bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC P15 Outcomes of Endoscopic Submucosal Dissection for Neoplasia in Barrett's Oesophagus at a Single Tertiary UK Centre
Authors: Siggens Katie , Htet Hein , Abdelrahim Mohamed , Aslam Shahila , Subramaniam Sharmila , Bhandari Pradeep 
Published: December 2022

Abstract

Background
Endoscopic therapies for dysplasia or early cancer in Barrett's Oesophagus have become well established over recent years. Endoscopic Submucosal Dissection (ESD) offers the benefit of en bloc resection and accurate histological staging of lesions which is particularly advantageous in cancers and may eliminate the need for major surgery in selected patients. However, ESD is not widely available in the United Kingdom (UK) and it remains a high risk procedure in Western settings with complication rates of up to 12–27% reported in the literature. Here we report our outcomes at a single tertiary referral centre in the UK.

Methods
Retrospective review of prospectively maintained database.

Results
244 consecutive ESD were carried out in patients with Barrett's neoplasia with visible lesions. The mean age was 69.8 years and 201 patients were male. Median Prague classification was C2M5. The median lesion size was 30mm (range 5–120mm). En bloc resection was achieved in 95.5% of cases. Bleeding, perforation and strictures occurred in 0.82%, 0.82% and 6.97% of cases respectively. These were all managed endoscopically.
Histology showed low grade dysplasia in 12 cases, high grade dysplasia in 37 cases, and adenocarcinoma in 192 cases. In the cases of adenocarcinoma, 131 were intramucosal (stage pT1a) and 60 were submucosally invasive (pT1b). Of the submucosally invasive cancers, 36 were SM1 and 24 &gt;SM1. R0 resection was achieved in 74% of cancer cases.
Following ESD, 93 patients underwent ablation of residual Barrett's, 25 underwent further endoscopic resection, 21 entered endoscopic surveillance only and 25 patients underwent oesophagectomy.
Of the patients who underwent oesophagectomy, 9 were for T1b &gt;SM1 disease, 8 for poor prognostic factors (including poorly differentiated adenocarcinoma, lymphovascular invasion or signet ring cells), 4 for R1 resection at deep margin, 3 for patient choice and 2 for difficult recurrence.

Conclusions
Our data demonstrates that ESD can be effectively targeted for cancers in patients based on endoscopic assessment by experienced endoscopists with 78.7% of procedures being carried out for early cancers. ESD is safe and effective in the majority of patients and informed the need for surgery in the appropriate group of individuals.
OGC P23 Omentopexy Reduces the Incidence of Symptomatic Post-Operative Diaphragmatic Herniation Following Minimally Invasive Oesophagectomy: a 15-year Prospective Study in a UK Specialist Centre
Authors: Doe Matthew , Brown Oliver , Jones Michael , Dwerryhouse Simon , Higgs Simon , Hornby Steve , Messenger David , Wadley Martin 
Published: December 2022

Abstract

Background
Post-oesophagectomy diaphragmatic hernia (PODH) occurs in up to 26% of laparoscopically assisted oesophagectomy. Preventative measures have been suggested, but no formal efficacy data are available. This study compared the incidence of symptomatic PODH before and after introduction of omentopexy in a UK specialist centre.

Methods
Consecutive patients undergoing oesophagectomy using a laparoscopic abdominal approach between 2005 and 2020 were included. Omentopexy was introduced in 2014 and was achieved by suture fixation of the greater omentum to the anterior abdominal wall around or lateral to the feeding jejunostomy. Patient demographics, surgical details and complications were collected from a prospective database. All patients were followed up for a minimum of 2 years.

Results
Symptomatic PODH developed in 7 of 142 patients (4.9%) in the omentopexy cohort, compared to 9 of 68 patients (13.2%) in the non-omentopexy cohort [Odds Ratio = 0.32 (95% Confidence Interval: 0.12–0.91), p=0.032]. Five of the 9 PODHs in the non-omentopexy cohort developed in the early post-operative period, whereas no early PODHs developed in the omentopexy cohort. There were no complications attributable to omentopexy.

