Improving Barrett's Diagnosis and Surveillance Service at a District General Hospital in the United Kingdom

Introduction: Barrett's oesophagus is a well identified precursor for oesophageal adenocarcinoma, with the risk of malignant transformation being 0.5% annually. It is therefore crucial that diagnosis and surveillance standards meet national guidelines. This audit was carried out to assess if our District General Hospital was meeting the standards set by the British Society of Gastroenterology with regards to Barrett's diagnosis and surveillance. Method(s): Data was collected looking at 143 OGDs carried out for Barrett's diagnosis and surveillance at a District General Hospital in the United Kingdom from 01/01/2018 to 30/06/2018. The OGD reports were compared against recommended national standards set by the British Society of Gastroenterology. A proforma was created and was put into use from August 2020. It was utilized by all endoscopists when carrying out OGDs for Barrett's diagnosis and surveillance. The proforma was added to the end of the hospital's standard endoscopy report. Following the intervention and use of the proforma, the second cycle of the audit was carried out looking at 58 OGDs completed between 05/08/2020-27/02/2021 to see if they met the standards set out by the British Society of Gastroenterology. The Barrett's surveillance service and the volume of OGDs carried out following the introduction of the proforma was affected by the Covid-19 pandemic. Result(s): The first cycle of the audit found that only 34% of OGDs had a Prague classification documented correctly. 0% of OGDs had the correct biopsy protocol followed and 12.6% of endoscopies did not have any biopsies taken. 26% of patients had no follow up or surveillance endoscopy interval documented or organised. Following the intervention, it was found that 96% of endoscopies now had a Prague classification documented, an increase of 62%. There was a 65% increase in correct biopsy technique being followed and 100% of OGD reports now had surveillance interval documented if deemed appropriate. Conclusion(s): The audit clearly displays that following our intervention there was a significant improvement in the quality of Barrett's diagnostic and surveillance endoscopies, when compared to national guidelines. Given its potential for malignant transformation, correct surveillance is exceptionally important to improve patient care and reduce mortality. The introduction of a proforma drastically improved the standard of the service provided at our District General Hospital and is one that can be transferable to other hospitals.

Indonesian female academics and the pandemic: the challenges of COVID-19 and academic work

The COVID-19 pandemic brought unprecedented challenges to higher education. This paper explores the challenges Indonesian female academics encountered during the pandemic in which the boundaries between home and work were further blurred. Accordingly, the gender gap was further widened as unpaid and unacknowledged academic and domestic work disproportionately affected women. This paper draws on data gathered from survey, diary studies and in-depth interviews with female academics in the social sciences and humanities. It examines how Indonesian female academics juggled domestic and professional work at home, caring duties both at home and work, and shouldering administrative workloads. In addition, findings reveal that female academics found new meanings in their academic work and the importance of caring and collective solidarity, especially in a crisis such as the pandemic. © 2023 Association for Tertiary Education Management and the Melbourne Centre for the Study of Higher Education.

Preface

The introduction of this book comes at a time when three co-occurring crises are challenging the United States: The COVID-19 pandemic, economic recession, and the heightened struggle for racial justice. School social workers (SSWs) who faithfully serve schools, students, and families are bearing witness to the drastic economic, academic, social, emotional, and physical effects said crises are having. And the most vulnerable of these populations, the economically challenged and/or marginalized racial groups served by SSWs, are experiencing devastatingly negative effects that will cause issues for decades. SSWs are finding their way through these crises;engaging in telehealth technology to service children, youth, and families;continuing to provide services to students most in need;and joining forces with others to stand as allies and colleagues in the fight for social justice. This book, then, is emerging out of the difficulties our society is experiencing: All of the activities that go into preparing a book-communication, recruitment of authors, creation of chapters, editing, and submission-are being done virtually. This book is a product of our environment, an effort to help new SSWs find their way in a confusing and disempowering world. © Oxford University Press 2022. All rights reserved.

CRC-PREVENT: Clinical validation trial to show expedited and diverse recruitment for the non-invasive RNA-FIT test that can detect advanced colorectal neoplasia with high sensitivity

Background: Prevailing methods for patient recruitment in large prospective studies can be time consuming, expensive, and introduce selection bias against patients with low health literacy or reduced access to healthcare. Previous clinical trials have reported low recruitment of women, minorities, and individuals who face socioeconomic barriers;a concern which has been exacerbated by the COVID-19 pandemic. Here we describe a novel recruitment strategy that helps to address healthcare disparities. This study will support a pre-market approval application to the FDA for a multi-factor RNA-FIT assay for detection of colorectal neoplasia in average-risk individuals between the ages of 45-75. Methods: A decentralized clinical trial (CRC-PREVENT) was launched through a digital campaign (https://www.colonscreeningstudy.com/;NCT04739722) after the RNA-FIT test system entered design-lock. Online advertisements were published on multiple social media sites and engagement with materials directed patients to an online screener. Participants who completed the screener were considered eligible for enrollment if they met CRC-PREVENT inclusion/ exclusion criteria and were willing to complete all components of the clinical trial, including providing a stool sample prior to an optical colonoscopy. Results: After 3 months of active enrollment, 51,588 individuals have engaged with digital advertisements and completed pre-screener surveys to determine eligibility. In total, 35,280 individuals were deemed eligible based on survey response, and 13,294 eligible individuals also expressed interest in the CRC-PREVENT clinical trial. Of these individuals, 48% were female and 34% were over the age of 60 years old. Regarding race, interested individuals directly represented the intended use population: 17% were Black or African American, 2.7% were Asian, and 1.3% were Native Hawaiian, Pacific Islander, American Indian, or Alaskan Native. With respect to ethnicity, 8.4% identified as Hispanic or Latinx. The decentralized approach also permitted access to individuals with socioeconomic healthcare inequities: 27% had income under $29,999 and 14% were on Medicaid. Individuals were derived from all 48 continental United States, and of those who reported their residential location, approximately 3% were from rural areas. Conclusions: Use of a decentralized recruitment strategy permitted highly successful enrollment in the face of challenges associated with COVID-19. With respect to race, ethnicity, socioeconomic status, and geography, all metrics represented significantly more diverse populations than observed in traditional clinical studies. Decentralized enrollment mitigated selection bias, and will result in data more reflective of the intended use population.