Cabrini Hospital

Today's common practice of empiric activity prescription in radiopharmaceutical therapy is inconsistent with the modern philosophy of personalized medicine. We investigate the radiobiologic relationship between tumor mean absorbed dose (D mean) and progression-free survival (PFS) in 177Lu-PSMA I&T therapy guided by personalized predictive dosimetry in metastatic castration-resistant prostate cancer. Methods: We conducted a single-center retrospective study of the first 20 patients treated with 177Lu-PSMA I&T at our institution. PFS was calculated from the day a patient was assessed by a nuclear medicine physician in the clinic until treatment cessation (due to progression or toxicity) or death. D mean was estimated by predictive dosimetry. Correlation with PFS was performed on the following baseline characteristics: age, Gleason score, Eastern Cooperative Oncology Group performance status, estimated glomerular filtration rate, prostate-specific antigen (PSA) doubling time, injected activity per treatment, D mean and D mean per gigabecquerel. Results: Twenty patients naïve to 177Lu-PSMA were treated over a 2-y period, totaling 65 infusions. The median PSA doubling time was 1.6 mo at baseline. The median follow-up time was 8.4 mo (interquartile range [IQR], 4.6-14.5 mo). Each patient received 3 ± 1 treatments (range, 1-5), with a mean injected activity of 7.74 ± 0.66 GBq per treatment. The mean injected activity for the first treatment was 7.85 ± 0.71 GBq. The median D mean for the first treatment was 23 Gy (IQR, 15-36 Gy). The median PFS was 10.6 mo for a D mean of 23 Gy or greater and was 3.1 mo for a D mean of less than 23 Gy (hazard ratio, 0.39; 95% CI, 0.22-0.68; P < 0.01). There were statistically significant correlations between PFS, PSA doubling time, and D mean (P < 0.05). However, there was no statistically significant correlation between the injected activity per treatment versus PFS or D mean (P > 0.05). Conclusion: We found a strong direct correlation between D mean and PFS in patients with metastatic castration-resistant prostate cancer treated with 177Lu-PSMA in a real-world setting. We identified a D mean of 23 Gy as a possible threshold for significantly better PFS in our cohort with median PSA doubling time of 1.6 mo. Our findings support radiobiologically sound prescription based on the radiation absorbed dose by personalized predictive dosimetry.

Previous stage I-III colon cancer trials demonstrated improved peri-operative and similar long-term oncological outcomes with minimally invasive approaches compared with open surgery. Subsequent technical developments, including intracorporeal anastomosis, complete mesocolic excision (CME), refined pathologic grading systems and robotic approaches are increasingly used despite minimal supporting evidence. This international phase II trial aims to assess patient, surgical and pathological outcomes following robotic (RRHC) with laparoscopic right hemicolectomy (LRHC) for right sided colon cancer. Prospective, international multicentre pilot randomised phase II trial for patients with right colon adenocarcinoma, randomised 2:1 to robotic (RRHC) or laparoscopic (LRHC) surgery performed by accredited surgeons. Primary outcome was 90-day surgical morbidity measured using the Comprehensive Complication Index (CCI). Standardised pathology reviews, patient reported quality of life and surgeon task load index data was captured. RRHC vs. LRHC surgery allocation was 19 vs. 10, mean operative time 3.8 vs. 3.1 h with no operative mortality, all had R0 resection, CME rate 53 vs. 50% and intact mesocolon 94 v 100%. CCI was significantly lower at 30 and 90 days after RRHC (median (Q1, Q3): 0 (0, 9) vs. 21 (21, 26); median difference: 21; 95% CI 9-26; p = 0.005 at 30 days; p = 0.008 at 90 days). No significant differences in pathological nor quality of life data was observed. Surgeons task load data tended to favour robotic procedures. Median follow-up was 6 months. Limited funding led to early study closure. RRHC improved short-term surgical morbidity and surgeon physical demand and performance whilst obtaining similar quality of life and pathological specimen quality compared to LRHC for right sided colon cancer, supporting the case for larger randomised trials. ACTRN12620001378910.

