bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘I do not know if I will have the energy to come to placement tomorrow’: Fast-Tracking Racially Minoritised Students to Failure in Social Work Education
Authors: Tedam Prospera , Finch Jo 
Published: September 2024

Abstract
We build upon previous work that explored the evidence base of ‘failure to fail’ on practice placements across professions. We found a lack of convincing evidence of ‘fail to fail’ within assessed practice learning placements and could not ascertain the extent of this issue. The literature was stronger about why it ‘might’ or ‘could’ be difficult to fail students on placement. We concluded that if there was a reluctance to fail students, that hesitancy was not shown when failing racially minoritised students. Using critical race theory, we noted instead, fast tacking to failure. Data were re-examined from two previous studies that focused on the experiences of Black African social work students in England. We identified two ways in which practice educators operationalised fast tracking to failure. Firstly, the speed at which negative judgments were made about students’ abilities, and related to this, asking personal and insensitive questions, and secondly, the speed of decision about placement failure. We argue that the debate needs to move away from fail to fail and instead, focus on who is being fast tracked to failure, and how racism and other discrimination is addressed forcefully in social work policy, practice and education.
226. PHILOSOPHICAL CONSIDERATIONS IN SURGICAL INNOVATION
Authors: Khoma Oleksandr , Laurence Jerome , Sandroussi Charbel , Wijnhoven Bas 
Published: September 2024

Abstract

Background
Innovation in surgery has been viewed as synonymous with progress. This is not always the case as many new innovative processes, devices and techniques do not yield same results in "real world" as they do in the experimental stage. The purpose of this presentation is to discuss the role of philosophical experiment in the process of appraisal of surgical innovation.

Methods
A thought experiment was conducted analysing past surgical innovations. Introduction of electrosurgery, laparoscopic cholecystectomy, surgical safety checklist and laparoscopic aortic aneurysm repair were tested. All consequences (known and hypothetical) of these innovations were considered in attempt to establish a more holistic metric of success.

Results
Significant limitations exist in the current assessment methods of innovation "success" which is commonly defined based on the results of a study of chosen pre-set metrics (main outcome). The utility of key metric used to assess innovation (e.g. lengths of hospital stay or visual pain scores) is limited by the choice of these outcomes. This reduces the changes of detecting rate, but possibly, much more significant unintended effects both advantageous and harmful (e.g. discovery of insulin vs thalidomide). The magnitude of detectable change is dictated by practicality of powering controlled studies and exposes results to the sensitivity bias. Unanticipated effects of the innovation are frequently not discovered until it is adopted on a large scale. Various outcomes of innovation are non-commensurable and further complicate the definition of "success".
A novel innovation outcome assessment process is proposed: net global utility, a composite outcome measure which considers all potential effects of innovation (clinical, social, economic, ethical and other). Net global utility is a subjective measure that allows observer to compare non-commensurable values by not using them in isolation. One of the main advantages of net global utility is that it only requires knowledge of available metrics and principles of logical argument, providing an easy assessment tool to boost local oversight of introduction of innovation and policy-making. It includes calculation of risk (probability x consequence) which allows to account for improbable but highly consequential outcomes. Net global utility is compared to the best available alternative and derives internal face validity from this. Net global utility encompasses potential incidental future benefits as well as assessment of innovation against the test of justice.

Conclusion
Defining success in surgical innovation can be challenging. The use of thought experiment and logical argument is described to introduce a novel metric "net global utility" allowing for composite assessment of innovation success. Various previous surgical innovations used to demonstrate the application of the net global utility.
231. DESCRIBING THE LANDSCAPE OF ESOPHAGECTOMY BETWEEN EASTERN AND WESTERN ESOPHAGEAL SOCIETIES: COMPARATIVE STUDIES FROM THE JAPANESE NCD AND DUTCH DUCA
Authors: Matsuda Satoru , van der Sluis Pieter , Kumamaru Hiraku , Kingma Eeike , Kawakubo Hirofumi , Ruurda Jelle , Watanabe Masayuki , Miyata Hiroaki , Lagarde Sjoerd , Takeuchi Hiroya , van Hillegersberg Richard , Shirabe Ken , Wijnhoven Bas PL , Kitagawa Yuko 
Published: September 2024

Abstract

Objective
Differences in clinicopathological characteristics of patients with esophageal cancer between countries may exist and impact on perioperative and surgical treatment as well as outcomes. Identification of these discrepancies may help the interpretation of present and future studies.

