) are common causes. Ascariasis is more prevalent in areas with poor sanitation and is acquired through ingestion of contaminated food or water. Respiratory symptoms such as cough and wheeze precede gastrointestinal symptoms as the parasites migrate to the gut. Migratory infiltrates on chest X-ray, marked peripheral eosinophilia, clinical presentation, and exposure history support diagnosis. Larvae may appear in sputum, but eggs are more often detected in stool. Treatment includes albendazole or mebendazole. Strongyloidiasis is endemic in tropical and subtropical regions, including Australia’s Northern Territory. It typically follows skin

30 | JANUARY 2026

Strongyloides stercoralis parasite on sputum microscopy

contact with contaminated soil, especially in those walking barefoot. Immunocompromised patients, particularly those on steroids, are at risk of life-threatening hyperinfection. Clinical signs include GI symptoms, urticarial rash, and respiratory symptoms during larval lung migration. Imaging shows patchy, migratory infiltrates, and eosinophilia is common. Unlike other helminths, S.stercoralis can complete its life cycle within humans, leading to false-negative stool tests. Ivermectin is the first-line treatment.

Visceral larva migrans Pulmonary visceral larva migrans is a parasitic condition caused by migrating Toxocara canis or Toxocara cati larvae, typically acquired through ingestion of eggs from soil contaminated with dog or cat faeces. It primarily affects children and immunocompromised individuals in areas with poor sanitation and pet exposure. After ingestion, larvae penetrate the intestinal wall and migrate via the bloodstream to visceral organs such as the lungs, liver, and eyes.

CPD VERIFIED

CLINICAL UPDATE

Key messages Parasitic infections are important causes of eosinophilic lung disease, particularly in those with relevant travel or exposure history Symptoms can be non-specific and require prompt targeted treatment to avoid chronic disease, so consideration of specific investigations is worthwhile ABPA is an important nonparasitic cause seen in asthma.

As Toxocara invades these organs, it triggers intense eosinophilia and leucocytosis, resulting in a granulomatous response. Patients may develop fever and respiratory symptoms like dry cough, wheeze, and dyspnoea. In children, hepatomegaly and fatigue are common. Marked eosinophilia and elevated IgE result from a T-cell response to a parasitic protein. Diagnosis is supported by clinical features, positive Toxocara IgG serology, and chest X-ray findings such as ground-glass opacities and patchy infiltrates. As with Loeffler’s syndrome, treatment targets the parasitic infection, with supportive care as needed for vulnerable groups. Prognosis is excellent with treatment, though chronic infection and inflammation may cause pulmonary fibrosis.

Schistosomiasis Caused by the trematode Schistosoma, it is endemic to tropical regions such as Japan, the Philippines, China, Indonesia, Africa, and Latin America. The lungs can be affected in both acute and chronic stages. In acute schistosomiasis (AS), respiratory symptoms like dyspnoea and cough result from immunoallergic reactions to parasite eggs in the lungs, often appearing on CT as nodular lesions.

CT Chest showing ground-glass nodules and subpleural consolidation of the left lung consistent with eosinophilic infiltration in acute pulmonary schistosomiasis

that may progress to fibrosis. While serum eosinophilia is less common in CS, granulomas show high eosinophil concentrations. Diagnosis is confirmed by microscopic detection of eggs in stool or respiratory samples. If eggs are absent, AS can be diagnosed clinically based on symptoms, eosinophilia, and relevant travel history. Treatment is a single dose of praziquantel, which usually offers a complete cure.

Allergic Bronchopulmonary Aspergillosis Aspergillus fumigatus is the primary non-parasitic cause of infectious eosinophilia in the lung. Allergic Bronchopulmonary Aspergillosis (ABPA) is a hypersensitivity reaction to airway colonisation by Aspergillus fungus and is nearly exclusively seen in patients with asthma or cystic fibrosis.

Eosinophilia occurs in 75% of AS cases within weeks, reflecting the acute immune response.

Presentation is with recurrent asthma exacerbations, often with mucus expectoration. Blood eosinophilia (>500 cells/ uL) is characteristic, in addition to raised total serum IgE level.

In chronic schistosomiasis (CS), eggs in the pulmonary vasculature trigger granulomatous inflammation

Specific IgE and IgG to Aspergillus confirms the diagnosis, and sputum often cultures Aspergillus fungus.

