Western Health

Deciding what foods to consume during pregnancy can be overwhelming. Accurate and culturally appropriate nutrition resources are particularly important for migrant women navigating different cultural influences. Research with African migrant women has highlighted the need for tailored pregnancy nutrition resources, yet this need remains unmet. Providing African migrant women with appropriate resources can support informed food choices and contribute to improved maternal and foetal health outcomes. This study explored the views and opinions of African migrant women and healthcare professionals (HCPs) in Australia on the development of a culturally appropriate pregnancy nutrition resource. The authors drew on previously prioritised needs for culturally tailored pregnancy nutrition resources as a starting point for co-design workshops. Four workshops were conducted via Zoom with seven African migrant women and five HCPs. Participants included women and HCPs from an earlier study as well as new participants recruited through convenience sampling. Data were analysed using reflexive thematic analysis, combining deductive and inductive approaches. Three themes captured the preferred formats and features of a tailored pregnancy nutrition resource. Among the suggested formats, the top four preferred were a mobile application, website, pamphlet, and food guide. Key features included incorporating African foods, identifying suitable alternatives available in Australia, providing information on common cultural food restrictions, and listing where African and substitute foods could be purchased. Across all formats, participants emphasised the importance of concise, visually engaging resources. Co-designed, culturally tailored nutrition resources can support women's nutritional needs, foster culturally sensitive care, and improve maternal and foetal health outcomes. African migrant women and HCPs contributed to co-design workshops, guiding the development of culturally tailored pregnancy nutrition resources.

Colorectal cancer liver metastasis (CRCLM) profoundly impacts the overall survival rates of affected individuals. Although chemotherapy remains a cornerstone of treatment, the variability in tumour response presents a considerable challenge to effective clinical management. Radiomics-based artificial intelligence (AI) modelling, utilising pre-treatment imaging, has been proposed as a tool to predict treatment response and inform therapeutic decision-making. A systematic search using Clarivate (Web of Science) and Ovid (Embase and MEDLINE) from inception to April 8, 2025, was performed in accordance with Preferred Reporting Items for Reviews and Meta-Analysis (PRISMA) guidelines. Studies evaluating the use of AI radiomics models to predict CRCLM response to chemotherapy treatment, alone or in combination with targeted therapies were identified. Full-text review and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Checklist for Diagnostic Test Accuracy Studies. Thirteen studies met inclusion criteria. All studies described the development and validation of AI models with no implementation studies. The AI models developed demonstrated a varied ability to predict CRCLM response to chemotherapy. Predictive performance was classified as good in six studies and excellent in three. Model development used differing combinations of imaging modalities (CT or MRI), lesion inclusion criteria, dimensionality (2D vs. 3D), and use of clinical features. Most studies did not validate model performance in an external dataset. Radiomics-based AI models show potential in predicting chemotherapy response in CRCLM. However, limited external validation and methodological variability currently restrict clinical applicability. Standardisation and prospective validation are required for clinical translation.

A major limitation to robotic training internationally is sufficient access to console and bedside operating time. It is important that trainees are “robot ready” when clinical opportunities arise. Delivering the didactic component of training in advance of hands-on training opportunities is needed to maximise the efficiency of console time. This study describes the development and implementation of a platform agnostic online curriculum (Foundations in Robotic Surgery -IMRA) that provides an overview of robotic surgery as didactic learning prior to hands-on experience. Curriculum development is reported using Kern’s model. A literature review was conducted in accordance with the PRISMA statement. A mixed-methods approach, incorporating surveys and semi-structured interviews, defined learning objectives and curriculum content. Curriculum outcomes were assessed via surgeon surveys, and modifications were made based on feedback from the Royal Australasian College of Surgeons. The literature review revealed a gap in vendor-neutral online curricula for robotic surgery. Six experts comprising of general surgeons and urologists, identified key learning objectives on safety, communication, and surgical technique. This gap was addressed by developing an online curriculum comprising of ten theory modules. In the development group (n = 28; 16 responses), Kirkpatrick assessment showed a 60% increase in participants rating their knowledge as good or excellent. Confidence in bedside assistance and console training rose by 37.5%. In the rollout group (n = 108; 88 responses), 89.8% rated the content quality as good or excellent. Development and implementation of the IMRA Foundations in Robotic Surgery Curriculum demonstrated improvements in learners’ self-rated knowledge and confidence in both bedside and console aspects of multi-platform robotic surgery.