Methods
Data on patient demographics, comorbidity, pathology, surgical procedure, and short-term outcomes were retrieved, and compared between countries. Furthermore, we conducted a risk factor analysis focused on the major postoperative complications after esophagectomy to reveal the similarities and differences in risk factors.

Results
The mean annual number of resections for oesophageal cancer was 6673 in NCD (5.3 cases per 100,000 population) and 551 (3.1 cases per 100,000 population) in DUCA. Patients from the NCD were older and had a lower BMI. Complete minimally invasive esophagectomy was performed in 52.7% in NCD and 85% in DUCA. A cervical anastomosis was performed in 83.5% of patients in the NCD and in 33.8% in the DUCA likely reflecting differences in the location of primary tumors. Mortality within 30 days after surgery in the NCD and DUCA was 0.8% and 2.7%, respectively. Risk factors for postoperative major complications were similar between countries.

Conclusions
Although there were differences in patient variables, no significant differences were observed in short-term outcomes and risk factors of postoperative complications. The current results provide insight into contemporary demographics and outcomes of esophageal cancer resections from two an Asian and Western perspective.
232. EPIDEMIOLOGY OF EOSINOPHILIC ESOPHAGITIS IN JAPAN: A POPULATION-BASED STUDY
Authors: Fujiwara Yauhiro 
Published: September 2024

Abstract

Backgrounds
Eosinophilic esophagitis (EoE) has been increasingly diagnosed in Western countries whilst there have been few general population-based studies in Asia. In addition, risk factors for EoE have not been examined completely. The aim of the study was to investigate the epidemiology and risk factors of EoE in Japanese general population.

Methods
We analyzed an employer-based health insurance claim database from January 2005 to September 2022. EoE cases were identified based on the International Classification of Diseases-tenth Revision code, K20.0. We calculated the incidence and prevalence of EoE using Poisson regression and binomial distribution with exact methods respectively. Using 10 times more matched controls for EoE cases, a nested case-control study identified potential risk factors for adult EoE.

Results
Of 15,200,895 individuals, 1,010 EoE cases were identified. The incidence and prevalence of EoE were 2.82 (95% CI 2.44–3.26) per 100,000 person-years and 10.68 (95% CI 10.01–11.37) per 100,000 people in 2022. Both rates had dramatically increased since 2017. smoking was associated with a 59% risk reduction of EoE whereas constant alcohol consumption was associated with a 63% increase in the risk of EoE. EoE was not associated with either body mass index or health-related diseases such as hypertension, diabetes mellitus, hyperuricemia, and dyslipidemia.

Conclusion
The incidence and prevalence of EoE in Japan has steadily increased over the past two decades. Nevertheless, EoE remains less common in Japan compared to Western countries. Factors contributing to the epidemiology of EoE on a global basis may improve our understanding of the contribution of genetic and environmental risk factors. In light of potential risk factors, further study is warranted to investigate whether lifestyle intervention can improve the management of EoE.
233. UTILITY OF SINGLE TRANSHIATAL CHEST DRAINAGE AFTER MINIMALLY INVASIVE OESOPHAGECTOMY: A PROPENSITY-SCORE MATCHED STUDY OF FEASIBILITY
Authors: Thong Da Wei , Gunawardene Ashok , Islam Shabnam Rabia , Kariyawasam Sanjeeva 
Published: September 2024

Abstract

Background
The routine placement of intercostal chest drains remains common practice following minimally invasive oesophagectomy (MIO). Chest drains may contribute to increased post-operative pain and morbidity. The aim of this study was to compare the outcomes of transhiatal chest drain with intercostal chest drain. We analysed use of analgesia, length of hospital stay, and postoperative pulmonary morbidity following MIO.

Methods
This was a retrospective case-control study of patients undergoing elective MIO at a quaternary centre in Western Australia between September 2016 and September 2023. To reduce confounding, propensity score matching was performed. All patients were identified from a prospectively maintained database. In patients undergoing MIO with exclusive transhiatal drainage, a 19 French Blake’s drain was advanced through the hiatus into the right pleural cavity and positioned adjacent to the anastomosis.

