Metabolic dysfunction-associated fatty liver disease (MAFLD) affects 1 in 3 Australian adults and is an under-recognised but growing cause of liver cirrhosis, hepatocellular carcinoma and liver transplantation. There is a major role for primary care in MAFLD prevention, diagnosis and management. Adults with obesity, type 2 diabetes or other metabolic risk factors should be assessed for MAFLD. Liver ultrasound is the recommended first-line test for diagnosing hepatic steatosis (fat accumulation in hepatocytes). Management of MAFLD includes noninvasive testing for liver fibrosis, addressing health risk behaviours and comorbidities, and hepatocellular carcinoma surveillance in those with liver cirrhosis.

Accurately measuring blood pressure is imperative for diagnosis and control of hypertension. There is a range of devices and methods for measuring blood pressure that each have advantages and limitations. To ensure accuracy of blood pressure measurement and hypertension diagnosis, clinicians and patients should use an accurate and validated blood pressure measurement device, an appropriately sized cuff, and take several measurements rather than only one measurement, using a standardised measurement protocol. Out-of-clinic measurement, using an ambulatory or home blood pressure monitoring device, depending on patient preference, should be used to confirm diagnosis and guide treatment of hypertension. There are emerging new technologies for blood pressure measurement (e.g. wearable technologies) that are yet to be validated and have the potential to improve blood pressure monitoring and patient self-management.

Vitamin B12 testing is recommended for individuals with clinical signs and symptoms suggestive of B12 deficiency, and when there is reasonable clinical suspicion of deficiency due to risk factors (e.g. inadequate dietary intake, malabsorptive conditions). Where vitamin B12 testing is indicated, total serum B12 is typically the first-line test. Active B12 may be requested if total B12 results are indeterminate, or during pregnancy. If total or active B12 tests are inconclusive, methylmalonic acid or homocysteine testing may be considered; however, their concentrations may be elevated in other conditions. In individuals with confirmed B12 deficiency, B12 supplementation is required, with the choice of formulation, duration and dosage guided by the underlying cause and severity of the deficiency and patient preference.

Cytomegalovirus (CMV) is the most common congenital infection in Australia and a leading cause of preventable childhood disability. Current Australian guidelines recommend targeted antenatal screening of women at higher risk for CMV infection. Serology testing should also be considered in women with clinical symptoms suggestive of CMV. Women with suspected CMV infection in pregnancy should be promptly referred to a maternal-fetal medicine or infectious diseases specialist. High-dose valaciclovir can reduce in utero transmission to the fetus following first-trimester maternal primary infection; however, long-term safety data are limited. Valaciclovir should only be prescribed by clinicians with specific expertise in CMV, such as maternal-fetal medicine or infectious diseases specialists. Universal hygiene counselling, targeted screening, careful timing of conception after infection, and structured psychological support are essential components of care.

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that is characterised by inattention, hyperactivity or impulsivity. It affects around 3 to 5% of adults. The main pharmacotherapies for adults with ADHD include psychostimulants, such as methylphenidate and amphetamines (dexamfetamine and lisdexamfetamine), and non-psychostimulants such as atomoxetine. In Australia, the eligibility for subsidy under the Pharmaceutical Benefits Scheme varies depending on whether the patient was diagnosed with ADHD during childhood or adulthood. Individuals prescribed ADHD drugs should be monitored for both physical (e.g. cardiac symptoms, appetite changes, seizures) and psychiatric (e.g. mood disturbances, anxiety, psychosis) adverse effects. While pharmacological treatment is effective for adults with ADHD, it should be integrated into a broader, multidisciplinary approach that also includes nonpharmacological strategies such as psychological therapies and allied health support.

Viscosupplementation with intra-articular hyaluronic acid derivatives and cross-linked polymers of hyaluronic acid is increasingly used to treat symptomatic osteoarthritis in the knee, hip and other joints. Most guidelines conditionally recommend against its use to treat knee osteoarthritis, and strongly or conditionally recommend against its use for other joints, indicating a large evidence-to-practice gap. Conclusive evidence from randomised placebo-controlled trials indicates that intra-articular hyaluronic acid provides no important benefits for people with knee (and other joints) osteoarthritis, and may have potentially serious harms including septic arthritis and severe inflammatory joint and cutaneous reactions. Use of computed tomography scans to guide hyaluronic acid injection exposes the patient to unnecessary radiation and has an unwarranted financial and environmental cost. When the topic arises in clinical practice, prescribers should use a shared decision-making approach that includes an explanation as to why hyaluronic acid injection is not recommended care for osteoarthritis and offer alternatives, taking into consideration the patient's values and preferences.