Hepatic encephalopathy (HE) is a reversible neuropsychiatric complication of cirrhosis associated with cognitive and psychomotor impairment that may compromise driving safety. Deficits in attention, visuospatial ability, reaction time and executive function contribute to impaired on-road performance and increased motor vehicle collision rates. Despite this, there are no standardised Australian guidelines addressing driving in patients with HE, and international guidelines remain heterogenous. This article reviews the impact of overt (OHE) and covert HE on driving performance and outlines a pragmatic, risk-stratified framework. For patients with prior OHE, our approach is a time-limited driving restrictions based risk assessment, with conditional return to driving following sustained clinical stability and adherence to therapy. This framework aims to balance public safety with preservation of patient autonomy and quality of life.

Australian medical workforce policy faces two interrelated challenges. Selection systems have increasingly favoured auditability and procedural defensibility over measures with stronger workplace validity, while expanding administrative demands have displaced time for direct patient care, teaching and professional development. Together these pressures may contribute to professional disengagement, diminished training culture and workforce attrition. Using Rumelt's framework of diagnosis, guiding policy and coherent action, we argue that both trends reflect a broader shift away from relational and apprenticeship-based professional structures. We propose four accreditation-linked reforms relating to specialist selection, administrative burden, psychological safety and protected teaching and mentoring time. The current Australian Medical Council Specialist Medical Programs Standards Review provides a timely opportunity to operationalise these reforms within existing accreditation frameworks.

The History of Medicine Library at the Royal Australasian College of Physicians is now one of the leading comprehensive research collections on the history of medicine of Australasia. This is a far cry from the founding fellows' original proposition in 1938, when they felt the need for a 'scientific library' to ensure the academic standards of their fledgling college. The present library has been made possible by donations from many personal and corporate collections. The first was a gift from the Royal College of Physicians of London in 1954, which redirected the focus to the history of medicine, followed in 1978 by the first munificent gift from Sir Edward Ford of his personal collection of Australiana. In the concluding decades of the 20th century, the value of all traditional history of medicine libraries worldwide was brought into question. Our library has survived the threat of dispersal on several occasions. The library and the extensive heritage collection of archives, artefacts, artwork and an image library have adapted to the challenges of the digital age, with greater visibility and accessibility through digital platforms. Our library, with its own unique history, has never looked so vibrant.

Transcatheter aortic valve implantation (TAVI) has evolved from a last resort for inoperable aortic stenosis into the preferred bioprosthetic strategy across much of the surgical-risk spectrum for anatomically suitable patients. As it expands into younger and lower-risk populations, the central question is no longer whether TAVI can be performed, but how to choose the first valve intervention so that future options remain open. This clinical perspective focuses on practical decision-making: which patients are better served by TAVI or surgical aortic valve replacement (SAVR), how computed tomography planning influences both immediate and lifetime outcomes, how to manage common early issues such as conduction disease and coronary access, and how to recognise valve dysfunction and plan reintervention. Rather than treating the choice between TAVI and SAVR as a single episode, we consider it as the first step in a treatment sequence. After implantation, ongoing outcomes are shaped by rhythm surveillance, optimisation of antithrombotic and heart failure therapy and early detection of leaflet thrombosis, endocarditis or structural valve degeneration. Contemporary aortic valve replacement practice therefore requires choosing the first procedure with the likely next procedure already in mind.

We write as an infectious diseases physician and a climate-health researcher who can see four breakthroughs during COVID that are instructive to effective climate action. These are the whole-of-government approach on COVID, targeted and rapidly available funding, prevention as a key focus and acting as a community despite curtailment of our liberties. These are all relevant and applicable to another of our world's wicked health problems: climate change.

Diabetes is often assumed to cause chronic kidney disease (CKD) in patients with diabetes, though non-diabetic pathology may coexist. We reviewed 84 patients with diabetes who underwent native kidney biopsy (2017-2023). Indications included active urinary sediment, nephrotic-range proteinuria and rapid renal decline. Non-diabetic pathology was found in 49% and mixed lesions in 21%, mainly IgA nephropathy, acute tubular necrosis and interstitial nephritis. Biopsy altered management in 23% of cases. These findings support the value of biopsy in patients with diabetes.