Consensus on Upper Gastrointestinal Endoscopy Key Performance Indicators to Reduce Post Endoscopy Upper Gastrointestinal Cancer

\ua9 2025 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.Background: Upper gastrointestinal (UGI) endoscopy lacks established key performance indicators. Up to three-fold variation in post endoscopy upper gastrointestinal cancer rates has been observed among endoscopy providers in England, highlighting the need for standardisation of UGI endoscopy practices. Objective: We aimed to achieve consensus on evidence-based key performance indicators to reduce post endoscopy upper gastrointestinal cancer. Methods: Modified nominal group technique was employed in two consensus workshops, with representation from clinicians, patients and relatives, moderated by James Lind Alliance facilitators. Potential indicators were identified from the umbrella systematic review, English provider post endoscopy upper gastrointestinal cancer rates, and differences in endoscopy practices from the National Endoscopy Database between providers with the highest (worst) and lowest (best) post endoscopy upper gastrointestinal cancer rates. KPIs were categorised as provider or endoscopist/procedure related and ranked as of major or minor importance. Minimum standards were proposed where possible. Results: Participants included 14 clinicians (gastroenterologists and UGI surgeons), 3 nurse endoscopists, 2 UGI cancer nurse specialists, 14 patients, their relatives and representatives from patient support groups and four observers. Endoscopy provider related major key performance indicators and proposed standards included monitoring post endoscopy upper gastrointestinal cancer rates (minimum standard ≤ 7%); less intense endoscopy lists (maximum 10 ‘points’ per list [one point is equivalent to 15 min]); endoscopy provider accreditation (all providers); and premalignant condition surveillance on dedicated lists by endoscopists with adequate training (> 90% surveillance endoscopies). Endoscopist/procedure related major key performance indicators included: examination time ≥ 7 min; training in early UGI neoplasia recognition (all endoscopists); mucosal view quality recorded and cleansing agents used if not excellent (> 90% endoscopies); intravenous sedation offered to all appropriate patients; recommended number of biopsies from cancer associated or premalignant lesions (> 90% endoscopy where such lesions identified); and endoscopists\u27 annual UGI endoscopy volume > 100 (all endoscopists). Conclusion: This study offers a consensus on the key performance indicators and minimum standards that should be used to improve UGI endoscopy quality and reduce post endoscopy upper gastrointestinal cancer

Highly diastereoselective oxy-Michael additions of enantiopure delta-lactol anions to nitroalkenes: asymmetric synthesis of 1,2-amino alcohols.

The "naked" alkoxide 1 of (S)-6-methyl-δ-lactol acts as an excellent chiral hydroxide equivalent in highly diastereoselective oxy-Michael additions to nitroalkenes (see scheme). The excellent stereoinduction arises from what becomes a superb protecting group in the resulting 1,2-amino alcohol products. R1 = alkyl, aryl, furanyl, thiophenyl; R2,R 3 = -(CH2)3CHCH3O-

Hypoglycaemia is associated with increased risk of fractures in patients with type 2 diabetes mellitus: a cohort study

Objective Type 2 diabetes is associated with an increased risk of fracture. Any factor that incrementally increases this risk should be taken into account when individualizing treatment. Hypoglycemia is a common complication of antidiabetes medications and suggested as a risk factor for fractures, yet its real-life clinical impact is unclear. Design A population-based, retrospective open cohort study using routinely collected data between 1st of January 1995 and 1st of May 2016 in The Health Improvement Network. Methods Patients with type 2 diabetes mellitus with documented hypoglycaemic events were compared to randomly matched patients with type 2 diabetes mellitus without documented hypoglycaemic events matched to exposed patients on age, sex, duration of diabetes and BMI. The primary outcome was any incident fracture. Secondary outcome was incident fragility (osteoporotic) fracture. Results A total of 41,163 patients with type 2 diabetes were included: 14,147 patients in the exposed cohort and 27,016 patients in the unexposed cohort. Patients with a documented hypoglycaemic event were significantly more likely to sustain any fracture compared to patients with no record of hypoglycemic events: adjusted IRR 1.20 (95% CI 1.12-1.30; p < 0.0001). Patients who had a documented hypoglycaemic event were significantly more likely to suffer a fragility fracture compared to controls: adjusted IRR 1.24 (95% CI 1.13-1.37; p < 0.0001). Conclusions Hypoglycaemic events are a significant risk factor for fractures in patients with diabetes mellitus. This observation is clinically relevant when individualizing targets for glycaemic control and selecting antidiabetic agents

Hypoglycaemia is associated with increased risk of fractures in patients with type 2 diabetes mellitus: a cohort study