To evaluate the quality (DISCERN), understandability and actionability (Patient Education Materials Assessment Tool for Printable Materials [PEMAT-P]), readability (Flesch-Kincaid), and misinformation of patient-facing information on interstitial cystitis generated by four publicly available artificial intelligence (AI) chatbots: ChatGPT-4.0, Perplexity, ChatSonic, and Bing AI. A total of 10 queries derived from Google Trends and Hopkins Medicine content were submitted to each chatbot. Responses were evaluated by two blinded reviewers using validated tools: the DISCERN instrument (reliability/quality), PEMAT-P (understandability/actionability), and Flesch-Kincaid Grade Level (readability). Word count and citation inclusion were also recorded. Across chatbots, information quality was moderate with a median (interquartile range [IQR]) DISCERN score of 3/5 (2-3), with Perplexity performing best and Bing AI worst. Understandability was moderate (median [IQR] PEMAT-P score 75% [66.7-83.3%]), highest for ChatSonic with Hopkins Medicine-derived prompts and lowest for ChatGPT with Google Trends inputs. Actionability was consistently poor (median [IQR] score 40% [20-60%]), with ChatSonic performing best and Bing AI lowest. Responses averaged 256 words and college-level readability (median [IQR] Flesch-Kincaid score 25.4 [20.89-28.50]) across all platforms, limiting accessibility. Misinformation was minimal across all platforms. Chatbots referencing clinically curated prompts (Hopkins Medicine) scored higher in understandability and completeness than those responding to public search trends. Artificial intelligence chatbots offer generally accurate and understandable information about interstitial cystitis but lack actionable guidance and generate content at reading levels above typical patient comprehension. Enhancing readability, actionability, and personalisation may increase their utility as adjunct tools for patient education in functional urology.

Obesity is now a recognised carcinogen with growing implications for gastrointestinal surgical oncology. Excess adiposity promotes tumourigenesis through endocrine, inflammatory, and mechanical pathways, contributing to increased cancer incidence, stage at diagnosis, and worse oncological outcomes. For patients undergoing gastrointestinal cancer surgery, obesity adds significant technical complexity and elevates perioperative morbidity. While effective interventions such as bariatric surgery and GLP-1 receptor agonists now exist, their integration into cancer care remains limited. Emerging evidence suggests potential oncological benefit, but high-quality data on perioperative implementation and impact on treatment response are scarce. Randomised trials evaluating short-course pharmacological strategies during neoadjuvant pathways are urgently needed. In the interim, routine preoperative obesity screening and referral for structured weight loss should be embedded into multidisciplinary workflows. This perspective underscores the importance of recognising and addressing obesity not only as a comorbidity, but as a modifiable risk factor and therapeutic target across the cancer continuum.

Evidence suggests that curative treatment for low-risk prostate cancer (LRPC) has no survival benefits over active surveillance (AS); thus, treatment choice becomes a value-sensitive decision. Decision aids (DAs) have the potential to facilitate this process, yet no DA has been tailored to the Australian health care system or population. This study aims to evaluate the impact of an online DA (Navigate) on the uptake of AS, quality of life, and decision-making in Australia. This parallel-group, prospective, randomised controlled trial recruited men (from May 2017 to May 2021) from participating cancer centres, via self-referral, or via clinician referral. The inclusion criteria were the following: a recent LRPC diagnosis, no decision on treatment, and clinical suitability for AS. Partners could also enrol. Assessments were undertaken at baseline (before decision) and after baseline (1, 2, and 6 mo). Participants were randomised 1:1 to Navigate (online DA, intervention) or a national prostate cancer website (usual care), stratified by the site/recruitment method. Partners were allocated to the group matching their respective partners. The primary outcome was self-reported uptake of AS for first-line treatment at 1 mo. The secondary outcomes included decision-making preparedness; decisional conflict, regret, and satisfaction; illness communication; and prostate cancer-specific quality of life. Intention-to-treat analyses were conducted. Of the 619 patients referred, those eligible (n=302) were randomised to either Navigate (n=153) or usual care (n=149), with no significant between-group differences at baseline. The proportion of men self-reporting AS versus another treatment was 90.6% (Navigate) versus 79.0% (usual care; p=0.008). Navigate participants also reported greater decision-making preparedness (p<0.001). Partners were allocated to Navigate (n=70) or usual care (n=49); no significant between-group differences were found. Longer-term outcomes were not measured. Providing men with an online DA resulted in higher uptake of AS for LRPC than standard resources and in increased decision-making preparedness. By increasing the uptake of AS, DAs may help reduce treatment-related morbidity. Implementation research assessing the possibility of integrating Navigate into standard care is needed.

