bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-P35 Textbook outcomes after pancreaticoduodenectomy in high risk patients: results from a high volume UK centre
Authors: Raza Syed Soulat , Nutu Anisa , Powell-Brett Sarah , Chatzizacharias Nikolaos , Dasari Bobby , Isaac John , Abradelo Manuel , Marudanayagam Ravi , Mirza Darius , Roberts Keith , Sutcliffe Robert 
Published: December 2021

Abstract

Background
Textbook Outcome (TO) after pancreaticoduodenectomy (PD) is a quality metric that may be used to compare outcomes between centres, but the effect of casemix on TO is unknown. The aim of this study was to determine if TO after PD is affected by casemix.

Methods
TO was evaluated in a prospectively maintained database of 830 consecutive patients who underwent PD between 2009-2019 in a high volume centre. TO was defined as an absence of POPF, bile leak, haemorrhage, Clavien III+ complications, readmission and hospital mortality. Frequency of TO was compared between high and low risk cases. High risk was defined as any of the following: age ≥ 75 years, significant comorbidity (Charlson index ≥5), vascular resection or additional procedures. Multivariable analysis using binary logistic regression analysis was performed to assess factors associated with TO.

Results
Overall, 599/830 patients (72%) had TO after PD. There has been no change during the study period (2009-2013 v 2014-2018: 70% v 75%; p = 0.148). There was no difference in TO in elderly patients (p = 0.774), severe comorbidity (p = 0.483), vascular resection (p = 0.187) or additional procedures (p = 0.189). On multivariable analysis, cardiac disease (OR 0.47, 95%CI 0.28-0.81; p = 0.006), pancreatic adenocarcinoma (OR 1.55 95%CI 1.02-2.35; p = 0.039) and hard gland (OR 3.12, 95%CI 2.06-4.736; p &lt; 0.001) were independently associated with TO.

Conclusions
Acceptable Textbook Outcomes can be achieved in high risk patients and those undergoing complex surgery, when performed in high volume specialist centres with appropriate patient selection.
P-P43 Lymph Node Negative Duodenal Adenocarcinoma Is Associated with Long-term Patient Survival following Pancreaticoduodenal Resection
Authors: Patel Pranav , Likos-Corbett Marina , Mudan Satvinder , Khan Amir , Kumar Sacheen , Bhogal Ricky 
Published: December 2021

Abstract

Background
Duodenal adenocarcinoma (DA) is a rare gastrointestinal malignancy. Due to the low incidence of DA there is limited data reporting patient outcomes following radical pancreatic resection. Large retrospective single and multi-centre studies suggest that lymph node metastasis is an important factor for long-term patient survival following resection. The management of DA has tended to favour aggressive surgical resection with pancreaticoduodenectomy (PD), although a morbidity of up to 50% has been reported, mostly related to post-operative pancreatic fistulas. We assessed the disease-free (DFS) and overall survival (OS) in patients undergoing pancreaticoduodenectomy for DA in our institution.

Methods
We retrospectively analysed all patients undergoing pancreatic resection for DA at our institution between January 2009 – March 2020 inclusive. All DAs were cytologically or histologically proven prior to surgical resection following imaging review in a Hepato-pancreaticobiliary multidisciplinary team meeting. Patients underwent a Whipple’s with distal gastrectomy or pylorus preserving pancreaticoduodenectomy (PPPD) based on tumour size and location. Statistical analysis was performed by a Mann-Whitney U test using a p-value significance of 0.05 (SPSS, IBM, USA). DFS and OS curves were presented by Kaplan- Meier survival curves.

Results
19 patients underwent pancreatic resection at our institution for DA during the study period. 12 patients underwent Whipple’s with distal gastrectomy and 9 patients underwent PPPD. The overall postoperative morbidity and mortality was 37% and 5% respectively. R0 resection was achieved in 18 patients (95%). 9 patients (47%) had no nodal involvement. Median follow up was 31 months (range 1-108 months). Median DFS was 17 months but was significantly higher in patients with no nodal metastasis [p &lt; 0.001]. Median OS was 9.5 months for the whole cohort but was significantly higher in the patients with no nodal vs nodal metastasis (60 vs 17.5 months respectively) p &lt; 0.003].