HRCT is the gold standard imaging choice, showing fleeting opacities bronchiectasis (which is usually central and involving upper and middle lobes) plus findings related to mucus impaction and bronchiolar obstruction. Other manifestations include centrilobular nodules, ground glass changes, peripheral consolidation and gas trapping. Acute ABPA is traditionally managed with a tapering course of oral steroids. Azole antifungals may be used as steroid-sparing agents, though relapse after cessation is common. Emerging smaller studies suggest a possible role for asthma biologics in patients with recurrent ABPA exacerbations or inability to taper off oral glucocorticoids, though long-term studies on efficacy and safety are pending. Author competing interests – nil

This was part of our September 2025 CPD catalogue. Scan here to claim your time.

JANUARY 2026 | 31

CPD VERIFIED

CLINICAL UPDATE

The shoulder – complex joints made easy By Dr Sheldon Moniz, Orthopaedic Surgeon, Murdoch & Albany The shoulder is one of the most complex and versatile joints in the human body, allowing for a remarkable range of motion. However, this complexity makes it particularly vulnerable to a variety of injuries and degenerative conditions. The shoulder is made up of three main joints or spaces - the acromioclavicular joint (ACJ), the subacromial space and glenohumeral joint. In clinical discussions, the shoulder joint typically refers to the glenohumeral joint. There are multiple sources that can contribute to pain within the shoulder.

A patient with proximal biceps rupture

Same patient with intact opposite side

Identifying specific areas is crucial for targeted injections. For example, if suspecting subacromial bursitis – a targeted injection into the glenohumeral joint may be of limited benefit to the patient.

Frozen Shoulder (Adhesive Capsulitis): Marked by progressive stiffness and pain, often idiopathic or associated with diabetes.

Presenting complaint is key

Blood tests are useful for detecting infections and systemic conditions such as rheumatoid arthritis or diabetes.

Investigations

Diagnostic approach for shoulder disorders is structured around four key clinical domains. Systematically assessing pain, instability, weakness, and stiffness allows clinicians to effectively narrow a differential diagnosis and identify the most relevant underlying pathology within a patient age group. Shoulder problems often correlate with a patient's age. One of the most common age-related conditions is degenerative rotator cuff tears. Studies show that 70% of individuals aged 70 and above will have some degree of rotator cuff degeneration, though only 5% of these patients will progress to cuff-related arthropathy. Recognising the natural history of these conditions can help guide treatment decisions and patient expectations.

Plain film X-Ray remains a crucial first-line investigation that is often underutilised. Ultrasound can diagnose rotator cuff tears, bursitis, and other soft tissue injuries. Haemarthrosis in cuff deficient shoulder

Biceps Rupture: Patients may report a "pop" followed by pain and a noticeable bulge in the upper arm – Popeye sign. Shoulder Dislocation: Anterior dislocations are the most common and require immediate reduction and referral.

Diagnostic clues

Impingement Syndrome: Caused by compression of the rotator cuff tendons and bursa, often leading to pain with overhead movements.

Understanding of diagnostic clues can help differentiate between various shoulder pathologies. Some key conditions to recognise include:

Instability: Can be due to repetitive microtrauma or acute dislocation, leading to shoulder subluxation or persistent laxity.

ACJ Disruption: Often resulting from trauma, this condition presents with localised pain and deformity at the acromioclavicular joint.

Glenohumeral Osteoarthritis (OA): Characterised by progressive pain, stiffness, and loss of external rotation.

32 | JANUARY 2026

MRI is considered the gold standard for assessing soft tissue structures, including the rotator cuff, labrum, and biceps tendon. However, findings should always be correlated with clinical symptoms, and it is not a first-line investigation. Certain shoulder conditions require immediate referral to an orthopaedic specialist or emergency department. These include fractures, infections, tumours, acute rotator cuff tears and unreduced dislocations. Prompt recognition and referral of these conditions are crucial to preventing complications and ensuring the best possible patient outcomes.

Treatment options Conservative management is often effective and includes rest, physical therapy, and anti-inflammatory medications.

