scholarly journals Delivering esophago-gastric cancer care during the COVID-19 pandemic in the United Kingdom: a surgical perspective

2020 ◽  
Vol 33 (9) ◽  
Author(s):  
S Wahed ◽  
J Chmelo ◽  
M Navidi ◽  
N Hayes ◽  
A W Phillips ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Surgical Intervention ◽  
Clinical Care ◽  
High Volume ◽  
Good Communication ◽  
The United Kingdom ◽  
Tertiary Center ◽  
High Level ◽  
The Impact ◽  
Multi Disciplinary Team

Summary Background The COVID-19 pandemic continues to have a significant impact on the provision of medical care. Planning to ensure there is capability to treat those that become ill with the virus has led to an almost complete moratorium on elective work. This study evaluates the impact of COVID-19 on cancer, in particular surgical intervention, in patients with esophago-gastric cancer at a high-volume tertiary center. Methods All patients undergoing potential management for esophago-gastric cancer from 12 March to 22 May 2020 had their outcomes reviewed. Multi-disciplinary team (MDT) decisions, volume of cases, and outcomes following resection were evaluated. Results Overall 191 patients were discussed by the MDT, with a 12% fall from the same period in 2019, including a fall in new referrals from 120 to 83 (P = 0.0322). The majority of patients (80%) had no deviation from the pre-COVID-19 pathway. Sixteen patients had reduced staging investigations, 4 had potential changes to their treatment only, and 10 had a deviation from both investigation and potential treatment. Only one patient had palliation rather than potentially curative treatment. Overall 19 patients underwent surgical resection. Eight patients (41%) developed complications with two (11%) graded Clavien-Dindo 3 or greater. Two patients developed COVID-19 within a month of surgery, one spending 4 weeks in critical care due to respiratory complications; both recovered. Twelve patients underwent endoscopic resections with no complications. Conclusion Care must be taken not to compromise cancer treatment and outcomes during the COVID-19 pandemic. Excellent results can be achieved through meticulous logistical planning, good communication, and maintaining high-level clinical care.

scholarly journals Results of Annual Screening in Phase I of the United Kingdom Familial Ovarian Cancer Screening Study Highlight the Need for Strict Adherence to Screening Schedule

2013 ◽  
Vol 31 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Adam N. Rosenthal ◽  
Lindsay Fraser ◽  
Ranjit Manchanda ◽  
Philip Badman ◽  
Susan Philpott ◽  
...  
Keyword(s):  
United Kingdom ◽  
High Risk ◽  
Surgical Intervention ◽  
Transvaginal Ultrasound ◽  
High Risk Population ◽  
Predictive Values ◽  
Strict Adherence ◽  
Screening Interval ◽  
The United Kingdom ◽  
The Impact

Purpose To establish the performance characteristics of annual transvaginal ultrasound and serum CA125 screening for women at high risk of ovarian/fallopian tube cancer (OC/FTC) and to investigate the impact of delayed screening interval and surgical intervention. Patients and Methods Between May 6, 2002, and January 5, 2008, 3,563 women at an estimated ≥ 10% lifetime risk of OC/FTC were recruited and screened by 37 centers in the United Kingdom. Participants were observed prospectively by centers, questionnaire, and national cancer registries. Results Sensitivity for detection of incident OC/FTC at 1 year after last annual screen was 81.3% (95% CI, 54.3% to 96.0%) if occult cancers were classified as false negatives and 87.5% (95% CI, 61.7% to 98.5%) if they were classified as true positives. Positive and negative predictive values of incident screening were 25.5% (95% CI, 14.3 to 40.0) and 99.9% (95% CI, 99.8 to 100) respectively. Four (30.8%) of 13 incident screen-detected OC/FTCs were stage I or II. Compared with women screened in the year before diagnosis, those not screened in the year before diagnosis were more likely to have ≥ stage IIIc disease (85.7% v 26.1%; P = .009). Screening interval was delayed by a median of 88 days before detection of incident OC/FTC. Median interval from detection screen to surgical intervention was 79 days in prevalent and incident OC/FTC. Conclusion These results in the high-risk population highlight the need for strict adherence to screening schedule. Screening more frequently than annually with prompt surgical intervention seems to offer a better chance of early-stage detection.