Conclusions
DA can be resected by PD or segmental resection. PD is favoured due to improved resection margins and overall increased patient survival, despite an increased morbidity. Our series reports comparable morbidity and mortality to the published literature for DA resected by PD. This study reports a 95% R0 resection rate for DA with a 3- and 5-year survival of 50% and 30% respectively. DFS was found to be significantly higher in patients with no nodal disease, despite predominant T4 disease. This series has identified that lymph node metastasis is one of the most important prognostic determinants of long-term patient survival.

Program permission
yes
P-P52 Overuse of CT scans in the diagnosis of Acute Pancreatitis
Authors: Thomas Joel Joy , Mitra Smrthi , Vulliamy Paul , Osilli Dixon , Mukherjee Samrat 
Published: December 2021

Abstract

Background
Acute pancreatitis is an acute inflammatory process affecting the pancreas with variable involvement of local tissues and remote organs and may sometimes progress into necrosis of the pancreas. Diagnosis is usually made based on the clinical presentation of abdominal pain alongside a positive biochemical result of either serum amylase or lipase levels. Current guidelines by International Association of Pancreatology (IAP) state that early use of computed tomography (CT) is only indicated in patients who have no definite diagnosis, and should be delayed to at least 96 hours after the onset of the symptoms to evaluate complications. We aimed to assess the over-utilization of CT scans in the diagnosis of acute pancreatitis.

Methods
We performed a prospective cohort study of patients with confirmed acute pancreatitis who presented to a single NHS trust between March and April 2021. We included patients with at least two out of the three findings: (1) an acute abdominal pain, (2) elevated serum amylase levels of more than three times the normal range and (3) acute pancreatitis as evidenced on abdominal imaging. We defined inappropriate CT scans as those performed within 96 hours in the presence of both clinical and biochemical diagnostic criteria.

Results
A total of 53 patients met the inclusion criteria and were admitted with acute pancreatitis during this 2-month period at our trust. 54.7% (29/53) of this cohort had at least one CT scan performed during the index admission. 28.3% (15/53) of the admitted patients had an early CT scan performed in the presence of positive biochemical and clinical diagnostic criteria. This represents 51.7% of the total number of CT scans performed in the study group.

Conclusions
We found evidence of excessive use of CT scans in the early phase of acute pancreatitis for diagnostic purposes. Limiting the overuse of CT scans in the diagnosis of the same will not just reduce the financial burden of the hospital and trust, but also limit the avoidable exposure of patients to radiation.
P-P54 Interpreting trends in post-operative drain fluid amylase according to type of anastomosis used to form a pancreaticojejunostomy
Authors: Britton Emily , Ranat Reesha , Skipworth James , Pope Ian 
Published: December 2021

Abstract

Background
The formation of the pancreaticojejunostomy during pancreaticoduodenectomy is the most technically challenging aspect of the procedure, with its failure increasing rates of both morbidity and mortality significantly. Early identification and management of a clinically relevant post-operative pancreatic fistula (CR-POPF) can be critical in reducing the threat of potentially avoidable harm to the patient. The most used indicator for a CR-POPF is the level of drain fluid amylase. There are many different techniques for forming the anastomosis, with considerable analysis but no consensus on superiority. We aimed to look at our centres experience using different techniques and the trends we observed in drain amylases and clinical outcomes.

Methods
A prospective database of all patients in a single UK centre undergoing pancreatic or duodenal resection has been maintained. This includes patient demographics, diagnosis pre and post operatively, operative details and duration, complications, and outcomes. All patients undergoing a pancreaticoduodenectomy between 1st January 2020 and 31st July 2021 were identified and their data retrospectively analysed.