CPD VERIFIED

CLINICAL UPDATE

Key messages A structured approach that incorporates patient age and symptoms aids in narrowing the differential diagnosis and guiding appropriate management strategies Know your target – injections can be a useful tool for both diagnostic and therapeutic purposes and are often more judicious than MRI to guide management Early diagnosis, appropriate investigations, and timely referrals can significantly improve patient outcomes. However, some conditions may require surgical intervention, including: • Rotator cuff repair for significant tears, especially in younger or active patients • Shoulder stabilisation surgery for recurrent dislocations or instability • ACJ excision for painful ACJ arthritis • Subacromial decompression for impingement syndrome to relieve pain and improve function

• Biceps tenotomy or tenodesis for symptomatic biceps tendon pathology • Shoulder arthroplasty – a total or reverse shoulder replacement is considered for severe osteoarthritis or irreparable rotator cuff tears.

affecting daily activities, suspected structural damage requiring surgical intervention and urgent conditions (fractures, dislocations, infections, or tumours).

General practitioners play a crucial role in the early diagnosis and management of shoulder conditions.

This was part of our June 2025 CPD catalogue. Scan here to claim your time.

Referral to an orthopaedic specialist is warranted in cases of persistent pain despite conservative treatment, functional limitations

Author competing interests – Nil

Complete your CPD with Medical Forum Scan the QR code at the bottom of each article. Belly lesions

Exercise and cancer

Vulval conditions

Infectious pulmonary eosinophilia

ADHD in men

Investigating anxiety in children

Shoulder joint injuries

Respiratory and palliative care

JANUARY 2026 | 33

SUMMER SERIES

in the West n O t’s

this

Summer

Summer in the west is a glorious time. From movies under the stars to trips to the beach and the outrageous laughs to be had at Fringe World, there’s so many ways to be entertained around the city over the next few months. This list isn’t exhaustive, but it will certainly give you some ideas of where to look, play, be challenged or have fun.

By Ara Jansen

Sculpture by the Sea

Sculpture by the Sea at Cottesloe Beach returns from March 6-23 after a year’s hiatus. Expect the iconic exhibition to showcase the works of local, national and international sculptors, transforming Cottesloe Beach into a temporary sculpture park for what is Perth’s largest free-to-the-public arts event. Find out more at www.sculpturebythesea.com/cottesloe

Perth Comedy Festival

The Perth Comedy Festival runs from April 2 to May 17 and serves up another round of international hilarity, teasing more of the big names set to hit the stage in 2026. From the quick wit of Stephen K. Amos to the physical mayhem of The Umbilical Brothers, this lineup brings global comedy gold – including Colin Mochrie and Asad Mecci, Schalk Bezuidenhout, Chan Lok Tim, Joanne McNally and Nurse Georgie Carroll. At venues all over Perth. Find out more at www.perthcomedyfestival.com

34 | JANUARY 2026

SUMMER SERIES

Perth Festival

A hallmark of summertime, Perth Festival brings art in all its forms from around WA and the world. One of Australia’s longest running cultural festivals, this year’s program is designed to excite, challenge and provoke as the city comes alive in a kaleidoscope of creativity. Highlights include Lacrima, a breathtaking new work of French theatre from filmmaker Caroline Guiela Nguyen and Black Swan State Theatre’s Meow Meow’s The Red Shoes, a mischievous and subversive cabaret spectacular. The East Perth Power Station returns as a riverside hub alive with music, art and community, from free sunset sessions at Casa Musica to main stage performances by Max Cooper, Nilüfer Yanya, Baker Boy and Sudan Archives. The Embassy brings its late-night flair with jazz, soul and cabaret. On from February 6 – March 1. Find out more at www.perthfestival.com.au

Outdoor cinemas

If you like your cinema outdoors, then Luna Outdoor in Leederville is the place to be over summer. This hidden gem screens the latest festival favourites, cult classics and arthouse adventures. Plus, it wouldn’t be the same without the hosted cult phenomenon The Room, now in its 15th year, hosted by Tristan Fidler, James Palm and new host Alice Finnegan.

For 18 balmy weeks beneath the Somerville pines at UWA, Lotterywest Films will roll out a hand-picked lineup of Cannes-laurelled adventures, pulse-quickening thrillers, eye opening docos, spicy romcoms and emotional dramas. Travel across the globe from the streets of 1960s Paris and the mountain villages of Italy to the coastlines of Brazil and the towns of the American south.