Results
Thirty patients were included in the study, fifteen of whom had exclusively transhiatal drain placement. Mean total daily oral morphine dose equivalent was significantly lower in the transhiatal drain group (58mg+/-35.8) compared with intercostal drain group (100.8mg+/-64.0) on day 1 (p=0.04). There is no statistically significant difference between the total oral morphine use on days 3 (p=0.44) and 6 (p=0.97). No significant difference was observed in reintervention rate (p=1.00), length of stay (p=0.78) or postoperative pulmonary complications (p=1.00).

Conclusion
The results of this study suggest that transhiatal drain placement following MIO is associated with a reduction in post-operative pain and no increase in pulmonary complications or length of stay. Larger, prospective studies are needed to further evaluate the safety of single transhiatal chest drain placement following MIO.
237. THE PROGNOSTIC VALUE OF NODAL SKIP METASTASIS IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Li Xiaokun , Yuan Yong 
Published: September 2024

Abstract

Background
Nodal skip metastasis (NSM), a common form of lymphatic spread in esophageal cancer (EC), refers to metastatic involvement of distant lymph nodes (LNs) without prior engagement of adjacent LNs. Previous studies examining the association between NSM and survival outcomes in EC patients have yielded inconsistent and even contradictory results. This systematic review and meta-analysis aim to assess the prognostic value of NSM and summarize NSM definitions used in prior studies.

Methods
Four databases were employed for this meta-analysis. The relationship between NSM and overall survival (OS) was assessed using pooled hazard ratios (HRs) and their 95% confidence intervals (CIs). Sensitivity analysis and funnel plots were utilized to evaluate publication bias.

Results
This meta-analysis incorporated nine studies, and the pooled results revealed no significant association between NSM and OS (HR = 0.99, 95% CI: 0.75–1.31; P = 0.951). Sub-group analyses based on histological features, method of lymphadenectomy, node staging system, and NSM definitions also failed to identify a significant association between NSM and OS.

Conclusions
Based on the available evidence, NSM cannot be considered a prognostic factor for EC patients. Future studies examining the prognostic value of NSM should focus on employing three-field lymphadenectomy with an adequate number of harvested LNs. NSM definitions based on lymph node station and anatomical compartment could both serve as feasible classifications for EC.
245. ESOPHAGECTOMY AFTER NEOADJUVANT CHEMOTHERAPY WITH AN INDICATION FOR CONVERSION SURGERY FOR HIGHLY ADVANCED ESOPHAGOGASTRIC JUNCTION ADENOCARCINOMA
Authors: Okamoto Hiroshi , Taniyama Yusuke , Sato Chiaki , Ozawa Yohei , Ishida Hirotaka , Ando Ryohei , Shinozaki Yasuharu , Kamei Takashi 
Published: September 2024

Abstract

Background
There is currently no strong evidence for preoperative chemotherapy for advanced esophagogastric junction adenocarcinoma. Furthermore, no curative treatment strategy has been established for advanced junction adenocarcinoma, including Stage IV disease, with no indication for conversion surgery.

Subjects and Methods
In this study, we retrospectively reviewed nine patients with highly advanced esophagogastric junctional adenocarcinoma, including Stage IV adenocarcinoma, who underwent systemic chemotherapy followed by planned resection at our hospital.

Results
The participants included 6 males and 3 females, with median age of 64 (range: 45–72) years. Pretreatment stages III, IVA, and IVB, categorized based on UICC TNM classification (esophageal adenocarcinoma), were observed in 1, 4, and 4 cases, respectively, with 1 case of (#104) subclavian lymph node metastases, 1 case of (#16) abdominal para-aortic lymph node metastases, and 2 cases of liver metastases, including multiple lesions. All patients received S-1 plus oxaliplatin (SOX) therapy as preoperative chemotherapy (2–40 courses). Although we observed one patient with unresectable abdomen malingnancies, the others underwent R0 resection, six underwent esophagectomy (with three total gastrectomy and one liver resection), and two open (+ continuous right thoracotomy) lower esophagectomy + total gastrectomy. Pathological stages I, II, III, and IV were observed in two, one, four, and one patients, respectively. Postoperatively, stereotactic irradiation, chemotherapy, and immune checkpoint inhibitors were administered to the patients to treat recurrent brain and liver metastases, and the 1-year survival rate was found to be 71.4% with a median observation period of 17 (range: 0–61) months. Among them, downstage and pN0 cases were relatively promising.