Results
Thirty-three patients underwent a pancreaticoduodenectomy during the study period. The pancreatojejunostomy was formed using a duct-to-mucosa anastomosis in twenty-eight patients and using a dunking technique in five patients.
The mean of the highest drain fluid amylase on post-operative day one for the patients with a dunking anastomosis was 14804.8 (range 3643-43686), on day three 2376.12 (range 167-8008.6) and of the three patients whose drains were in situ at day 5 it was 522.2 (range 31 to 983. An 83.9% reduction in mean drain amylases was observed between Day One and Day Three, followed by a further 78% reduction between day 3 and day. One patient (20%) had a CR-POPF with a grade B fistula, two others had a biochemical leak.
The mean Day One drain amylases for patients with a duct-to-mucosa anastomosis was 71% lower at 4274.5 (range 15.4 to 41755). However this increased by 11.5% by Day Three to 4766.4 (range 5 to 46300) before falling by 64.7% to 1681.9 (range 5 to 13015) on Day Five. Eight patients (28.6%) had a CR-POPF – 3 grade B and 5 grade C fistula - and three patients had a biochemical leak.

Conclusions
In our centre’s experience, the type of anastomosis used to perform the pancreatic reconstruction post pancreaticoduodenostomy significantly impacts the post-operative trend in drain fluid amylase. This is important for clinicians to appreciate in order to avoid premature suspicion of a CR-POPF and prevent potentially unnecessary intervention.
Effects of home-based Baduanjin combined with elastic band exercise in patients with chronic heart failure
Authors: Ma Chunhua , Zhou Wei , Jia Yanyan , Tang Qiubo 
Published: December 2021

Abstract

Aims
Many studies show that aerobic exercise combined with resistance training is beneficial for patients with chronic heart failure (CHF). The benefits of traditional Chinese exercise Baduanjin combined with an elastic band in this population are not known. To evaluate the effects of Baduanjin in conjunction with an elastic band on exercise capacity, physical function, muscle strength of the upper and lower extremities, quality of life (QoL), and exercise self-efficacy among CHF patients in a home-based setting.

Methods and results
A prospective randomized controlled trial was conducted in this study. A total of 136 CHF patients were randomly assigned to the exercise or the control group. Chronic heart failure patients in the exercise group received Baduanjin combined with elastic band and CHF community care, while those in the control group accepted CHF community care. The duration of the interventions was 24 weeks. The measured outcomes included exercise capacity, physical function, muscle strength of the upper and lower extremities, QoL, and exercise self-efficacy. A generalized estimating equation model was employed to examine the effects of Baduanjin combined with the elastic band on the outcome variables. Chronic heart failure patients showed significant improvements in physical performance testing (PPT) (P = 0.023), 30-s arm curl test (30ACT) (P = 0.035), 10 sit-stand-to-sit tests (STS10) (P = 0.017), 6-min walk test (6MWT) (P &lt; 0.001), QoL (P &lt; 0.001), and exercise self-efficacy (P = 0.009) in the exercise group, while these variables did not differ in the control group. There were also significant differences in these variables between the two groups at Weeks 12 and 24 (P &lt; 0.05). There were significant group-by-time interactions in the exercise group, with enhancements in PPT (F = 5.40, P = 0.032), 6MWT (F = 9.04, P &lt; 0.001), muscle strength in the 30ACT and STS10 (F = 5.32, P = 0.037; F = 6.69, P = 0.005), QoL (F = 6.69, P &lt; 0.001), and self-efficacy (F = 4.60, P = 0.038) revealed in CHF patients in this group from baseline to Week 24.

Conclusion
Baduanjin combined with elastic band exercise may improve exercise capacity, physical function, muscle strength, QoL, and exercise self-efficacy for CHF patients in a home-based setting, which may be a complementary exercise model for home-based CHF patients who are clinically stable and cannot participate in centre-based exercise-based cardiac rehabilitation programmes.
Longitudinal Profiling in Phenotypic Metric of Aging: Insights From the Baltimore Longitudinal Study of Aging
Authors: Kuo Pei-Lun , Levine Morgan , Schrack Jennifer , Shardell Michelle , Ferrucci Luigi 
Published: December 2021