Telethon Community Cinemas happen at Bassendean, Burswood, Joondalup and Murdoch and they’re screening new and recent movies along with the odd classic with plenty of family-friendly flicks. Look out for some free screenings too. Snuggle down in a beanbag at Rooftop Movies which run on top of the Roe Street Car Park in Northbridge until the end of March. There’s also Moonlight Cinema located at May Drive Parkland in Kings Park. If they’re not sold out, check out Film Club at Rendezvous Scarborough.

West Australian Opera

West Australian soprano Jessica Blunt makes her role debut as Violetta, a popular courtesan who is harbouring a deadly secret in Sarah Giles’ lavish retelling of Verdi’s famous opera La Traviata. Paul O’Neill, James Clayton and Matthew Lester round out the all-star cast in the March 14-18 season at His Majesty’s Theatre. Find out more at www.waopera.asn.au

West Australian Symphony Orchestra

WASO heads out of Perth as Concertmaster Laurence Jackson takes centre stage to celebrate classical music at its finest in Mandurah and Bunbury. Beethoven, Dvorak, Mahler and Haydn are on the menu in February. As part of Perth Festival, you’ll see WASO in Echoes Through Time at St Mary’s Cathedral and The Trail in Forrest Chase. Rounding out the month, Timeless Stories is led by conductor Benjamin Northey and features mezzo-soprano Jessica Aszodi.

West Australian Ballet

This year begins with a stalwart on the WA calendar, Ballet at the Quarry (February 6-28). This season features four world premieres created especially for this unique and breathtaking location, from internationally acclaimed choreographers Tim Harbour and Ihsan Rustem and WA Ballet’s own Chihiro Nomura and Polly Hilton in their mainstage choreographic debuts. Each new work illuminates a different area of dance – from luminous lyricism to striking athleticism – together forming an unforgettable celebration of artistry, light and movement. Bring a rug and a picnic. Find out more at www.waballet.com.au

Find out more at www.waso.com.au

JANUARY 2026 | 35

SUMMER SERIES

Candlelight concerts

From Vivaldi’s Four Seasons to '80s rock anthems, a tribute to Taylor Swift or Ed Sheeran and Bridgerton on Strings, there’s something for everyone at Candlelight Concerts at venues like Perth Town Hall and Perth Modern School. Find out more at www.candlelightexperience.com

Community picnic

Yirra Yaakin’s annual Family Picnic on February 22 from 3-6pm is a chance to connect with community and bring people together to share the stories and spirit behind contemporary Aboriginal theatre. Meet and yarn with Yirra Yaakin artists, staff and creatives in the gardens surrounding Subiaco Arts Centre (Wandarguttagurrup), where they are the company-in-residence. Enjoy music, food and entertainment and discover more about the company’s exciting year of programming.

Get your theatre tickets

Find out more at www.yirrayaakin.com.au

Now You See Me For the first time in Perth, four trailblazing illusionists will unleash a mind-blowing spectacle: Now You See Me Live. Inspired by the hit film franchise, the “Four Horsemen” will stun audiences in a showcase of unmatched synergy, pushing the boundaries of stage magic to the absolute edge, making the impossible possible with an unbelievable arsenal of solo skills, shocking twists and grand feats of illusion. Crown Theatre from January 23 – February 1. Anastasia Inspired by the mysterious tale of Grand Duchess Anastasia Romanov’s rumoured escape in the dawning days of the Russian Revolution and the animated fairytale of the same name, hit Broadway musical Anastasia is a lavish musical for all ages. Transporting audiences from the twilight years of the Imperial rule to the euphoria and exuberance of Paris in the 1920s, a brave young woman named Anya sets out to discover the mystery of her past and embark on an epic adventure to help her find home, love and family. Crown Theatre from March. Find out more at www.crownperth.com.au/ entertainment/crown-theatre

Get to a gig

Concerts There’s plenty of concerts on around Perth, including Wheatus, Jimmy Barnes, Ed Sheeran, Viagra Boys, Kate Bollinger, Hothouse Flowers, Bjorn Again, Kesha, Stella Donnelly, Electric Six, Jon Stevens and Wolfmother, RAC Arena HoopsFest and West Coast Fever games, The Lumineers, David Byrne, Disney Jr Live, Good Charlotte, One Republic, Lorde, Lainey Wilson, Hill Top Hoods and Machine Gun Kelly. Red Hill The Last Dinner Party, Turnstyle, Old Dominion, Pierce the Veil and James Reyne. Astor Deacon Blue, Teddy, Amble, Wyatt Flores, The Black Sorrows, Gregory Alan, Nick Mulvey, Thornhill, Jonathan Van Ness, Tony Hadley, Anh Do and Lloyd Cole. Crown Theatre Kevin Bloody Wilson and Jenny Talia, MJ: The Michael Jackson Musical and Pretty Woman: The Musical.