Objective Type 2 diabetes is associated with an increased risk of fracture. Any factor that incrementally increases this risk should be taken into account when individualizing treatment. Hypoglycemia is a common complication of antidiabetes medications and suggested as a risk factor for fractures, yet its real-life clinical impact is unclear. Design A population-based, retrospective open cohort study using routinely collected data between 1st of January 1995 and 1st of May 2016 in The Health Improvement Network. Methods Patients with type 2 diabetes mellitus with documented hypoglycaemic events were compared to randomly matched patients with type 2 diabetes mellitus without documented hypoglycaemic events matched to exposed patients on age, sex, duration of diabetes and BMI. The primary outcome was any incident fracture. Secondary outcome was incident fragility (osteoporotic) fracture. Results A total of 41,163 patients with type 2 diabetes were included: 14,147 patients in the exposed cohort and 27,016 patients in the unexposed cohort. Patients with a documented hypoglycaemic event were significantly more likely to sustain any fracture compared to patients with no record of hypoglycemic events: adjusted IRR 1.20 (95% CI 1.12-1.30; p < 0.0001). Patients who had a documented hypoglycaemic event were significantly more likely to suffer a fragility fracture compared to controls: adjusted IRR 1.24 (95% CI 1.13-1.37; p < 0.0001). Conclusions Hypoglycaemic events are a significant risk factor for fractures in patients with diabetes mellitus. This observation is clinically relevant when individualizing targets for glycaemic control and selecting antidiabetic agents

Postnatal care and pathways for childbirth-related perineal trauma in England: A qualitative study of healthcare professionals' experiences and perspectives on future development

Background: Perineal trauma is a common outcome of vaginal birth, affecting 8/10 women in the UK. While many injuries heal without issue, complications such as infection, wound breakdown, and pain can impact maternal recovery, daily functioning, and wellbeing. Despite the burden of complications, postnatal wound management remain inconsistent, with limited evidence to guide optimal care. Purpose: To examine the current postnatal care provision and care pathways used by healthcare professionals to address childbirth-related perineal trauma in England and explore their views on enhancing care. Methods: The study was guided by an interpretive descriptive approach. Data was collected using semi-structured interviews with national health service healthcare professionals providing care to women following childbirth-related perineal trauma. Demographic data were analysed using descriptive statistics. Interview data were analysed by hybrid codebook thematic analysis. Results: Healthcare professionals were interviewed in 2024 (N = 36). The current care provided for childbirth-related perineal trauma is described and represented visually, indicating that multiple care pathways and healthcare services are used. Healthcare professionals reported that improvements to childbirth-related perineal trauma care could come from enhancements to maternal awareness and information; healthcare professional education and training; and standardised evidence-based care pathways both for universal postnatal care and specialist childbirth-related perineal trauma care. Conclusions: This study offers a unique insight postnatal care for women following childbirth-related perineal trauma in England, revealing a complex and regionally variable landscape. Healthcare professionals highlighted the need for greater standardisation and targeted improvements in care pathways to enhance outcomes for women.</p

Association of Metformin with Susceptibility to COVID-19 in People with Type 2 Diabetes

OBJECTIVE: Diabetes has emerged as an important risk factor for mortality from COVID-19. Metformin, the most commonly prescribed glucose-lowering agent, has been proposed to influence susceptibility to and outcomes of COVID-19 via multiple mechanisms. We investigated whether, in patients with diabetes, metformin is associated with susceptibility to COVID-19 and its outcomes. RESEARCH DESIGN AND METHODS: We performed a propensity score-matched cohort study with active comparators using a large UK primary care dataset. Adults with type 2 diabetes patients and a current prescription for metformin and other glucose-lowering agents (MF+) were compared to those with a current prescription for glucose-lowering agents that did not include metformin (MF-). Outcomes were confirmed COVID-19, suspected/confirmed COVID-19, and associated mortality. A negative control outcome analysis (back pain) was also performed. RESULTS: There were 29 558 and 10 271 patients in the MF+ and MF- groups, respectively, who met the inclusion criteria. In the propensity score-matched analysis, the adjusted hazard ratios for suspected/confirmed COVID-19, confirmed COVID-19, and COVID-19-related mortality were 0.85 (95% CI 0.67, 1.08), 0.80 (95% CI 0.49, 1.30), and 0.87 (95% CI 0.34, 2.20) respectively. The negative outcome control analysis did not suggest unobserved confounding. CONCLUSION: Current prescription of metformin was not associated with the risk of COVID-19 or COVID-19-related mortality. It is safe to continue prescribing metformin to improve glycemic control in patients with