Abstract
It remains challenging to quantify the pace of aging across lifespan due to lack of comprehensive longitudinal measurements across wide range of age. In Baltimore Longitudinal Study of Aging, we have measured the longitudinal trajectories of more than 30 phenotypes across four pre-identified domain - body composition, energy regulation, homeostatic mechanisms and neurodegeneration/neuroplasticity, among participants with age between 20+ and 90+. We implemented a two-stage approach to summarize the longitudinal trajectories of these phenotypes across four domains into a summarized score. We demonstrated that higher summarized score (denoting for slower longitudinal phenotypic decline) is associated with slower decline in both cognitive and physical functions, across different stages of adulthood. Our results imply that deep longitudinal profiling contains rich information and may potentially replace diseases as an early endpoint in trials targeting at aging. Further, understanding the underpinning of longitudinal phenotypic trajectories may provide clues to the biological mechanisms of aging.
Benchmarking Age-Friendly University Practices: AFU Inventory and Campus Climate Survey (ICCS) Study Insights
Authors: Montepare Joann , Silverstein Nina 
Published: December 2021

Abstract
The Age-Friendly University (AFU) initiative endorsed by GSA’s Academy for Gerontology in Higher Education (AGHE) provides institutions of higher education with guiding principles for addressing the needs of aging populations. Benchmarks are now needed for assessing age-friendly academic, workplace, and physical campus environments, perceptions of campus constituents, and recommendations for advancing age inclusivity. This symposium will discuss what the AFU Inventory and Campus Climate Survey (ICCS) administered to a national sample of colleges and universities is revealing about the study of age-friendliness in higher education. The sample includes data from over 10,000 faculty, staff, students, and older learners surveyed in 2020-21. Whitbourne will introduce the conceptual model that served as the foundation for the ICCS, with special attention to the need to assess and compare “objective” age-friendly practices with “subjective” perceptions of these practices. Bowen will describe the utility of examining age-friendliness across institutional units with different functions: outreach-engagement, personnel, physical environment, research, services-resources, student affairs, and teaching-learning. Beaulieu will present data demonstrating the importance of assessing perceptions of specific constituent groups including faculty, staff, students, and lifelong learners. Montepare will discuss insights gained about the definition and manifestation of what it means to be ageist, age-friendly, and age-inclusive in higher education. Silverstein will describe strengths and challenges observed across campuses along with recommendations and promising new directions for advancing age inclusivity in higher education.
Hypertensive Retinopathy Is Associated With Worse Cognitive Function in Women: The SWAN Study
Authors: Moroi Sayoko , Hood Michelle , Gutierrez Carrie Karvonen , Ehrlich Joshua , Gillespie Brenda , Wood Sarah Dougherty , Musch David 
Published: December 2021

Abstract
Based on the 2018 American Academy of Neurology guideline, the prevalence of mild cognitive impairment (CI) increases from 6.7% at 60-64 years to 25.2% at 80-84 years. There is interest to identify potential biomarkers in the retina for CI and dementia. The aims of this analysis was to test whether hypertensive retinopathy (HR) was associated with cognitive function using data from the Study of Women’s Health Across the Nation (SWAN), Michigan cohort. SWAN, launched in 1996/97, is a longitudinal study of women traversing midlife and into late adulthood. Starting in 2000, cognitive function tests were administered: East Boston Memory Test immediate (EBMTi) and 10-minute delay (EBMTd) for verbal episodic memory; digit span backwards (DSB) for working memory; and symbol digits modalities test (SDMT) for perception speed, motor speed, and visual scanning. Z-scores were calculated for EBMTi, EBMTd, DSB and SDMT and averaged at follow-up visit 15 (2015/16). Eye exams were performed on 255 women (66 + 2.6 years) at follow-up visit 16 (2016/17). HR was based on presence/absence of arteriovenous nicking. Logistic regression showed a statistically significant association of lower average cognitive Z-score with HR (p-value 0.03, beta=-0.21 [95% confidence interval: -0.40 to -0.02]) adjusting for measured hypertension or anti-hypertensive drugs, years of measured hypertension, race, education, and age. Preliminary results indicate that HR is associated with lower cognitive test scores in women in their 60s-70s. This association between a simple ophthalmic exam finding of systemic hypertension, i.e., arteriovenous nicking, and lower cognitive function is consistent with a cerebrovascular mechanism of CI.
Methodological Approaches to Transform, Develop, and Evaluate Cancer Care Interventions
Authors: Halpin Sean 
Published: December 2021

