Patients' views on their experience of the delivery of single-sex accommodation within the endoscopy department: is it worth it?

INTRODUCTION: Provision of single-sex accommodation (SSA) in hospitals is a key National Health Service objective. Department of Health policy to eliminate mixed-sex accommodation (MSA) was implemented in our endoscopy department in 2011. We found no published studies of patients' views on MSA in endoscopy units. AIM: We explored patients' views on MSA and their experience of attending our unit at Royal Albert Edward Infirmary (Wigan, UK) since implementation of the SSA policy. METHODS: Patients attending the endoscopy unit August-October 2012 and February-April 2015 were invited to participate. Views were surveyed using a 10-point questionnaire. RESULTS: 155 patients were included. A minority were aware of national (36%) or local (39%) policies regarding MSA provision. Only 20.0% and 22.9% reported that they would feel uncomfortable changing behind a curtain or waiting in a gown in a mixed-sex area, respectively. Most of those that felt uncomfortable (81% and 71%) were female, and women ranked importance of SSA significantly higher than men. However, both sexes ranked importance of SSA significantly lower than that of prompt investigation/treatment. Admissions to an alternative recovery area specifically to maintain SSA compliance reduced from 25% (2012) to 8% (2015), following simple measures to improve list efficiency, with corollary reduction in reports of compromised patient experience. CONCLUSIONS: SSA is an important healthcare priority for some patients, especially women. However, most consider prompt investigation/treatment a much higher priority. Measures to comply with SSA can negatively affect patient experience. However, we demonstrate that simple measures can result in significant improvements in service delivery and patient experience while remaining compliant with SSA guidance.

Deregulation of the FOXM1 target gene network and its coregulatory partners in oesophageal adenocarcinoma.

BACKGROUND: Survival rates for oesophageal adenocarcinoma (OAC) remain disappointingly poor and current conventional treatment modalities have minimal impact on long-term survival. This is partly due to a lack of understanding of the molecular changes that occur in this disease. Previous studies have indicated that the transcription factor FOXM1 is commonly upregulated in this cancer type but the impact of this overexpression on gene expression in the context of OAC is largely unknown. FOXM1 does not function alone but works alongside the antagonistically-functioning co-regulatory MMB and DREAM complexes. METHODS: To establish how FOXM1 affects gene expression in OAC we have identified the FOXM1 target gene network in OAC-derived cells using ChIP-seq and determined the expression of both its coregulatory partners and members of this target gene network in OAC by digital transcript counting using the Nanostring gene expression assay. RESULTS: We find co-upregulation of FOXM1 with its target gene network in OAC. Furthermore, we find changes in the expression of its coregulatory partners, including co-upregulation of LIN9 and, surprisingly, reduced expression of LIN54. Mechanistically, we identify LIN9 as the direct binding partner for FOXM1 in the MMB complex. In the context of OAC, both coregulator (eg LIN54) and target gene (eg UHRF1) expression levels are predictive of disease stage. CONCLUSIONS: Together our data demonstrate that there are global changes to the FOXM1 regulatory network in OAC and the expression of components of this network help predict cancer prognosis.

Risk factors for neoplastic progression in Barrett's esophagus.

Barrett's esophagus (BE) confers a significant increased risk for development of esophageal adenocarcinoma (EAC), with the pathogenesis appearing to progress through a "metaplasia-dysplasia-carcinoma" (MDC) sequence. Many of the genetic insults driving this MDC sequence have recently been characterized, providing targets for candidate biomarkers with potential clinical utility to stratify risk in individual patients. Many clinical risk factors have been investigated, and associations with a variety of genetic, specific gastrointestinal and other modifiable factors have been proposed in the literature. This review summarizes the current understanding of the mechanisms involved in neoplastic progression of BE to EAC and critically appraises the relative roles and contributions of these putative risk factors from the published evidence currently available.