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- Bill-Axelson, Anna, et al.
(författare)
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Radical prostatectomy versus watchful waiting in localized prostate cancer : the Scandinavian prostate cancer group-4 randomized trial
- 2008
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Ingår i: Journal of the National Cancer Institute. - : Oxford University Press. - 0027-8874 .- 1460-2105. ; 100:16, s. 1144-1154
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The benefit of radical prostatectomy in patients with early prostate cancer has been assessed in only one randomized trial. In 2005, we reported that radical prostatectomy improved prostate cancer survival compared with watchful waiting after a median of 8.2 years of follow-up. We now report results after 3 more years of follow-up.METHODS: From October 1, 1989, through February 28, 1999, 695 men with clinically localized prostate cancer were randomly assigned to radical prostatectomy (n = 347) or watchful waiting (n = 348). Follow-up was complete through December 31, 2006, with histopathologic review and blinded evaluation of causes of death. Relative risks (RRs) were estimated using the Cox proportional hazards model. Statistical tests were two-sided.RESULTS: During a median of 10.8 years of follow-up (range = 3 weeks to 17.2 years), 137 men in the surgery group and 156 in the watchful waiting group died (P = .09). For 47 of the 347 men (13.5%) who were randomly assigned to surgery and 68 of the 348 men (19.5%) who were not, death was due to prostate cancer. The difference in cumulative incidence of death due to prostate cancer remained stable after about 10 years of follow-up. At 12 years, 12.5% of the surgery group and 17.9% of the watchful waiting group had died of prostate cancer (difference = 5.4%, 95% confidence interval [CI] = 0.2 to 11.1%), for a relative risk of 0.65 (95% CI = 0.45 to 0.94; P = .03). The difference in cumulative incidence of distant metastases did not increase beyond 10 years of follow-up. At 12 years, 19.3% of men in the surgery group and 26% of men in the watchful waiting group had been diagnosed with distant metastases (difference = 6.7%, 95% CI = 0.2 to 13.2%), for a relative risk of 0.65 (95% CI = 0.47 to 0.88; P = .006). Among men who underwent radical prostatectomy, those with extracapsular tumor growth had 14 times the risk of prostate cancer death as those without it (RR = 14.2, 95% CI = 3.3 to 61.8; P < .001).CONCLUSION: Radical prostatectomy reduces prostate cancer mortality and risk of metastases with little or no further increase in benefit 10 or more years after surgery.
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| 2. |
- Jansson, Markus, 1982-, et al.
(författare)
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Kostnadsminimeringsanalys av antibiotikaprofylax vid elektiva sectio : Vetenskapligt ST-projekt
- 2015
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Konferensbidrag (refereegranskat)abstract
- BakgrundPostoperativa infektioner efter elektiva sectio är främst endometrit och ytlig sårinfektion. Endometrit komplicerar omkring 7 % av elektiva sectio och ytlig sårinfektion 8,5 % men variationen studier emellan stor. Antibiotikaprofylax minskar risken för endometrit med 61 % och risken för ytlig sårinfektion med 38 %. I Sverige ges ej antibiotikaprofylax vid elektiva sectio rutinmässigt. En amerikansk studie visar att antibiotikaprofylax är kostnadsbesparande. Forskning saknas om antibiotikaprofylax vid elektiva sectio är kostnadsbesparande i en svensk kontext.Metod Delstudie I är en retrospektiv journalstudie. Samtliga kvinnor som genomgått elektivt sectio i sjukvården i Örebro läns landsting 2011-2012 inkluderas. Postoperativa infektioner och riskfaktorer för detta registreras. Delstudie II är en kostnadsminimeringsanalys. Kostnader för de identifierade postoperativa infektionerna vid inneliggande vård hämtas ur landstingets ekonomisystem. Kostnader för öppenvård beräknas utifrån schablonkostnader för debitering till andra landsting. Kostnader för att administrera antibiotikaprofylax (ampicillin 2 g iv) beräknas och jämförs med hur stor kostnadsbesparing ett införande av antibiotikaprofylax skulle ge givet att riskreduktion är densamma som i tidigare studier.ResultatInförande av antibiotikaprofylax skulle ge en kostnadsminskning på 275 kr per utfört sectio. Incidensen av postoperativa infektioner är 4,7 % varav 3,5 % är djupa sårinfektioner (endometriter) och 1,3 % är ytliga sårinfektioner. Studien är för liten för att kunna påvisa att riskfaktorerna ger en signifikant ökad risk för infektion.Konklusion Antibiotikaprofylax är kostnadsbesparande vid elektiva sectio vid den givna incidensen av postoperativa sårinfektioner i den aktuella sjukvårdsorganisationen. Detta talar för ett införande av rutinmässig antibiotikaprofylax vid elektiva sectio.
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| 4. |
- Wennerholm, U. B., et al.
(författare)
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Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS) : multicentre, open label, randomised, superiority trial
- 2020
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Ingår i: Geburtshilfe und Frauenheilkunde. - : Georg Thieme Verlag KG. - 0016-5751 .- 1438-8804. ; 80:10, s. E76-E76
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with low risk pregnancies compared with expectant management and induction at 42 weeks.Methods: A multicenter, randomised controlled superiority trial.Women with low risk singleton pregnanies (n = 2760) were randomised to either induction or expectant management group. The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score < 7 at five minutes, pH < 7.00 or metabolic acidosis (pH < 7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, obstetric brachial plexus injury. Primary analysis was by intention to treat.Results: The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group (no deaths compared to six deaths, p = 0.03). The primary outcome did not differ: 2.4 % (33/1381) in the induction group and 2.2 % (31/1379) in the expectant management group (RR 1.06, 95 %CI 0.65 to 1.73; p = 0.90). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups.Conclusions: There was no significant difference in the primary composite outcome when comparing induction at 41 weeks with expectant management and induction at 42. However, a reduction of the secondary outcome perinatal mortality was observed without increasing adverse maternal outcomes. To offer induction at 41 weeks could be one of few interventions that reduces the rate of stillbirths.
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