Conclusions
Omentopexy is safe and effective at reducing the incidence of symptomatic PODH, particularly in the early post-operative period, and should be routinely performed in all patients undergoing laparoscopically assisted oesophagectomy.
OGC P34 Endoscopy vacuum therapy for anastomotic leak after oesophagectomy – A single centre's experience
Authors: (Linda) Lin Yi-Tzu , Almonib Ahmed , Tan Benjamin 
Published: December 2022

Abstract

Background
Anastomotic leak is one of the major complications following oesophagectomy and is associated with a prolonged ICU and hospital stay with high mortality. Over the years, endoscopic vacuum therapy (EVT) has an evolving role in managing anastomotic leak. The aim of this study was evaluate our experience in the use of EVT in managing anastomotic leak.

Methods
A retrospective analysis was conducted in patients who underwent elective oesophagectomy at our tertiary centre from May 2021 to April 2022. Patient demographics, complication profiles, length of stay (LOS) and survival outcomes were collected. The details of endoscopic procedure, therapy results, and adverse events were evaluated. Endo-SPONGE® by B Braun Medical Ltd was used at our centre.

Results
Over the last 12 months, 3 out of 11 patients (27.3%) who had anastomotic leak were treated with EVT. All 3 patients were males and diagnosed with anastomotic leak on Day 8, 9, 9. Two patients were treated with a stent at the time of the diagnosis and the management changed to Endo-Sponge on the subsequent endoscopy as the defect increased in size. They required 3 and 8 times of sponge exchange respectively. One patient was managed with Endo-Sponge at the time of diagnosis and required 7 times of sponge exchange. The successful anastomotic leak healing rate was 100% and none of them required further endoscopic or surgical interventions. The median changing time interval of sponges was 3 days (range 2–5 days). The average sponge exchange rate was 6 times. The median duration of EVT was 25 days (range 18–29 days). No other adverse events occurred during EVT. The average LOS was 49.3 days.

Conclusions
EVT is an effective and safe treatment option in patients with anastomotic leak post oesophagectomy for oesophageal cancer. With careful patient selection, EVT can be considered as the first-line treatment instead of surgery. Future studies involving a greater number of patients are essential to evaluate the efficacy of EVT.
Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by radical surgery for locally advanced oesophageal squamous cell carcinoma: meta-analysis
Authors: Kamarajah Sivesh K , Evans Richard P T , Griffiths Ewen A , Gossage James A , Pucher Philip H 
Published: December 2022

Abstract

Background
The literature lacks robust evidence comparing definitive chemoradiotherapy (dCRT) with neoadjuvant chemoradiotherapy and surgery (nCRS) for oesophageal squamous cell carcinoma (ESCC). This study aimed to compare long-term survival of these approaches in patients with ESCC.

Methods
A systematic review performed according to PRISMA guidelines included studies identified from PubMed, Scopus, and Cochrane CENTRAL databases up to July 2021 comparing outcomes between dCRT and nCRS for ESCC. The main outcome measure was overall survival (OS), secondary outcome was disease-free survival (DFS). A meta-analysis was conducted using random-effects modelling to determine pooled adjusted multivariable hazard ratios (HRs).

Results
Ten studies including 14 092 patients were included, of which 30 per cent received nCRS. Three studies were randomized clinical trials (RCTs) and the remainder were retrospective cohort studies. dCRT and nCRS regimens were reported in six studies and surgical quality control was reported in two studies. Outcomes for OS and DFS were reported in eight and three studies respectively. Following meta-analysis, nCRS demonstrated significantly longer OS (HR 0.68, 95 per cent c.i. 0.54 to 0.87, P &lt; 0.001) and DFS (HR 0.50, 95 per cent c.i. 0.36 to 0.70, P &lt; 0.001) compared with dCRT.