scholarly journals Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Esther Victoria Wright ◽  
Omar Musbahi ◽  
Abhinav Singh ◽  
Naresh Somashekar ◽  
Christopher P. Huber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Femoral Neck ◽  
Clinical Care ◽  
Multidisciplinary Care ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Perioperative Mortality ◽  
The United Kingdom ◽  
Using Data ◽  
The Impact

Abstract Background The coronavirus disease 19 (COVID-19) pandemic has presented modern healthcare with an unprecedented challenge. At the peak of the pandemic, trauma and orthopaedic services at our institutions undertook internal restructuring, diverting resources to frontline medical care. Consequently, we sought to assess the impact on the elderly and comorbid patients presenting with femoral neck fractures, with a particular focus on 30-day mortality, length of stay, multidisciplinary team involvement and departmental structuring. Method A retrospective analysis of patients presenting with femoral neck fractures at three separate West London NHS Trusts was undertaken between March 11, 2020, to April 30, 2020. Length of stay, 30-day mortality and adherence to parameters constituting the best care evidence-based practice tariffs were compared between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and negative patients. A similar comparison was also conducted between our cohort and the equivalent period in 2018 using data from the National Hip Fracture Database. Results A total of 68 patients presenting with femoral neck fractures were identified, mean age 81 (range 38–98), 73% female. There were 10 confirmed/suspected cases of COVID-19 on admission and a further seven confirmed as inpatients. The 30-day mortality within our cohort was 11.76% compared to 6% nationally in 2018 (p = 0.045). Orthogeriatric reviews occurred within 72 h in 71% of cases compared to 88% in the equivalent 2018 period. Within the cohort, mean length of stay was 17.13 days (SD 5.6, range 8-27 days) for SARS-CoV-2 positive patients compared to 10 days (SD 8.7, range 1–53 days) for negative patients (p < 0.05). Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation. Conclusions The increase in 30-day mortality for SARS-CoV-2 positive patients presenting with femoral neck fractures is multifactorial, resulting from a combination of the direct effects of COVID-19 pneumonia as well as changes to the delivery of orthopaedic services. The provision of multidisciplinary care was directly affected by staff redeployment, particularly reorganisation of orthogeriatric services and lack of continuity of ward based clinical care. Our experiences have re-directed efforts towards the management of theatre teams, patient services and staffing, should we be faced with either a resurgence of COVID-19 or a future pandemic.

Transplant Professionals' Attitudes toward Facial Transplantation in the United Kingdom

2007 ◽  
Vol 17 (3) ◽  
pp. 228-233 ◽  
Author(s):  
Alex Clarke ◽  
Fidelma Murphy ◽  
Paul White ◽  
Veronica Brough ◽  
Anthony Renshaw ◽  
...  
Keyword(s):  
Attitudes And Beliefs ◽  
Facial Transplantation ◽  
The United Kingdom ◽  
Retrieval Team ◽  
Reconstructive Option ◽  
Areas Of Concern ◽  
High Level ◽  
The Impact ◽  
Reconstructive Techniques ◽  
Relevant Education

Background In November 2005, the world's first partial facial transplantation positioned this treatment at the forefront in the development of facial reconstructive techniques. Objective Because the procedure is dependent on donation of facial tissue, we sought to understand the attitudes and beliefs of the general public and transplant professionals toward this treatment. Methods This research reports the results of a survey of 170 transplant professionals sampled by means of a questionnaire generated by a focus group of transplant coordinators. Results We found a high level of support for facial transplantation, with 76% of respondents in favor and none opposed to the procedure in principle. There was a significant association between knowing someone with a disfiguring condition and being in favor of facial transplantation. Areas of concern to this group can be summarized as factors that affect organ retrieval and the impact on the retrieval team and the donor family. Conclusions Consistency in ranking of item importance provides the basis for development of relevant education materials, team liaison, and care pathways. These findings also validate the use of focus groups in sampling issues of concern to relevant groups as facial transplantation takes its place as a reconstructive option.

scholarly journals The impact of COVID-19 pandemic on IBD endoscopic procedures in a high-volume IBD Center

2020 ◽  
Vol 08 (07) ◽  
pp. E980-E984
Author(s):  
Loris Riccardo Lopetuso ◽  
Franco Scaldaferri ◽  
Gianluca Ianiro ◽  
Stefano Bibbò ◽  
Carlo Romano Settanni ◽  
...  
Keyword(s):  
Health Care Systems ◽  
High Volume ◽  
Healthcare Personnel ◽  
Experimental Therapy ◽  
Endoscopic Management ◽  
Endoscopic Procedures ◽  
National Health Care ◽  
Care Systems ◽  
High Level ◽  
The Impact

