Impact of neoadjuvant therapy on post-operative pancreatic fistula: a systematic review and meta-analysis.

INTRODUCTION: The use of neoadjuvant therapy (NAT) for pancreatic cancer is increasing, although its impact on post-operative pancreatic fistula (POPF) is variably reported. This systematic review and meta-analysis aimed to assess the impact of NAT on POPF. METHODS: A systematic literature search until October 2019 identified studies reporting POPF following NAT (radiotherapy, chemotherapy or chemoradiotherapy) versus upfront resection. The primary outcome was overall POPF. Secondary outcomes included grade B/C POPF, delayed gastric emptying (DGE), post-operative pancreatic haemorrhage (PPH) and overall and major complications. RESULTS: The search identified 24 studies: pancreatoduodenectomy (PD), 19 studies (n = 19 416) and distal pancreatectomy (DP), five studies (n = 477). Local staging was reported in 17 studies, with borderline resectable and locally advanced disease comprising 6% (0-100%) and 1% (0-33%) of the population, respectively. For PD, any NAT was significantly associated with lower rates of overall POPF (OR: 0.57, P < 0.001) and grade B/C POPF (OR: 0.55, P < 0.001). In DP, NAT was not associated with significantly lower rates of overall or grade B/C POPF. CONCLUSION: NAT is associated with significantly lower rates of POPF after PD but not after DP. Further studies are required to determine whether NAT should be added to POPF risk calculators.

Implementing the illness management and recovery program for consumers with severe mental illness.

OBJECTIVE: The primary purpose of this study was to evaluate the statewide implementation of the illness management and recovery program, a curriculum-based intervention for adults with severe mental illnesses. METHODS: Using knowledge gained from the National Evidence-Based Practices Project, the ACT Center of Indiana assisted seven community mental health centers with implementation of the illness management and recovery program. Implementation was conducted by trainers, who provided in-depth skills training, ongoing monitoring and supervision, and consultation as needed. At six and 12 months, the fidelity of implementation was assessed by use of the Illness Management and Recovery Fidelity Scale, and changes in illness self-management, hope, and satisfaction with services were assessed for 324 consumers with severe mental illness by use of the Illness Management and Recovery Scale, the Adult State Hope Scale, and the Satisfaction With Services Scale, respectively. RESULTS: The illness management and recovery program was successfully implemented at six of seven sites; five sites achieved high fidelity by 12 months and the sixth by 24 months. Self-reports of consumers and clinicians indicated significant changes in illness self-management. Consumers reported increased hope but no changes in satisfaction with services. CONCLUSIONS: The illness management and recovery program can be implemented with a high degree of fidelity and may be a meaningful way for mental health providers to promote recovery and provide an evidence-based intervention.