Conclusion
Even in highly advanced cases, cases with promising prognoses with multidisciplinary treatment, including surgery, were observed. We hope that large-scale clinical trials, such as JCOG2203, will help clarifying the significance of this approach, and advancements in chemotherapy regimens are expected.
263. LEARNING CURVE ANALYSIS USING CUMULATIVE SUM TECHNIQUES FOR ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Mukoyama Tomosuke , Goto Hironobu , Koterazawa Yasufumi , Sawada Ryuichiro , Harada Hitoshi , Urakawa Naoki , Hasegawa Hiroshi , Kanaji Shingo , Yamashita Kimihiro , Matsuda Takeru , Oshikiri Taro , Kakeji Yoshihiro 
Published: September 2024

Abstract

Introduction
Robot-assisted minimally invasive esophagectomy (RAMIE) has improved the technical difficulty of the conventional minimally invasive esophagectomy, by more precisely operated forceps and stability of the surgical fields. Although it is widely accepted that RAMIE demands excellence in robotic surgery, it is unclear how many cases were needed to reach the proficiency. This study aimed to investigate the learnings curve of two surgeons, with respect to perioperative findings.

Methods
Patients who underwent RAMIE using a Da Vinci Xi Surgical System between November 2018 and February 2024 were included. Surgeon A introduced RAMIE and Surgeon B started the training of RAMIE after standardization. Both surgeons were certified by the Japan Society for Endoscopic Surgery and qualified surgeon by the Japan Esophageal Society. A cumulative sum (CUSUM) analyses were performed for console time for thoracic procedure to generate the learning curves of each surgeon. The cases before the changepoint of the CUSUM curve was defined as phase I (learning phase), and after the changepoint as phase II (proficiency phase). The perioperative outcomes were compared between the phases.

Results
Surgeon A and B performed 63 and 33 cases, respectively. Surgeon B started RAMIE under guidance of Surgeon A, who had already experienced 39 cases at that time. CUSUM curve showed that Surgeon B required fewer cases to reach the phase II (proficiency phase) than Surgeon A (16 cases for Surgeon B vs. 27 cases for Surgeon A). There was no significant difference between the phase I and II in patient characteristics including age, sex, tumor location, neoadjuvant chemotherapy, and clinical TNM stages and the extent of lymph node dissection. Total operation time significantly decreased from phase I to phase II: 796 min [730-824] vs. 708 min [627-764]; P&lt;0.01 for Surgeon A, 806 min [751-853] vs. 686 min [635-707]; P&lt;0.01 for Surgeon B. During Phase I, console time of Surgeon B was significantly longer than console time of Surgeon A (408 min [354-432] vs. 360 min [325-385], P&lt;0.01). However, in Phase II, the difference in time attenuated (281 min [255-299] vs. 266 min [244-316], P=0.68). There was no significant difference in intraoperative blood loss or the incidence of postoperative complications including recurrent laryngeal nerve palsy, anastomotic leakage and pneumonia.

Conclusion
It is suggested that training in standardized surgical procedures for RAMIE under the guidance of an experienced surgeon could accelerate the pace of learning.
270. ANALYSIS OF THE RELATIONSHIP BETWEEN CARDIAC DIAMETER AND ANASTOMOTIC TROUBLE IN TRANS HIATAL ESOPHAGOGASTRIC JUNCTION CANCER SURGERY
Authors: Higuchi Yudai , Maruyama Suguru , Shoda Katsutoshi , Akaike Hidenori , Kawaguchi Yoshihiko , Saito Ryo , Takiguchi Koichi , Izumo Wataru , Nakata Yuki , Shiraishi Kensuke , Furuya Shinji , Amemiya Hidetake , Kawaida Hiromichi , Ichikawa Daisuke 
Published: September 2024

Abstract

Background
The number of esophagogastric junction (EGJ) cancers has been increasing in recent years, and the trans hiatal lower esophagectomy is widely used for cases with shorter esophageal invasion. However, the mediastinal surgical view through the hiatus is sometimes poor due to cardiac compression, and resection and reconstruction are often difficult in these cases. We therefore retrospectively examined the influence of cardiac diameter on short-term postoperative outcomes.

