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IMPORTANCE: The timing of adjuvant chemotherapy after surgery for colorectal cancer and its association with long-term outcomes have been investigated in national cohort studies, with no consensus on the optimal time from surgery to adjuvant chemotherapy. OBJECTIVE: To analyze the association between the timing of adjuvant chemotherapy after surgery for colorectal cancer and disease-free survival. DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc analysis of the phase 3 SCOT randomized clinical trial, from 244 centers in 6 countries, investigating the noninferiority of 3 vs 6 months of adjuvant chemotherapy. Patients with high-risk stage II or stage III nonmetastatic colorectal cancer who underwent curative-intended surgery were randomized to either 3 or 6 months of adjuvant chemotherapy consisting of fluoropyrimidine and oxaliplatin regimens. Those with complete information on the date of surgery, treatment type, and long-term follow-up were investigated for the primary and secondary end points. Data were analyzed from May 2022 to February 2024. INTERVENTION: In the post hoc analysis, patients were grouped according to the start of adjuvant chemotherapy being less than 6 weeks vs greater than 6 weeks after surgery. MAIN OUTCOMES AND MEASURES: The primary end point was disease-free survival. The secondary end points were adverse events in the total treatment period or the first cycle of adjuvant chemotherapy. RESULTS: A total of 5719 patients (2251 [39.4%] female; mean [SD] age, 63.4 [9.3] years) were included in the primary analysis after data curation; among them, 914 were in the early-start group and 4805 were in the late-start group. Median (IQR) follow-up was 72.0 (47.3-88.1) months, with a median (IQR) of 56 (41-66) days from surgery to chemotherapy. Five-year disease-free survival was 78.0% (95% CI, 75.3%-80.8%) in the early-start group and 73.2% (95% CI, 72.0%-74.5%) in the late-start group. In an adjusted Cox regression analysis, the start of adjuvant chemotherapy greater than 6 weeks after surgery was associated with worse disease-free survival (hazard ratio, 1.24; 95% CI, 1.06-1.46; P = .01). In adjusted logistic regression models, there was no association with adverse events in the total treatment period (odds ratio, 0.82; 95% CI, 0.65-1.04; P = .09) or adverse events in the first cycle of treatment (odds ratio, 0.77; 95% CI, 0.56-1.09; P = .13). CONCLUSIONS AND RELEVANCE: In this international population of patients with high-risk stage II and stage III colorectal cancer, starting adjuvant chemotherapy more than 6 weeks after surgery was associated with worse disease-free survival, with no difference in adverse events between the groups. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN59757862

Testing for DNA mismatch repair deficiency (MMRd) is recommended for all colorectal cancers (CRCs). Automating this would enable precision medicine, particularly if providing information on etiology not captured by deep learning (DL) methods. We present AIMMeR, an AI-based method for determination of mismatch repair (MMR) protein expression at a single-cell level in routine pathology samples. AIMMeR shows an area under the receiver-operator curve (AUROC) of 0.98, and specificity of ≥75% at 98% sensitivity against pathologist ground truth in stage II/III in two trial cohorts, with positive predictive value of ≥98% for the commonest pattern of somatic MMRd. Lower agreement with microsatellite instability (MSI) testing (AUROC 0.86) reflects discordance between MMR and MSI PCR rather than AIMMeR misclassification. Analysis of the SCOT trial confirms MMRd prognostic value in oxaliplatin-treated patients; while MMRd does not predict differential benefit of chemotherapy duration, it correlates with difference in relapse by regimen (PInteraction = 0.04). AIMMeR may help reduce pathologist workload and streamline diagnostics in CRC.

Malignant pleural mesothelioma (MPM) is difficult to diagnose. An accurate blood biomarker could prompt specialist referral or be deployed in future screening. In earlier retrospective studies, SOMAscan proteomics (Somalogic, Boulder, CO) and fibulin-3 seemed highly accurate, but SOMAscan has not been validated prospectively and subsequent fibulin-3 data have been contradictory.

Objective: The design of the consultation room remains largely unaltered despite major changes in clinical practice, such as the electronic medical record and patient-centered care. The value of redesigning the consultation room to accommodate these changes and the effect of a redesign on patient-clinician interaction are unclear.Methods: The authors randomly allocated 65 patient-physician dyads to consultations in a standard room (n= 30) or in an experimental room designed with a semicircular table around which the clinician and the patient sat, with equal access to the computer screen (n= 35). Participant responses to post-visit surveys, assessing patient experiences in these rooms, were compared in an intention-to-treat fashion.Results: The authors found no differences between the rooms in terms of patient satisfaction with the consultation, mutual respect, or communication quality. Compared to the standard room, patients in the experimental room were better able to interact with the computer monitor (24 [75%] vs. 17 [59%], P= 0.07) and had a greater ability to look at the screen at any time (22 [73%] vs. 8 [28%], P< 0.001); and they reported that clinicians allowed them to review the medical record on the screen (22 [71%] vs. 13 [45%], P= 0.012), shared information on the computer screen (24 [80%] vs. 18 [60%], P= 0.037), and reviewed information on the Internet with the patient (13 [43%] vs. 7 [26%], P= 0.010) more than those in the standard room.Conclusions: The design of the consultation room affects the clinical encounter. In particular, ready access to a computer screen using the electronic medical record and the Internet may enhance information sharing.

A study was conducted to examine the extent to which individualist–collectivist values were endorsed by Russian and British participants and the relationship between these values and allocation of rewards to self and co‐worker in a hypothetical scenario. It was predicted firstly, that the Russians would be more collectivist than the British in their orientation; secondly, that in reward allocation the British would be influenced only by levels of task performance while Russians would be influenced both by task performance and by the identity of their co‐worker as a friend or a stranger; and thirdly, that greater endorsement of collectivist values would be associated with a tendency to minimize personal gain in reward allocation. The first two predictions were supported by the data. In addition, qualitative data from group discussions is used to explain reward allocation decisions and to explore the specific ways in which Russian collectivism differs from British individualism.

This chapter examines the impact of group identification on intergroup perceptions and on willingness to take part in collective action. Based on social identity theory, the argument is put forward that strong group identification is associated with intergroup differentiation and stereotypic perception. This in turn has implications for the acceptance of social influence from ingroup and outgroup sources. In addition, group identification facilitates participation in collective action by promoting shared perceptions within the ingroup concerning the desirability and possibility of social change. Participation in collective action feeds back to affect the individual's attitudes and social identity.