Recent randomized controlled trials (RCTs) regarding the outcomes of neoadjuvant chemotherapy for patients with resectable pancreatic cancer (PC) reported inconsistent results. As the survival rate of FOLFIRINOX was found to be superior to that of gemcitabine, interest in the efficacy of neoadjuvant chemotherapy with FOLFIRINOX for resectable PC is growing. In this study, we aimed to investigate the efficacy of neoadjuvant FOLFIRINOX in patients with resectable PC. This international (South Korea, Australia, and Taiwan), multicenter, phase 3, RCT will include 609 patients with resectable pancreatic ductal adenocarcinoma and ECOG performance 0–1. Resectable PC is defined as no arterial contact and no tumour contact with the superior mesenteric vein/portal vein or ≤ 180°contact without vein contour irregularity. Neoadjuvant FOLFIRINOX consisted of oxaliplatin (85 mg/m2), administered intravenously over 2 h, followed by leucovorin (400 mg/m2) over 2 h and irinotecan (180 mg/m2) over 90 min, administered concurrently. Subsequently, an intravenous bolus infusion of 5-FU (400 mg/m2) and a continuous infusion of 5-FU (2400 mg/m2) over 46 h, repeated every 2 weeks for 6 cycles. Adjuvant therapy with modified FOLFIRINOX (mFOLFIRINOX) included oxaliplatin (85 mg/m2), irinotecan (150 mg/m2), leucovorin (400 mg/m2), and fluorouracil (2400 mg/m2) over 46 h and repeated every 2 weeks, with six cycles in the neoadjuvant group and 12 cycles in the upfront surgery group. The primary endpoint is a two-year survival rate by intention-to-treat. Secondary outcomes are overall survival, disease-free survival, resection rate, R0 resection rate, lymph node negative rate, recurrence rate, response rate. When calculating with a significance level of 5% and a statistical power of 80%, 171 events (deaths) are needed. Considering the 5-year participant enrollment period and a minimum of a 2-year follow-up period, 518 patients were required to observe 171 events. A total of 609 patients were required when the dropout rate was calculated as 15%. The NeoFOL-R trial investigates the efficacy of perioperative versus adjuvant FOLFIRINOX for patients with resectable PC. The study is ongoing, starting in February 2024 in South Korea, Australia, and Taiwan. NCT 05529940. Registered in September 2022. KCT0008360 (Korean Clinical Trial Database). Registered in April 2022.

Abstract Background: HR+/HER2− tumors account for ∼70% of all breast cancers (BCs)1 and are responsible for most BC-related deaths. CDK4/6 inhibitors (CDK4/6i) + endocrine therapy (ET) have improved outcomes for HR+/HER2− BC2; however, patients eventually experience progressive disease and require new therapies. B-cell lymphoma 2 (BCL2) is an anti-apoptotic protein involved in regulation of the intrinsic apoptosis pathway that is often dysregulated in tumors. In BC, estrogen receptor signaling leads to upregulation of BCL2, which is overexpressed in 70-80% of HR+ BC.3-5 When administered in rational combinations with other anticancer agents, BCL2 inhibitors (BCL2i) are likely to enhance potential antitumor effects.5 In HR+ BC mouse xenograft models, the addition of a BCL2i to ET enhanced antitumor activity relative to single agent ET.6 Furthermore, the addition of a CDK4i or CDK4/6i to BCL2i + ET significantly augmented this antitumor activity, suggesting further exploration of the triplet is warranted.6-9 BGB-21447 is a novel, orally bioavailable, next-generation BH3 mimetic that was designed to be a highly potent inhibitor of both wild-type and mutant BCL2, which is also active against BCL-xL and is currently in clinical trials for hematologic cancers and BC. BGB-43395 is a selective CDK4i with improved CDK4 coverage and greater selectivity for CDK4 over CDK6, thus minimizing off-target toxicities. BGB-43395 is currently under development with ET in HR+ BC and other selected solid tumors (NCT06120283, NCT06253195). Here, we describe an ongoing phase 1 study of BGB-21447 + fulvestrant with and without BGB-43395 (NCT06756932). Methods: This is an open-label, international, multicenter, phase 1 dose-escalation study evaluating the safety, tolerability, pharmacokinetics (PK), pharmacodynamics, and preliminary antitumor activity of BGB-21447 in combination with fulvestrant without (Part A) or with BGB-43395 (Part B) in patients with previously treated HR+/HER2− metastatic BC. Sequential cohorts will receive ascending doses of BGB-21447 and fulvestrant. BGB-43395 will be added to the doublet combination dose-escalation component. Key eligibility criteria include patients ≥18 years with histologically or cytologically confirmed HR+HER2− metastatic BC, previous treatment in the advanced/metastatic setting, including prior treatment with CDK4/6i and ET in any setting, Eastern Cooperative Oncology Group Performance Status ≤1, and adequate organ function. Patients with prior BCL2i exposure are excluded. Primary objectives are to assess the safety and tolerability of BGB-21447 in combination with fulvestrant, with or without BGB-43395, and to determine the maximum tolerated dose, maximum administered dose, and recommended dose for expansion of both the doublet and triplet combination. Secondary objectives are preliminary antitumor activity (objective response rate, duration of response, and time to response per Response Evaluation Criteria in Solid Tumors v1.1), characterization of the PK (single dose and steady state), and the preliminary effect of food on PK. This study is currently recruiting patients, with sites open across Australia, China, and the United States (Part A only). Citation Format: 1. Burstein HJ. N Engl J Med. 2020;383:2557-2570. 2. Thill M and Schmidt M. Ther Adv Med Oncol. 2018;3:1758835918793326. 3. Kawiak A, Kostecka A. Cancers (Basel). 2022;14:279. 4. Dawson SJ et al. Br J Cancer. 2010;103 :668-675. 5. Lok SW, et al. Cancer Discov. 2019;9:354-369. 6. Vaillant F, et al. Cancer Cell. 2013;24:120-129. 7. Whittle JR, et al. Clin Cancer Res. 2020;26:4120-4134. 8. Lindeman G, et al. Clin Cancer Res. 2025;31(12_Supplement):P2-07-18. 9. BeOne Medicines. Data on file. Citation Format: G. Lindeman, C. Muttiah, P. Lau, N. Hunter, J. Zhang, Y. Liu, Y. Dong, P. Zhou, A. Kavi, K. Keyvanjah, Z. Shao. Trial in progress: a phase 1 dose-escalation study evaluating BGB-21447 (BCL2 inhibitor) in combination with fulvestrant with and without BGB-43395 (CDK4 inhibitor) in patients with previously treated HR+/HER2− metastatic breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-07-29.

