Hepatobiliary complications of immune checkpoint inhibitors in cancer.

Immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of cancer therapy. Over the last decade, both their primary focus in trials and clinical application have exponentially risen, with repeated demonstrations of their efficacy in improving survival in various cancer types. The adverse effects of these drugs on various organ systems were recognised in early phase studies. Given their relatively new emergence on the market, there has been increasing interest into short- and long-term effects and management of ICIs in real-world settings. ICI-related hepatobiliary toxicities are often challenging to diagnose and difficult to distinguish from other causes of deranged liver biochemical tests. The aim of this review is to provide an up-to-date and detailed exploration of the hepatobiliary complications of ICIs, including pathogenesis and approaches to diagnosis and management.

Medical training in private and public.

BACKGROUND: Globally, the need for medical student training to be undertaken in the private sector is likely to increase. In Australia, it has increased by 250 per cent in the last decade. Effective clinical education is highly dependent on the attitudes and willingness to participate of both patients and medical staff. We aimed to examine these attitudes in both private and public hospitals. METHODS: Patients and medical staff at a private and a public hospital in Sydney were surveyed during December 2016 and January 2017 to investigate attitudes to medical student training. Attitudes were compared between hospitals. We also compared recent attitudes in the private hospital with those obtained in 2012. RESULTS: Patients at the public hospital were significantly more likely to want a student present at a consultation than those at a private hospital. Public hospital doctors had more positive attitudes towards medical students than their private colleagues. The negative financial impact of teaching was more significant for those in private practice. Since 2012, attitudes of private hospital patients towards medical students became significantly more positive whereas doctors' attitudes became less positive. The expansion of clinical education into the private sector is likely to increase globally DISCUSSION: The willingness of patients to participate in medical student training in both public and private hospitals is encouraging for future expansion into the private sector. The reduced willingness amongst private hospital medical staff over time and, in comparison to public hospital staff, suggests a need to address barriers for staff in the private sector.