Methods
From June 2004 to December 2022, 97 patients underwent radical surgery for EGJ cancer at our hospital, of those 67 patients underwent trans-hiatal approach. We retrospectively analyzed the relationship between cardiothoracic ratio (CTR) on preoperative chest radiographs and left ventricular diastolic diameter (LVDd) on echocardiography and postoperative complications in patients underwent trans hiatal approach.

Results
Patients with preoperative CTR &gt;50% had a significantly higher rate of anastomotic leakage (33% v.s. 7%, p&lt;0.05), and similarly for LVDd, when divided into two groups using 43 mm as cut-off, patients with larger heart diameter had significantly more anastomotic leakage (69% v.s. 24%, p&lt;0.05). We performed a multivariate analysis using CTR, ASA-PS, blood loss, operative time, BMI, and tumor diameter, and defined CTR as an independent risk factor for anastomotic leakage (OR: 7.76, 95%CI: 1.45-41.4, p&lt;0.05).

Conclusion
Trans-hiatal approach can be used for resection of EGJ cancer. However, special attention should be paid to the prevention of anastomotic leakage in patients with cardiac comorbidities or a large preoperative CTR or LVDd.
271. EFFICACY OF NEOADJUVANT CF OR DCF, FLOT PLUS NIVOLUMAB FOR RESECTABLE LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA (JCOG1804E: FRONTIER)
Authors: Tsushima Takahiro , Yamamoto Shun , Kato Ken , Daiko Hiroyuki , Hara Hiroki , Kojima Takashi , Abe Tetsuya , Tsubosa Yasuhiro , Kawakubo Hirofumi , Yoshii Takako , Fujita Takeo , Kadowaki Shigenori , Matsuda Satoru , Nagashima Kengo , Aoki Kazunori , Yachida Shinichi , Kitagawa Yuko 
Published: September 2024

Abstract

Background
The standard neoadjuvant therapy for resectable locally advanced esophageal squamous cell carcinoma (ESCC) in Japan is DCF (docetaxel [DTX] + cisplatin [CDDP] + 5-fluorouracil [5-FU]). In addition, neoadjuvant immune checkpoint inhibitors have shown a survival benefit for metastatic ESCC and several other cancers. We previously reported that neoadjuvant CF (CDDP + 5-FU) + nivolumab (Nivo), DCF + Nivo, and FLOT (5-FU + l-leucovorin [l-LV] + oxaliplatin [L-OHP] + DTX) + Nivo are tolerable and show promising short-term efficacy for resectable locally advanced ESCC. However, the long-term efficacy of these neoadjuvant treatments remains unclear.

Methods
JCOG1804E (FRONTiER) is a multi-cohort phase I study designed to evaluate the safety and efficacy of Nivo combined with neoadjuvant CF (cohorts A and B [adding run-in Nivo]) or DCF (cohorts C and D [adding run-in Nivo]) or neoadjuvant FLOT (cohort E) for resectable locally advanced ESCC. The eligibility criteria were histologically proven ESCC staged as cT1N1-3M0 or cT2-3N0-3M0 (8th UICC TNM classification), age 20-75 years, performance status (PS) ≤1, and no prior cancer treatment. Secondary efficacy endpoints were pathological complete response (pCR), progression-free survival (PFS), and overall survival (OS) for each treatment.

Results
Thirty-seven patients were enrolled (median age [range]: 62 [31-75] years; PS 0/1: 32/5; clinical stage I/II/III/IVA: 7/9/20/1; PD-L1 TPS &lt;1%/≥1%/unknown: 10/26/1). In CF-based treatment cohorts (n=13), median follow-up time (range), pCR, and 3-year PFS were 42.3 (20.9-50.1) months, 7.7%, and 66.6%, respectively. The respective values for the DCF-based treatment cohorts (n=12) were 32.2 (8.0-39.8) months, 33.3%, and 83.3% and for the FLOT-based treatment cohort (n=12) were 16.2 (5.3-20.6) months, 41.7%, and 91.7%. In the overall population (n=37), median follow-up time was 31.9 (5.3-50.1) months and 3-year OS was 82.4%.

Conclusion
Neoadjuvant CF or DCF or neoadjuvant FLOT + Nivo followed by surgery for resectable locally advanced ESCC showed promising short- and long-term efficacy. (NCT03914443)