To critically appraise the Radius, Exophytic/endophytic, Nearness of tumor to collecting system or sinus, Anterior/posterior, Location relative to polar lines (R.E.N.A.L.), Preoperative Aspects and Dimensions Used for an Anatomical classification (PADUA), and Radius, Position, iNvasion of sinus (RPN) nephrometry systems with respect to their classification of tumor complexity for surgical planning in robot-assisted partial nephrectomy (RAPN) and to compare their statistical validity, methodological rigor, and predictive performance. A structured synthesis of published evidence identified large multicenter series, prospective cohorts, and meta-analyses from 2009 to 2025 that evaluated the predictive accuracy, methodological design, and clinical relevance of these systems. Key evaluation domains included statistical validation, anatomical parameter selection, and correlation with surgeon-perceived difficulty in RAPN. Both the R.E.N.A.L. and PADUA scores were developed using empirically selected parameters and have historically been validated based on their correlation with perioperative outcomes. However, evidence in the literature now shows that such correlations are inconsistent and often clinically irrelevant in RAPN. In contrast, the RPN score was developed using a statistically modeled approach, reflecting the real-world surgical difficulty of RAPN as perceived by experienced robotic surgeons. Current evidence does not support the continued use of R.E.N.A.L. and PADUA scores as validated tools in RAPN. The RPN score, with its statistically validated, anatomy-based methodology and alignment with surgical difficulty, represents a scientifically superior and clinically practical alternative for standardizing tumor complexity in RAPN.

Purpose Co-design aims to strengthen design outcomes by meaningfully engaging users in design processes. To enhance architectural accessibility, there is increased interest in engaging people with disability in co-design processes. However, little is known about how co-design is implemented in the design of large-scale public buildings, what outcomes are achieved and what factors influence the meaningful participation of people with disability in architectural co-design. Design/methodology/approach A qualitative approach was employed to explore stakeholder perspectives on a co-design initiative undertaken to enhance the universal design of a civic precinct in Australia. Semi-structured interviews were conducted with nine participants – five architects, three City Council employees and one Council Access and Inclusion Advisory Committee member. Data were analysed using reflexive thematic analysis. This approach identified key themes that encapsulated participants’ experiences and perceptions of co-design with people with disability to enhance the universal design of a public building. Findings Four overarching themes were identified from the analysis: (1) Co-design is shaped by those involved; (2) Co-design must be meaningful and inclusive; (3) Co-design and universal design must be prioritised throughout design stages; and (4) Co-design leads to improved design and capacity building. Originality/value This study contributes new knowledge about the practice of co-design in the context of large-scale public architecture. It provides valuable insight into the experiences of architects, people with disability and local government stakeholders, revealing both the complexities and potential of inclusive co-design. Findings also suggest a reciprocal relationship between universal design and co-design whereby application of one approach may strengthen application of the other.

