P-OGC31 Robotic Upper GI Surgery: Is it Feasible, Safe and Can it Improve Patient Outcomes?

Abstract Background Robotic surgery has been increasingly applied in different specialties. The Rosemere Cancer Foundation funded the Da Vinci robot for Upper GI services at our tertiary Upper GI Cancer Centre which serves a population of approximately 1.5 million people. In 2017, two of our UGI surgeons performed the first robotic GIST excision in the UK successfully. The patient was discharged 5 days later after an uneventful recovery. We have subsequently performed increasingly complex benign and malignant Robotic UGI procedures. Our primary and secondary aims looked at the length of stay (LOS) in critical care and the complete hospital admission. Methods Two UGI Consultants observed cases in established centres in Netherlands and Germany. Following this, they undertook 60 hours of simulation practice, online modular training and 3 sessions of wet lab training. Their initial 10 resections were completed under proctorship. A database was designed collecting information from the notes, November 2017 till July 2021 prospectively. This database was compared against a retrospective database on the same outcomes for non robotic cases over the same time period, performed by the same surgeons. LOS was statistically assessed using Mann-Whitney U test. Results As of July 2021, we have completed 73 cases. These are 25 benign and 48 cancer cases. The M:F was 1.5:1 and the median age was 66 years (22-84 years). The primary and secondary outcomes are illustrated below. Conclusions Robotic Upper GI surgery is safe and feasible with good short term outcomes. There is a reasonable learning curve and therefore a structured learning programme is needed before embarking. The main advantage from preliminary data suggests a reduction in the LOS in critical care. The cost-effectiveness in complex benign surgeries remains to be determined with increase volume of cases. P-OGC31 Figure 1

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M2009 Audit of Palliation of Oesophageal Cancer in An Upper GI Cancer Centre in the UK

Gastroenterology ◽

10.1016/s0016-5085(08)62102-2 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-450

Author(s):

Purushothaman Premchand ◽

Noor Jawad

Keyword(s):

Oesophageal Cancer ◽

Cancer Centre ◽

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer ◽

The Uk

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Potential health and economic impacts of dexamethasone treatment for patients with COVID-19

Nature Communications ◽

10.1038/s41467-021-21134-2 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Ricardo Águas ◽

◽

Adam Mahdi ◽

Rima Shretta ◽

Peter Horby ◽

...

Keyword(s):

Full Potential ◽

Potential Health ◽

Middle Income ◽

Middle Income Countries ◽

Time Period ◽

Life Years ◽

Exposure Levels ◽

The Uk ◽

The Cost ◽

The Impact

AbstractDexamethasone can reduce mortality in hospitalised COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Here, we estimate the potential number of lives saved and life years gained if this treatment were to be rolled out in the UK and globally, as well as the cost-effectiveness of implementing this intervention. Assuming SARS-CoV-2 exposure levels of 5% to 15%, we estimate that, for the UK, approximately 12,000 (4,250 - 27,000) lives could be saved between July and December 2020. Assuming that dexamethasone has a similar effect size in settings where access to oxygen therapies is limited, this would translate into approximately 650,000 (240,000 - 1,400,000) lives saved globally over the same time period. If dexamethasone acts differently in these settings, the impact could be less than half of this value. To estimate the full potential of dexamethasone in the global fight against COVID-19, it is essential to perform clinical research in settings with limited access to oxygen and/or ventilators, for example in low- and middle-income countries.

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Communication in Critical Care Environments: Mobile Telephones Improve Patient Care

Yearbook of Critical Care Medicine ◽

10.1016/s0734-3299(08)70429-5 ◽

2007 ◽

Vol 2007 ◽

pp. 313-314

Author(s):

R.P. Dellinger

Keyword(s):

Critical Care ◽

Patient Care ◽

Improve Patient Care ◽

Mobile Telephones ◽

Improve Patient

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Impact of Socio-Economic Deprivation on Mortality Rates after Upper GI Cancer Surgery

Endoscopy ◽

10.1055/s-2006-956827 ◽

2006 ◽

Vol 38 (11) ◽

Author(s):

Y Leigh ◽

J Seagroatt ◽

S Cole ◽

M Goldacre ◽

P McCulloch

Keyword(s):

Mortality Rates ◽

Cancer Surgery ◽

Economic Deprivation ◽

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer

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Neither Victors nor Victims

10.1093/oso/9780198801825.003.0011 ◽

2017 ◽

Author(s):

David Whetham

Keyword(s):

First Century ◽

National Interests ◽

Civil Military Relations ◽

High Street ◽

National Survival ◽

The Uk ◽

Military Relations ◽

The Cost ◽

Realistic Goal

Between 2007 and 2011, Wootton Bassett, a small Wiltshire town in the UK, became the focus of national attention as its residents responded to the regular repatriations of dead soldiers through its High Street. The town’s response came to symbolize the way that broader attitudes developed and changed over that period. As such, it is a fascinating case study in civil–military relations in the twenty-first century. Success may be the same as victory, but victory, at least as it has been traditionally understood, is not a realistic goal in many types of contemporary conflict. Discretionary wars—conflicts in which national survival is not an issue and even vital national interests may not be at stake—pose particular challenges for any government which does not explain why the cost being paid in blood and treasure is ‘worth it’.

