We assessed six publicly available large language models (LLM) on Royal Australasian College of Physicians (RACP) adult medicine written examination questions. In a 30-question set with answers, models achieved 93% correct responses overall, and accuracy was higher for text-based than visual-media questions. In a 170-question exploratory set without an answer key, complete inter-model agreement occurred in 86% of questions but was lower for visual-media than text-based questions and for scenario-based than knowledge-based questions. Contemporary LLM performed strongly on RACP-style written questions, but interpretation of visual media and complex clinical vignettes remains a limitation.

It is well recognised that modern healthcare has an enormous carbon footprint that is contributing to the climate crisis. However, the contribution of medical societies and their associated activities is largely ignored. The Australian and New Zealand Society of Nephrology and its Environmental Sustainability Committee (ESC) are taking action to mitigate their impact on climate change. This viewpoint describes actions taken since the formation of the ESC in 2017 and serves as encouragement for all medical societies to incorporate environmental sustainability into their everyday practice.

Chimeric antigen receptor (CAR) T-cell therapies directed against cluster of differentiation 19 (CD19) are a standard of care for relapsed or refractory B-cell lymphomas. Infection is the leading cause of non-relapse mortality, and this risk may persist for years after CAR T-cell receipt. Recipients of CAR T-cells can present in various clinical settings, and few trials have prospectively assessed prevention and management of infection in this group. This position statement provides Australian and New Zealand clinicians with a rational approach to preventing, investigating and managing infections after CD19-directed CAR T-cell therapy for lymphoma.

Chronic kidney disease (CKD) and cardiovascular disease (CVD) are major causes of morbidity and mortality in people with type 2 diabetes (T2D). Contemporary CKD guidelines increasingly support incorporation of glucagon-like peptide-1 receptor agonists (GLP-1RAs) as an additional pillar of cardiorenal therapy alongside renin-angiotensin-aldosterone system (RAAS) blockade, sodium-glucose co-transporter 2 inhibitors (SGLT2i) and finerenone. Semaglutide is the first GLP-1RA with kidney-outcome data from a dedicated trial in T2D-CKD: the Evaluate Renal Function with Semaglutide Once Weekly (FLOW) study. In FLOW, once-weekly subcutaneous semaglutide 1 mg reduced major kidney disease events by 24%, major adverse cardiovascular events by 18% and all-cause mortality by 20% versus placebo on a background of guideline-directed therapy. Here a multidisciplinary expert panel summarises Australian Therapeutic Goods Administration indications and Pharmaceutical Benefits Scheme restrictions, highlights common access barriers and outlines approaches to shared care between primary and tertiary services for use of GLP-1RAs. Guidance is also provided on treatment sequencing of GLP-1RA alongside RAAS blockade, SGLT2i and finerenone. Evidence from key GLP-1RA trials, in addition to FLOW, is reviewed and translated into practical, implementable prescribing strategies for Australian clinicians. The panel also identified priority patient groups for GLP-1RA therapy, including those with residual albuminuria, heart failure with preserved ejection fraction, established CVD, obesity and Aboriginal and Torres Strait Islander peoples at high cardiorenal risk. Remaining evidence gaps, particularly for non-diabetic CKD, advanced CKD, dialysis and transplant populations and equity of access, are identified as priorities for future research and policy.