Screening tools for attention-deficit/hyperactivity disorder (ADHD) help to identify individuals likely to have ADHD. Several screening scales are used for identifying adults with ADHD, based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The ADHD symptoms described in the DSM were originally developed to describe the behaviours of children, not adults, and focus on the triad of symptoms of inattention, hyperactivity, and impulsivity. Clinical research and experience, however, have revealed additional dimensions of adult ADHD, such as hyperfocus, racing thoughts, emotional lability, impaired sleep, and differences in time perception. Commensurate with the conditions' growing recognition, the adult ADHD presentation requires rethinking. To understand better the ADHD symptomatology experienced by adults, qualitative interviews were conducted with 11 diagnosed adults. Using thematic analysis, nine themes of adult ADHD symptoms were identified. The first three themes map to the original triad of symptoms - attentional difficulties, hyperactivity, and impulsivity. A further three themes identified are briefly mentioned in the DSM - disorganisation, forgetfulness, and reduced activation. The final three themes are covered to some degree in the current rating scales but are absent from the DSM 5 - emotional lability, sleep difficulties, and time perception difficulties. This study highlights nine themes relevant to adult ADHD, six of which are absent from the DSM 5's triad. This research highlights gaps in current assessment tools and suggests symptoms that are more reflective of the adult experience of having ADHD.

ABSTRACTNecrotising fasciitis (NF) is a rapidly progressing, life‐threatening infection with mortality rates that are exceedingly high. Despite the notably high risks of developing NF in patients with diabetes mellitus (DM), factors associated with mortality in this population are poorly understood. Therefore, to determine at‐risk patients and to improve overall clinical outcomes via hastening management, the objective of this systematic review is to determine what factors are associated with mortality for diabetic patients with NF. This systematic review followed the PRISMA guidelines. Patient data pertaining to outcomes and surgical management were extracted, and mortality rates were evaluated. Studies were assessed for quality using the Alberta Heritage Foundation for Medical Research (AHFMR) and Risk of Bias tool. A total of 25 studies were reviewed, covering 7879 patients with NF and DM with a 23.5% mortality rate. The most prevalent comorbidities among those who died included chronic kidney disease (15.95%), hypertension (9.42%) and obesity (9.02%). While limbs were the most common location for the disease, NF in the trunk and groin regions showed the highest mortality rates at 62.07%. Among those who died, common complications were acute renal failure (13.41%), pulmonary issues (20.41%) and septicaemia (12.80%). Mortality rates by surgical management were fasciotomy (42.9%), surgical debridement (40.68%) and amputation (9.09%). Mortality was comparable between patients with NF and DM (23.54%) and those with NF alone (23.61%). Although DM may not independently increase mortality, it can worsen outcomes when combined with other comorbidities, indicating a need for clearer clinical guidance.

Background: Mental illness stigma among healthcare professionals can adversely affect patient care and recovery. While attitudes are shifting globally, limited data exist on stigma among non-psychiatrist doctors (NPDs) in India. This study aimed to assess the attitudes of NPDs toward mental illness and psychiatry using the Mental Illness Clinicians’ Attitudes Scale (MICA-4), and to explore associated sociodemographic and clinical factors. Methods: A cross-sectional online survey was conducted across India over six months in 2022, following ethics approval. The survey link was distributed via professional social media platforms using convenience and snowball sampling. Non-psychiatrist doctors with at least an MBBS degree were eligible. The MICA-4 scale assessed stigma across five domains. Descriptive statistics, correlation analyses, and multiple regression analysis were conducted. Results: A total of 102 responses were analysed. The mean MICA-4 score was 48.37, indicating moderately positive attitudes. Domain-wise analysis revealed higher stigma in knowledge/misconception and self-disclosure domains, while attitudes towards ethics and patient care were more favourable. No significant differences were found by gender, specialty, or practice setting. Weekly psychiatric caseload was not associated with reduced stigma. Internal consistency of the scale was low (Cronbach’s α = 0.46), raising concerns about cultural fit. The regression model was statistically significant F (5, 96) = 661.95, p < 0.001, explaining 97.18% of the variance in overall attitudes toward mental illness. Among the five domains, Respect for Psychiatry and Knowledge and Misconceptions emerged as the strongest predictors, highlighting their critical role in shaping positive professional attitudes in the public sector. Conclusions: Stigma toward mental illness persists among NPDs, particularly around misconceptions and help-seeking attitudes. These biases are culturally embedded and may not be significantly influenced by clinical exposure alone. While stigma was generally moderate, persistent misconceptions and self-stigma point to the importance of further developing culturally adapted tools and systemic interventions to promote reflective practice and ethical parity in clinical settings.