Conclusion
Neoadjuvant chemoradiotherapy followed by oesophagectomy correlated with improved survival compared with definitive chemoradiation in the treatment of ESCC; however, there is a lack of literature on RCTs.
Service users’ experiences of social and psychological avoidable harm in mental health social care in England: Findings of a scoping review
Authors: Carr Sarah , Hudson Georgie , Amson Noa , Hisham Idura N , Coldham Tina , Gould Dorothy , Hodges Kathryn , Sweeney Angela 
Published: December 2022

Abstract
Avoidable harm—that is, harm to service users caused by unsafe or improper interventions, practices or services and which could have been mitigated or prevented—is embedded in social care legislation and inspections. However, the concept of avoidable harm has largely been defined by policymakers, academics, practitioners, regulators and services, with little known about service users’ experiences of avoidable harm in practice. This survivor-controlled review maps and synthesises peer-reviewed literature on service users experience of social and psychological avoidable harm in mental health social care (MHSC) in England. The review was guided by an Advisory Group of practitioners and service users. Six databases were systematically searched between January 2008 and June 2020 to identify relevant literature. Following de-duplication, 3,529 records were screened using inclusion and exclusion criteria. This led to full-text screening of eighty-four records and a final corpus of twenty-two papers. Following data extraction, thematic analysis was used to synthesise data. Six key themes were identified relating to relationships and communication, information, involvement and decision-making, poor support, fragmented systems and power-over and discriminatory cultures. Impacts on MHSC service users included stress, distress, disempowerment and deterioration in mental health. We discuss our findings and indicate future research priorities.
‘I have enough pressure as it is, without the worry of doing something wrong because of ignorance’: The impact of Covid-19 on people who employ social care personal assistants
Authors: Leverton Monica , Samsi Kritika , Woolham John , Manthorpe Jill 
Published: December 2022

AbstractPeople with care and support needs were often badly affected by Covid-19, although the impact on people employing Personal Assistants (PAs) has not been addressed. We aimed to explore the experiences of people employing PAs during the pandemic to inform care systems and social work practice. Remote qualitative interviews were conducted with seventy PA employers across England in 2021–2022. Data were analysed thematically to explore salient themes. The Covid-19 pandemic elucidated role tensions of PA employers: Navigating care arrangements during a time of unprecedented uncertainty reinforced participants’ role as an employer, but exposed some aspects of employment responsibilities and legal obligations that participants felt ill-equipped to manage. Reports of contact with or by social workers were few and not perceived as helpful. The often-informal nature of PA arrangements and its blurred relational boundaries affected participants’ expectations of their PAs. PA employers would welcome support from social workers in their employment role and flexibility with care plans, albeit with greater autonomy over their Direct Payment (DP) budget to enhance the potential of this arrangement. In the context of declining DP uptake in England, our study offers some potential explanations for this, with suggestions for systemic change and social work practice.
When the Neighboring Village is Not Treated: Role of Geographic Proximity to Communities Not Receiving Mass Antibiotics for Trachoma
Authors: Mosenia Arman , Haile Berhan A , Shiferaw Ayalew , Gebresillasie Sintayehu , Gebre Teshome , Zerihun Mulat , Tadesse Zerihun , Emerson Paul M , Callahan E Kelly , Zhou Zhaoxia , Lietman Thomas M , Keenan Jeremy D 
Published: December 2022

Abstract

Background
Mass administration of azithromycin is an established strategy for decreasing the prevalence of trachoma in endemic areas. However, nearby untreated communities could serve as a reservoir that may increase the chances of chlamydia reinfection in treated communities.

Methods
As part of a cluster-randomized trial in Ethiopia, 60 communities were randomized to receive mass azithromycin distributions and 12 communities were randomized to no treatments until after the first year. Ocular chlamydia was assessed from a random sample of children per community at baseline and month 12. Distances between treated and untreated communities were assessed from global positioning system coordinates collected for the study.

Results
The pretreatment prevalence of ocular chlamydia among 0 to 9 year olds was 43% (95% confidence interval [CI], 39%-47%), which decreased to 11% (95% CI, 9%-14%) at the 12-month visit. The posttreatment prevalence of chlamydia was significantly higher in communities that were closer to an untreated community after adjusting for baseline prevalence and the number of mass treatments during the year (odds ratio, 1.12 [95% CI, 1.03-1.22] for each 1 km closer to an untreated community).