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Metaphors of migration over time

Discourse & Society ◽

10.1177/0957926521992156 ◽

2021 ◽

pp. 095792652199215

Author(s):

Charlotte Taylor

Keyword(s):

Emigration And Immigration ◽

Emigrants And Immigrants ◽

Economic Resource ◽

Historical Discourse ◽

Continuity And Change ◽

The Past ◽

Perception Of Control ◽

Time Period ◽

Metaphor Use ◽

The Uk

This paper aims to cast light on contemporary migration rhetoric by integrating historical discourse analysis. I focus on continuity and change in conventionalised metaphorical framings of emigration and immigration in the UK-based Times newspaper from 1800 to 2018. The findings show that some metaphors persist throughout the 200-year time period (liquid, object), some are more recent in conventionalised form (animals, invader, weight) while others dropped out of conventionalised use before returning (commodity, guest). Furthermore, we see that the spread of metaphor use goes beyond correlation with migrant naming choices with both emigrants and immigrants occupying similar metaphorical frames historically. However, the analysis also shows that continuity in metaphor use cannot be assumed to correspond to stasis in framing and evaluation as the liquid metaphor is shown to have been more favourable in the past. A dominant frame throughout the period is migrants as an economic resource and the evaluation is determined by the speaker’s perception of control of this resource.

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“At Least until the Second Wave Comes…”: A Twitter Analysis of the NHS and COVID-19 between March and June 2020

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083943 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3943

Author(s):

Kathy McKay ◽

Sarah Wayland ◽

David Ferguson ◽

Jane Petty ◽

Eilis Kennedy

Keyword(s):

Health Care ◽

Social Media ◽

Content Analysis ◽

Well Being ◽

Profound Impact ◽

Time Period ◽

Twitter Analysis ◽

The Uk ◽

Media Narratives ◽

Second Wave

In the UK, tweets around COVID-19 and health care have primarily focused on the NHS. Recent research has identified that the psychological well-being of NHS staff has been adversely impacted as a result of the COVID-19 pandemic. The aim of this study was to investigate narratives relating to the NHS and COVID-19 during the first lockdown (26 March–4 July 2020). A total of 123,880 tweets were collated and downloaded bound to the time period of the first lockdown in order to analyse the real-time discourse around COVID-19 and the NHS. Content analysis was undertaken and tweets were coded to positive and negative sentiments. Five main themes were identified: (1) the dichotomies of ‘clap for carers’; (2) problems with PPE and testing; (3) peaks of anger; (4) issues around hero worship; and (5) hints of a normality. Further research exploring and documenting social media narratives around COVID-19 and the NHS, in this and subsequent lockdowns, should help in tailoring suitable support for staff in the future and acknowledging the profound impact that the pandemic has had.

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‘Rising demand and decreasing resources’: Theorising the ‘cost of austerity’ as a barrier to social worker discretion

Journal of Social Policy ◽

10.1017/s0047279421000507 ◽

2021 ◽

pp. 1-18

Author(s):

CIARÁN MURPHY

Keyword(s):

Social Worker ◽

Child Protection ◽

Child Protection Services ◽

Radical Reform ◽

Critical Realist ◽

Documentary Analysis ◽

Effective System ◽

The Individual ◽

The Uk ◽

The Cost

Abstract The Munro Review of Child Protection asserted that the English child protection system had become overly ‘defensive’, ‘bureaucratised’ and ‘standardised’, meaning that social workers were not employing their discretion in the interests of the individual child. This paper reports on the results of an ethnographic case study of one of England’s statutory child protection teams. The research sought to explore the extent of social worker discretion relative to Munro’s call for ‘radical reform’ and a move towards a more ‘child-centred’ system. Employing an iterative mixed methods design – encompassing documentary analysis, observation, focus group, questionnaire, interview and ‘Critical Realist Grounded Theory’ – the study positioned the UK Government’s prolonged policy of ‘austerity’ as a barrier to social worker discretion. This was because the policy was seen to be contributing to an increased demand for child protection services; and a related sense amongst practitioners that they were afforded insufficient time with the child to garner the requisite knowledge, necessary for discretionary behaviour. Ultimately, despite evidence of progress relative to assertions that social worker discretion had been eroded, the paper concludes that there may still be ‘more to do’ if we are to achieve the ‘child-centred’ and ‘effective’ system that Munro advocated.

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Multi-Drug Featurization and Deep Learning Improve Patient-Specific Predictions of Adverse Events

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052600 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2600

Author(s):

Ioannis N. Anastopoulos ◽

Chloe K. Herczeg ◽

Kasey N. Davis ◽

Atray C. Dixit

Keyword(s):

Machine Learning ◽

Real World ◽

Variable Number ◽

Patient Specific ◽

Real World Evidence ◽

Genetic Features ◽

The Uk ◽

Therapeutic Compounds ◽

Improve Patient ◽

Reaction Profile

While the clinical approval process is able to filter out medications whose utility does not offset their adverse drug reaction profile in humans, it is not well suited to characterizing lower frequency issues and idiosyncratic multi-drug interactions that can happen in real world diverse patient populations. With a growing abundance of real-world evidence databases containing hundreds of thousands of patient records, it is now feasible to build machine learning models that incorporate individual patient information to provide personalized adverse event predictions. In this study, we build models that integrate patient specific demographic, clinical, and genetic features (when available) with drug structure to predict adverse drug reactions. We develop an extensible graph convolutional approach to be able to integrate molecular effects from the variable number of medications a typical patient may be taking. Our model outperforms standard machine learning methods at the tasks of predicting hospitalization and death in the UK Biobank dataset yielding an R2 of 0.37 and an AUC of 0.90, respectively. We believe our model has potential for evaluating new therapeutic compounds for individualized toxicities in real world diverse populations. It can also be used to prioritize medications when there are multiple options being considered for treatment.

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