ABSTRACT
OBJECTIVE: In this study we analyzed the impact of centralization on key metrics, outcomes and patterns of care at the Irish National Center. SUMMARY BACKGROUND DATA: Overall survival rates in esophageal cancer in the West have doubled in the last 25 years. An international trend towards centralization may be relevant, however this model remains controversial with Ireland, centralizing esophageal cancer surgery in 2011. STUDY DESIGN: All patients (n=1245) with adenocarcinoma of the esophagus or junction treated with curative intent involving surgery, including endoscopic surgery, were included (n= 461 from 2000-2011, and 784 from 2012-2022). All data entry was prospectively recorded. Overall survival was measured (i) for the entire cohort; (ii) patients with locally advanced disease (cT2-3N0-3); and (iii) patients undergoing neoadjuvant therapy. All complications were recorded as per Esophageal Complication Consensus Group (ECCG) definitions, and the Clavien Dindo (CD) severity classification. STATISTICAL ANALYSIS: Data were analyzed using GraphPad Prism (v.6.0) for Windows and SPSS (v.23.0) software (SPSS,Chicago,IL) RStudio (Rversion4.2.2). Survival times were calculated using log-rank test and a Cox-regression analysis, and Kaplan-Meier curves generated. RESULTS: Endotherapy for cT1a/IMC adenocarcinoma increased from 40 (9% total) to 245 (31% total) procedures between the pre-centralization (pre-C) and post-centralization (post-C) periods. A significantly (P<0.001) higher proportion of patients with cT2-3N0-3 disease in the post-C period underwent neoadjuvant therapy (66% vs 53%). Operative mortality was lower (P=0.02) post-C, at 2% vs 4.5%, and>IIIa CD major complications decreased from 33% to 25% (P<0.01). Recurrence rates were lower post-C (38% vs 53%, P<0.01). Median overall survival was 73.83 versus 47.23 months in the 2012-22 and 2000-11 cohorts respectively (P<0.001). For those who received neoadjuvant therapy, the median survival was 28.5 months pre-C and 42.5 months post-C (P<0.001). CONCLUSION: These data highlight improvements in both operative outcomes and survival from the time of centralization, and a major expansion of endoscopic surgery. Although not providing proof, the study suggests a positive impact of formal centralization with governance on key quality metrics, and an evolution in patterns of care.
ABSTRACT
The classical androgens, testosterone and dihydrotestosterone, together with dehydroepiandrosterone, the precusrsor to all androgens, are generally included in diagnostic steroid evaluations of androgen excess and deficiency disorders and monitored in androgen replacement and androgen suppressive therapies. The C11-oxy androgens also contribute to androgen excess disorders and are still often excluded from clinical and research-based steroids analysis. The contribution of the C11-oxy androgens to the androgen pool has not been considered in androgen deficiency. An exploratory investigation into circulating adrenal and gonadal steroid hormones in men was undertaken as neither the classical androgens nor the C11-oxy androgens have been evaluated in the context of concurrent measurement of all adrenal steroid hormones. Serum androgens, mineralocorticoids, glucocorticoids, progesterones and androgens were assessed in 70 healthy young men using ultra high performance supercritical fluid chromatography and tandem mass spectrometry. Testosterone, 24.5 nmol/L was the most prominent androgen detected in all participants while dihydrotestosterone, 1.23 nmol/L, was only detected in 25% of the participants. The 11-oxy androgens were present in most of the participants with 11-hydroxyandrostenedione, 3.37 nmol, in 98.5%, 11-ketoandrostenedione 0.764 in 77%, 11-hydroxytestosterone, 0.567 in 96% and 11-ketotestosterone: 0.440 in 63%. A third of the participants with normal testosterone and comparable 11-ketotestosterone, had significantly lower dehydroepiandrosterone (p < 0.001). In these males 11-hydroxyandrostenedione (p < 0.001), 11-ketoandrostenedione (p < 0.01) and 11-hydroxytestosterone (p < 0.006) were decreased. Glucocorticoids were also lower: cortisol (p < 0.001), corticosterone (p < 0.001), cortisone (p < 0.006) 11-dehydrocorticosterone (p < 0.001) as well as cortisol:cortisone (p < 0.001). The presence of dehydroepiandrosterone was associated with 16-hydroxyprogesterone (p < 0.001), which was also significantly lower. Adrenal and gonadal steroid analysis showed unexpected steroid heterogeneity in normal young men. Testosterone constitutes 78% of the circulating free androgens with the 11-oxy androgens abundantly present in all participants significantly contributing 22%. In addition, a subset of men were identified with low circulating dehydroepiandrosterone who showed altered adrenal steroids with decreased glucocorticoids and decreased C11-oxy androgens. Analysis of the classical and 11-oxy androgens with the additional measurement of dehydroepiandrosterone and 16-hydroxyprogesterone may allow better diagnostic accuracy in androgen excess or deficiency.
Subject(s)
Androgens , Testosterone , Humans , Male , Adult , Androgens/blood , Young Adult , Testosterone/blood , Testosterone/analogs & derivatives , Gonadal Steroid Hormones/blood , Dehydroepiandrosterone/blood , Dehydroepiandrosterone/analogs & derivatives , Androstenedione/blood , Androstenedione/analogs & derivatives , Tandem Mass Spectrometry , Dihydrotestosterone/blood , AdolescentABSTRACT
BACKGROUND: Sport-related concussion (SRC) management may be poor in community sports such as Ladies Gaelic Football (LGF). This study examined factors associated with SRC management behavior in adult LGF players. METHODS: Participants (n = 657) answered an online survey on demographic factors, concussion knowledge, attitudes, and education, and SRC management behavior. Data from participants who reported sustaining an LGF-related SRC during the previous year (n = 115) were further analyzed. RESULTS: Being diagnosed with SRC was the main factor influencing subacute management behavior. Players with diagnosed SRCs had increased odds of following a graded return-to-play (RTP) programme (OR = 4.89), following a medically supervised graded RTP programme (OR = 10.16), and being medically cleared before full RTP (OR = 13.45) compared with those with suspected SRCs. Concussion history was associated with increased odds of informing a coach of a possible SRC (OR = 2.86). Demographic factors, previous use of Ladies Gaelic Football Association concussion education resources, and concussion knowledge and attitudes had minimal or no influence on management behaviors. CONCLUSION: Greater access to medical personnel at LGF training and matches is recommended. Due to limited medical resources in community sport, a clear referral pathway for players with SRC and comprehensive SRC education should be introduced to ensure players receive adequate medical care.