Conclusions
Mass azithromycin distributions to wide, contiguous geographic areas may reduce the likelihood of continued ocular chlamydia infection in the setting of mass antibiotic treatments.
Stratification mechanisms in labour market matching of migrants
Authors: Burnazoglu Merve 
Published: December 2022

Abstract
I aim to challenge the standard framework in which systematic exclusion is mistakenly characterised as only a frictional phenomenon that fails to be captured in migrants’ labour market matching mechanisms. Societies organise and rank people in a hierarchical way, not only in terms of individual differences and characteristics but with respect to social groups and categories of people. These macro patterns systematically subject some migrant groups to different forms of exclusion. Social stratification, explained in terms of social identity-based institutional structures, organises labour markets into different destinations like clubs with sharply different sets of opportunities. It functions like a trap for migrants: it reinforces itself by reproducing systems of exclusion and creates dilemmas for migrants. Can migrants organise themselves to avoid such traps? I show that exclusion is endogenous to employment as a type of good in the standard goods typology. Treating different types of employment opportunities as being like clubs, I investigate how migrants join or create alternative employment clubs as a response to real or perceived exclusion from native employment clubs. If these alternative clubs are ‘sticky’ and discourage migrants from trying to join natives’ exclusive employment clubs, the trap becomes inescapable. For migrants to escape the stratification trap, employment should be seen not only as an investment but as a collective action problem structurally targeting exclusion.
A review of supportive care for older people with advanced chronic kidney disease
Authors: FitzGerald Ted J , Joosten Hanneke , van Buren Marjolijn , Vinen Katie , Brown Edwina A 
Published: December 2022

ABSTRACTSupportive care (SC) is a multidimensional and person-centred approach to managing advanced CKD that engages the person and their caregivers in shared decision making from the outset. Rather than focusing on disease-specific therapies, SC is a collection of adjuvant interventions and adaptations to conventional treatments that can be used to improve the individual's quality of life. Recognizing that frailty, multi-morbidity and polypharmacy are more common among older people with advanced chronic kidney disease (CKD) and that people in this group tend to prioritize quality of life over survival as a goal of care, SC represents an important adjunct to disease-specific therapies in CKD management. This review provides an overview of SC in the older person with advanced CKD.
Digital health interventions in chronic kidney disease: levelling the playing field?
Authors: Graham-Brown Matthew P M , Smith Alice C , Greenwood Sharlene A 
Published: December 2022

ABSTRACT
Digital health interventions (DHIs) have long been thought of as a convenient way to deliver aspects of healthcare and broaden access to services. For patients with chronic kidney disease (CKD), DHIs designed to improve health literacy, self-efficacy and health-related behaviours such as physical activity, diet and adherence have been developed and are being tested, but their translation into clinical practice will be challenging. While DHIs potentially have broad reach, it is increasingly clear that patients from lower socio-economic and educational backgrounds, minority ethnic groups, elderly patients and those who face digital poverty are the least likely to access and benefit from DHIs, when they are precisely the patients who stand to gain the most. This article discusses the potential for DHIs to level the playing field for patients with CKD as well as the steps researchers, clinicians and developers should consider ensuring DHIs are developed, in collaboration with patients, to be inclusive and effective, as well as strategies that should be considered during development to support translation into practice.
The functional significance of residual yolk in lizards
Authors: Guo Kun , Wang Cai-Feng , Du Yu , Qu Yan-Fu , Braña Florentino , Ji Xiang 
Published: December 2022

Abstract
Residual yolk is assumed to be an important source of energy and nutrients during early life in nonmammalian amniotes. Available data show that the mean size of residual yolk is far smaller in lizards than in turtles, snakes, crocodiles, and birds, raising a question of whether residual yolk is of functional significance in lizards. Here, we compared data from 26 lizard species with those from other nonmammalian amniotes to test the hypothesis that residual yolk is functionally less significant in species producing more fully developed offspring. In our sample, species mean offspring water contents ranged from 73% to 84% of body wet mass; species mean proportions of carcass dry mass, fat-body dry mass, and residual yolk dry mass to offspring dry mass ranged from 84% to 99%, 0% to 5.0%, and 0% to 14.4%, respectively. Lizards are, on average, more fully developed at hatching or birth than snakes, as revealed by the fact that the mean proportion of carcass dry mass to body dry mass and offspring water contents were both higher in lizards than in snakes. We conclude that the functional significance of residual yolk during early life is generally less evident in lizards. Even in the lizards where residual yolk is of potential functional significance, this portion of yolk contributes little, if any, to postembryonic growth. Future work could usefully collect data across a wider spectrum of reptile taxa to establish a precocial–altricial continuum and test the hypothesis that species with a smaller amount of residual yolk are closer to the precocial end of the continuum.
Early mobilization after esophageal cancer surgery: a retrospective cohort study
Authors: Schuring N , Geelen S J G , van Berge Henegouwen M I , Steenhuizen S C M , van der Schaaf M , van der Leeden M , Gisbertz S S 
Published: December 2022