Abstract
Cancer diagnoses in older adults are often abrupt and unexpected, requiring patients to make quick therapy choices. Further, reflecting on traumatic therapy is often difficult. In our symposium, we bring together researchers from varied disciplines to report on patients’ cancer therapy choices. Carrion will discuss her mixed-methods approach to older Latino adults’ cancer therapy preferences. Next, Blackberry will present how patient-derived photographs (photovoice) can improve supportive care for older Australians in facilitating empowerment, patient-centered care, and shared decision making. Halpin, who will apply conversation analysis to examine how multiple myeloma patients interacted with supplemental material during in-person nurse-led education. Last, Seaman will use his work with head and neck cancer survivors to illustrate the conceptual and methodological challenges of investigating those who discontinue care. Understanding how patients from diverse populaces with various cancer diagnoses navigate their therapy may help inform future cancer-related health services’ approaches.
New Issues in Life Course Research: Which Early-Life Factors Matter for Late-Life Outcomes?
Authors: Smith Jacqui , Walsemann Katrina 
Published: December 2021

Abstract
The increased availability of retrospective information about the lives of participants in population panel studies has expanded the range of precursors to include in life course research. However, this also challenges researchers to select among many potential precursors to a late-life outcome and to determine the relative role of factors from different periods in the life course. Each paper in this symposium uses life course information from the Health and Retirement Study (HRS) to examine different late-life outcomes. Speakers will discuss what guided the particular selection of factors and outcome to examine in their study. Sonnega, Helppie-McFall, and Lee focus on indicators of childhood financial and social adversity as potential predictors of early retirement due to poor health. Park, Larkina, and Smith ask if decisions taken in early adulthood about how to balance work-and family-life by individuals and their partners are related to the categories of important life accomplishments older adults report in their life review. Two papers examine precursors of late-life health outcomes. Williams-Farrelly and Smith identified different profiles of physical activity in early- and mid-adulthood. They discuss associations between these profiles and cognitive aging. Whereas social losses, relocation, and multimorbidity are well-documented precursors of Major Depression in old age, Bergmans and Smith asked if poor health in childhood played a distal role. The session concludes with an integrative discussion of issues by Walsemann.
A Systematic Review of Interventions That Reduce Family Caregiving Time
Authors: Baker Zachary , Jutkowitz Eric , Gaugler Joseph 
Published: December 2021

Abstract
Due to multiple long-term sociodemographic and health trends contributing to the impending family care gap, there likely is no single policy or intervention that could increase the number of family caregivers in the U.S. to the levels required to fill such a gap. However, the amount of time that a family caregiver spends providing assistance is potentially mutable. Given the pressing concerns of the family care gap, identifying interventions or approaches that could reduce existing caregiving time is of considerable importance. This presentation provides the results of a systematic review of published research to identify the effects of interventions on the amount of time family caregivers spend on their caregiving tasks. Pharmaceutical approaches directed to care recipients, technology interventions, case management, multicomponent interventions, and care settings all appeared to reduce caregiving time. Improved operationalization, study design, and similar factors will help guide future intervention research to reduce caregiving time.
Identifying, Assessing, and Supporting Family Caregivers in Health and Long-Term Care: Progress and Opportunities
Authors: Riffin Catherine , Wolff Jennifer 
Published: December 2021

Abstract
Family caregivers are a largely hidden but vital workforce within medical and long-term care settings. Family caregivers are actively involved throughout care delivery systems and provide crucial assistance to people with chronic conditions. Building on the person- and family-centered care approach and recent recommendations from national organizations, this presentation sets forth a roadmap for research, policy, and practice that outlines practical solutions and opportunities to address existing barriers to systematic assessment and support of family caregivers in clinical practice. With the impending family care gap and projections for a steep decline in the availability of family caregivers in the coming decades, it is more important than ever to prepare health care systems for this shift. If put into action, the recommendations of this presentation can help to bridge the care gap by promoting sustainable solutions and infrastructure to ensure that families are recognized and adequately supported in care delivery settings.