When We Fight, We Win: Eviction Defense as Subversive Lawyering

This Essay will examine the “sword and shield” model in action to explore the meaning of “subversive lawyering” in the housing context, particularly in eviction defense. In this model, we—the lawyers and law students— provide the “shield” (i.e., legal defense), while the organizers and members of grassroots housing justice organizations provide the “sword” (i.e., public pressure and protest). The lawyers are shielding tenants and foreclosed homeowners in the courts, which allows these “defendants” to simultaneously work with organizers to take necessary extralegal actions to ensure they are protected from displacement

Laparoscopic peritoneal lavage versus sigmoidectomy for management of perforated diverticulitis: meta-analysis of Randomized Controlled Trials

Introduction: Controversy exists regarding the role of laparoscopic peritoneal lavage in patients with perforated diverticulitis. Our objective was to conduct the first meta-analysis of Randomized Controlled Trials (RCT's) to compare the outcomes of patient undergoing laparoscopic peritoneal lavage with sigmoidectomy in patients with perforated diverticulitis. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; CENTRAL; The World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall morbidity, mortality, and postoperative complications were defined as the primary outcome parameters. Procedure time and length of hospital stay were secondary outcomes. The combined overall effect sizes were calculated using fixed-effect or random-effects models. Results: We identified 4 RCT's comparing outcomes of laparoscopic peritoneal lavage and open sigmoidectomy for perforated diverticulitis. All studies included only Hinchey grade III diverticulitis. The subsequent analysis, including 390 patients, demonstrated that laparoscopic peritoneal lavage of perforated diverticulitis was associated with significantly increased rates of overall morbidity (OR: 1.30, 95% CI 1.07-1.57, p = 0.007) and intra-abdominal abscess (OR: 3.10, 95% CI 1.71-5.63, p = 0.0002) compared to sigmoidectomy. However, there was no significant difference in mortality (OR: 0.86, 95% CI 0.42-1.77, p = 0.69) and re-operation (OR: 1.20, 95% CI 0.36-4.02, p = 0.77) rates between the two groups. Between-study heterogeneity was non-significant in all analyses, except reoperation rate (I2 = 79%, p = 0.002). The available data did not allow an appropriate analysis of procedure time, length of hospital stay and other postoperative complications. Conclusion: Our analysis of randomised trials demonstrated that laparoscopic peritoneal lavage of perforated diverticulitis may lead to more adverse events than open sigmoid resection. Future high quality RCT's are indeed required to provide stronger evidence as no definitive conclusion can be drawn considering the limited number of available RCT's

COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS: Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION: Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING: British Heart Foundation Data Science Centre, led by Health Data Research UK

Linked electronic health records for research on a nationwide cohort of more than 54 million people in England: data resource

Abstract: Objective: To describe a novel England-wide electronic health record (EHR) resource enabling whole population research on covid-19 and cardiovascular disease while ensuring data security and privacy and maintaining public trust. Design: Data resource comprising linked person level records from national healthcare settings for the English population, accessible within NHS Digital’s new trusted research environment. Setting: EHRs from primary care, hospital episodes, death registry, covid-19 laboratory test results, and community dispensing data, with further enrichment planned from specialist intensive care, cardiovascular, and covid-19 vaccination data. Participants: 54.4 million people alive on 1 January 2020 and registered with an NHS general practitioner in England. Main measures of interest: Confirmed and suspected covid-19 diagnoses, exemplar cardiovascular conditions (incident stroke or transient ischaemic attack and incident myocardial infarction) and all cause mortality between 1 January and 31 October 2020. Results: The linked cohort includes more than 96% of the English population. By combining person level data across national healthcare settings, data on age, sex, and ethnicity are complete for around 95% of the population. Among 53.3 million people with no previous diagnosis of stroke or transient ischaemic attack, 98 721 had a first ever incident stroke or transient ischaemic attack between 1 January and 31 October 2020, of which 30% were recorded only in primary care and 4% only in death registry records. Among 53.2 million people with no previous diagnosis of myocardial infarction, 62 966 had an incident myocardial infarction during follow-up, of which 8% were recorded only in primary care and 12% only in death registry records. A total of 959 470 people had a confirmed or suspected covid-19 diagnosis (714 162 in primary care data, 126 349 in hospital admission records, 776 503 in covid-19 laboratory test data, and 50 504 in death registry records). Although 58% of these were recorded in both primary care and covid-19 laboratory test data, 15% and 18%, respectively, were recorded in only one. Conclusions: This population-wide resource shows the importance of linking person level data across health settings to maximise completeness of key characteristics and to ascertain cardiovascular events and covid-19 diagnoses. Although this resource was initially established to support research on covid-19 and cardiovascular disease to benefit clinical care and public health and to inform healthcare policy, it can broaden further to enable a wide range of research

Management and outcomes of spontaneous rupture of hepatocellular carcinoma: current practice

Objectives: To review the current management options for ruptured hepatocellular carcinoma (HCC) at acute presentation and assess the impact of each treatment modality on short- and long-term patient related outcome. Study design: A PubMed search was undertaken for review articles from 1950 to 2019 using key phrases “Ruptured hepatocellular carcinoma”, “trans-arterial embolization”, “resection”, “computed tomographic scan” and “conservative management”. Further manual search was performed to identify key articles from the reference list. Methodology: All papers with previous described management for ruptured HCC were reviewed. The morbidity, mortality and comparison of various management options were reviewed. Current practice guidelines were visited to identify common practice protocols. Conclusion: Ruptured HCC is associated with significant morbidity and mortality. Multiple management options can be applied guiding by patient’s overall condition. Conservative management is associated with overall poor outcome. Staged liver resection is associated with better outcome with improved morbidity and mortality

A model for assessment of peri-operative outcomes following hepato-pancreatic and biliary surgery

Hepato-pancreatic and biliary surgery is associated with significant morbidity and mortality. A large number of these complications can be avoided and promote better outcomes. Peri-operative complications can have significant impact on the overall cost of the procedure. Number of steps can be adopted in the post-procedure phase with accurate documentation, stratification, classification and categorisation of complications. This will help to monitor departmental surgical outcomes and necessary steps that can be adopted to improve patient safety. This study will aim to propose a structure to record post-operative surgical complications following hepato-pancreatic and biliary (HPB) surgery. This record keeping and reflection will help to improve patient care and outcome