36 | JANUARY 2026

SUMMER SERIES

2026 21 January – 15 February

NonnaMia!

Hypnotist Matt Hale Perth’s viral comedy hypnotist returns home after having too much fun in Edinburgh. Matt Hale’s Funbelievable! 90s Rewind is a full-throttle comedy hypnosis show where everyday people become the stars – dancing, singing, and embracing the glorious weirdness of the decade that gave us Britpop, girl power and dial-up internet.

The Briefs Factory The Briefs Factory return with The Hubba Hubba Club – a sweaty, glitter-drenched spectacle of filthy fun, dancefloor anthems and unrestrained chaos every Friday and Saturday of Fringe at the Rechabite. It’s the disco, dance and late-night party filled with the DJs, drag and burlesque your summer self has been craving. Loud, luscious and unapologetically queer.

Fringe favourite Etta D'Elia is back with a brand-new show, NonnaMia! Featuring all the songs that Nonna loves to sing, but with Etta D’Elia and her jazz band’s signature swing, this concert combines heartwarming storytelling with brilliant music that celebrates everyone’s favourite matriarch – Nonna. Shows at Shelter Brewing, Encore Rockingham and the State Theatre Centre.

She Said What? Iconic songs by Australia’s fiercest women songwriters are reimagined for chamber ensemble in She Said What? Reimagine the music of Missy Higgins, Angie McMahon and Sia alongside Katie Noonan, Emily Wurramara and Kate MillerHeidke. Expect raw emotion, bold storytelling and unexpected beauty as Mirabilis Collective dives into anthems of love, loss, protest and power in a show celebrating the guts and genius of Australian women in song.

Lisa Woodbrook and her backup dancers return with Millennial: Hits of the 90s and 00s. Get ready for more 90s and 00s bangers in this extended edition of Lisa’s hit show at the Liberty Theatre, which is part comedy, part singalong. Millennial includes hits from all of your favourite 90s and 00s artists including Beyoncé, Britney Spears, Hilary Duff, Backstreet Boys, N*SYNC, Vengaboys, Robbie Williams, Shania Twain, Kylie Minogue and more.

Enter a neon-soaked, near-future Japan where circus, dance and acrobatics collide. A haunting, visually stunning dreamworld of identity, memory and movement.

Casey Filips: Virtuoso Tobias Finlay-Fraser is “the world’s greatest actor”, according to… himself. Played by comedian Casey Filips, this one-man comedy hour is pretentious, brilliant, chaotic and laugh-out-loud hilarious.

#Since1994 An all-female contemporary eye-catching circus explosion. Breathtaking aerials, bold storytelling and raw power are a hallmark for this groundbreaking Taiwanese troupe which flips gravity and gender stereotypes on their heads. Fierce and fearless.

Primal Finding Connie

illennial: Hits of the M 90s and 00s

Gasha

Before Bob Dylan and before Joni Mitchell, there was Connie Converse – a pioneering singersongwriter who disappeared without a trace in 1974. Finding Connie is a spellbinding 60-minute concert weaving live arrangements of her songs with narration about her extraordinary life and mystery. Part music, part theatre, part detective story, this evocative production from Mirabilis Collective has captivated audiences with its blend of haunting folk melodies and lyrical storytelling.

Turn up the heat! This adults-only circus–cabaret hybrid unleashes fire, burlesque, aerials and pure animal instinct. A wild, sexy, high-voltage ride through desire, identity and everything deliciously untamed.

Bubba Licious A soft, colourful sensory wonderland for babies and toddlers, filled with bubbles, puppetry, movement and gentle magic. Pure joy for tiny humans while offering a breather for their grown-ups. More at www.fringeworld.com.au JANUARY 2026 | 37

LIFESTYLE LIFESTYLE

Fierce women against the odds Despite a painful disorder, Tara Moss brings her feisty female private investigator back in her latest book, The Italian Secret.

