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Background and Aims: Per-oral endoscopic myotomy (POEM) has become an accepted treatment for patients with achalasia. Despite its excellent efficacy rate of greater than 80%, a small percentage of patients remain symptomatic after the procedure. Limited data exist as to the best management for recurrence of symptoms after POEM. We present the first international, multicenter experience on the efficacy and safety of a repeat POEM in the management of achalasia., Methods: Patients who underwent a redo POEM from 15 centers in 9 countries were included in a dedicated registry. Technical success was defined as successful completion of a second myotomy. Clinical success was defined as an Eckardt score of less than or equal to 3 after the second myotomy. Adverse events including anesthesia-related, operative, and postoperative adverse events were recorded., Results: Forty-six patients were included in the study. The average age was 49.3 ± 16.78 years. Twenty (45%) patients were male. The mean pre-redo-POEM Eckardt score was 4.3 ± 2.48. Technical success was achieved in 46 (100%) patients. Clinical success was achieved in 41 patients (85%). The average post-POEM Eckardt score was 1.64 ± 1.67, with a significant difference of 2.58 (P < .00001). Eight patients (17%) had adverse events consisting of procedural bleeding, all managed endoscopically. There were no deaths. No POEMs were aborted or required surgical conversion or assistance., Discussion: For patients with persistent symptoms after POEM, repeat POEM appears to be an efficacious and safe technique. Further randomized trials comparing redo POEM versus Heller should be considered. (Clinical trial registration number: NCT02162589.)., (Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Objectives: Informal caregivers of hospice patients experience multiple stressors that can negatively impact physical, psychological, and emotional health. The Caregiver Life Line (CaLL) study was a one-group, intervention-only feasibility study of a telephone cognitive-behavioral stress-management intervention consisting of 10 to 12 weekly telephone counseling calls designed specifically for informal caregivers of home-based hospice patients., Methods: Caregivers, who were recruited via seven participating hospices, were assessed at baseline, 3, and 6 months. Psychosocial measures included depression, perceived stress, benefit finding, social support, and quality of life (QoL). Process evaluation was also conducted at 6 months., Results: Of the 25 participants, 19 completed the 12-week intervention. The mean age was 60.3 years; 91% were female and 70% married. Forty-eight percent were caring for a spouse; 51% were caring for a parent or other family member. Participating caregivers and hospice staff reported high levels of satisfaction with the intervention. Although the small sample size and lack of a control group limit our ability to assess the efficacy of the intervention, psychosocial outcomes changed in the expected direction and participants reported high levels of self-efficacy regarding their ability to implement the adaptive coping skills. Interestingly, we observed a decrease in physical QoL across the three time points., Conclusions: This pilot study demonstrated that the CaLL intervention is feasible and acceptable to informal hospice caregivers. This report describes important lessons learned from the pilot study with the intention of informing future intervention studies with this population., Competing Interests: Author Disclosure Statement No competing financial interests exist.

Identifying cancer patients who are experiencing psychosocial challenges during the early phase of oncology treatment can prevent escalating patient distress. Standardized screening methods allow the medical team to identify those at high risk for poor adjustment. The purpose of this study was to provide preliminary psychometric evidence for a brief, self-administered screening instrument, the Psycho-Oncology Screening Tool (POST), designed to evaluate emotional and physical distress, depressive symptoms, and social concerns. Participants included 944 radiation oncology patients who completed the POST prior to their treatment appointment and a subgroup of 516 patients who completed the POST and one of six concurrent validity measures. Psychometric analysis included construct validity evidence provided through confirmatory factor analysis (CFA), internal reliability estimates, and concurrent validity estimates assessed with bivariate correlations between POST subscales scores and conceptually similar established measures. A three-factor CFA model was found to produce acceptable model fit, supporting the three domain structure of the POST. Furthermore, the three subscales--emotional and physical distress, depressive symptoms and social concerns--were found to produce acceptable internal reliability estimates (α = .73-.88). Concurrent validity evidence was observed with significant, moderate to large correlations between the POST subscales and all relevant measures (i.e., Profile of Mood States, Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy Fatigue, Beck Depression Inventory, Pain Disability Index, and the Interpersonal Support Evaluation List) with correlations ranged from 0.42 to 0.83, p < 0.01. Patients and clinic staff reported no problems administering or completing the POST. Results of this study support the psychometric soundness as well as the feasibility and acceptability of the POST as a brief screening tool for oncology patients receiving outpatient services.

Studies published from 1980 through 2004, which explored intelligence and executive function outcomes in early-treated PKU, were included in the present meta-analysis. The objective of this study was to examine the degree of difference between early-treated PKU and unaffected control groups (primarily non-familial controls), known as effect size, for various components of measured intelligence (i.e., full-scale, verbal, performance, and "other") and executive function (i.e., planning, working memory, inhibition, flexibility, and "other"). Secondly, in the case of heterogeneity among observed effect sizes, the moderator variables of "years since publication" and "measurement tools" were examined for their potential contribution to this heterogeneity. Thirty-three primary studies, with a total 200 outcomes meeting our inclusionary and exclusionary criteria, were meta-analyzed using Hedges g for effect size to correct for small samples in primary studies. The effect sizes for intelligence outcomes were "small" to "moderate" falling in the range of .20 to .42, with no significant heterogeneity among outcomes. Effect sizes for executive function and its various component processes were in the "moderate" and "large range" falling between .591 (planning) and 1.15 (flexibility). Significant heterogeneity among the executive function effect sizes was identified, and both "years since publication" and "measurement tools" were found to be significant moderators. Studies published more recently exhibited larger effect sizes, and particular executive function tasks demonstrated larger effect sizes than other tests. The results are discussed in terms of the contributions this meta-analysis makes to our understanding of neurocognitive outcomes in early-treated PKU, as well as suggestions for the conduct and reporting of future research in this area.