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- Enlund, Mats, et al.
(författare)
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Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane
- 2023
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Ingår i: EClinicalMedicine. - : Elsevier. - 2589-5370. ; 60
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Tidskriftsartikel (refereegranskat)abstract
- Background Anaesthesia may impact long-term cancer survival. In the Cancer and Anaesthesia study, we hypothesised that the hypnotic drug propofol will have an advantage of at least five percentage points in five-year survival over the inhalational anaesthetic sevoflurane for breast cancer surgery. Methods From 2118 eligible breast cancer patients scheduled for primary curable, invasive breast cancer surgery, 1764 were recruited after ethical approval and individual informed consent to this open label, single-blind, randomised trial at four county- and three university hospitals in Sweden and one Chinese university hospital. Of surveyed patients, 354 were excluded, mainly due to refusal to participate. Patients were randomised by computer at the monitoring organisation to general anaesthesia maintenance with either intravenous propofol or inhaled sevoflurane in a 1:1 ratio in permuted blocks. Data related to anaesthesia, surgery, oncology, and demographics were registered. The primary endpoint was five-year overall survival. Data are presented as Kaplan-Meier survival curves and Hazard Ratios based on Cox univariable regression analyses by both intention-to-treat and perprotocol. EudraCT, 2013-002380-25 and ClinicalTrials.gov, NCT01975064. Findings Of 1764 patients, included from December 3, 2013, to September 29, 2017, 1670 remained for analysis. The numbers who survived at least five years were 773/841 (91.9% (95% CI 90.1-93.8)) in the propofol group and 764/829 (92.2% (90.3-94.0)) in the sevoflurane group, (HR 1.03 (0.73-1.44); P = 0.875); the corresponding results in the per-protocol-analysis were: 733/798 (91.9% (90.0-93.8)) and 653/710 (92.0% (90.0-94.0)) (HR = 1.01 (0.71-1.44); P = 0.955). Survival after a median follow-up of 76.7 months did not indicate any difference between the groups (HR 0.97, 0.72-1.29; P = 0.829, log rank test). Interpretation No difference in overall survival was found between general anaesthesia with propofol or sevoflurane for breast cancer surgery. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd.
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- Håkansson, Nina, et al.
(författare)
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A strategic analysis of slaughterhouses and animal transportation in Sweden
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The number of slaughterhouses in Sweden has decreased over time. Fewer slaughterhouses are expected to affect the transport time for animals and as a consequence animal welfare. We have analyzed the transportto- slaughter system, for pigs and cattle, using transport-data from 2008, geographical information for slaughterhouses and farms, and actual route distances between facilities. We made a strategic analysis of the existing slaughterhouses and tested the impact of numbers decreasing further. With strategic planning the potential reduction of transport distance is 25% for pigs and 40% for cattle. About 50% of the slaughterhouses in Sweden could be closed down with small effect on the total transport work. This implies that for the national total animal welfare which animals are sent where, is much more important than the number of slaughterhouses. However for the welfare (transport time and distance) of the animals in long transports number of slaughterhouses (regular or mobile) is important. Animal welfare weights of distances in the objective function decreases the amount of transports with long route times. We have investigated where in Sweden it would be beneficial to use mobile slaughterhouses. Animals are usually not sent to closest slaughterhouse; we show how slaughterhouse capacity must change if that transport strategy was applied.
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- Håkansson, Nina, et al.
(författare)
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Improvement of animal welfare by strategic analysis and logistic optimisation of animal slaughter transportation
- 2016
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Ingår i: Animal Welfare. - : Universities Federation for Animal Welfare. - 0962-7286 .- 2054-1538. ; 25:2, s. 255-263
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Tidskriftsartikel (refereegranskat)abstract
- The transportation of animals to slaughterhouses is a major welfare concern. The number of slaughterhouses has decreased over time in Europe due to centralisation. This is expected to increase transport time for animals and as a consequence negatively affect animal welfare. We propose an optimisation model based on a facility location model to perform strategic analysis to improve transportation logistics. The model is tested on the Swedish slaughter transport system. We show that, by strategic planning and redirection of transports while keeping the slaughterhouse capacities as of the originaldata, the potential exists to reduce transport distance by 25% for pigs and 40% for cattle. Furthermore, we demonstrated that approximately 50% of Swedish slaughterhouses can be shut down with a minimal effect on total transport distances. This implies that in terms of the overall welfare picture, the decision of which animals to send where plays a for more significant role than the number of slaughterhouses. In addition, by changing relative weights on distances in the optimisation function the amount of individualtransports with longjourney times can be decreased. We also show results from altered slaughterhouse capacity and geographical location of slaughterhouses. This is the first time an entire country has been analysed in great detail with respect to the location, capacity and number of slaughterhouses. The focus is mainly on the analysis of unique and detailed information of actual animal transports in Sweden and a demonstration of the potential impact redirection of the transports and/ or altering of slaughterhouses can have on animal welfare.
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