To compare perioperative and oncological outcomes between stapler and manual closure in patients undergoing total laryngectomy for advanced endolaryngeal squamous cell carcinoma.

Patients with advanced endolaryngeal tumours operated between July 2017 and July 2023 were retrospectively dichotomised into stapler closure and manual closure cohorts and compared.

Seventy-one patients with a median age of 57 years were included in our study. The median surgical duration was 270 minutes for the manual closure cohort and 245 minutes for the stapler closure cohort. The pharyngo-cutaneous salivary fistula rate was 6 per cent less in the stapler closure cohort. The estimated mean survival was not significantly different 54.5 months (95 per cent, confidence interval 46.3–62.71) in the manual closure cohort versus 28.12 months (95 per cent, confidence interval 23.6–32.63) in the stapler closure cohort (p = 0.79).

Stapler closure can be used in endolaryngeal tumours, and it reduces operating time, thus facilitating efficient utilisation of operation time with non-inferior oncological outcomes as compared to traditional manual closure.

This article takes stock of the 2030 Agenda and focuses on five governance areas. In a nutshell, we see a quite patchy and often primarily symbolic uptake of the global goals. Although some studies highlight individual success stories of actors and institutions to implement the goals, it remains unclear how such cases can be upscaled and develop a broader political impact to accelerate the global endeavor to achieve sustainable development. We hence raise concerns about the overall effectiveness of governance by goal-setting and raise the question of how we can make this mode of governance more effective.

A recent meta-analysis on the political impact of the Sustainable Development Goals (SDGs) has shown that these global goals are moving political processes forward only incrementally, with much variation across countries, sectors, and governance levels. Consequently, the realization of the 2030 Agenda for Sustainable Development remains uncertain. Against this backdrop, this article explores where and how incremental political changes are taking place due to the SDGs, and under what conditions these developments can bolster sustainability transformations up to 2030 and beyond. Our scoping review builds upon an online expert survey directed at the scholarly community of the ‘Earth System Governance Project’ and structured dialogues within the ‘Taskforce on the SDGs’ under this project. We identified five governance areas where some effects of the SDGs have been observable: (1) global governance, (2) national policy integration, (3) subnational initiatives, (4) private governance, and (5) education and learning for sustainable development. This article delves deeper into these governance areas and draws lessons to guide empirical research on the promises and pitfalls of accelerating SDG implementation.

As SDG implementation lags behind, this article explores 5 governance areas asking how to strengthen the global goals.

Return to driving after moderate-to-severe traumatic brain injury (TBI) is often a key step in recovery to regain independence. Survivors are often eager to resume driving and may do so despite having residual cognitive limitations from their injury. A better understanding is needed of how cognition and self-awareness impact survivors’ driving after injury. This study examined the influence of cognition and self-awareness on driving patterns following moderate-to-severe TBI.

Participants were 350 adults aged 19-87 years (mean age = 46 years; 70% male) with history of moderate-to-severe TBI, who resumed driving and were enrolled in the TBI Model System. Cross-sectional data were obtained ranging 1-30 years post injury, including questions on driving practices, the Brief Test of Adult Cognition by Telephone (BTACT), and the Functional Independence Measure (FIM). Self-awareness of cognitive function was measured via the discrepancy between dichotomized ratings (intact versus impaired) of objective cognitive testing (BTACT) and self-reported cognitive function (FIM Cognition subscale). Driving patterns included frequency (driving 'more than once a week’ versus 'once a week or less') and restricted driving behavior (total number of driving situations the survivor described as restricted, ranging 0-15). Regression analyses were conducted to examine the relationships between cognition, self-awareness, and each driving outcome (frequency and restriction), followed by causal mediation analyses to examine the mediating effect of self-awareness. Demographics (age, sex, education), injury characteristics (time since injury, injury severity, history of seizures in past year), and medical/social factors (family income, motor function, urban-rural classification) were included in the models as covariates.