Subject(s)
Athletic Injuries , Brain Concussion , Adult , Humans , Brain Concussion/epidemiology , Brain Concussion/therapy , Brain Concussion/diagnosis , Surveys and Questionnaires , Educational Status , Athletic Injuries/therapy , Athletic Injuries/diagnosis , Team SportsABSTRACT
OBJECTIVE: To describe the prevalence, characteristics, and management behavior of self-reported sport-related concussion (SRC) in Ladies Gaelic Football (LGF) players. DESIGN: Cross-sectional study. SETTING: Online survey distributed to LGF clubs throughout Ireland. PARTICIPANTS: Elite and nonelite adult LGF players (n = 657). INTERVENTIONS: Participants were recruited by convenience sampling and answered an online survey. Questions on demographic characteristics, SRC history, symptoms, injury characteristics, and management behavior after SRCs that occurred while playing LGF during the previous season were included. MAIN OUTCOME MEASURES: Overall concussion history, occurrence of an SRC during the previous LGF season, clinical profile scores, characteristics (eg mechanism and setting), and management behavior (eg following a graded RTP program) after SRCs that occurred during the previous season. RESULTS: Approximately one-fifth (17.5%) of participants sustained a suspected or diagnosed SRC during the previous season, which was higher among elite (26.1%) than nonelite (15.3%) players ( P < 0.01). The highest scoring clinical profiles were the ocular and migraine profiles. Only 3.5% of respondents adhered to all SRC management recommendations. Although players who reported a medically diagnosed versus a suspected SRC more often followed these guidelines, SRC management beyond the initial phase of injury remained inadequate. CONCLUSION: SRC is common in LGF; however, adherence to recommended management guidelines is poor, even among players who receive medical assistance. In particular, few LGF athletes receive clinical concussion care beyond the initial diagnosis and acute management phase. Further research is needed to examine the underlying reasons for poor SRC management in LGF, which will guide the development of future sport-specific interventions.
Subject(s)
Athletic Injuries , Brain Concussion , Team Sports , Adult , Humans , Athletic Injuries/epidemiology , Athletic Injuries/therapy , Brain Concussion/diagnosis , Brain Concussion/epidemiology , Brain Concussion/therapy , Cross-Sectional Studies , Self Report , FemaleABSTRACT
OBJECTIVES: Concern regarding identification and management of sports-related concussion (SRC) in the community sports of Gaelic games exists. This study aimed to examine Gaelic games coaches' and referees' previous SRC experiences, knowledge of and attitudes on SRC and views on SRC education. DESIGN: Cross-sectional study; SETTING: Online survey instrument. PARTICIPANTS: Irish male and female Gaelic games coaches (n = 144) and referees (n = 110). MAIN OUTCOME MEASURES: Demographics, SRC previous experience, SRC knowledge, attitudes towards SRC reporting and previous and future interest in SRC education. RESULTS: Most coaches (70.1%) and referees (74.5%) previously dealt with a suspected SRC event. In the most recent SRC event, coaches predominantly removed the player from play (97.0%) and referees frequently informed medical staff (97.1%) or coaches present (96.3%). Coaches and referees were predominantly (>90%) able to identify common SRC signs and symptoms such as dizziness, nausea, confusion, poor balance and headache. Coaches and referees displayed positive attitudes towards removing players from play regardless of game importance. CONCLUSIONS: Good knowledge of common SRC symptoms were displayed, however their ability to recognise false signs and symptoms was limited. Widespread promotion of Gaelic games SRC education across all stakeholders is warranted and should target the misconceptions highlighted in this study.
Subject(s)
Athletic Injuries/diagnosis , Brain Concussion/diagnosis , Health Knowledge, Attitudes, Practice , Mentoring , Adolescent , Adult , Cross-Sectional Studies , Female , Health Education , Humans , Ireland , Male , Middle Aged , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVES: To examine self-reported concussion history, knowledge and attitudes towards concussion reporting and education in Irish adult Gaelic games players. DESIGN: Cross-sectional survey. SETTING: Data were collected using an online survey instrument. PARTICIPANTS: Two hundred and sixteen adult Gaelic games athletes (106 male, 110 female). MAIN OUTCOME MEASURES: Self-reported concussion history for the previous season, reporting history for participants' most recent concussion, concussion knowledge, willingness to report future concussions in a variety of situations and desire for further concussion education. RESULTS: Seventy-three percent of participants suspected they had sustained a concussion in the past. Most (72.2%) informed someone of their most recent concussion, although two-thirds continued to play during their most recent concussion. Participants had a good overall understanding of concussion, although concussion knowledge score was not associated with safer behaviour following participants' most recent concussion. While most agreed that concussion is a serious injury (95.8%), 46.8% would not report a concussion during important games. CONCLUSIONS: The high proportion of participants playing following concussion and their reluctance to report concussions during important games is concerning. Interventions aimed at improving attitudes towards concussion reporting among athletes and other stakeholders are required to improve concussion management in amateur Gaelic games athletes.