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To compare publicly available information on aged care systems in 7 countries to determine the degree of transferability for research on aged care between these countries. A cross-country comparative analysis. Aged care systems in 7 countries classified as liberal welfare states (Australia, Canada, Japan, New Zealand, Switzerland, United Kingdom, and United States). This study involved the search and review of international data sets, government reports and national statistics, and relevant peer-reviewed literature. Information was extracted for 24 variables at the macro (societal), meso (organizational), and micro (individual) levels to enable a multilevel comparison of aged care systems in each country. The structured search identified 63 relevant documents. All 7 countries included in the review were overall generally comparable across the 3 domains with some expected variations. Comparison of information was not possible for all variables owing to a paucity of publicly available information reported in a consistent manner. Using Australia as a reference point, Canada and New Zealand were the most comparable with Australia, followed by the United Kingdom, United States, and Switzerland. Japan was the least comparable country with Australia based on the variables considered. This is the most recent collation and detailed comparison of national-level information on aged care systems in countries classified as liberal welfare states. This information provides policy makers in these countries the data necessary to determine the degree contemporary research findings from another country are transferable to their local aged care system. Efforts to improve the health, well-being, and quality of care for older people continue to be hampered by the overall paucity of consistently reported standardized data to enable valid international comparisons. Optimal use of standardized data also requires developing explicit criteria to describe the key factors to be considered in determining transferability of an intervention from 1 country to another. [ABSTRACT FROM AUTHOR]

Splenic hemorrhage secondary to retching and vomiting from incarceration of paraesophageal hernia is a rare but life-threatening complication. Clinicians need to be aware of this complication in the event of sudden unexplained hemodynamic instability. Surgical intervention for the hernia is best performed as soon as possible once the patient is stabilized, before complications such as perforation or further bleeding occur. We report two cases of splenic rupture and intraperitoneal bleeding resulting from traction of the gastrosplenic pedicle associated with retching and vomiting from a giant paraesophageal hernia. [ABSTRACT FROM AUTHOR]

Consensus about the definition and treatment of oligometastatic oesophagogastric cancer is lacking. To assess the definition and treatment of oligometastatic oesophagogastric cancer across multidisciplinary tumour boards (MDTs) in Europe. European expert centers (n = 49) were requested to discuss 15 real-life cases in their MDT with at least a medical, surgical, and radiation oncologist present. The cases varied in terms of location and number of metastases, histology, timing of detection (i.e. synchronous versus metachronous), primary tumour treatment status, and response to systemic therapy. The primary outcome was the agreement in the definition of oligometastatic disease at diagnosis and after systemic therapy. The secondary outcome was the agreement in treatment strategies. Treatment strategies for oligometastatic disease were categorised into upfront local treatment (i.e. metastasectomy or stereotactic radiotherapy), systemic therapy followed by restaging to consider local treatment or systemic therapy alone. The agreement across MDTs was scored to be either absent/poor (<50%), fair (50%–75%), or consensus (≥75%). A total of 47 MDTs across 16 countries fully discussed the cases (96%). Oligometastatic disease was considered in patients with 1–2 metastases in either the liver, lung, retroperitoneal lymph nodes, adrenal gland, soft tissue or bone (consensus). At follow-up, oligometastatic disease was considered after a median of 18 weeks of systemic therapy when no progression or progression in size only of the oligometastatic lesion(s) was seen (consensus). If at restaging after a median of 18 weeks of systemic therapy the number of lesions progressed, this was not considered as oligometastatic disease (fair agreement). There was no consensus on treatment strategies for oligometastatic disease. A broad consensus on definitions of oligometastatic oesophagogastric cancer was found among MDTs of oesophagogastric cancer expert centres in Europe. However, high practice variability in treatment strategies exists. [Display omitted] • 47 tumour boards of cancer expert centers discussed 15 real-life clinical cases. • A consensus on definitions of oligometastatic oesophagogastric cancer was found. • However, high practice variability in treatment strategies exists. • This practice variability could potentially impact on quality of care. [ABSTRACT FROM AUTHOR]