Thirty-nine percent of survivors had impaired self-awareness, 88% of survivors drove numerous times per week, and the average survivor reported limited driving in 6 situations (out of 15 total situations). Cognition was inversely related to impaired self-awareness (OR = 0.03, p < 0.001) and inversely related to restricted driving behavior (b = -0.79, p < 0.001). Motor function was positively related to impaired self-awareness (OR = 1.28, p < 0.01). Cognition was not related to driving frequency, and self-awareness did not mediate the relationships between cognition and driving patterns (all p > 0.05).

Most survivors who drive after their injury are driving frequently, but the situations they drive in differ based on their cognitive ability. Impaired self-awareness of cognitive deficits is common after TBI, and self-awareness of cognitive function does not affect driving patterns. Future research needs to focus on how cognition affects nuanced aspects of driving behavior after injury (i.e., types of situations survivors drive in).

Fabry disease is a rare, inherited X-linked lysosomal storage disease characterized by a wide spectrum of heterogeneously progressive clinical phenotypes, and which results in progressive kidney disease, cardiomyopathy, cerebrovascular disease, and reduced life expectancy. Disease-specific therapy aims to improve symptoms, stabilize current disease and delay progression. In Australia treatment access requires that patients meet pre-specified criteria, which have been in place for more than 15 years. Patient questions prompted the patient organization, Fabry Australia, to investigate why these criteria had remained unchanged despite significant progress in the understanding and management of Fabry disease.

A panel comprising two members of Fabry Australia and its Medical Advisory Committee conducted a review of the literature. The aim of this was to inform the clinical quality of the Australian treatment access criteria with reference to international guidelines and contemporary data. The findings from the literature were applied to develop consensus recommendations for classification and Fabry-specific treatment initiation criteria in diagnosed patients.

Evidence supports earlier treatment with reduced barriers to access in some circumstances. Australian access criteria are misaligned with this. They do not distinguish between classical and non-classical Fabry phenotypes, neglect the impact of quality of life and gastrointestinal symptoms, and impose symptom-severity related criteria, which may lead to unnecessary treatment initiation delay. An updated framework is presented. It differentiates phenotypes, facilitates more timely access to Fabry-specific treatment for classical males, and supports relevant organ involvement criteria in classical females and patients with non-classical disease.

A well-performing health technology assessment system facilitates patient access to cost-effective treatments that improve health outcomes. Timely treatment initiation is important to avoid irreversible organ damage in Fabry patients. Patients’ questions about out-dated access criteria has prompted research and uncovered barriers that are no longer clinically valid. The perspectives of the patient as a stakeholder in their disease management should not be overlooked when assessing the value of health technologies in the rare disease setting.

Sleep disturbances are common among adult patients with cancer and their caregivers. To our knowledge, no sleep intervention to date has been designed to be provided to both patients with cancer and their caregivers simultaneously. This single-arm study aimed to pilot test the feasibility and acceptability, and to illustrate the preliminary efficacy on sleep efficiency of the newly developed dyadic sleep intervention, My Sleep Our Sleep (MSOS: NCT04712604).

Adult patients who were newly diagnosed with a gastrointestinal (GI) cancer and their sleep-partner caregivers (n = 20 persons: 10 dyads, 64 years old, 60% female patients, 20% Hispanic, 28 years relationship duration), both of whom had at least mild levels of sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] ≥ 5) participated in this study. MSOS intervention consists of four 1-hour weekly sessions delivered using Zoom to the patient–caregiver dyad together.

We were able to enroll 92.9% of the eligible and screened patient–caregiver dyads within 4 months. Participants reported high satisfaction in 8 domains (average 4.76 on a 1–5 rating). All participants agreed that the number of sessions, interval (weekly), and delivery mode (Zoom) were optimal. Participants also preferred attending the intervention with their partners. Both patients and caregivers showed improvement in sleep efficiency after completing the MSOS intervention: Cohen’s d = 1.04 and 1.47, respectively.

Results support the feasibility and acceptability, as well as provide the preliminary efficacy of MSOS for adult patients with GI cancer and their sleep-partner caregivers. Findings suggest the need for more rigorous controlled trial designs for further efficacy testing of MSOS intervention.