Summary
A key component of the Enhanced Recovery After Surgery pathway for esophagectomy is early mobilization. Evidence on a specific protocol of early and structured mobilization is scarce, which explains variation in clinical practice. This study aims to describe and evaluate the early mobilization practice after esophagectomy for cancer in a tertiary referral center in the Netherlands. This retrospective cohort study included data from a prospectively maintained database of patients who underwent an esophagectomy between 1 January 2015 and 1 January 2020. Early mobilization entailed increase in activity with the first target of ambulating 100 meters. Primary outcomes were the number of postoperative days (PODs) until achieving this target and reasons for not achieving this target. Secondary outcomes were the relationship between preoperative factors (e.g. sex, BMI) and achieving the target on POD1, and the relationship between achieving the target on POD1 and postoperative outcomes (i.e. length of stay, readmissions). In total, 384 patients were included. The median POD of achieving the target was 2 (IQR 1–3), with 173 (45.1%) patients achieving this on POD1. Main reason for not achieving this target was due to hemodynamic instability (22.7%). Male sex was associated with achieving the target on POD1 (OR = 1.997, 95%CI 1.172–3.403, P = 0.011); achieving this target was not associated with postoperative outcomes. Ambulation up to 100 m on POD1 is achievable in patients after esophagectomy, with higher odds for men to achieve this target. ERAS pathways for post esophagectomy care are encouraged to incorporate 100 m ambulation on POD1 in their guideline as the first postoperative target.
The association between postoperative complications and long-term survival after esophagectomy: a multicenter cohort study
Authors: Fransen Laura F C , Verhoeven Rob H A , Janssen Thijs H J B , van Det Marc J , Gisbertz Suzanne S , van Hillegersberg Richard , Klarenbeek Bastiaan , Kouwenhoven Ewout A , Nieuwenhuijzen Grard A P , Rosman Camiel , Ruurda Jelle P , van Berge Henegouwen Mark I , Luyer Misha D P 
Published: December 2022

Summary
Conflicting results are reported on the association between post-esophagectomy complications and long-term survival. This multicenter study assesses the association between complications after an esophagectomy and long-term overall survival. Five Dutch high-volume centers collected data from consecutive patients undergoing esophagectomy between 2010 and 2016 and merged these with long-term survival data from the Netherlands Cancer Registry. Exclusion criteria were non-curative resections and 90-day mortality, among others. Primary outcome was overall survival related to the presence of a postoperative complication in general. Secondary outcomes analyzed the presence of anastomotic leakage and cardiopulmonary complications. Propensity score matching was performed and the outcomes were analyzed via Log-Rank test and Kaplan Meier analysis. Among the 1225 patients included, a complicated course occurred in 719 patients (59.0%). After matching for baseline characteristics, 455 pairs were successfully balanced. Patients with an uncomplicated postoperative course had a 5-year overall survival of 51.7% versus 44.4% in patients with complications (P = 0.011). Anastomotic leakage occurred in 18.4% (n = 226), and in 208 matched pairs, it was shown that the 5-year overall survival was 57.2% in patients without anastomotic leakage versus 44.0% in patients with anastomotic leakage (P = 0.005). Overall cardiopulmonary complication rate was 37.1% (n = 454), and in 363 matched pairs, the 5-year overall survival was 52.1% in patients without cardiopulmonary complications versus 45.3% in patients with cardiopulmonary complications (P = 0.019). Overall postoperative complication rate, anastomotic leakage, and cardiopulmonary complications were associated with a decreased long-term survival after an esophagectomy. Efforts to reduce complications might further improve the overall survival for patients treated for esophageal carcinoma.