includes Epworth’s scholarly publications http://hdl.handle.net/11434/1 2026-06-21T10:45:43Z 2026-06-21T10:45:43Z Hill, Bridget Williams, Gavin Banky, Megan http://hdl.handle.net/11434/2430 2026-05-08T11:02:09Z 2025-12-01T00:00:00Z

Title: Development of a core outcome set for the assessment of spasticity in adults: a study protocol. Epworth Authors: Hill, Bridget; Williams, Gavin; Banky, Megan Abstract: Background: Muscle spasticity is common in adult-onset neurological conditions such as stroke, traumatic brain injury, multiple sclerosis, and spinal cord injury. Although effective interventions exist, studies evaluating interventions to improve rehabilitation or management outcomes for those with spasticity are methodologically heterogeneous, making meta-analysis impossible. This paper reports a protocol to develop a spasticity core outcome set (COS) to standardise the reporting of clinical trials and enable better evidence synthesis in future studies. Further, a spasticity COS may facilitate better patient assessment, guide treatment planning and goal setting, and further support evaluation of treatment outcomes in clinical practice. Methods: This protocol has been developed according to the Core Outcome Measures in Effectiveness Trial (COMET) initiative guidelines. It has been prospectively registered on the COMET website. Outcome measures for inclusion in the COS will be based on COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The study will adhere to the minimum standards for the design of a COS study (Core Outcome Set-Standards for Development [COS-STAD]). This project involves four phases. Phase 1 involves semi-structured interviews of people with a lived experience of spasticity to determine important areas for outcome evaluation. Phase 2 is a Delphi survey with experts in spasticity, together with people with lived experience, to select the outcome domains for inclusion in the COS. Phase 3 consists of systematic reviews of the literature to identify outcome measures specific to each of the domains selected in phase 2 and their psychometric properties. Phase 4 is a second Delphi survey with the spasticity experts, conducted to obtain consensus on outcome measures included in the COS. Discussion: This proposal represents the first spasticity COS to improve the consistency in outcome measurement selection and reporting in clinical trials to enable future meta-analyses and reduce research waste. It will also provide clinicians with a resource for documenting and reporting patient outcomes that can be used for benchmarking and optimising care. Trial registration: https://www.comet-initiative.org/Studies/Details/3345 . 31st January, 2025.

2025-12-01T00:00:00Z Carll, Jonathon Lawrentschuk, Nathan http://hdl.handle.net/11434/2429 2026-05-08T11:02:17Z 2026-04-01T00:00:00Z

Title: Guideline of guidelines: pelvic lymph node dissection at time of radical prostatectomy. Epworth Authors: Carll, Jonathon; Lawrentschuk, Nathan Abstract: Objective: To provide a comprehensive review, analysis and critique of guidelines from various oncological and urological organisations regarding the use pelvic lymph node dissection (PLND) in men undergoing radical prostatectomy (RP) for primary treatment of prostate cancer (PCa). Methods: PubMed, Google Scholar and the official webpages of major urological and oncological societies were searched for PCa guidelines. Guidelines were assessed for recommendations and opinions regarding the use of PLND. A total of 15 guidelines were identified and included for this review. Results: There is consensus amongst guidelines that an extended template (ePLND), is the preferred templated when PLND is to be undertaken. The majority of guidelines acknowledge the lack of proven oncological benefit from PLND, and that the largest benefit is from improved staging information. However, there is significant divergence between the guidelines about which patients should undergo PLND. Some guidelines advocate for the abandonment of PLND altogether, whilst others adopt a risk-stratified approach, suggesting that patients should be offered PLND based on nomograms or clinical risk stratification. Conclusion: Whilst ePLND is recommended by some guidelines for select patients undergoing RP, it remains a contentious topic with significant discordance between guidelines regarding patient selection. Given the lack of proven oncological benefit and significant morbidity from the procedure, careful selection is required. It is uncertain as to how pathological findings on PLND will change management given recent trends towards salvage rather than adjuvant radiotherapy, and improved preoperative staging with prostate-specific membrane antigen-positron emission tomography/computed tomography.

2026-04-01T00:00:00Z Grainger, Brian Abeyakoon, Chathuri Prince, Miles http://hdl.handle.net/11434/2428 2026-05-08T00:02:10Z 2026-04-01T00:00:00Z

Title: Innovative approaches for managing relapsed or refractory peripheral T-cell lymphoma. Epworth Authors: Grainger, Brian; Abeyakoon, Chathuri; Prince, Miles Abstract: Introduction: Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of hematologic malignancies arising from mature, post-thymic T- and natural killer (NK) cells. This review explores innovative approaches to managing relapsed or refractory PTCL, emphasising the need for tailored treatment strategies given the generally poor prognosis associated with these entities. Areas covered: Literature selection followed a comprehensive search of PubMed, MEDLINE and EMBASE up to 2026. The conventional frontline approach remains cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP)-based chemotherapy. However, the addition of brentuximab vedotin (BV) has improved overall survival (OS) and progression-free survival (PFS) in specific subtypes, particularly anaplastic large cell lymphoma (ALCL). Despite these advances, most patients experience disease relapse or are primary refractory, highlighting a persistent unmet clinical need. Allogeneic stem cell transplantation (allo-SCT) offers curative potential for selected patients, but biological and logistical barriers constrain its wider application. Expert opinion: These advances support a shift toward a more personalised management strategy, prioritising immunotherapies, epigenetically directed therapies, and small-molecule inhibitors, tailored to disease subtype. By outlining current challenges and emerging treatment modalities, we aim to guide clinicians in optimising care for this patient population.

2026-04-01T00:00:00Z de Steiger, Richard http://hdl.handle.net/11434/2427 2026-05-06T11:02:10Z 2026-01-01T00:00:00Z

Title: Association of antioxidant-added highly cross-linked polyethylene on revision risk: a registry-based study of 198,073 total hip replacements from the Australian Orthopaedic Association National Joint Replacement Registry between 2014 and 2023. Epworth Authors: de Steiger, Richard Abstract: Background and purpose: Adding antioxidant to highly cross-linked polyethylene (XLPE) is proposed to improve oxidation resistance and decrease wear in total hip replacements (THR), but long-term performance is unknown. We aimed to compare the revision rates of THR using cementless acetabular components where the insert was made of either XLPE with antioxidant (AOXLPE) or XLPE, using data from a large national registry. Methods: The population was THR from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) in the 10-year period 2014–2023 with modular cementless acetabular components and ceramic or metal femoral heads used for osteoarthritis. We compared primary THR using XLPE with antioxidant (AOXLPE) acetabular inserts with XLPE acetabular inserts. The outcome measured was all-cause revision. Cumulative percentage revision (CPR) was calculated using the Kaplan–Meier method, and comparisons made using Cox proportional hazards models. Results: There were 198,073 THRs, of which 35,309 had AOXLPE inserts. There were 769 and 4,327 revisions with AOXLPE and XLPE inserts, respectively. While there was no early difference, the AOXLPE group had a lower revision rate after 3 years (HR 0.64, 95% confidence interval [CI] 0.48–0.84). When adjusted for multiple factors the AOXLPE group still had a lower revision rate after 3 years (HR 0.63, CI 0.47–0.83). Revisions for loosening, wear-related causes, and fracture were proportionately lower in the AOXLPE group, but no difference was found with revisions for dislocation/instability or infection. Conclusion: While there was no early difference, THR with AOXLPE acetabular inserts had a lower revision rate after 3 years than XLPE. This suggests a possible clinical benefit using AOXLPE but the difference may, in part, be related to the associated femoral or acetabular components.

2026-01-01T00:00:00Z