By Ara Jansen Never one to armchair the writing of a book, Tara Moss explored the ancient tunnels under the Italian city of Naples and stayed at a famous hotel for her latest read. In The Italian Secret, the bestselling author delivers the third instalment of her Billie Walker mystery and historical crime series. Set in 1948 post-war Sydney and then moving to Naples, the feisty and fiercely independent private investigator discovers a forgotten box in her late father’s office. Curiosity draws her into a mystery which spans continents and decades. “This book felt like such a beautiful and challenging experience to write because of everything going on in my personal life,” Tara says of her 15th book. 38 | JANUARY 2026

“On the other hand, writing was a useful escape into another world, but I also needed to have the mental peace to do this work.” While she is in remission now, Tara was diagnosed with complex regional pain syndrome (CRPS) following a hip injury around eight years ago. The severe pain (for which she needed a wheelchair or cane for periods) combined with symptoms like brain fog made it hard for Tara to write. She had to grab the periods when she felt clear. Conversely, the character of Billie Walker has never been a struggle to write. She apparently arrived quite fully formed. “It’s like a character I was already living with before I started to write

her. I like spending time with her and being in her world. I just keep writing her story, as being published is never assured, but every time it happens, I consider it a privilege.” The author says one of the aspects of the post-war era she finds fascinating and compelling is the adaptability and bravery of ordinary people doing extraordinary things. “Billie has a sense of that and she’s a representation of a certain type of woman of her time. It’s a tough world, but why not do good while you are there. “One reason I felt like she would make such an unusual character is because the work she does is part of what birthed an industry of women as investigators.

LIFESTYLE They were also outnumbered by their male colleagues. There’s not been a lot written about that. “Billie does it her way. She’s good but tough in her own way, as evidenced by the free sessions she does offering advice, and how the women share information. She’s by no means an angel but she has her own compassion and I like that about her.” As a certified private investigator and an expert researcher, Tara Moss has explored all sorts of avenues from shooting a gun, to touring the FBI Academy and spending time in morgues. She’s even been choked unconscious and set on fire, all in the name of book research. For The Italian Secret she visited the World War II tunnels under Naples, which are part of a larger network called Napoli Sotterranea (Underground Naples) and the Bourbon Tunnel (Galleria Borbonica). She also stayed at the famed Excelsior Hotel in the city, as did her characters. Famous hotel guests have included Billie Holiday, Alfred Hitchcock and Humphrey Bogart.

Not only is Tara an author, but she has also been a long-standing UNICEF ambassador and is an outspoken advocate for human rights and the rights of women, children, people living with pain and people with disability. This focus informs much of her work. Additionally, she is a holistic practitioner – working with runes and reiki – as well as being a life celebrant and funeral officiant. More and more, she is being called to speak at funerals or end of life celebrations. “My work in end of life, grief and funerals is not so removed from my work as a writer and public speaker. It’s combining those skills and being able to distil information, stories and history into something that families find difficult to put together or speak in front of a group. “I can do that in a home, in a temple or a church. I feel comfortable holding that space. It’s still a form of storytelling. I’m interested in people and their stories and their experiences.”

Tara headlines the UN Women Australia’s International Women’s Day lunch on March 4 at Optus Stadium. Tickets from iwd.net.au/perth. The Italian Secret is out now.

n o s a e s e h T d e n i a t r e to be ent Stewart Copeland

Andy and the Odd Socks

Taylor: A Tribute to the Eras Of Taylor Swift

MON 12TH JAN

SAT 17TH JAN

Andy Day and the Band deliver a hilarious, uplifting, high-energy live kids show.

Swifties unite for the ultimate unofficial tribute show to every Taylor Swift era.

Where Is The Green Sheep?

Hits Of The ‘60s and ‘70s By The 60 Four

The 70s80s90s Show

TUE 20TH JAN

SAT 7TH FEB

An immersive theatre experience inspired by the beloved book Where is the Green Sheep?

The 60 Four celebrate the sounds of Elvis, The Beach Boys and The Beatles.

The Ultimate TimeTravelling Party – Three Decades of Hits, One Electrifying Show!

SUN 11TH JAN Legendary drummer Stewart Copeland embarks on his first spoken word tour.

SAT 14 FEB

regaltheatre.com.au

JANUARY 2026 | 39

DISCOVER NOW

www.scagnetti.com.au

SCAGNETTI FINE JEWELLERS