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Background Oesophageal adenocarcinoma (OAC) is a lethal condition. The management is typically multifaceted with oesophagectomy being the cornerstone of treatment. Quality performance indicators (QPIs) are objective measurements of aspects of patient's care that affect clinical outcomes. We look to measure a set of clinically relevant QPIs that can be used to capture key aspects of patient management at our institution. Methods all patients with OAC treated from 2010 to 2015, and 2020 to 2021 at Te Whatu Ora Waitemata were included. Patients with secondary metastases to the oesophagus or gastric cancer with extension to the oesophagus were excluded. Electronic data in the form of clinic letters, operation notes, histology and radiology reports were reviewed. QPI adherence was collected in binary form. Results QPIs with consistently high compliance rates include radiological staging and histological diagnosis, perioperative dietitian involvement, explanations of disease and treatment intent, and pathology report documentation. QPIs demonstrating significant change and improvement across the two groups include endoscopic resection (60.0% of patients with T1 disease in 2010 to 88.9% in 2020 group), multimodality treatment (majority ECF and ECX perioperative chemotherapy in 2010 to majority FLOT chemotherapy in 2020 group) and minimally invasive approach (30.4% hybrid in 2010 compared to 72.4% hybrid in 2020). Conclusions QPIs from the systematic review were readily measurable and were variably implemented in clinical practice. Areas requiring improvement were identified however relevance to real-world clinical outcomes require further focus of investigation. [ABSTRACT FROM AUTHOR]

Objective To explore whether the non-invasive method of ultrasound elastography can diagnose and grade hepatic steatosis by using a rat model system. Methods Fifty healthy male Wistar rats were divided into a model group (n =40 ) and a control group (n = 10) . The model was induced by high-fat diet (20% lard), alcohol intake (10% in drinking water), and CCl4 subcutaneous injections (40% in olive oil ; 0.2 ml/kg two times a week) . The control rats received normal diet, no alcohol, and olive oil injections. After weeks 6, 8, 10, 12, and 14 of the regimen, rats from each group were randomly selected and subjected to liver ultrasound elastography analysis ( Hitachi HV900 Color Doppler instrument; 6-13 MHz linear probe frequency), first as transabdominal imaging then by fully exposed rat liver imaging, followed by pathological examination with hematoxylin-eosin staining. The imaging techniques were performed in triplicate for each rat and averaged. The imaging findings of controls (B) were compared to those of models (A) and used to calculate the strain ratio (B/A). Hepatic steatosis detected by pathology was graded as percent of fatty degeneration: normal, <5%; mild, 5%-33%; moderate, 34% -66%; severe, >66%. The correlations between B/A and pathology grades were assessed by Kruskal-Wallis and Spearman's coefficient tests. Results Ten rats died during the establishment of the hepatic steatosis model system. Of the 30 surviving model rats assessed by ultrasound and pathology, the hepatic steatosis grade was mild in 10, moderate in 12, and severe in 8; all control rats showed normal liver. The transabdominal imaging results (B/A) were significantly different between control rats (0.25±0.04) and rats with all three grades of hepatic steatosis ( vs. mild: 0.43 ± 0.05, moderate: 0.59 ± 0.17, and severe : 0.89 ± 0.21; P<0.05). The B/A was positively correlated with the pathology grade (r=0.88, P<0.001) . Conclusion Ultrasonic elastography effectively diagnosed hepatic steatosis and was able to quantitate various pathologic grades in a non-invasive manner, suggesting its potential utility for clinical application. [ABSTRACT FROM AUTHOR]