Abstract Background and study aims The COVID-19 pandemic is having a major clinical and also organizational impact on national health care systems, particularly in high-volume hospitals that are utilized for several essential clinical needs. We aimed to analyze the short-term impact of the SARS-CoV-2 pandemic on management of endoscopic procedures in patients with inflammatory bowel disease (IBD). Patients and methods This was an observational prospective study exploring major clinical and organizational changes in endoscopic management at the IBD Center – CEMAD of the Fondazione Policlinico Gemelli IRCCS, Rome, Italy since the beginning of SARS-CoV-2 pandemic. Results Our IBD Unit, with up to 1,500 IBD patients receiving biotechnological or experimental therapy, represents a high-volume Italian and European IBD center. Since the beginning of the outbreak, our hospital has been extremely impacted by care related to COVID-19 cases, with a consequent need to dramatically reorganize management of endoscopic procedures for IBD. Conclusions Outbreak restrictions have significantly impacted the volume of endoscopic activities for IBD. Specific strategies have been designed to guarantee a high level of safety for both patients with IBD and healthcare personnel dedicated to their treatment.

Redefining High-Volume Gastric Cancer Centers: The Impact of Operative Volume on Surgical Outcomes

2021 ◽  
Author(s):  
Michelle R. Ju ◽  
James-Michael Blackwell ◽  
Herbert J. Zeh ◽  
Adam C. Yopp ◽  
Sam C. Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Surgical Outcomes ◽  
High Volume ◽  
Cancer Centers ◽  
The Impact

scholarly journals A contingency theory perspective of environmental management: Empirical evidence from entrepreneurial firms

2021 ◽  
Vol 47 (1) ◽  
pp. 3-17
Author(s):  
Muaz Mahmud ◽  
Danny Soetanto ◽  
Sarah Jack
Keyword(s):  
Environmental Management ◽  
Social Relationships ◽  
Contingency Theory ◽  
External Pressure ◽  
Theory And Practice ◽  
Entrepreneurial Firms ◽  
Global Awareness ◽  
The United Kingdom ◽  
High Level ◽  
The Impact

This article examines the roles of organizational structure of decision-making and external pressure in determining the practice of environmental management. Using contingency theory, this study argues that having a decentralized structure, entrepreneurial firms are able to adapt to external pressure while implementing environmental management. The data were drawn from 106 small and medium-sized firms in the United Kingdom. The study found that a decentralized structure is positively associated with the practice of environmental management while external pressure from global awareness and social relationships has less impact on firms’ environmental management. Interestingly, the impact of decentralized structure on environmental management is strengthened in the context of high level of technological dynamic. Overall, the findings of the study have provided some recommendations to theory and practice of environmental management especially in the context of entrepreneurial firms.

scholarly journals The Impact of Nerve Involvement on the Prognosis of Gastric Cancer Patients with Curative Gastrectomy: An International Multicenter Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Kun Yang ◽  
Yu-Qing Dan ◽  
Yoon Young Choi ◽  
Zong-Guang Zhou ◽  
Woo Jin Hyung ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Significance ◽  
High Volume ◽  
Tumor Location ◽  
Lymphatic Invasion ◽  
Stage Iii ◽  
Curative Gastrectomy ◽  
Additional Information ◽  
Gastric Cancer Patients ◽  
The Impact

Background. Several studies have been conducted to investigate the association between the presence of perineural invasion (PNI) and overall survival (OS) of gastric cancer (GC) patients who underwent curative resection, but no consensus has been reached. This study is aimed at determining the prognostic significance of PNI in gastric cancer. Study Design. The data of 2969 patients with gastric cancer and who had undergone curative gastrectomy from 2006 to 2010 in two high-volume hospitals of China and Korea were retrospectively analyzed. PNI positivity was identified when carcinoma cells were found to infiltrate into the perineurium or neural fascicles. The relationships between PNI and other clinicopathological factors were evaluated, and survival analyses were performed. Results. The presence of PNI was detected in 1055 of the 2969 patients (35.5%). Nationality, age, tumor location, size of tumor, differentiation of the tumor, pT stage, pN stage, lymphatic invasion, and vascular invasion had been associated with PNI positivity. The mean survival time of patients with and without PNI was 62.5 months and 87.3 months, respectively ( P < 0.001 ). However, the presence of PNI was not an independent prognostic factor for gastric cancer, except for patients in stage III ( P = 0.037 , hazard ratio: 1.21, 95% confidence interval: 1.01-1.44). Conclusion. PNI occurs frequently in patients with gastric cancer, and the incidence of PNI increases with the staging of the tumor. The presence of PNI can provide additional information in predicting the survival outcome for those with stage III tumors.