Knee osteoarthritis significantly limits mobility and increases pain in patients. Pain self-efficacy, a crucial psychological construct, is essential for optimal recovery outcomes. This study,grounded in Bandura's self-efficacy theory and Linton's cognitive-behavioral model, evaluated the effectiveness of an empowerment program on pain intensity indices and self-efficacy in patients undergoing total knee arthroplasty. A quasi-experimental design was employed. Ninety-eight patients were recruited via convenience sampling and randomly assigned to intervention (n=49) or control (n=49) groups. The intervention group received six structured sessions (one preoperative, five postoperative) including education on pain management, coping strategies, and goal setting, in addition to routine care. Pain intensity was assessed using the Short McGill Pain Questionnaire (SF-MPQ), Present Pain Intensity (PPI) index, and Visual Analogue Scale (VAS), while Pain self-efficacy was measured with the Pain Self-Efficacy Questionnaire (PSEQ). Evaluations were conducted at baseline (preoperatively) and six weeks postoperatively. Demographic (age, sex, education), medical (BMI), and theory-related variables were collected. Analysis of covariance, adjusting for confounders, was used to compare outcomes, with statistical significance set at p < 0.05. Among 98 participants (predominantly women; mean age 62.72 years, mean BMI 29.77, limited formal education), no significant baseline differences existed between groups. Post-intervention, the intervention group demonstrated significantly greater pain reduction: sensory-affective pain (MD = 1.8, 95% CI [-3.86 to -0.96], p = 0.015), Present Pain Intensity (0.62, [-1.04 to -0.18], p = 0.023), and Visual Analogue Scale scores (1.57, [-2.12 to -1.01], p < 0.001). Pain self-efficacy increased significantly (9.81, [0.71 to 1.24], p < 0.001). Analysis of covariance confirmed intervention effectiveness after adjusting for confounding variables. The empowerment program proved effective as an interactive, applicable, and non-invasive approach for enhancing pain management and self-efficacy in total knee arthroplasty patients.

ABSTRACTAimThis study used Bayesian model averaging to develop an online dynamic nomogram for predicting colon cancer survival, showcasing its value in integrating key prognostic factors for clinical use.MethodsThis retrospective study analysed surgical colon cancer cases from the Cabrini Monash colorectal neoplasia database using Bayesian model averaging to identify survival risk factors. Model performance was validated with data from Alfred Hospital, and dynamic online nomograms were developed using the DynNom R package.ResultsThe study analysed 2475 colon cancer patients (2010–2021), reporting an overall mortality rate of 6.4 per 100 (95% CI: 5.9–7.1) and post‐relapse mortality of 7.0 per 100 (95% CI: 6.4–7.6), with 5‐year overall and relapse‐free survival probabilities of 0.75 and 0.74, respectively. Bayesian model averaging identified key predictors with posterior inclusion probabilities greater than 0.3, including age, ASA score, stage, chemotherapy, lymph node ratio and cancer side. The model showed strong performance (C‐index: 0.84 training, 0.80 validation; AUCs: 0.88–0.91 training, 0.84–0.88 validation), good calibration and clinical utility across thresholds. A dynamic nomogram incorporating these factors was developed using the entire dataset as an accessible online tool to support personalised survival prediction in clinical practice.ConclusionThis study showcases the robust capabilities of Bayesian model averaging in uncovering key prognostic factors for colon cancer survival. By integrating these predictors into a dynamic online nomogram, it delivers a powerful, clinician‐friendly tool that significantly enhances prognostic accuracy and enables personalised, data‐driven decision‐making in oncology care.

Abstract Aims Traumatic events of road traffic accidents (RTAs) lead mostly to post-traumatic stress disorders (PTSD). We aimed to investigate the psychometric properties of the PTSD-5 checklist at consecutive phone follow-ups and its applicability in screening for PTSD in RTA survivors. Subject and Methods The study assessed the reliability and applicability of PTSD-5 tool through phone surveys, within a national traffic cohort platform. We recruited 150 patients at one-, six-, and twelve-month follow-ups after discharge, enrolling 50 patients per phase. We measured reliability and the agreement using Kappa coefficients, percentages of agreement and Bland-Altman method. Data were analysed using STATA statistical software package version 15. Results The participants were mostly male (79.8%), with a mean age (SD) of 41 (14.7). More than 70% of participants were married or employed or educated. It had excellent internal consistency reliability at total and follow-up levels (Cronbach’s α = 0.95) and good total stability reliability (ICC=0.77,95%CI:0.68, 0.83). One month follow-up data showed poor stability reliability (ICC=0.32,95%CI:-0.10, 0.59). The agreement between test and retest data at six- and 12-month follow-ups was excellent. Total Kappa coefficient and the percentage of agreement were 0.58 and 71.3%, respectively. The Bland Altman plot on one-year follow-up data revealed more agreement at healthier state (lower scores). Conclusion The Persian PTSD checklist was highly reliable and applicable through phone interviews post discharge in road traffic injury adult patients. It was suitable to apply within the national cohort study and would decline the data collection costs.