The transition of elite youth footballers through academy systems towards the first team is highly complex, competitive, and often unsuccessful. A myriad of factors including technical competence, physical prowess, and the development environment combine to determine youth player progression. Current research has focused on broad investigations of multiple clubs and stakeholders, providing a valuable overview of the key aspects associated with elite youth player transition. This study aimed to provide an in-depth, context-specific investigation of key stakeholders within an elite level club in the United Kingdom (UK). Seven key stakeholders including the head of the academy ( n = 1), the head of sports science ( n = 1), coaches ( n = 3), and lead sports scientists ( n = 2) were recruited. Framework analysis led to the development of a practical framework outlining the key facilitators and barriers of youth-to-first-team transition. Facilitators of transition included overcoming adversity, high-level physical prowess, exceptional technical competence, and possessing at least one elite-level attribute. Barriers to transition included a lack of opportunity, lucrative youth player contracts and a lack of development-specific coaching. In addition, the developmental environment and developing individuals within a team environment were key influences on youth-to-first-team transition. This study complements recent broad investigations of the UK and global stakeholders by corroborating many of their findings while providing transferable, context-specific accounts of applied issues related to successful transition to first-team football.
Aims
Approximately a fifth of stomas have to be sited in emergency setting and the National Bowel Cancer Audit found almost one third of patients undergoing anterior resection do not have reversal of their stoma within 18 months following surgery. We aim to explore the reversal rate of stoma post emergency laparotomy (EmLap).
Methods
Retrospective analysis was performed on all patients undergoing EmLap over 12 months (2018) from one site using the local ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit) database. Demographic, indication for surgery, stoma formation/ type, 30-days morbidity and mortality were collected. Follow-up and stoma reversal data were evaluated at 12 months postoperative.
Results
205 patients underwent EmLap (52.5% female, median age 66 years). 42% (n=85) had emergency stoma formation: 58% ileostomy, 42% colostomy.
Of those who had stoma formed (51% female, median age 67 years), 45% presented with bowel obstruction and 24% had new colorectal cancer diagnosis. Of those alive at follow-up (89%), 19% had stoma reversed (1:1 ileostomy:colostomy; mean reversal time 11 months). Of the 81% not reversed: 28% declined, 12% were unfit, 4% technically not feasible, 4% on waiting list, 11% had 30-day mortality. The remaining 22% had no documented stoma reversal discussion (5%) or no follow-up (17%).
Conclusions
Compared to the elective setting, the stoma reversal rate post-EmLap is significantly lower (reversal of ileostomy 9.5% in this study vs 85% in Close-IT study). Although this may reflect a higher risk surgical population, post-EmLap pathways should consider routine follow up to ensure shared decision making.
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