Lifecourse determinants and incomes in retirement: Belgium and the United Kingdom compared

2011 ◽  
Vol 32 (4) ◽  
pp. 587-615 ◽  
Author(s):  
CAROLINE DEWILDE
Keyword(s):  
United Kingdom ◽  
Welfare State ◽  
Labour Market ◽  
Old Age ◽  
Panel Study ◽  
The United Kingdom ◽  
New Finding ◽  
The Uk ◽  
High Level ◽  
The Impact

ABSTRACTIn this paper, the impact of lifecourse family and labour market experiences on household incomes of older people in Belgium and the United Kingdom (UK) is analysed. To this end, panel data and life-history information from the Panel Study of Belgian Households and the British Household Panel Survey are combined. The results show that old-age income is indeed influenced by previous lifecourse experiences, and that differences between Belgium and the UK can be explained in terms of (the development over time of) welfare regime arrangements. Family experiences have a larger impact on old-age incomes in ‘male-breadwinner’ Belgium, while in Britain labour market events are more important. As social transfers in Britain are more aimed at poverty prevention and less at income replacement, a ‘scarring effect’ of unemployment persists even into old age. Also, the more of one's career is spent in blue-collar work or self-employment/farming, the lower the income in old age. A new finding is that, notwithstanding the high level of ‘de-commodification’ achieved by the Belgian welfare state, this effect turns out to be significantly stronger in Belgium than in the UK. Compared to the market, the welfare state is hence a more efficient ‘mechanism’ of stratification for incomes in old age.

scholarly journals P-OGC23 Significance of neoadjuvant downstaging in gastric adenocarcinoma

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Pooja Prasad ◽  
Ashwin Sivaharan ◽  
Shajahan Wahed ◽  
Alexander Phillips
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Clinical Outcomes ◽  
Gastric Adenocarcinoma ◽  
Clinical Stage ◽  
Neoadjuvant Treatment ◽  
High Volume ◽  
Recurrence Rates ◽  
The Impact

Abstract Background Neoadjuvant chemotherapy is established in the treatment of gastric adenocarcinoma. Histopathological regression as a result of neoadjuvant treatment can potentially have important prognostic implications in gastric cancer. There is little data comparing the clinical outcomes of patients with gastric adenocarcinoma at the same pathological stage with and without neoadjuvant treatment. The aim of this study is to determine the impact of neoadjuvant chemotherapy upon the prognosis of patients being treated for gastric adenocarcinoma.  Methods Consecutive patients with gastric cancer treated in a single, tertiary high-volume centre between 2007 and 2017 were evaluated. All patients with gastric adenocarcinoma were treated with either a subtotal or total gastrectomy with D2 lymphadenectomy. A stage-by-stage comparison of the extent of pathological downstaging was conducted for patients who received neoadjuvant treatment (ypTNM) and those that did not (pTNM). The pTNM and ypTNM stages were defined as per the TNM 8th Edition.  Results Among 384 patients undergoing gastrectomy for gastric adenocarcinoma, 141 patients received neoadjuvant chemotherapy. Of them, 86 patients (58.1%) benefitted from a downstaging effect. Patients with downstaged disease had improved overall survival compared to patients who did not respond to neoadjuvant chemotherapy (NR vs 66 months, p &lt; 0.001). Downstaging by &gt; 3 stages was the strongest independant predictor of overall survival (hazard ratio: 0.17; 95% Confidence Interval (CI) 0.062-0.44). Overall survival was significantly better when a stage-by-stage comparison was performed between patients in the ypTNM and pTNM groups. Conclusions Pathological staging following neoadjuvant chemotherapy is a more accurate predictor of prognosis compared to pre-neoadjuvant chemotherapy clinical stage with downstaged patients benefitting from lower recurrence rates and improved overall survival. Patients downstaged due to neoadjuvant chemotherapy receipt can potentially have more favourable clinical outcomes compared to stage-matched patients who did not receive this.

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